From Fires to Outbreaks: Translating 2025 Wildfire and WHO EMT Lessons into ED Resilience and Surge Coordination

During 2025 extreme events — from the Los Angeles County wildfires to WHO-coordinated Ebola deployments — the persistent gap between surge threats and operational readiness is becoming painfully clear. Emergency departments are repeatedly encountering predictable but unaddressed failure points: insufficient surge space, brittle infrastructure, uneven mutual aid governance, and siloed clinical–public-health data. For ED medical directors and disaster officers, the work is therefore practical and immediate: translate system-level lessons from these events into prioritized actions that shore up ED surge capacity (space, staff, supplies), formalize hospital coordination—especially for wildfire response—through mutual aid agreements, and integrate clinical and public health functions before the next wave

For example, the Los Angeles County wildfires in early 2025 were a live stress-test of emergency department systems.

That event created a predictable set of clinical loads—respiratory exacerbations from smoke, trauma from fire-related injury, and displacement-related urgent care needs—while also stressing hospital power and bed capacity. Contemporary reporting and local coordination summaries, captured in the ACEP Now coverage of the LA County fires, emphasized how pre-existing emergency power resilience work by the LA County EMS Agency and rapid patient redistribution kept any single ED from collapsing. Operational responses that mattered were concrete: rapid decanting of non-urgent patients to virtual or alternate sites, surge staffing rosters called within hours, activation of regional bed boards to route ambulance traffic, and predefined evacuation protocols. It also highlighted flexible surge staffing models used during the LA fires, such as ICU-to-ED redeployment and regionally shared respiratory care teams. These practical lessons define the surge-management priorities in the next section.

Therefore, optimizing ED surge capacity (space, staff, supplies) is the primary operational priority; building on LA’s experience, leaders are reframing surge as a set of discrete, testable controls rather than an amorphous pressure. Space actions include pre-designated triage expansion areas, rapid conversion protocols for respiratory hubs, and agreements with alternate care sites to decant low-acuity visits. Staffing controls require tiered surge rosters, cross-trained personnel, and formal mutual aid triggers so clinicians can be mobilized within defined timeframes. Supplies actions prioritize oxygen concentrator caches, portable suction and PPE staging, and logistics plans for rapid restocking. Surge activation needs explicit, measurable criteria—example local triggers include sustained ED census >120% baseline for 2 hours, boarding exceeding 6 hours, or respiratory visit rate above 150% of the daily median—and these should be embedded in operational playbooks and drills; consult the guidance on optimizing ED surge capacity for general principles. These specifics are the operational counterpart to the mutual-aid governance described next.

Furthermore, when mutual aid is formalized and joint triage is practiced, single-ED overload becomes manageable rather than inevitable. Building on the surge controls above, the key mechanism is load-balancing: rapid ambulance screening to identify critical cases, then formal triage and distribution to facilities matched to capability. This approach is embodied in the joint triage multi-hospital model, which operationalizes a two-phase arrival screening and routing mechanism that requires prior agreement on capabilities and patient pathways. Operational governance must therefore include signed MOUs for bed-sharing and staff augmentation, a regional bed board with real-time visibility, a designated inter-hospital coordination officer with delegated authority during activations, and legal frameworks for cross-institution credentialing. Practically, ED leaders should be establishing a template MOU, a daily bed-status feed, and quarterly multi-hospital drills tied to mutual-aid activation criteria to convert transfers into predictable, auditable system actions.

First, WHO’s EMT architecture during the 2025 Ebola response illustrates how governance, standardized data, and a central coordination cell scale operationally. Mirroring inter-hospital mutual aid, WHO is using clear team classification (Type 1–3 and specialist cells), verified minimum standards, and daily Minimum Data Set reporting so national authorities and partners can see caseloads and needs in real time. The EMT Coordination Cell (EMTCC) is functioning as the operational hub—assigning roles, managing logistics, aggregating MDS feeds, and liaising with Ministries of Health to align clinical deployment with public health containment. These governance levers—verification, standardized reporting, and a single coordination node—were associated with the rapid deployment and interoperability of more than 50 teams during the Ebola 2025 response, as noted in the WHO Director-General's remarks on EMT coordination. The international approach underscores the value of pre-defined classification and reporting for faster, safer deployments.

Although standards and coordination cells are establishing a backbone for outbreak response, integrating clinical care and public health is still being impeded by workforce gaps, fragmented data systems, and cultural silos between hospital clinicians and public health teams. The operational result is delayed case ascertainment, duplicated reporting, and slower containment decisions. Practical solutions are pragmatic and immediate: create a joint incident management structure that embeds a public health liaison into ED command; adopt a shared Minimum Data Set for daily reporting and integrate it with the electronic health record; run routine, combined clinical–public-health drills that exercise laboratory, triage, and isolation workflows; and cultivate an 'outbreak science' interface that translates models and surveillance into actionable clinical thresholds. Evidence supporting these approaches and their implementation pathways is synthesized in outbreak science methods for clinical–public-health integration, which is improving decision speed and alignment when adopted operationally.

During the next preparedness cycle ED leaders are prioritizing a tight, time-bound action set that converts lessons into measurable resilience. Governance: sign mutual-aid MOUs with regional hospitals, designate a single ED disaster lead with delegated authority, and join or create a regional coordination cell within 30 days. Drills: schedule quarterly combined clinical–public-health exercises (tabletops, functional drills, and at least one full-scale annual exercise) that test joint triage and MDS reporting. Infrastructure: test and document emergency power, oxygen and HVAC redundancy, and pre-identify decant spaces; perform a 72-hour simulator test of oxygen and power systems. Metrics: adopt specific indicators—mutual-aid activation time, time to open decant space, MDS reporting completeness within 24 hours, and surge staffing fill-rate—and include them in after-action reviews. These priorities are aligned with a broader evidence synthesis captured in the practical emergency preparedness roadmap and are designed to yield rapid, testable operational gains.

In short, the operational lessons from wildfire emergency response as seen in LA County 2025 and from WHO-coordinated EMT deployments during Ebola 2025 are converging on three essentials: clear governance that assigns decision authority, shared data standards that make demand visible, and practiced mutual aid that redistributes load before systems fail. ED leaders are therefore translating these lessons into concrete actions—MOUs, MDS adoption, infrastructure tests, and combined drills—that are measurable and repeatable. Implementing this compact set of priorities is what is protecting access and capacity now; use the Key Takeaways below as a short, actionable checklist for immediate implementation and evaluation.

Key Takeaways:

• Formalize mutual aid and joint triage now; measure activation time and run quarterly multi-hospital drills to ensure rapid load redistribution.
• Test and document critical infrastructure—emergency power, oxygen supply, and decant spaces—with a 72-hour operational proof-of-readiness and tracked remediation items.
• Adopt a Minimum Data Set for ED reporting into regional dashboards (a reasonable operational target is ≥90% completeness within 24–48 hours) so clinical demand is visible to public health and coordination cells.
• Run combined clinical–public-health exercises and appoint an ED outbreak liaison; track drill-to-real activation gaps and close them through iterative after-action metrics.