Forest Fires, the Plague & A Hospital ER

The fires which now burn in Northern California bring to mind a time, more than twenty years ago, when it seemed that the entire countryside near Big Sur was in flames. As it turned out, it wasn't the fire that had the potential for creating a disaster. It was a disease which was transmitted because of the fire.

During that fire, animals normally secluded in the forest, desperately sought to escape. They came into contact with humans, and in particular with one person who sought to care for those animals who were injured. That contact created a potentially explosive medical illness.

Hospital emergency rooms were very different than they are today. There was no long wait. Physicians did not "sign out" to the hospital emergency room when they went off-call (many hospital medical staff bylaws specifically prohibited such a practice) and young physicians were eager to develop their practices, and augment their incomes, by providing prompt consultations to emergency department doctors.

The patient who had been in contact with the animals fleeing the fire knew he was very sick, but did not know that he had contracted the plague through his care of injured animals. The doctors who cared for him in the emergency department, and later in the intensive care unit, did not immediately know that they were dealing with a person suffering from one of the most feared diseases in human history. By the time that the patient died, just a few days later, the diagnosis had been established and the patient had been treated with antibiotics which presumably controlled his infectiousness. There was no further spread of the plague that week.

If that person came into a hospital emergency room today, how many hours would he have had to wait to be seen? How many people would he have come into contact with? How seriously would the doctors who saw him have considered his non-specific complaints. If he was uninsured, would he have been deemed sick enough to warrant admission? If he had had insurance, would the insurer have balked at authorizing his admission. Would his illness been promptly and competently treated, as it was, or would overloaded bureaucratic and impersonal health system which can be found in hospital emergency departments in cities throughout the United States, through a combination of system incompetence, lack of concern, overwork and financial overextension have allowed this man's infection to become explosive devastating pneumonic plague?