How mobile clinics are helping those affected by Canada’s wildfires

How wildfires affect health

Wildfire smoke contains a mixture of gases and fine particles. These particles can cause significant cardiorespiratory distress in vulnerable people. In some cases, wildfire smoke can lead to acute exacerbation of respiratory diseases and increase the risk of emergency care and hospital admission. According to research conducted at Stanford University, breathing air with an AQI of just 20 is equivalent to smoking one cigarette a day.6

The health effects of wildfires go beyond air pollution, however, including triggering or worsening psychiatric disorders. Mobile clinics can help to identify those with urgent mental health needs such as suicidal ideation or severe panic attacks. Their assessments can aid clinical decision making and expedite referral of at-risk people that need emergency care.

The physical and psychological stress of wildfires can also exacerbate chronic disease symptoms. “Wildfires can cause acute exacerbation of respiratory diseases such as chronic asthma and emphysema because of airway irritation and inflammation,” says Paul Biddinger, chief of the division of emergency preparedness for Mass General Brigham and director of the Center for Disaster Medicine at Massachusetts General Hospital.

Mobile clinics play a crucial role in evaluating the health status of people affected by wildfires and referring those requiring emergency care, says Biddinger. The clinics can quickly evaluate patients with background respiratory disorders and provide prescription refills for those with chronic diseases who are now displaced. They can also check the blood pressure and blood sugar levels of people with chronic hypertension or diabetes.

Challenges during crises

Despite the benefits of mobile clinics, there are some barriers to their use during public health crises. According to a review published in the International Journal of Health Systems and Disaster Management, shortage of specialised mobile clinic workers and inadequate funding are common.7

“Collaboration and communication with the appropriate health authorities can reduce some of these challenges,” Biddinger says, adding that public health and emergency management authorities need to be more aware of where mobile clinics are operating. This will help to identify the health needs of people caught up in disasters. Collaboration with health authorities can also aid the efficient and effective distribution of resources to the mobile clinics that need them the most, says Biddinger.

In Nova Scotia, health authorities have deployed multiple mobile primary care clinics in the province, with the locations and contact details kept up to date on its health department’s website.8 This information helps people caught up in wildfires to find the nearest mobile clinic and call for help when necessary.

“Keeping the mobile clinic space and workers safe during a wildfire is extremely important. Wildfires may change direction and possibly damage the mobile clinic location. Operators should regularly update emergency management authorities and come up with a relocation plan,” says Biddinger. “If a mobile clinic location has been damaged by wildfire it can then partner with nearby non-mobile clinics to find an alternative. Also, continuous communication is essential if a mobile clinic relocates so that people can access the new location. This will prevent barriers to continuous care during a crisis.”

Primary care facilities should have a referral system and plan in preparation for a health crisis, he adds. The plan should include the referral of those in need of specialised care, such as mental healthcare and counselling. Mobile clinic workers should know where people affected by disasters can access resources like emergency shelter, food, and water. Partnering with the relevant health authorities can help mobile clinic workers stay updated with accurate information.9

Funding and expansion

Most mobile health clinics in Canada are privately run but partnered with local government authorities or may receive funding from charitable organisations.

The situation is similar in the US. Grants and foundation funding are the major forms of funding for mobile clinics, says Priya Sarin Gupta, medical director for the community based clinical programme at Mass General Brigham in Boston. In some cases, and depending on the intensity of the acute health crisis, federal and state governments may assist in funding mobile clinics, she adds, as happened during the pandemic. In Europe, mobile clinics that provide healthcare to disaster sites rely on funding from non-governmental agencies such as the International Organisation for Migration and the Center for Disaster Philanthropy.

Gupta says there is a need for health policies that promote the adequate funding and expansion of mobile clinics across disaster prone locations. Mobile clinics in Canada typically have a core of paid staff, usually consisting of a physician or nurse, an operations manager, a community health worker, and a medical assistant. But they also rely heavily on a pool of volunteers.

Gupta tells The BMJ that the growth in the frequency of wildfires because of the climate emergency could increase both the need for, and the cost burden of, providing health services in these clinics.

Disasters like wildfires can overwhelm primary care facilities without an appropriate emergency preparedness plan. People affected by disasters have different health needs and a system to accommodate them is required.

Mobile clinics could become a more permanent solution, rather than a disaster response. This would also have the benefit of helping hospitals, clinics, and healthcare authorities to develop better emergency plans for disasters.