Half of California Inpatient Beds Are Within 1 Mile of Wildfire Risk

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All but 5% of the state's inpatient beds are within 4 miles of an identified high fire-threat zone, according to new public health analyses.

About half of all of California’s inpatient health care facilities beds are less than a mile from a high fire-threat zone (FTZ), according to a new public health assessment.

In new research that takes into consideration the breadth and burden of recent California wildfires, a team of Boston-based investigators observed a clear risk of threat from wildfires among a significant proportion of California’s inpatient care facilities—among the latest indirect effects of climate change on health care.

A team led by Neil Singh Bedi, of the Boston University School of Medicine, and Caleb Dresser, MD, MPH, of the Beth Israel Deaconess Medical Center and Harvard Medical School, conducted an analysis of wildfire risks in California as they relate to the state’s inpatient care facilities in 2022. As they noted, California is amid an “intensifying wildfire crisis,” with 17 of the state’s 20 largest wildfires in history occurring in the last 20 years. In fact, 7 such wildfires occurred in 2020 – 2021 alone.

“Wildfires pose a threat to the structural integrity, operations, and accessibility of health care facilities, accounting for 18.4% of hospital evacuations in the United States during the 21st century,” investigators wrote. “Inpatient facility evacuations are a complex process and often require coordination across health systems and jurisdictions. They can pose a danger to patients and staff, even when advance warning is available.”

Bedi, Dresser and colleagues mapped locations for inpatient facilities and their associated inpatient bed capacities relative to the California Department of Forestry and Fire Protection’s FTZs—which are graded on risk severity scales including “high,” “very high,” and “extreme.” Inpatient facility location and capacity information were retrieved from the state’s Department of Health and Human Services, which includes such data on the 15,684 licensed and certified California health care facilities at the time.

Inpatient facilities generally need to treat patients for ≥24 hours, investigators noted, and as such may have “complex evacuation needs.”

The final analysis included 214,358 inpatient beds across 3087 facilities. A majority of beds were from long-term care facilities (n = 131,356 [61.2%]), followed by general (n = 74,041 [34.5%]) and behavioral health (n = 8961 [4.2%]).

The team observed 4 facilities within a very high FTZ and 22 within a high FTZ. A total of 107,290 inpatient beds (50.1%) were within 0.87 miles of a high FTZ; 203,665 (95.0%) were within 3.7 miles of a high FTZ.

Another approximate half of all inpatient beds were within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ.

Along with the clear risk of evacuation or need for shelter in place among hospital patients and staff, the findings also elucidate the risk of structural and infrastructure damage to relied-upon hospitals in range of wildfires.

“We found that a high percentage of inpatient health care facilities in California are at risk for potential operational disruption or evacuation from wildfires,” investigators wrote. “Facilities near wildfires may face risks from windblown embers, transportation interruptions, and conversion of wildland fires to structure fires, which can affect the safety, operability, or accessibility of facilities or increase the risk of fire at facility sites.”

Bedi, Dresser and colleagues concluded their findings show the importance of policymakers and health system leaders assessing facilities’ vulnerability to wildfire hazards in California—whether it result in a clear evacuation or shelter in place plan.

“The interinstitutional, transjurisdictional coordination and cooperation that will be required to minimize health care interruptions will necessitate investments in data architecture, community awareness, and infrastructure resilience,” they wrote. “As the climate crisis continues to raise wildfire risk, it is vital to protect inpatient health care facilities so that they can meet the needs of their communities.”


  1. Bedi NS, Dresser C, Yadav A, Schroeder A, et al. Wildfire Threat to Inpatient Health Care Facilities in California, 2022. American Journal of Public Health 113, 555_558,