Skip to main content Accessibility help

Prevalence of Unmet Health Care Needs and Description of Health Care–seeking Behavior Among Displaced People After the 2007 California Wildfires

  • J. Lee Jenkins, Edbert B. Hsu, Lauren M. Sauer, Yu-Hsiang Hsieh and Thomas D. Kirsch...


Objectives: The southern California wildfires in autumn 2007 resulted in widespread disruption and one of the largest evacuations in the state’s history. This study aims to identify unmet medical needs and health care–seeking patterns as well as prevalence of acute and chronic disease among displaced people following the southern California wildfires. These data can be used to increase the accuracy, and therefore capacity, of the medical response.

Methods: A team of emergency physicians, nurses, and epidemiologists conducted surveys of heads of households at shelters and local assistance centers in San Diego and Riverside counties for 3 days beginning 10 days postdisaster. All households present in shelters on the day of the survey were interviewed, and at the local assistance centers, a 2-stage sampling method was used that included selecting a sample size proportionate to the number of registered visits to that site compared with all sites followed by a convenience sampling of people who were not actively being aided by local assistance center personnel. The survey covered demographics; needs following the wildfires (shelter, food, water, and health care); acute health symptoms; chronic health conditions; access to health care; and access to prescription medications.

Results: Among the 175 households eligible, 161 (92.0%) households participated. Within the 47 households that reported a health care need since evacuation, 13 (27.7%) did not receive care that met their perceived need. Need for prescription medication was reported by 47 (29.2%) households, and 20 (42.6%) of those households did not feel that their need for prescription medication had been met. Mental health needs were reported by 14 (8.7%) households with 7 of these (50.0%) reporting unmet needs. At least 1 family member per household left prescription medication behind during evacuation in 46 households (28.6%), and 1 family member in 48 households (29.8%) saw a health care provider since their evacuation. Most people sought care at a clinic (24, 50.0%) or private doctor (11, 22.9%) as opposed to an emergency department (6, 12.5%).

Conclusions: A significant portion of the households reported unmet health care needs during the evacuations of the southern California wildfires. The provision of prescription medication and mental health services were the most common unmet need. In addition, postdisaster disease surveillance should include outpatient and community clinics, given that these were the most common treatment centers for the displaced population. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S24–S28)


Corresponding author

Address correspondence and reprint requests to Dr J. Lee Jenkins, Department of Emergency Medicine, Johns Hopkins University School of Medicine, 5801 Smith Ave, Suite 3220, Davis Building, Baltimore, MD 21209(e-mail:


Hide All
1.Berlant D. 2007 Fire Siege Overview. Accessed November 27, 2008.
2.California Fire Wildland 2007 Fire Summary. Accessed November 29, 2008.
3.Steinhauer J. California fires out of control as more than 500,000 flee. New York Times. October 24, 2007.,000%20flee&st=cse. Accessed March 17, 2009.
4.Southern California Recovers From Massive Wildfires (DR-1731-CA). Accessed June 27, 2008.
5.Brodie, M, Weltzien, E, Altman, D, et alExperiences of Hurricane Katrina evacuees in Houston shelters: implications for future planning. Am J Public Health. 2006;96:14021408.
6.Greenough, PG, Lappi, MD, Hsu, EB, et alBurden of disease and health status among Hurricane Katrina–displaced persons in shelters: a population-based cluster sample. Ann Emerg Med. 2008;51:426432.
7.Millin, MG, Jenkins, JL, Kirsch, T.A comparative analysis of two external health care disaster responses following Hurricane Katrina. Prehosp Emerg Care. 2006;10:451456.
8.Irvin, CG, Atlas, JG.Management of evacuee surge from a disaster area: solutions to avoid non-emergent, emergency department visits. Prehosp Disast Med. 2007;22:220223.
9.Eastman, AL, Rinnert, KJ, Nemeth, IR, et alAlternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. J Trauma. 2007;63:253257.
10.RxResponse: Getting Medications to Patients Who Need Them During a Crisis. Accessed December 12, 2008.
11.Centers for Disease Control and Prevention. Monitoring health effects of wildfires using the biosense system—San Diego County, California, October 2007. MMWR Morb Mortal Wkly Rep. 2008;57:741744.
12.Kornstein, SG, Schatzberg, AF, Yonkers, KA, et alGender differences in presentation of chronic major depression. Psychopharmacol Bull. 1995;31:711718.


Prevalence of Unmet Health Care Needs and Description of Health Care–seeking Behavior Among Displaced People After the 2007 California Wildfires

  • J. Lee Jenkins, Edbert B. Hsu, Lauren M. Sauer, Yu-Hsiang Hsieh and Thomas D. Kirsch...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed