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Primary Submission Category: Reproductive health
Present-day and Future Wildfire Threats to United States Neonatal Intensive Care Units
Authors: Joan Casey, Mathida Ngamsiripol, Amanda Gassett, Kristin Darwin, Alexander Northrop, Joel Kaufman, Tim Bruckner, Alison Gemmill, Alison Stolte, Nicole Errett, Ralph Catalano,
Presenting Author: Joan Casey*
Objective: Characterize historical and future wildfire risks at present-day U.S. NICUs and estimate transport distances between NICUs in the event of a wildfire-induced NICU evacuation.
Methods: All U.S. NICU locations were geocoded from the 2023 Neonatology Solutions Directory. Wildfire risk was quantified at each NICU as the number of historical (2006–2024) wildfires within 25km, the 2017 and 2050 (projected) Keetch–Byram Drought Index (KBDI), and 2015–2024 and 2046–2055 (projected) wildfire fine particulate matter (PM2.5) concentrations. Transport distances from the sending NICU to NICUs of the same level or higher were calculated under multiple occupancy scenarios. Social Vulnerability Index (SVI) scores in 2022 were linked to NICUs.
Results: 559 (40.2%) level II, 697 (49.8%) level III, and 140 (10.0%) level IV NICUs were included, with 32% located in census tracts in the highest SVI quartile. Between 2006–2024, 485 (34.7%) NICUs had a wildfire within 25km in 1+ years, median KBDI was 222 (in 2017), and 350 (25.0%) NICUs experienced average wildfire PM2.5 exceeding 1 µg/m3. Under climate mid-century scenarios, wildfire PM2.5 concentrations will increase the most at NICUs in Washington (6.9 µg/m3) and Montana and Oregon (6.7 µg/m3). In the event of a wildfire-initiated evacuation, median transport distances to same- or higher-level care varied by NICU level: 23 km for level II, 21 km for level III, and 171 km for level IV, under 100% sending and 75% receiving occupancy. Level IV NICUs with the greatest historical wildfire exposure had the longest evacuation transport distances, exceeding 300 km.
Conclusion: Wildfire risk for U.S. NICUs is a present and growing threat, with geographic expansion projected beyond the West by mid-century. Social vulnerability and level IV NICU scarcity compound evacuation burden, underscoring the need for a tiered, equity-informed approach to wildfire preparedness.