Wildfire Forces Evacuation of Critical Access Hospital in Estes Park, Colorado
Multiple devastating wildfires burned across Colorado, California, and the western United States throughout
2020. This included the top 2 largest fires in Colorado's history based on acreage burned: the Cameron Peak
and the East Troublesome Fires. The Cameron Peak Fire began in early August 2020 and threatened Estes Park
Health (EPH), a Critical Access Hospital (CAH) in Estes Park, Colorado, for several months. EPH serves the
town of Estes Park and several small communities in Larimer County, Colorado, and is licensed for 23 beds,
plus 2 birthing center rooms. EPH also has a Level IV trauma center and a highly equipped, 24-hour emergency
department that can handle an influx of tourists. Additionally, EPH has an ambulatory clinic with healthcare
providers offering services such as internal medicine, orthopedics, pediatrics, obstetrics, gynecology, and
Hospital staff worried that the winds might push the wildfire, which was burning a couple valleys over,
closer to Estes Park. The CAH is situated to the east of Rocky Mountain National Park, near the park's main
entrance. Though the small town has a population of around 6,500 permanent residents, it receives over 4
million national park visitors a year, with a significant tourist surge in the summertime. There was concern
that the fire could move in the direction of the town with great speed, due to the enormous number of dead
trees from a Mountain Pine Beetle infestation a decade prior. However, the fire avoided EPH, crossing about
4 to 5 miles north of the town of Estes Park and eventually moving down Poudre Canyon toward Fort Collins
and other cities on the Front Range of the Rocky Mountains in Larimer County.
As the seasons turned to fall, anxiety about the Cameron Peak Fire subsided in Estes Park. However, on
October 14, 2020, the East Troublesome Fire started over the Continental Divide on the other side of the
Rocky Mountains, east of Troublesome Creek in Grand County. This wildfire took off at an accelerated rate
and, in just a few days, grew to over 100,000 acres near the Grand Lake area. It became the second largest
wildfire in Colorado, only behind the Cameron Peak Fire earlier that year, in terms of acreage
In the early morning on October 22, 2020, some ash or cinder made its way over the mountain divide and
landed in Spruce Canyon, located a few miles west of Estes Park. The trees, killed by beetles and more
susceptible to fire, caught flame, and by noon that same day, Larimer County issued an emergency evacuation
for the entire town of Estes Park. The speed at which EPH had to evacuate was a surprise to hospital staff
and presented logistical challenges, despite prior planning.
The East Troublesome Fire was racing toward the town, said Gary Hall, Chief Operating Officer (COO) for EPH.
He remembered the sky at 2:00 p.m. was “as dark as night” from the smoke of the approaching
flames. Huge lines of traffic backed up as the town evacuated throughout the afternoon.
Hall has worked at EPH since 2005. He has remained through multiple administrations and staffing changes,
inheriting many other roles and responsibilities over the years. In addition to his position as COO, he is
the Chief Information Officer (CIO) and manages facilities, housekeeping, dietary, marketing, and ancillary
clinical departments such as laboratories, radiology, pharmacy, and rehabilitative services at EPH.
EPH had only 3 inpatients and around 17 long-term care (LTC) residents when the evacuation began. Two of the
3 inpatients were discharged and sent home to evacuate with their families, while the remaining patient was
placed at a partner healthcare facility further out on the Colorado plains.
Early in the course of the Cameron Peak Fire in 2020, EPH set up an Incident Command under Incident Command
System (ICS) protocols to manage fire preparations, and each department director at the CAH developed or
updated their evacuation plans to prepare for the possibility of the fire approaching the hospital.
Ultimately, EPH never had to enact these plans during the Cameron Peak Fire. However, having these plans in
place immensely helped EPH when it had to evacuate for the East Troublesome Fire. EPH had reviewed each
department's shutdown procedure, so most of the departments followed the existing plans and executed their
evacuations as expected in October 2020.
The biggest surprise was the speed with which the hospital was required to evacuate. EPH only had an hour to
get their inpatients and residents transferred to transportation. Modifications to the existing plans were
made following the event. The planning process now identifies 2 scenarios: the first outlines everything
that needs to happen if EPH has reasonable time to evacuate, and the second outlines the absolute minimum
requirements for a safe evacuation procedure when circumstances require immediate action. Despite these
changes, the exercise of refreshing the departmental evacuation protocols in the summer of 2020 was very
valuable for EPH during the East Troublesome Fire response.
The EPH emergency department closed with the rest of the hospital. However, EPH emergency medical services
(EMS) stayed in Estes Park to assist the firefighters, since they were trained in ICS for emergency
management. During this time, they set up a mobile emergency department with ambulance crews and equipment
close to the fire lines.
EPH administrators decided to let the major equipment in the CAH, such as lab analyzers and magnetic
resonance imaging (MRI) and computed tomography (CT) machines, continue to run, in order to avoid a complete
shutdown. Key focus areas during the response were patients and LTC residents as well as the emergency
department and the clinical equipment — getting people out of harm's way and ensuring that vital
stayed running through the event took priority. As firefighters poured into the town, EPH staff gave the
responders a quick tour of the hospital facilities in case they needed to close things down. The entire town
began leaving at noon, and by 4:00 p.m., the CAH had been completely evacuated. Once the last administrators
left, the hospital facilities were released to the Denver Fire Department.
Denver Fire responded to the East Troublesome Fire as soon as it sparked in Spruce Canyon near Estes Park.
They responded with tanker trucks and began by spraying the trees, hospital, and surrounding buildings with
water to deter the fire from destroying the hospital buildings and infrastructure if it encroached further
on the town. The responders also knocked down multiple trees and dug out huge trenches to slow the
wildfire's spread. The firefighters kept the flames away from the hospital for 3 to 4 days — the
fire ever got was about 2 miles from the CAH. Denver Fire's firefighting tactics kept the blaze away from
the town until October 26, 2020, when the winds changed, and the first major snowstorm of the season hit the
Return and Recovery
The firefighting tactics, combined with the cooler temperatures and favorable winds, allowed the residents
of Estes Park to return to the town on October 27, 2020. The state hospital inspectors had to approve the
premises before EPH could be reopened. Though the hospital did not burn, cinder and ash littered the
hallways. Hospital staff had to clean out all the debris and replace every filter in the hospital air
conditioning and filtration units before opening again. Hall was surprised that EPH staff were able to walk
back into the CAH and start using it without any major repairs. He was concerned that he would have to
rebuild his server room, but it was untouched by the flames. EPH began opening services to the public again
on October 30, 2020.
Other issues in the town included the logistical challenges associated with where residents could pick up
their mail that had come during the evacuation and where town services would be provided until permanent
services were restored. It took weeks for the rural town of Estes Park to get caught up with these services
following the evacuation disruption. Fortunately, the fire was diverted about 2 miles to the west edge of
the town, so utilities stayed intact, including power, water, and sewer access.
During 2020, in the months prior to the wildfires, EPH staff became very familiar with remote communication
platforms due to work-from-home initiatives during the COVID-19 pandemic. Telecommuting, teleconferencing,
and telehealth options were key to maintaining communication during the wildfire evacuation and aftermath.
The leadership team as well as the physician team remained accessible through use of their personal smart
phones and email, even though individuals evacuated to various locations in and out of the state of
Colorado. The main concerns, according to Hall, were whether the hospital building was going to stay intact,
whether utilities were going to continue, and whether EPH's information technology (IT) networks and
services would continue running. If hospital IT services remained intact, said Hall, then hospital
communications could continue remotely, which is why he had decided to leave all equipment running at the
hospital before evacuating.
Once situated, Hall set up a remote workspace in Loveland, about an hour east of Estes Park, that became the
central hub of communications for the following days. Hall also instituted measures to communicate with the
residents of Estes Park in their various evacuation destinations. Using social media sites and email, he was
able to communicate the status of the hospital as well as instructions on how to speak with a physician or
primary care provider to receive care remotely. Changes were made to the EPH website to make it accessible
and informative for evacuees during the incident.
Over the past dozen years, Hall had focused on transitioning the hospital's IT applications and databases to
the cloud or external hosting as much as possible. This would help mitigate a loss of information, should
EPH's physical premises become compromised. During 2020, the vast majority of patient information was housed
in a larger hospital system on the Front Range of Colorado, away from the 2 large fires. Thus, most of the
important information Hall manages as CIO is housed externally, which contributed to EPH's relatively
painless IT recovery after the evacuation.
EPH has faced many other disasters in the years prior to the East Troublesome Fire that helped develop its
emergency response capacity. In September 2013, a large weather system caused catastrophic flooding on the
Front Range in parts of northern Colorado and, according to a U.S. Forest Service article, Our
Relationship with a Dynamic Landscape: Understanding the 2013 Northern Colorado Flood, killed 10
people across multiple counties. After the flood, a third of the town's sewer system was knocked out for
several months. Estes Park has also faced town-wide communication outages, a cyberattack on the CAH,
crippling winter storms, and the COVID-19 pandemic.
EPH has not had much administrative turnover since experiencing the wildfires in 2020. Since the CAH's
leadership has largely stayed the same, the events of the East Troublesome Fire evacuation are “embedded
in the minds and souls and the DNA” of those who experienced the incident. This positions EPH in a
good place for emergency preparedness, especially coming off the COVID-19 pandemic. Monthly emergency
planning and preparedness meetings are focused on updating processes for future emergencies but, “from
an institutional knowledge and readiness” standpoint, Hall is confident in the CAH's ability to
respond to real events.
EPH has a great relationship with the town of Estes Park, as well as with Larimer County officials, that
allowed them to maintain emergency management information sharing. During the East Troublesome Fire
response, the CAH had an emergency liaison for the town and county — a role which Hall and the
EPH EMS have since come to share as of 2022. As important were the relationships and liaisons with other
hospitals and healthcare facilities located further along the Front Range. These partnerships allowed the
CAH to safely relocate their patients and LTC residents during the evacuation. EPH also had an established
memorandum of understanding with Estes Park School District R-3, the local school district, to provide
additional transportation for their charges. This measure was doubly important for maintaining social
distancing to prevent COVID-19 while evacuating. Emergency preparedness contractors held memoranda of
understanding (MOU) with the CAH as well. For example, a fuel provider worked with Hall to arrange for the
provision of emergency power, should the hospital lose access to utilities and need to run emergency
electrical generators. Multiple partnerships with private and public sector contractors, as well as
government agencies such as the school district, contributed to the success of the CAH's emergency
evacuation and response.
As a Level IV trauma center hospital, EPH staff were used to dealing with emergencies and critical
situations when the evacuation need arose. Even those with non-patient-facing roles experience a high-stress
environment on a daily basis. According to Hall, the hospital employees' “strength and resilience and
ability to think logically through the crisis” gave the CAH an advantage during emergency response.
In 2020, EPH had a small LTC facility housed with the hospital. This presented significant challenges, as
the CAH had to designate special focus to evacuating the non-mobile residents. There were multiple elderly
individuals who could not evacuate themselves, so a “human chain” of healthcare workers was
formed to help
transfer the residents in their wheelchairs to ambulances and evacuation buses.
A few days before the evacuation order, the LTC unit documented its first cases of COVID-19 among residents,
7 months into the pandemic. COVID-19 presented its own issues, and COVID-positive residents had to be
transferred separately from the other residents. Masks during the evacuation served the dual purpose of
preventing the spread of COVID-19 and the inhalation of smoke from the air.
EPH leveraged their existing MOU with Estes Park School District R-3 to use school buses in the event of an
evacuation. The main challenge was assembling the staff needed to complete the evacuation — many
employees, including the Chief Executive Officer (CEO) of EPH, assisted in evacuating the nursing home.
During preparation for the Cameron Peak Fire, the CAH established an agreement to place their residents at a
nursing home in Greeley, a town about an hour and a half east of Estes Park, further out on the plains of
In addition to complications with evacuating the nursing home, EPH faced challenges based on the demographic
makeup of the town itself. Just over 40% of the population of Estes Park is age 65 or older, according to
the 2020 U.S. Census. While an aging
population in and of itself is not a problem, demographics must be considered by planners and responders in
an emergency situation. One such factor is that of communication — Hall used social media and email to
Estes Park residents updated on hospital operations and healthcare opportunities during the time when the
town was evacuated. Many older adults, however, were not comfortable using electronic and internet-based
communications. Therefore, EPH also supplemented digital communication with traditional outreach methods,
such as phone calls.
During the evacuation, EPH had difficulties balancing the needs of their patients with the needs of their
staff. With very little notice that the town would need to be evacuated, hospital staff wanted to go home
and pack up their houses and families for their own evacuations. Staff, said Hall, remained calm and logical
due to their previous experience working with critically ill or trauma patients in high-stress situations,
which led to good personal and organizational readiness during the event. A significant challenge was
determining when staff should leave the hospital to evacuate their families and homes. Especially for those
who lived alone or had a spouse who was also working, being able to go home, collect their belongings, and
pack their children and pets into their vehicles became a high-priority concern. As the afternoon
progressed, there were fewer and fewer hospital staff to assist in preparing the facilities and patients.
“When to leave” was left up to the individual, as Hall expressed that EPH could not expect staff
to stay at
the expense of their families, pets, or homes. He remembered being one of the last to leave the hospital
Human beings have limits, said Hall. The “existential weariness” of the nursing profession by
late 2020 was severe, due to fatigue, grief, and burnout related to the COVID-19 pandemic. This weariness is
not just limited to nursing staff but also to laboratory technicians, radiology technicians, and other
support staff in the healthcare setting. Hall, in his facilities manager role, has had difficulties
maintaining environmental and housekeeping services staff throughout the pandemic. By the time of the East
Troublesome Fire in 2020, Hall said that the healthcare organization was weary. This continued through 2021
and beyond. He noted that 2021 was supposed to be a year of recovery, yet EPH was still dealing with
COVID-19 surges and worries about fires. This anxiety carried over into 2022, especially in the drier
months, as spot fires cropped up in the middle of winter and the town's post-traumatic stress disorder
Since Estes Park experiences a large influx of tourists visiting the Rocky Mountain National Park each year,
the CAH faces different challenges in the summer compared to the winter. Estes Park is not a ski town, so
they are never as busy in the wintertime as they are in the warmer months. This causes staffing challenges
at EPH. EPH must keep a sufficient number of trained, experienced staff year-round. While this is not a
factor that affects the hospital's emergency preparedness, said Hall, it certainly affects its clinical
readiness and emergency response capacity. In order to handle the summer swing, hospital administrators must
ramp up but also be able to retain staffing throughout the year. This can sometimes lead to spending
deficits for the CAH.
One of the constant challenges for the residents of Estes Park is not knowing what nature will do. There is
a huge amount of dead timber in Colorado called beetle-kill wood, as a result of the Mountain Pine Beetle
that destroyed large parts of the forests. Hall expressed worry that the area is going to catch fire and
spread rapidly someday, just as Grand Lake did during the East Troublesome Fire. One spark is all it takes
to lead to these types of disasters, whether from lightning, careless campers, or other causes. Dry seasons
without adequate rainfall are particularly dangerous. EPH is a CAH — the nearest hospital is a
drive away. With the threat of more wildfires, the surrounding community is vulnerable in regard to
emergency healthcare. Additionally, EPH is at risk during winter storms, which may cause freezing,
blizzards, high winds, flooding, lightning, hail, and more. Emergency planners cannot predict nor control
nature; however, they must do their best to prepare for potential hazards and prevent the loss of essential
The challenges associated with an immediate evacuation were not thoroughly explored during the initial
evacuation planning process for the Cameron Peak Fire. The East Troublesome Fire, however, was fanned by
unfavorable winds and spread over 100,000 acres in just a few days. Once the fire jumped over the mountain
divide into Spruce Canyon, it was only a few miles from Estes Park. The town was ordered to evacuate at noon
that same day, leaving no time to plan. Ultimately, the evacuation worked well, but it was challenging due
to the pace of the evacuation and congestion of the roads out of town. EPH learned to consider the highly
improbable during emergency planning, because it is possible, and it is better to overprepare than be caught
The challenge of remote work for hospital positions has been a concern for EPH since the beginning of the
COVID-19 pandemic in early 2020. The fire exacerbated these concerns as hospital essential functions had to
continue during the evacuation. The CAH conducted an analysis to determine who in the organization could
perform remote work, including billing, human resources, finance, and even doctors in certain documentation
capacities. The hospital also launched a telehealth program in 2020 that allowed primary care providers and
physicians to evaluate patients for certain ailments that do not require an in-person assessment. Between
the COVID-19 pandemic, the wildfire, and “the evolution of the world,” EPH has learned important
lessons in how to properly set up safe and secure remote access environments to provide patient care.
One challenge for the EPH administration in the aftermath of the emergency evacuation was deciding what to
pay their employees. Staff were not working while they were evacuated, and the hospital was considering
whether they would need to use paid time off (PTO) or vacation time. Ultimately, the CAH decided to pay
their staff for the evacuation time and were able to get insurance reimbursement eventually as well.
For rural communities and CAHs responding to similar emergencies, Hall provided the following advice:
Evacuation is only one aspect of an emergency response. The majority of events EPH has experienced, said
Hall, have required shelter-in-place but not evacuation. Planners must make sure that the emergency
generators are tested regularly and can handle the full load they are required to hold; ensure that potable
water is available, stored in a place where it will remain fresh, and in sufficient quantities to give to
patients for drinking and bathing; and have a backup plan in the event that the building loses air
conditioning in the summer or heating in the winter. These and other concerns are important because most
crises result in maintaining operation in place.
Planning for emergency response should be a regular, ongoing event that involves a committee made up of the
appropriate people within the healthcare organization. Emergency response planning is required of the CAH by
Medicare, said Hall — however, the regularity of planning is what keeps people and organizations as
possible. Partnerships should be established in advance with suppliers and government agencies; it is
important to have these relationships in place before an emergency event. Regular planning and drills may
reveal discrepancies, noted Hall, such as the need to update evacuation plans, train staff members in the
ICS processes, or set up a room to become an emergency command center. If the planning committee meets
regularly, then they have a higher chance of understanding and addressing what needs to be done to
Hall emphasized to keep emergency planning “percolating all the time.” Organizations should
complete drills once or twice a year. If there is not a real crisis happening, tabletop exercises give
responders the opportunity to talk through a situation and exercise emergency response logic in a
non-threatening scenario. Hall likened preparedness to an actor onstage, saying, “You can rehearse
those lines and know them well, but when you step on a stage in front of a live audience, that's when you
find out how well you really know your lines.” Events may occur where you do not know what to do next.
The reality of an emergency event, he said, will always add new stress and surprising variables on top of
the situation. That is why continuous planning and emergency preparedness exercises are vital and why
individuals and organizations must strive to learn how to remain rational and logical, no matter what
circumstance may arise.
Gary Hall, Chief Operating Officer (COO), Chief Information Officer (CIO)
Estes Park Health, Park Hospital District
Opinions expressed are those of the interviewee(s) and do not necessarily reflect the views of the Rural
Health Information Hub.