NFPA Journal

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At about 6:30 a.m. on November 8, Ryan Ashlock left for work from his home in Chico, California. His office was about 20 miles “up the hill,” as locals say, in the town of Paradise, at Feather River Hospital, where Ashlock is chief financial officer.

As Ashlock left Chico, a small brush fire ignited in the Sierra foothills just outside of Paradise. By the time Ashlock arrived at the hospital, around 7 a.m., he could see smoke, but, as he recalls, it didn’t seem like anything to be too concerned about, even though the wind continued after blowing hard most of the night.

Twelve hours later, that small brush fire had blown up into a wind-driven juggernaut, expanding to 20,000 acres and consuming everything in its path, including much of Paradise: homes, businesses, schools, churches. At its peak, according to estimates, the fire roared through Paradise and other Butte County communities at the rate of 80 football fields per minute. By November 25, when it was announced that the fire was 100 percent contained, the Camp Fire, as it had been called, had burned more than 153,000 acres, or about 240 square miles, killed at least 86 people, and destroyed an estimated 19,000 structures, becoming the deadliest and most destructive wildfire in California history. Loss estimates for the Camp Fire have run as high as $13 billion.

Ashlock was “administrator on call” that morning, a role that rotates weekly among hospital leadership. “You’re the key point of contact on the administrative team to help make a decision if the team inside the hospital feels it needs a higher level of approval if an issue arises—a patient issue, physician, staff, or some type of emergency situation,” Ashlock told NFPA Journal in a recent interview. “I was the guy that day.”

Over the course of about two hours, Ashlock, along with the hospital’s staff and patients, faced a health care facility nightmare in the form of a sudden and complete evacuation as fire surrounded the hospital's campus, then began to burn outlying buildings. No local firefighting resources were available to protect the main hospital, and no ambulances were available—almost all of the roughly 80 patients evacuated, including 67 inpatients, were bundled into the cars, trucks, and SUVs of hospital staff for transport to nearby hospitals, including one in Chico. One person, a critically ill intensive-care unit patient, died that day. Despite harrowing near-misses, all other evacuated patients, as well as roughly 200 staff members, made it to safety.

Ashlock had recently been named chair of the hospital’s safety committee, but the post had more to do with managing protocols for Joint Commission accreditation than it did for overseeing a code black, an emergency condition called when a hospital is threatened with potential destruction. Ashlock had never participated in an actual evacuation of any kind.

Ashlock spoke with Scott Sutherland, NFPA Journal editor, about the roughly two hours he spent at the hospital that morning, from the moment he arrived until the last evacuated patient left the facility—and about his own escape from the increasingly dangerous Feather River Hospital campus. The following is an edited, condensed version of that conversation.

7 a.m.

When I got to the hospital, I could see smoke in the distance. I didn’t think much of it at the time, but I did think, “Well, today could be an interesting day.”

The wind was blowing pretty good, maybe 20 to 30 mph. I’d heard they’d been blowing 30 to 50 mph all night. A Cal Fire vehicle went speeding down Pentz Road with its lights on. Something was definitely going on.

7:15 a.m.

Inside it was business as usual. From my office window I could see an orange glow outside from the smoke that was starting to come into the area. I started rounding in the hospital, since I was administrator on call. I ran into our house supervisor, who coordinates the nursing operations. She said we were starting to get smoke in the hospital and that we needed to close some entrances. I said let’s do that.

7:30 a.m.

We had a call scheduled with the town of Paradise to talk about the status of the power. We’d been told the day before that the electric utility, PG&E, was likely going to shut off all power to the town due to the potential for significant winds the night of November 7 and into November 8, but the power had remained on. There was supposed to be Cal Fire and Butte County fire folks on that call, but no one from those agencies joined.

During the call, the town didn’t have a good idea of what was going on with the fire. They asked us if we had any concerns, and we said yes, we had concerns about the fire that was in the area. They said they didn’t have much information but that they didn’t think there was much to worry about.

7:45 a.m.

We started to get calls from employees who were coming in to start their shifts. They were seeing fires in the area and wanted to give me a heads up. I ran into our house supervisor again and she said there was some growing concern about what was going on with the fire. I called another brief leadership meeting for 8 a.m. to assess the situation.

Right before we met, we called a code triage external, which means there’s something going on in the outside world that we need to be aware of, and that units need to prepare themselves for anything that might be coming.

Trapped The sudden order to evacuate the entire town of Paradise created traffic jams as people tried to flee. Patients and staff leaving Feather River Hospital faced bumper-to-bumper traffic as they attempted to exit the hospital's campus. Elsewhere in the town, fire cut off escape routes, and residents were forced to abandon their vehicles and flee on foot. Photograph: Getty Images

8 a.m.

We met in the boardroom, and the leadership team learned that the area the hospital was in was under mandatory evacuation.

In a hospital, we don’t immediately evacuate. You’ve got firewalls and other things in there that can make it safer to stay inside the hospital than to evacuate. We told our hospitalist group and our nursing leaders that we should identify the patients who can be discharged right now and get them out of the facility. Otherwise it was business as usual. The possibility of the power being out meant we’d reduced our operating room schedule, since we won’t do those procedures on generator power, and that limited some of the work going on in the hospital that morning. It wasn’t as busy as it might’ve been.

8:04 a.m.

I got a call from an employee in human resources, which has offices on the edge of our campus, and he said he could see flames from his office. And I thought, “OK, this is maybe a little more emergent than I thought.” At the same time, a call came in for the IT director, who was in the room with me. It was from someone on his staff, located at the opposite end of campus from HR, and they also had fire near their building. So now fire is at both ends of the campus, and is somewhat surrounding us.

8:07 a.m.

I made the call to do a full evacuation of the hospital. We called a code black and started the process. The plan was to send all patients to a competing hospital, Enloe Medical Center, down in Chico. We directed everybody to send patients through the ambulance bay in the emergency department. Right after that, we heard from someone who was monitoring the radios of the authorities that the evacuation order had been changed to include the entire town of Paradise.

That’s when we knew this would be a difficult situation. Part of my concern was that, given there’s fire on the campus, we don’t have an easy ability to start evacuating because we don’t have emergency vehicles on site. I called Enloe to see what support they could provide. They said they’d try to send up their ambulances and helicopters.

8:15 a.m.

I walked outside to see what was happening, and there were flames all around the campus. Fire was probably 400 or 500 yards from the hospital. Paradise is heavily wooded, with lots of tall pine trees, and many trees around the exterior of campus were on fire. We needed to get off that campus asap.

Back in the boardroom with the leadership team, there wasn’t a ton of discussion about what to do. We had to get our patients prepped and ready and lined up to leave, and we needed to do it as coordinated and calmly as we could.

We heard from Enloe that the smoke was too thick for landing helicopters, but they’d try to send ambulances.

8:20 a.m.

Our evacuation plan called for ambulances to come from the town of Paradise. But it’s a small community, so there aren’t many ambulances readily available. Most would come from Butte County. But we weren’t seeing any of those local ambulances and we didn’t know where they were. We were also concerned that ambulances from Chico might not get up here because of the traffic resulting from the entire town of Paradise being evacuated.

Someone over in the emergency department figured out that ambulances weren’t coming. There were Paradise police and Butte County Sheriff’s Office people on site, and I went out to talk to them. As nicely as I could, I asked them, “Where are the firefighters to protect the hospital, and where are the ambulances to help us evacuate?” They said, “We’ve called, and no one’s responding.”

The decision was made to start putting patients into the emergency vehicles that happened to be there, and the rest would have to be put into the personal vehicles of hospital employees—we weren’t going to get off that campus by sitting and waiting for ambulances or firefighters to show up. Clinicians got patients into wheelchairs, patients who could walk were escorted down to the emergency department, patients who were in the ICU or who were unable to walk or get into wheelchairs were rolled out in their beds.

Watch a video of footage shot by Feather River Hospital employees as the growing wildfire threatens the hospital's campus.

8:30 a.m.

Patients in vehicles started leaving for Enloe. A few ended up going to Oroville, another area hospital.

There needed to be one leader who was helping coordinate things and keep everybody calm, and that was the role I took on. I tried to keep track of the patients who’d been put into vehicles, where they were going, what areas of the hospital still needed to be evacuated, things like that. Our clinic director was on his way up the hill, and I called him to say he needed to go down to Chico and open an incident command because we couldn’t have an IC in Paradise. I was going into various support areas in the hospital and letting people know they needed to get out and not worry about grabbing personal belongings. A lot of our evacuation protocols went out the window when we found out how close the fire was. We didn’t even have time to grab the emergency binders and check to see what the process is supposed to be.

As I was running through the hospital I was struck by how calm it was. You would’ve expected complete chaos, since we were telling people to get out so quickly, but there was none. One of the advantages of the way the hospital is designed is that, as you go from the nursing units to the emergency department, there are very few windows. I’d seen for myself what was going on outside and the danger we were in, but for staff or patients who couldn’t really see outside, you’d think they were lined up on a normal day, waiting to get into the car and go home. I’m sure as people were getting loaded into cars and they saw the environment around them, they were thinking, OK, this is maybe a little scarier than I thought.

Two ambulances from Chico made it up at the very end of our evacuation. One got out, but the other caught fire and burned about a half mile north of the hospital. The patient was a woman who had just given birth by c-section, and she and the medical personnel were able to take shelter in the garage of a nearby home and survived the fire.

8:50 a.m.

All patients were out of the hospital. The fire stayed about 400 yards away because of the defensible area around the hospital. But the wind started to kick up and embers were blowing over us, and spot fires were starting all around us. Our central plant, where we have our boilers and chillers and generators, was starting to catch fire about the time we got everyone out of the main hospital building. Some of our buildings at the edge of campus were burning, along with our IT building.

In the hospital, the facility team shut down utility systems and medical gases. Other staff went through the hospital putting tape on areas that had been evacuated, so we knew they were clear.

Most clinical staff stayed through the evacuation. Other staff like the pharmacy and administrative support were evacuated along with the patients. But the staff who stayed created a bottleneck getting out—Pentz Road is the only way in and out of the hospital, and staff were with a lot of other Paradise residents trying to get out. Traffic was all backed up.

9 a.m.

We closed the doors to the emergency department, and I tried to figure out my next step. Where was I going to go? Traffic was bumper to bumper on Pentz Road, and it was going to be better if I stayed put for a little while. I just stood there and watched. I called my wife and told her we’d gotten the patients out and that I’d be heading back down to Chico in a bit. I tried not to give her too much of a sense of what was going on because I didn’t want her to worry.

Then this really big gust of wind came through, maybe 50 mph. The embers really started to fly, and it got very dark, like it was midnight. Embers were falling on my suit, and for the first time I felt like I was in significant danger. I thought, “Well, maybe these embers are going to catch me on fire and I’m just going to go up right here.” I ran to my car, which was a couple hundred yards away. The traffic on Pentz had been moving, but by the time I drove a few feet in the parking lot, I could see it was bumper to bumper again. One of my directors pulled up next to me and we sort of looked at each other, and he said, “What do you think?” I told him I was ditching my car because he had a bigger vehicle, a Toyota SUV, and if we needed to do some four-wheeling it would be better to do it in his. I jumped in, we said a quick prayer, and off we went.

9:15 a.m.

We had a decision: At Pentz Road, do we go left or right? We’d heard while we were evacuating that authorities were sending everybody right, which is further up into Paradise—they felt that was the right place to go, based on where the fire was coming from. A lot of people were still going right. We ended up going left, which in hindsight was the right choice. All the houses and buildings surrounding the hospital were burning, and cars were burning. But a half mile or a mile up the road, we got out of the flames. Later, we heard the stories. Some of the people who went right on Pentz got caught in the fire and ended up in some scary situations.

I had to get down to Chico to help lead the command center. It took us two hours to get down there—typically it’s about 20 minutes.

"Maybe I'm just going to go up right here": Ryan Ashlock, Feather River Hospital CFO.

We’ve been in temporary office space in Chico ever since. I’ve been up to the hospital in Paradise five times. My car survived, but it smelled pretty bad. We lost nine administrative buildings out of about 15, and one clinic on the campus. The lower level of the hospital burned pretty extensively. We’re doing everything we can to assess the damage and determine how quickly we can reopen, but it’s too soon to tell. We had some big rains shortly after the fire, and that’s made recovery more challenging because now we’re dealing with water damage in addition to fire damage.

Every time I see the devastation in the surrounding area, and in the hospital itself, it reaffirms that we made the right decision. I’ve run a lot of scenarios in my mind—could we have potentially stayed? Considering the situation and the lack of firefighters on the campus, we had to get out. I consider the evacuation a success. That doesn’t mean people didn’t have some very traumatic experiences as part of that process. But people are safe.

Clear & Present Danger The evacuation of Feather River Hospital was conducted as outlying buildings on the hospital's campus began to burn (top). Nine hospital buildings were destroyed. Below, search and rescue teams assist with the evacuations. Photographs: Getty Images

Looking to the future, the town could try to figure out how to come up with a better evacuation plan, knowing there are very few arteries out of the town. The plan that existed had evacuation zones that would leave zone by zone, but that didn’t work in a fire like this, where it’s moving so fast and essentially the whole town was on fire within a very short period of time. A new plan needs to allow for a more coordinated evacuation of a town in a somewhat isolated area.

We should also look at strategies for how firefighters and other emergency personnel can assist the hospital during events like this. But in their defense, I’ve also heard this wildfire described as “the perfect fire,” where everything happened in such a way that there wasn’t time for firefighters to get to us. Fire authorities had to make the decision that the focus was on getting residents out safely and not defending buildings.

SCOTT SUTHERLAND is executive editor for NFPA Journal. Top Photograph: Josh Edelson/AFP/GETTY IMAGES