Fueling the Frontlines: A Post-Disaster Support Initiative for Community Health Workers Responding to Wildfires

Abstract

Post-disaster support is critical for responders’ well-being who navigate the physical, mental, and emotional challenges of crisis intervention. The January 2025 Eaton Fire destroyed structures and disproportionately impacted Black and Latino neighborhoods. AltaMed deployed approximately 230 staff members to serve as frontline responders, providing medical and psychosocial support to evacuees at the Pasadena Convention Center. AltaMed frontline responders were invited to participate in a four-phase support initiative that included on-site peer-led debriefings, a needs and experiences survey, resilience-building workshops, and formal recognition of their contributions. A mixed-methods analysis was conducted on quantitative and qualitative survey data to assess well-being. Survey participants (n = 113) were highly motivated by community service, with 93% reporting a desire to contribute during crisis response. In addition, 53% identified the emotional impact as challenging, and 56% expressed interest in additional training. Peer support and reflection activities were cited as protective factors. Responders requested additional trauma-informed resources and infection prevention training. AltaMed’s support initiative successfully addressed the stressors of disaster response. Structured recognition, resilience-building, and professional development can promote long-term workforce well-being. These findings offer scalable strategies for Federally Qualified Health Centers and health systems supporting frontline workers during emergencies exacerbated by climate change and systemic disparities.

1. Introduction

On 7 January 2025, the Eaton Wildfire ignited in Eaton Canyon, a 190-acre, publicly accessible recreational area at the base of the San Gabriel Mountains in northeast Los Angeles County [1]. Rapid spread, due to strong Santa Ana winds, devastated the residential communities of Altadena and Pasadena, displacing thousands of residents and disproportionately impacting historically Black, Latino, and immigrant neighborhoods [2,3]. Many families face systemic barriers to recovery, including high housing costs and housing insecurity in the wake of recent gentrification, and limited access to emergency resources [4]. The blaze resulted in 24 fatalities, destroyed over 9400 structures, and displaced thousands of residents [5]. The fire’s impact was particularly severe in Altadena’s historically Black middle-class community, with nearly half of Black households suffering destruction or severe damage [4].

Chen (2021) noted that despite the extensive body of research on disaster relief, there are relatively few studies that specifically examine frontline responders on a global scale [6]. Disaster response places immense physical and psychological strain on frontline responders [6]. Resilience is the “ability of people, families, or communities to withstand stressors and return to the pre-stressor state when the stressor ends” and can be increased or decreased based on experiences over time [7].

AltaMed, a Federally Qualified Health Center (FQHC) system, implemented a structured frontline responder support program to improve individual resilience from stressors and ensure psychological safety from experiences and loss after the January 2025 wildfires that swept across Southern California [7,8]. Recognizing the Conservation of Resources (COR) theory by Hobfoll [7], AltaMed’s program was designed to assist frontline responders to gain or restore resources such as self-care strategies, social support, and psychological safety through onsite peer-led debriefings and resilience-building workshops.

AltaMed is one of the largest independent nonprofit health providers in California, delivering comprehensive medical, dental, and behavioral health services to predominantly Latino, multi-ethnic, low-income, and underserved communities.

AltaMed launched an immediate humanitarian response, contributing clinical, operations, support services, and leadership staff to an evacuation site housed in a local convention center to render clinical services and access to critical social support for evacuees [9]. These services ranged from chronic and infectious disease management, medication reconciliation, access to daily essentials, and connecting evacuees to wildfire recovery resources [9]. Within the first day, an estimated 1500 individuals flooded into the evacuation center, many experiencing physical, mental, and/or emotional distress [9]. Evacuees often carried their only possessions, personal documents, pets, and pieces of family history from the blaze and filled several halls designed to host conventions. The spaces were ill-equipped to manage the large number of individuals in distress with a critical need for food, shelter, and medical care.

The wildfires had a profound effect on AltaMed patients as well as employees, with over 6000 patients residing in the fire-affected and evacuation zones [9]. The Eaton Fire destroyed the AltaMed East Washington clinic in Pasadena, while six additional clinic locations were forced to close temporarily due to evacuation mandates, disrupting medical care access for thousands. The crisis displaced many AltaMed employees, with 17 losing their homes, and countless others evacuated or “red-flagged” for potential evacuation (a highly stress-inducing circumstance with heightened uncertainty) [9].

Across the approximate one-month commitment AltaMed made to provide services at the Pasadena Convention Center (PCC) evacuation site, responders experienced a number of challenges associated with their service. This included personal protective equipment (PPE) shortages, the emotional toll of working with displaced and traumatized evacuees, long and unpredictable shifts, the complexities of delivering medical and social support in a rapidly evolving emergency environment, and infection prevention and control (IPC) as several communicable infections emerged due to the cramped and unsanitary circumstances [9,10,11,12].

As the need for staff at PCC diminished, AltaMed frontline response staff ultimately needed to transition back to their original roles. To facilitate a smooth return to work after the challenging experiences they may have had at the evacuation site, our leadership team identified the need for a responder support program to address their specific needs. AltaMed’s data-driven response aimed at addressing the short- and long-term emotional and professional recovery of its workforce [13]. This initiative began on day 3 of the evacuation site activities and continued until clinical care was no longer being offered by AltaMed and another health system partner, Kaiser Permanente. This program integrates evidence-based resilience workshops, peer support networks, and structured debriefing sessions to mitigate burnout and ensure sustained engagement in disaster response efforts.

Study Objective

This paper describes interventions used to support frontline responders from AltaMed during the Eaton Wildfire response. We aimed to assess the needs and experiences of frontline responders and implement a four-phase support strategy: (1) on-site peer-led debriefings; (2) needs and experiences survey; (3) resilience-building workshops, and (4) formal recognition of their contributions.

2. Materials and Methods

AltaMed’s post-disaster support strategy was designed to provide structured interventions before, during, and after shifts. The study performed a mixed-methods analysis using quantitative survey data and qualitative feedback to assess front-line well-being. All post-disaster support activities were undertaken on-site at the PCC, in Pasadena, California, or delivered virtually after their service. All activities were optional for AltaMed frontline responders who opted into the post-service programming and survey. Our roll-out strategy reflects the immediacy of the identified needs, or discoveries from needs assessments, including a post-service survey. These activities were organized into four distinct phases: Phase 1, on-site peer-led debriefings by an Incident Command Nurse Leader; Phase 2, needs and experiences survey collection and analysis; Phase 3, resilience building workshops; and Phase 4, formal recognition of their contributions.

2.1. Eligibility

AltaMed employees who were deployed as frontline responders to the Eaton Wildfire and served at PCC were eligible. Approximately 230 responders were identified as eligible to participate. Exclusion criteria were frontline responders at PCC who were not AltaMed employees.

2.2. Phase 1. Onsite Peer-Led Debriefings

At the start of each clinical shift, responders participated in pre-shift peer briefings, acknowledging their contributions, outlining available support resources, and setting expectations for well-being strategies throughout the day. Recent studies have indicated that debriefing in the field may have benefits for sharing lessons learned, reflections, and improved emotional well-being [14,15,16]. When operationally feasible, responders engaged in group post-shift debriefs at the end of the day, often utilizing reflective activities to identify positive experiences and challenges. Each day at different times based on emerging issues, impromptu “huddles” were also initiated with staff to make announcements, regroup when there appeared to be a breakdown in care delivery, address issues with coverage, or issue alerts about new infectious diseases that had been identified.

Each meeting began with participants standing in a circle and receiving daily assignments, updates, or planning for the next day, depending on the time of the session. The meetings quickly shifted to positive feedback from the facilitator, highlighting specific moments of exceptional care delivery, instances of kindness and mutual support observed, or other aspects of the team’s performance that inspired a general sense of appreciation for their efforts. A “rose & thorn” activity was often used to end the post-shift meeting. In this activity, the group would go around the circle, giving each responder time to first describe a “thorn” of an uncomfortable experience they felt that was potentially upsetting, and then a “rose,” the beautiful lesson or growth they achieved through having confronted or overcome the challenge. As responders had different experiences on-site daily, this same activity could be used without fear of redundancy across multiple post-conferences.

2.3. Phase 2. Needs and Experiences Survey

Our post-service wildfire survey was developed by an AltaMed Institute for Health Equity senior scientist as a practical tool to capture timely and meaningful insights from responders who assisted in wildfire response efforts. While the survey is not a validated instrument, it was carefully designed to gather firsthand experiences and identify the most effective ways to support responders as they transition back to their regular roles. The heuristic driving survey tool development was an emphasis on “fast” over “best” (speed of an activity over the quality of the result). The same approach was used to create the subsequent Los Angeles (LA) County-wide wildfire recovery needs assessment (LA County Department of Public Health). To support volunteers, a survey was generated based on anecdotal or observational data about the event, rather than using an “out-of-the-box” validated survey that might not apply to our population of concern. Non-validated questions supported rapid (“fast”) collection of information, yet this data was not considered comprehensive or robust (“best”). Subsequent efforts to triangulate or verify data collected in this way are needed.

Responders were contacted via AltaMed email to participate in the Needs and Experience Survey (see Supplementary Materials). The survey was designed to be completed anonymously to help alleviate concerns regarding potential judgement or professional repercussions. Demographic and role-related data were intentionally excluded from the survey to protect anonymity and minimize potential response bias. Exclusion criteria for the survey were frontline responders at PCC who were not AltaMed employees. The study received ethical approval from the Institutional Review Board and anonymity was maintained throughout data collection and analysis. The Qualtrics survey included an informed consent statement at the beginning, indicating that completion of the survey constituted voluntary agreement to participate.

The purpose of the survey was to identify the needs and experiences of AltaMed first responders and assess potential protective factors such as motivation which is shown to have a positive correlation with overall health and satisfaction [17]. Inclusion criteria for the survey were AltaMed employees who were deployed as frontline responders to the Eaton Wildfire and served at PCC, including, but not limited to roles of Medical Assistants, Community Health Workers, Allied Health Professionals, Nurses, Physicians, and Administrators. By focusing on immediate feedback, the survey helped us understand the emotional, mental, and physical impacts of their service, ensuring that future support initiatives are responsive to their needs.

The survey included five multiple-choice questions, with a final, sixth question that requests participants’ email addresses if they are willing to be contacted for further information. Each of the six questions explored topics that were raised during on-site huddles or pre- and post-conferences with AltaMed responders. Each question allowed to select all that apply and an option to select “other (please specify)”. By selecting this option, participants could add a narrative response to a free-text box. These responses are being used as qualitative data, in vivo quotes, to augment the quantitative data collected. Because the survey consisted of five brief, event-specific multiple-choice items designed for rapid situational assessment, it was not intended as a psychometric scale. As such, no exploratory or confirmatory factor analysis was conducted.

2.4. Phase 3. Resiliency Building Workshops

In response to needs identified by the post-service survey, and to further support responders transitioning back to their regular duties, AltaMed hosted two dedicated sessions titled “Trauma, Tragedy, and Our Work: How to Support Well-Being as Health Workers.” These sessions were facilitated by Brooke Briggance of the Cypress Resilience Project who is highly trained in emotional and mental health support, holding certifications as a Grief Recovery Specialist, Mental Health First Aid Instructor, and Trauma-Informed Systems and Practice Trainer. These credentials qualify her to handle sensitive subjects such as trauma, grief, and confidentiality with skill and care. The purpose of these optional sessions was to provide a space for responders to process their experiences, normalize stress responses, and reinforce awareness of available mental health resources by providing them with stress management tools and self-care strategies. These sessions were conducted virtually for greater accessibility and evidence supports digital interventions use [18]. To supplement the workshop, the research team also created a flyer linking participants to resources available within the organization and local and statewide.

The first session, held on 24 January 2025, was attended by 56 individuals, with a follow-up session on 31 January 2025, attended by 46 individuals. To supplement the resources provided in the sessions, the research team also created a flyer to provide supplemental resources available with the organization and local and state-level resources.

2.5. Phase 4. Formal Recognition of Services

In our final phase of post-service support, our team focused on providing a formal acknowledgement of service via the creation of a letter of acknowledgement, signed by AltaMed executive leadership, and a certificate of service for each responder for display in their workspace. Previous research on burnout has found that recognition can boost employee engagement, compassion satisfaction and decrease burnout [19,20].

2.6. Qualitative Data Analysis

Qualitative data were analyzed using a Content Analysis approach [21]. According to Zhang and Wildemuth (2009) the goal is to “identify important themes or categories within a body of content”, and provide “rich description of the social reality” in a particular social setting [22]. In this effort, we were somewhat limited due to the nature of the qualitative content reflecting free-text box responses versus a 1:1 interview or focus group. As with more traditional content analysis, the study team began by inductively generating codes based on both (1) frequency of occurrence and (2) conceptual significance. Recurring patterns were noted and collapsed into meaning units, which informed the creation of focus codes and ultimately the central concepts described below. All qualitative data were managed using Microsoft Word to facilitate organization and retrieval of coded material. To support trustworthiness, study team members met to review the emerging categories, reconcile any coding discrepancies and ensure interpretive consistency across team members. As noted above to describe the heuristic and justification for creating and using a non-validated survey, the synthesis of final themes was similarly achieved by comparing patterns across participants through a “fast versus best” analytic lens. This again prioritized timely, experiential insights to inform the well-being strategy supporting volunteer recovery and their return to pre-event roles.

3. Results

As part of the second phase of the study, AltaMed frontline responders (N = 230) were recruited on an opt-in basis to complete an anonymous survey via Qualtrics to provide feedback on their experience, identify additional resource needs, and highlight training opportunities for future disaster response efforts (n = 113) before the phase III workshops. This represents approximately half (49%) of the responders (113/230) documented on-site across the weeks of wildfire response, providing valuable data for improving future support strategies. Considering the anonymity of the survey participants, demographic information was not collected.

Data analysis did not reveal any statistically significant p-values (p < 0.05) when assessing the relationship between volunteering motivation (Q1) and perceived support during the role (Q3). This suggests that, within this sample, there is no significant correlation between specific motivations and feelings of support among frontline responders. The dataset was cleaned by removing extra metadata and converting multi-select responses into binary indicators, enabling chi-square tests to assess relationships between categorical variables in the survey. A chi-square test of independence revealed no significant association between motivations for volunteering (Q1) and perceived support during the role (Q3), as all p-values exceeded 0.05, indicating that the two variables are statistically independent. The absence of significant results may be attributed to small expected cell counts, a limited sample size that reduces statistical power, or the possibility that no meaningful relationship exists between the variables examined. It is also important to note that since these questions allow for a multiple selection option, select all that apply, the total of these results does not add up to one hundred percent.

3.1. Motivations

Survey findings indicate that the majority of responders were driven by a strong sense of community service (Figure 1). Many respondents expressed a desire to help the community: 93% (95% CI = 86.6–96.4%) and found the most rewarding aspects of their experience (Figure 2) to be making a difference in people’s lives: 81% (95% CI = 72.3–86.8%) and collaborating with a valued team: 56% (95% CI = 46.6–64.6%). Some responders also highlighted the opportunity to learn new skills/gain experience: 46% (95% CI = 37.1–55.2%).

In analyzing qualitative responses, several key themes emerged. Responders consistently noted the emotional toll of their experiences and emphasized the importance of structured reflection opportunities to process their emotions. Many highlighted the value of the experience for professional growth and requested additional training to prepare for future crisis response roles, including a better understanding of infection control strategies. A recurring theme was the power of peer support, identifying teamwork and shared experiences as a crucial resilience factor.

Overall, commitment to their community and service was evident across responders [23]. One participant said it was “a blessing to be a part of a team that wanted to help,” indicating a sense of support across or on-site. Another said they felt tremendous gratitude that transcended the event: “I received so much love, prayers, hugs! They were so sweet! The connections I built with them were real.” They added that “two people wanted to invite me later and cook for me! I wanted to cry whenever I heard them being happy.” This sense of connection felt “personal” to another responder, stating this experience created “(a) Personal connection to the affected areas/community”, indicating the work resonated deeply in a meaningful way.

3.2. Challenges

Responders encountered numerous challenges during their time assisting the Eaton fire-affected communities, reporting they were grappling with feelings of helplessness despite their dedicated and generous efforts. In fact, more than half reported the “emotional impact of the work” to be challenging 53% (95% CI = 43.9–62.0%) (Figure 3). Furthermore, respondents also felt challenged by a “lack of role clarity” 43% (95% CI = 34.6–52.6%) reflecting insufficient experience with pivoting to a position during a crisis, either as a frontline responder or related to leaders’ limited fluency in disaster response. One responder expressed frustration, stating that “most challenging was not being able to do more,” while another reflected on the difficulty of assessing their own impact: “I don’t feel like I made a difference in people’s lives, they’re going through so much, but I felt like I helped with small things… One less thing for impacted families to worry about.” Others highlighted the emotional and logistical complexities of crisis/disaster response, emphasizing the importance of creating stability amid uncertainty; “being able to provide a safe space for those affected” was both a challenge and a critical goal.

Our responders also navigated significant health risks, reporting personal concerns about “exposure to illnesses,” particularly in an environment where public health protocols were in flux and numerous contagious infections had emerged. One participant described the early response as chaotic, explaining:

…the process for patient care, resources, and the way to carry out certain situations like positive cases for COVID-19 and flu (Influenza A&B), were changing often at the beginning and it was unclear on who to speak to or who to refer the resident to. The last few times I responded were a lot more organized and clear on the processes.

Beyond operational challenges, responders also observed systemic barriers that hindered effective support. Frustrations arose from “observations of how those impacted by the fires were being treated, stonewalling and lack of collaboration/communication,” illustrating the difficulties of interagency coordination in emergency response. Despite these obstacles, responders reported remaining committed to their roles, underscoring both the resilience required and the structural improvements needed to enhance future crisis response efforts when FQHCs or community clinics play a major role in supporting those fleeing disaster.

Significant infection control challenges arose during the wildfire response, particularly in a convention center environment not originally designed for or conducive to preventing the spread of illness. One responder noted that the “environment [was] not good for controlling spread of infectious disease,” leading to their concern about “the possibility of getting infected.” A major source of frustration also stemmed from a partner organization’s approach to infection prevention, with one participant asserting that this national organization was “not understanding proper infection prevention/control measures, allowing outbreaks to worsen.” Other responders noted this organization’s reluctance to implement basic preventive strategies, such as making overhead announcements about handwashing, ensuring that bathrooms were adequately cleaned, or engaging in standard quarantine protocols. In post-conference meetings and daily huddles, our responders also reported their belief that gaps in infection control were compounding existing vulnerabilities in the convention center shelter environment.

Beyond logistical challenges, responders also described challenges in working alongside staff and responders from the national organization, particularly in relation to cultural competency and power dynamics. One participant reflected on the racial disparities they witnessed, explaining that “witnessing racial dynamics (White redacted responders vs. Black/Brown evacuees) was difficult,” while another noted that “seeing people from other organizations who were there to ‘help’ cause more harm because they centered their ego and savior approaches and dehumanized many residents at the shelter.” The cultural and attitudinal differences between responders and national organization staff seemed to further complicate relief efforts, with one participant summarizing that “having to work with redacted as they have a different work culture and attitude towards the evacuees” created additional strain. These challenges highlight the critical need for stronger infection control protocols, culturally responsive disaster response strategies, and improved interagency collaboration to better support vulnerable communities in disaster response.

3.3. Support and Needs

Overall, most participants felt either “supported” or “very supported”(Felt supported or very supported: 85% (95% CI = 77.2–90.4%), indicating the efforts of AltaMed leaders on-site and after service were welcomed, appreciated, and effective (Figure 4).

A significant portion of the survey focused on the emotional and psychological needs of responders post-service (Figure 5). More than half survey respondents expressed interest in training/resources: 56% (95% CI = 46.6–64.6%). The results revealed a strong demand for structured support, with over 40% of the respondents expressing a need for opportunities to debrief or reflect with peers 43% (95% CI = 34.6–52.6%). Potentially as a reflection of this, some indicated a desire for self-care resources to aid in their recovery 32% (95% CI = 24.0–40.9%), while a notable percentage requested access to mental health support, including counseling and resilience workshops similar to those offered through the Cypress Resilience Project 23% (95% CI = 16.2–31.6%).

3.4. Knowledge/Training Requested

Opportunities for improved training and knowledge-sharing emerged as another key theme, with responders expressing a need for better preparedness in future disaster responses. In response to the question on what skills or knowledge responders expressed a desire for training in disaster response or emergency management (52%; 59/113) 95% CI = 43.1–61.2%. (Figure 6). One responder emphasized the importance of ongoing updates, requesting “updates on how people are doing in the shelters, any improvements in infection rates, etc.” Others suggested that AltaMed formalize lessons learned, proposing that the organization take the lead in “drafting a guide of what was learned during COVID-19 and fire so that we have a resource for the future.”

Infection prevention remained a major concern across our responders, with one participant advocating for “better infection prevention methods in the building, including better air conditioning/circulation” to reduce disease transmission risks in emergency shelters. In addition to environmental improvements, some responders called for “better data collection and use of analysis” to enhance response efforts and track key health and safety outcomes more effectively. Despite these requests, responders also acknowledged the strengths of the existing response, recognizing that “all these things can be benefited from, but also the team did debrief, we did check in with each other, and breaks were provided to step away and help collect ourselves.” These reflections underscore a desire for structured training, real-time data collection, and ongoing evaluation to refine future crisis response efforts while also building on the strengths of peer support and debriefing mechanisms.

4. Discussion

AltaMed’s post-disaster responder support initiative demonstrates the effectiveness of proactive psychological aid in responder disaster response and recovery. By embedding structured appreciation, reflection, and mental health resources into the experience, AltaMed leaders fostered well-being and minimized burnout risk across a multi-disciplinary team. Mixed-method data collection and analysis allowed for a targeted exploration of recovery needs and benefited from the resilience workshop, while the strategy of initiating responder support on-site, before event resolution, likely created an environment of openness that bolstered survey completion.

Qualitative findings from the post-responder survey underscore the significant emotional and professional impact of participating in the wildfire disaster response. Many respondents expressed deep gratitude for the opportunity to serve and highlighted the strong sense of connection they developed with the affected community. Existing literature suggests that altruism is a key motivator for responders following natural disasters, a finding that aligns with AltaMed’s mission-driven approach and organizational commitment to service [24]. Clary (1998) posited that responding provides individuals with an avenue to “express altruistic values” and demonstrate their “humanitarian concern for others” [25]. These findings suggest that engagement in the wildfire disaster response allowed employee responders to actualize their professional ethos and commitment to service beyond the traditional healthcare setting. Additionally, cultural norms and socioeconomic status can influence whether individuals choose to express distress, discuss sensitive topics, seek formal assistance for mental health, or rely on informal support networks. We believe that the sample size of the survey was sufficient to draw meaningful findings and was representative of the responder population.

While altruism-associated motivations, usually associated with selflessness and a disregard for public recognition, emerged in the quantitative data, recognizing and acknowledging responders’ service was a critical aspect of the post-disaster responder support program [26]. By providing a letter of thanks signed by AltaMed leadership, and access to virtual post-conference sessions, we responded to a potential responder’s need for recognition and validation, reinforcing their sense of purpose and contribution. Such gestures not only honored their efforts but also aligned with best practices in responder retention, fostering continued engagement in future disaster response efforts [27].

A darker side to the responders’ experience was their report of an emotional toll, underscoring the necessity of structured and facilitated reflections to process negative exposures. An emotional toll has been described in disaster response literature, and we acknowledge that responders may not accurately self-report their attitudes or experiences, which may lead to potential inaccuracies. Gebreyesus (2022) noted that group debriefs during emergency public health responses can help reduce the impact of trauma, and our group debriefs were similarly tailored to remind responders that the emotional toll is recognized and support is available [16]. Thormar (2010) suggests the emotional toll can be mitigated by access to post-disaster support, similar to the virtual resilience-building workshops offered by Cypress Resilience [13,28]. The onsite peer-led debriefings and resilience-building workshops targeted personal resilience as an internal resource and psychological safety as an environmental or social resource, two key resource domains identified by the COR theory [7,8]. According to the COR theory, losing resources increases stress, while gaining resources supports well-being and recovery [7,8]. This is reflected in the survey responses, which emphasized the availability of peer support, teamwork, and shared experiences as strengths. Peer support has been previously explored in relation to the COVID-19 pandemic; Godfrey (2022) found that not only was peer support beneficial, but also that providing peer support to others in a similar situation could have potentially protective aspects [29].

Responders faced significant health risks, particularly concerning exposure to infectious diseases in an environment where public health guidelines were continuously evolving. These findings underscore the need for clearer protocols and targeted training to help responders manage emotional distress, set realistic expectations, and contribute effectively during crisis situations. Infection control often becomes a major concern in the aftermath of natural disasters [30,31], and responders identify gaps in preventive measures within the shelter environment. These gaps were ultimately addressed through a coordinated strategy among the on-site agencies. However, prior to this intervention, the lack of consistent infection prevention measures contributed to their heightened stress and increased risk of illness for both responders and evacuees.

Interagency collaboration challenges, a well-documented issue in disaster response [31,32,33,34], further complicated these efforts. Responders reported resistance from a partner organization in implementing basic health and safety protocols, which exacerbated concerns about infection control. Additionally, cultural and power dynamics created tensions, with some responders noting racial disparities in how evacuees were treated. Research suggests that deploying culturally congruent, bilingual, or multilingual responders who reflect the affected community can improve care-seeking behaviors and adherence to clinical recommendations in crisis settings [35]. This approach may have strengthened clinical interventions in this disaster response. These findings highlight the critical need for improved interagency coordination, culturally responsive disaster response approaches, and stronger infection control protocols to protect responders and disaster-impacted communities.

Applied to a global perspective, it demonstrates how structured support and resilience interventions can enhance workforce sustainability during climate emergencies. The World Health Organization (WHO) and International Labour Organization highlight that approximately 2.4 billion workers are exposed to climate-related health risks, such as emotional exhaustion and stress [36,37]. The WHO’s Climate-Smart Health Workforce guidance emphasizes the integration of resilience and well-being into organizational policies and training [38].

Findings highlight how structured post-disaster support models can inform the development of formal policies at local, state, and federal levels for responder protocols, retention incentives, and funding for workplace well-being and infection prevention training. On a global policy level, implementation of these elements supports the Exploration, Preparation, Implementation, Sustainment (EPIS) guide, which is used to guide disaster preparedness and psychosocial workforce interventions [39]. Recent cross-sectional studies, such as Santos (2025), have found that promoting the well-being of nurses in global healthcare settings can increase quality of life, a goal similar to building resilience and well-being for healthcare responders [40].

A key takeaway from these findings is the need for enhanced training and knowledge-sharing to improve future disaster response efforts. Responders expressed interest in ongoing updates about shelter conditions, infection rates, and best practices learned from their experiences. They also advocated for formalizing lessons learned into a structured guide to inform future crisis responses. Recommendations for improved air circulation, real-time data collection, and systematic evaluations were also identified as priorities. Despite these challenges, responders acknowledged the strengths of the existing response, particularly the emphasis on peer support, debriefing, and structured breaks.

Limitations

This study focuses on frontline responders employed by AltaMed in Southern California and may have limited applicability to broader populations. The dedication of responders exemplifies the profound impact of service and stands as a testament to their compassion and unwavering commitment to uplifting those in need. While we acknowledge their great acts of service, we recognize that our survey participants were a self-selected group. Only approximately half of the responders participated in the survey (49%; 113 out of 230), which may introduce response bias, as those who chose to complete the survey could have had particularly strong positive or negative feelings about their responder experience. This limitation may affect the generalization of our findings, as the perspectives of those who did not participate remain unknown. Additionally, using a non-validated survey can lead to limitations for reproduction, generalizability, and increase the risk for misinterpretation. This study may be subject to self-selection bias due to voluntary participation and is further limited by the lack of a control group, which restricts the ability to infer causality. Given the brevity and event-specific design of the five-item survey, psychometric validation procedures such as factor analysis were not appropriate and were therefore not undertaken. Future studies should consider alternative data collection methods, such as focus groups or brief in-person interviews, to capture a more comprehensive range of responder experiences and insights.

5. Conclusions

This study underscores the importance of embedding workforce well-being strategies into emergency response protocols, an imperative made more urgent by the increasing frequency and severity of climate-related disasters. As climate change accelerates the pace and complexity of public health emergencies, already overstretched healthcare systems face mounting pressure amid persistent workforce shortages. Organizations engaging in disaster relief must prioritize structured pre- and post-shift check-ins to provide emotional support and reinforce psychological safety for healthcare and administrative personnel. Expanding access to virtual and in-person resilience workshops tailored to the unique stressors of safety-net and frontline workers can further strengthen institutional preparedness. Establishing formal peer support networks and investing in sustainable, long-term mental health resources are critical to maintaining a resilient workforce capable of withstanding repeated climate-driven crises.

AltaMed’s multi-phase post-disaster responder support program provides a replicable model and demonstrates the value of integrating structured peer-debriefing and resilience-building workshops into emergency response frameworks to increase the well-being of frontline responders. Additionally, embedding formal recognition and development pathways in policy frameworks can strengthen responder retention. The organization sets a precedent for integrating psychological safety into disaster response efforts through debriefings, resilience workshops, and mental health resources. Future initiatives should refine these strategies by utilizing responder feedback to enhance workforce preparedness, emotional well-being, and job satisfaction during times of crisis. Further developing this evidence base can inform the development of climate emergency response systems that protect both community well-being and sustain the health workforce.