The sponsors had no role in the design and conduct of the study: collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. All the data used in this commentary are derived from sources in the public domain, as referenced. G.A.W. currently serves as a consultant for Google, LLC (Mountain View, CA) and the Health Effects Institute (Boston, MA).
Objectives. To assess wildfire risks to California inpatient health care facilities in 2022. Methods. Locations of inpatient facilities and associated inpatient bed capacities were mapped in relation to California Department of Forestry and Fire Protection fire threat zones (FTZs), which combine expected fire frequency with potential fire behavior. We computed the distances of each facility to the nearest high, very high, and extreme FTZs. Results. Half (107 290 beds) of California’s total inpatient capacity is within 0.87 miles of a high FTZ and 95% (203 665 beds) is within 3.7 miles of a high FTZ. Half of the total inpatient capacity is within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ. Conclusions. Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk. Public Health Implications. Wildfires in California are rapid-onset disasters with short preimpact phases. Policies should address facility-level preparedness including smoke mitigation, sheltering measures, evacuation procedures, and resource allocation. Regional evacuation needs, including access to emergency medical services and patient transportation, must also be considered. (Am J Public Health. Published online ahead of print March 2, 2023:e1–e4. https://doi.org/10.2105/AJPH.2023.307236 )
W hen we first met, the two of us were just beginning our medical training. Through the campus grapevine-or at least what was left of it during the pandemic-we heard about Socially Responsible Surgery (SRS), the surgeons who "operate on the Social Determinants of Health (SDoH)." Not quite understanding how this worked or what they did, we met with the co-founder, Dr. Tracey Dechert. In her corner office in the Dowling building at Boston Medical Center, we asked the question: "We can be interested in surgery and public health?"Dr. Dechert's response: "We need students who are interested in both, there's so much work to be done." Many people, both inside and outside the field of medicine, conceive a narrow role for surgeons: they operate.Congruent with this view, the job description does not typically include significant patient contact, holistic care, or tackling medical issues through a public health lens. But abundant research demonstrates that surgical outcomes depend on factors well beyond the operating room. 1,2 As SRS co-founder Dr. Megan Janeway explains, "it is the elephant in the room, we should be identifying and addressing SDoH as we do for any other major risk factor or predictor of disease processes and outcomes. This is not beyond the scope of our practice but instead integral to the care of our patients." 2 For many reasons, including long-standing professional and educational norms, neither medical students-nor many surgeons-fully appreciate the linkage between SDoH and surgical outcomes. This is broadly concerning for the field of surgery, and especially for medical students interested in becoming surgeons. A new generation of medical students desire a specialty in which they can address healthcare disparities, in part through SDoH principles. 3 However, there is a traditional perception that SDoH and surgery are not compatible, and these students may opt-out of pursuing surgery before they are even exposed to the field. Many students don't interact with surgeons until later in their training. One study found that only 31% of first-year medical students reported that they believe surgeons actively
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