Leadership

Heat and smoke: Emergencies that can stretch a hospital without touching it

Written by ShiftKey

November 13, 2026

Preparing your hospital for heat waves and wildfire

The second post in our hospital preparedness series looks at two hazards that disrupt care in ways a standard evacuation plan can miss.

Our first post in this series was a start-to-finish framework for weather disasters that most hospital emergency plans are built around. This post goes deeper on two hazards that don't always fit that mold: extreme heat waves and wildfire smoke.

Both share a trait that makes them easy to underplan. Hurricanes are forecast well in advance and can cause physical damage to the building, but heat and smoke can be more insidious, doing damage without visibly touching the structure. They strain facility systems and drive up the volume of patients coming through the door at the same time, sometimes even if the event causing the damage is hundreds of miles away.

Heat waves strain the building and fill it at the same time

Extreme heat is one of the few hazards that raises demand and degrades the facility in the same stretch of days.

In 2023, U.S. emergency departments recorded 180 heat-related visits for every 100,000 total visits, compared with 151 per 100,000 across the prior five years. In the peak summer months of July and August, the rate topped 300 per 100,000, roughly 50% above the average peak of 2018 through 2022.

Every region of the country logged at least one day above the 95th percentile of prior-year rates. Those impacted are usually least able to regulate their temperature: older adults, infants, people managing chronic conditions and those recovering from surgery.

A prolonged heat wave can push cooling systems to their limit at the same time that the regional grid is most likely to brown out or fail, and backup power that keeps ventilators running does not always keep a building cool.

Temperature-sensitive medications and supplies need protection when delivery routes and refrigeration are under strain. None of this is unusual. It just tends to sit outside traditional emergency plans.

Questions worth thinking through before the season:

If the grid fails during a heat wave, does backup power maintain safe indoor temperature, or only essential equipment?
Which areas of the building can serve as cooling zones if capacity drops, and how do patients move there?
How are temperature-sensitive medications and supplies protected if delivery or refrigeration is disrupted?
Who is watching regional forecasts closely enough to trigger the plan before the first day of extreme heat, not after?

Wildfires disrupt care two ways and only one involves flames

Wildfires are worth a closer look because they combine two kinds of disruption, and the more common one has nothing to do with the fire reaching your campus.

Of course, the direct threat is real: a fire near the building can force full evacuation. But a hospital does not need to burn to close. In 2017, wildfires came within feet of an acute care hospital in Santa Rosa, California. The building never caught fire. Even so, severe smoke infiltration and a loss of power and water forced the evacuation of 122 patients, and the hospital and most of its clinics stayed closed for 17 days.

Even a campus far from actual fires can become uninhabitable because of smoke and degraded air quality. Hospital ventilation systems pull in outdoor air, and when that air is heavy with particulate, keeping patients and teams inside safe can become impossible.

Public safety power shutoffs used to prevent fires from spreading add another layer of disruption to buildings nowhere near the fire line.

The indirect threat travels much farther, as seen this year. Smoke from wildfires in Ontario and northern Minnesota drifted south across the country this summer, putting more than 100 million people across 18 states and the District of Columbia under air quality alerts.

During the 2023 Canadian wildfire smoke episodes, the CDC found asthma-related emergency visits ran 17% above expected levels across the affected days, and the agency specifically flagged the finding for regions where smoke had previously been uncommon.

A hospital with low wildfire risk, hundreds of miles from any fire, can still see respiratory volume climb for days due to poor air conditions.

Questions worth working through:

Can your ventilation system isolate intake and run on recirculated air during a smoke event, and are replacement filters on hand before demand spikes?
At what air quality threshold does the plan escalate, and who makes that call?
If a public safety power shutoff hits your area, how long can the building operate independently?
If roads close or evacuation orders are put in force, how many of your care team can reach the facility safely?
If another regional hospital is closed down, how much additional census could you handle?
Is respiratory surge part of the plan even if wildfire is not a local threat?

The variable both hazards share

During a heat wave, a smoke event or a fire evacuation, the professionals scheduled to work may be managing the same conditions as everyone else in the community. Some cannot safely travel. Some are evacuating their own homes.

Coverage becomes a variable when volume is climbing. However, this is a risk that can be mapped in advance, with a named path to backup coverage and a decision already made about when to activate it.

This is where a technology marketplace can fit into a preparedness plan. ShiftKey connects hospitals with independent and licensed professionals in their own communities who can step in when internal teams are stretched thin, with visibility to see who is available and flexibility to scale coverage up or down as conditions change over days. It is one option among several, and the right time to evaluate it is before a warning is ever issued.