An Eaton Fire First Responder Recalls Patients Fleeing the Fast-Growing Blaze

Eaton Fire evacuees, fleeing their homes for the safety of the Pasadena Convention Center, were arriving in numbers. For Fernando Fierro, vice president of nursing services at the community health center AltaMed, and the first of his response team to arrive, it was "chaotic."

"There wasn't any infrastructure in place," he recalled. More than 550 people sheltering at the convention center, in five event halls converted to dormitories, needed medical assessments. People had fled too urgently to bring their medications, or they needed canes and walkers, or they needed more intensive care than AltaMed's response team could provide in a shelter setting.

Complicating the situation were the close quarters and the presence of animals: People had brought their dogs, cats, and birds. Fierro, a U.S. Army combat veteran with extensive disaster response experience, knew the crowded shelter and animals would increase the likelihood of infectious diseases like norovirus and avian flu.

"My biggest fear was that we would lose a patient," he said. "I was making sure we didn't have that happen."

AltaMed, where Fierro works, is a community health center with facilities throughout Southern California that cares for underserved patients in many of the communities being ravaged by the current constellation of wildfires. The health center has a detailed plan for responding in evacuation settings, so when the city of Pasadena reached out to health center staff to ask for medical support, "it was automatic mode," Fierro said.

Nurses triaged patients - some of them so traumatized they were hiding under blankets, some of them patients evacuated from skilled nursing facilities or hospice care. Some were receiving end-of-life care: Fierro remembered the relief he felt when a dying patient was finally relocated to a hotel room from the shelter. "I wanted to make sure that's not where she spent her final days," he explained.

The AltaMed team set up a base station where people could pick up hygiene supplies and over-the-counter medications. Patients with chronic wounds were treated, doctors followed up on patients whom nurses had identified as needing care, and ambulances came to transport the most vulnerable patients. Dr. Esiquio Casillas, an AltaMed physician focused on older adult care, arranged placement for medically vulnerable patients.

"It was real triage," Fierro said.

Medical crises were a feature of that Wednesday night. A child with an irregular heartbeat needed urgent attention. Nurses caught a patient as she collapsed from stress-induced vertigo. At one point Fierro - a former veterinary technician - found himself giving veterinary IV fluids to a severely dehydrated dog: "That was an interesting patient."

With a background in combat engineering and crisis response, Fierro said "the training kicks in" during emergencies. But this disaster was different: These were his patients, his colleagues, his community. Helping in the field seemed even more urgent than usual.

"We need to be out there," he explained. "They trust us and the care we provide in our clinics, and they need to know that we're out here with them."

Since the health center's founding in 1969, improving community health outcomes - and mitigating the impacts of housing instability, food insecurity, and other factors that affect long-term health - hasn't just been a lofty goal. It's an urgent issue of health justice.

"We're making sure they're not forgotten," Fierro said of AltaMed's patients. "They tend to be the last ones to be thought of and the last ones to be supported."

Because the wildfires were a local event, AltaMed's providers and staff were heavily impacted too. One of the health center's facilities burned to the ground Tuesday night. Staff know three more sites are damaged and at risk of burning, but they don't yet know the extent of the damage. Many providers and staff members have been forced to evacuate themselves.

But when AltaMed asked for volunteers to staff the evacuation center, "we had an enormous response from our team members," Fierro recalled. Once staff know their families are safe, he said, the next question they ask is, "How can I help?"

They also know the fire's damage will last long after the flames are contained and the air clears. Now that the most emergent medical needs are met, Fierro said, his team is thinking about how best to address mental and emotional well-being, help people whose livelihoods and homes are lost, ensure kids are able to get to school…and make sure vulnerable communities are prepared for the next wildfire, pandemic, or whatever comes next.

"This won't be the last disaster," he said. "Organizations like AltaMed need to be able to care and support" vulnerable communities in an uncertain world.

Although Fierro knows decimated neighborhoods will rebuild, he also knows the people who were already vulnerable will be the most hurt by these wildfires - and the most at risk in a future catastrophe.

"When a disaster happens, health care doesn't stop," he said. "It can't stop."

Direct Relief has supported AltaMed's ongoing response to the Southern California wildfires with critical prescription medications for patient care and other requested medical aid. The organization will continue to support health centers and other community organizations providing patient care across Los Angeles.

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