Science
Can you survive a wildfire sheltering at home? For one community, L.A. County Fire says it may be the only option
Dozens of Topanga residents gathered in the town’s Community House to hear Assistant Fire Chief Drew Smith discuss how the Los Angeles County Fire Department plans to keep Topangans alive in a fierce firestorm.
In the red-brick atrium, adorned with exposed wood and a gothic chandelier, Smith explained that if a fire explodes next to the town and flames will reach homes within minutes, orchestrating a multi-hour evacuation through winding mountain roads for Topanga’s more than 8,000 residents will just not be a viable option. In such cases, Smith told attendees at the town’s Oct. 4 ReadyFest wildfire preparedness event, the department now plans to order residents to shelter in their homes.
“Your structure may catch on fire,” Smith said. “You’re going to have religious moments, I guarantee it. But that’s your safest option.”
Wildfire emergency response leaders and experts have described such an approach as concerning and point to Australia as an example: After the nation adopted a similar policy, a series of brush fires in 2009 now known as Black Saturday killed 173 people, many sheltering in their homes.
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Some in the bohemian community of nature lovers, creatives and free spirits — who often pride themselves on their rugged, risky lifestyle navigating floods, mudslides, wildfires and the road closures and power outages they entail — are left with the sinking realization that the wildfire risk in Topanga may be too big to bear.
Water tanks called “pumpkins” are available to helicopters to be used during a fire at 69 Bravo, an LAFD Command Center along Saddle Peak Road in Topanga.
They see the shelter-in-place plan as a perilous wager, with no comprehensive plan to help residents harden their homes against fire and no clear, fire-tested guidance on what residents should do if they’re stuck in a burning home.
“Do we need to have some way of communicating with first responders while we are sheltering in place? Would the fire front be approaching us and we’re just on our own?” asked Connie Najah, a Topanga resident who attended ReadyFest and was unsettled by the proposal. “What are the plans for helping people through this season and the next season while we’re waiting to have widespread defensible space implementation?”
No fire chief wants to face the scenario of a vulnerable town with no time to evacuate. But it is a real possibility for Topanga. Smith, speaking to The Times, stressed that the new guidelines only apply to situations where the Fire Department has deemed evacuations infeasible.
“If we have time to evacuate, we will evacuate you,” Smith said.
Emergency operations experts say not enough has been done in their field to address the very grim possibility that evacuating may not always be possible — in part because it’s a hard reality to confront. It’s not a small problem, either: Cal Fire has identified more than 2,400 developments around the state with at least 30 residences that have significant fire risk and only a single evacuation route. Topanga is home to nine of them.
“We’re pretty isolated. We’re densely populated. Fuel and homes are intermixed. It’s an extremely dangerous area.”
— James Grasso, president of the Topanga Coalition for Emergency Preparedness
Recent fires, including the 2018 Camp fire in Paradise and Woolsey fire in Malibu, have made the issue too hard to ignore.
In Topanga, Najah has a ham radio license so she can stay informed when power and cell service inevitably go down. The elementary school relocates out of town during red-flag days. A task force including the Topanga Coalition for Emergency Preparedness, the Fire Department and other emergency operations agencies publishes a Disaster Survival Guide and distributes it to every household.
“The survival guide was born out of necessity,” said James Grasso, president of TCEP, who also serves as a call firefighter for the county Fire Department. “We’re pretty isolated. We’re densely populated. Fuel and homes are intermixed. It’s an extremely dangerous area, particularly during Santa Ana wind conditions.”
The guide had instructed residents to flock to predetermined “public safe refuges” in town, such as the baseball field at the Community House or the large parking lot at the state park, to wait out fires. If residents couldn’t make it to these, there were predetermined “public temporary refuge areas” within each neighborhood, such as street intersections and homes with large cleared backyards, that provide some increased chance of survival.
But when the Fire Department determined the spaces were not capable of protecting the town’s entire population from the extreme radiant heat, it pivoted to sheltering in place — the last and most dangerous option listed in the old guide.
Connie Najah, a 16-year resident of Topanga, points out photographs from the Topanga Disaster Survival Guide of places that were once considered “public safe refuges” to be used during a fire.
The survival guide’s old plan was consistent with what emergency response experts and officials have argued across the globe, but it failed to meet typical safety standards for such an approach.
In a March report from the National Institute of Standards and Technology, researchers who spent years investigating the response to the Camp fire recommended a network of safety zones and temporary fire refuge areas as a strategy to keep residents alive.
The report argued that, due to tightly packed combustible structures amid an accumulation of flammable vegetation, “nearly all” communities are “unsuitable” for sheltering in place.
David Shew, a trained architect and firefighter who spent more than 30 years at Cal Fire, said that for a shelter-in-place policy to be viable, a community would need to undertake significant work to harden their homes and create defensible space — work that has not been done in most California communities.
It’s “not really safe for people to just think, ‘OK, I’ve done nothing but they told me to just jump in my house,’” he said.
And once a house ignites, suggestions that Smith offered up at ReadyFest like sheltering in a bathroom are of little use, said Mark Ghilarducci, a former director of the California Governor’s Office of Emergency Services.
“Under certain circumstances, your home could potentially provide a buffer,” he said. But if a house is burning and surrounded by fire in the wildlands, “you’re in a position where you are essentially trapped, and your bathroom’s not going to save you.”
Smith said, however, that the Fire Department had done its own analysis of the Topanga area and determined that the fire dynamics in the area are too extreme for Topanga’s proposed public shelter spaces to be effective.
“There is no way that we can 100% eliminate the fire risk and death potential if you live in a fire-prone area.”
— Drew Smith, assistant fire chief at the Los Angeles County Fire Department
During hot, aggressive fires like the Woolsey, Franklin and Palisades fires, Smith said, “for 30 to 100 people, you need a minimum of clear land that’s 14 acres, which is 14 football fields.” Many of the safety areas in the survival guide, such as an L.A. County Public Works water tank facility, are barely larger than 1 acre.
The department argues sheltering in place, although far from guaranteeing survival, eliminates the risk of residents getting trapped on roadways, unable to see, with almost no protection.
“There is no way that we can 100% eliminate the fire risk and death potential if you live in a fire-prone area,” Smith said.
1. Topanga resident James Grasso, president of Topanga Coalition for Emergency Preparedness, walks toward a baseball field that was once declared a public safe refuge to escape to during a fire at the Topanga Community Center. 2. Connie Najah stands on a portion of Peak Trail that was at one time considered a public temporary refuge area during fires in Topanga.
Regardless of what residents (or emergency response experts) think of the department’s approach, the safest thing residents can do, experts say, is to always, always, always follow the department’s orders, whether that’s to evacuate, find a safety zone or shelter in their homes. The department’s plan to keep residents alive depends on it.
Still, the history of shelter-in-place policies — and their more aggressive companion, “stay and defend,” which involves attempting to actively combat the blaze at home — looms heavy.
After more than 100 bush fires swept through southeast Australia in 1983, killing 75 people in what became known as Ash Wednesday, Australian fire officials adopted a “stay or go” policy: Either leave well before a fire reaches you, or prepare to stay and fend for yourself. If you’re living in a high fire hazard area, the philosophy goes, it is your responsibility to defend your property and keep yourself alive amid strained fire resources.
Around the same time, California considered the policy for itself after dangerous fires ripped through the Santa Monica Mountains, Ghilarducci said. State officials ultimately decided against it, choosing instead to prioritize early evacuations. Cal Fire’s “Ready, Set, Go!” public awareness campaign became the face of those efforts.
In 2009, an explosive suite of brush fires broke out, yet again, in southeast Australia and seemed to confirm California’s worst nightmare: 173 people lost their lives in the Black Saturday tragedy. Of those, 40% died during or after an attempt to defend their property, and nearly 30% died sheltering in their homes without attempting to defend them. About 20% died while attempting to evacuate.
Afterward, Australia significantly overhauled the policy, placing a much greater emphasis on evacuating early and developing fire shelter building standards.
Nearly a decade later, California confronted its own stress test. The Camp fire ripped through Paradise in the early morning on Nov. 8, 2018. The time between the first sighting of the fire and it reaching the edge of town: one hourand 39 minutes. The time it took to evacuate: seven hours.
Among the miraculous stories of survival in Paradise were the many individuals who found refuge areas in town: a predetermined safety zone in a large, open meadow; the parking lots of stores, churches and schools; a local fire station; roadways and intersections with a little buffer from the burning trees.
But the same day, the intensity of the Woolsey fire in the Santa Monica Mountains — similarly plagued with evacuation challenges — unsettled fire officials. It’s in these conditions that Smith doubted Topanga’s refuge sites could protect residents.
Stuck without many options, the Fire Department began slowly thinking about refining the policies that proved disastrous for Australia. The Palisades fire brought a renewed urgency.
Just a month before ReadyFest, L.A. County Fire Chief Anthony Marrone stirred anxiety among emergency response officials when he appeared to endorse a stay-and-defend policy, telling KCAL-TV, “We’ve always told people that when the evacuation order comes, you must leave. We’ve departed from that narrative. With the proper training, with the proper equipment and with the proper home hardening and defensible space, you can stay behind and prevent your house from burning down.”
The department later clarified the statement, saying the change only applies to individuals in the Santa Monica Mountains’ community brigade who have received significant training from the department and operate under the department’s command. (The brigade is not intended as a means for members to protect their own homes but instead serve the larger community.)
Now, residents worry the policy to shelter in place is coming without enough preparation.
A worker stops traffic that has been reduced to one lane on a portion of Topanga Canyon Boulevard for underground cable installation Nov. 19.
A Times analysis of L.A. County property records found that roughly 98% of residential properties in Topanga were built before the state adopted home-hardening building codes in 2008 to protect homes against wildfires.
However, a significant number of Topangans have opted to complete the requirements regardless. Various fire safety organizations in the Santa Monica Mountains have visited more than 470 of Topanga’s roughly 3,000 residential properties to help residents learn how to harden their homes. These efforts are, in part, why the National Fire Protection Assn. designated the mountain town as a Firewise Community in 2022.
There are some relatively simple steps homeowners can take, such as covering vents with mesh, that can slightly reduce the chance of a home burning. But undertaking a comprehensive renovation — to remove wood decks, install noncombustible siding and roofing, replace windows with multipaned tempered glass, hardscape the land near the house and trim down trees — is expensive.
A report from the community development research nonprofit Headwaters Economics found a complete home retrofit using affordable materials costs between $23,000 and $40,000. With high-end materials that provide the best protection, it can cost upward of $100,000.
“We’re not the only rural community. All over the state, people are having to deal with this.”
— Connie Najah, 16-year resident of Topanga
Many Topangans have taken up the challenge, anyway. Grasso, who lost his home in the 1993 Old Topanga fire, has slowly been hardening his property since the rebuild. He’s even built a concrete fire shelter against a hillside with two steel escape doors and porthole windows.
Researchers have found comprehensive home hardening and defensible space can reduce the risk of a home burning by about a third, but not bring it down to zero. (Albeit, none have tested Grasso’s elaborate setup.)
1. Nancy Helms stands on top of “dwarf carpet of stars,” a succulent plant that surrounds a large area of her home as a fire prevention method on Rocky Ledge Road in Topanga. 2. Ryan Ulyate uses metal sculptures of plants and cactus outside his home in Topanga. He has eliminated any brush or flammable plants near his home and surrounds it in gravel to prevent his home from catching fire. 3. Ryan Ulyate shows a vent opening that he covered with metal filters to prevent embers from entering his home if a fire occurs in Topanga.
Wildfire safety experts hope the state someday adopts building standards for truly fire-proof structures that could withstand even the most extreme conditions and come equipped with life-support systems. But any such standards are years away, and the L.A. County Fire Department has to have a plan if a fire breaks out tomorrow.
For Grasso, fire risk is a risk like any other, like the choice to drive a car every day. In exchange for the beauty of living life in Topanga, some folks will learn to accept the risk and do what they can to mitigate it: Harden a home, fasten a seat belt. Others — especially those unable to take the drastic steps Grasso has been able to — will deem the beauty of life in Topanga not worth the risk of getting trapped by flames.
“The amount of money it takes to get to this point is too cost-prohibitive for us at this moment,” Najah said. “It’s really a tough place to be in. … It’s not going to be easy, and we’re not the only rural community. All over the state, people are having to deal with this.”
Times assistant data and graphics editor Sean Greene contributed to this report.
Science
Trump administration declares ‘war on sugar’ in overhaul of food guidelines
The Trump administration announced a major overhaul of American nutrition guidelines Wednesday, replacing the old, carbohydrate-heavy food pyramid with one that prioritizes protein, healthy fats and whole grains.
“Our government declares war on added sugar,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a White House press conference announcing the changes. “We are ending the war on saturated fats.”
“If a foreign adversary sought to destroy the health of our children, to cripple our economy, to weaken our national security, there would be no better strategy than to addict us to ultra-processed foods,” Kennedy said.
Improving U.S. eating habits and the availability of nutritious foods is an issue with broad bipartisan support, and has been a long-standing goal of Kennedy’s Make America Healthy Again movement.
During the press conference, he acknowledged both the American Medical Association and the American Assn. of Pediatrics for partnering on the new guidelines — two organizations that earlier this week condemned the administration’s decision to slash the number of diseases that U.S. children are vaccinated against.
“The American Medical Association applauds the administration’s new Dietary Guidelines for spotlighting the highly processed foods, sugar-sweetened beverages, and excess sodium that fuel heart disease, diabetes, obesity, and other chronic illnesses,” AMA president Bobby Mukkamala said in a statement.
Science
Contributor: With high deductibles, even the insured are functionally uninsured
I recently saw a patient complaining of shortness of breath and a persistent cough. Worried he was developing pneumonia, I ordered a chest X-ray — a standard diagnostic tool. He refused. He hadn’t met his $3,000 deductible yet, and so his insurance would have required him to pay much or all of the cost for that scan. He assured me he would call if he got worse.
For him, the X-ray wasn’t a medical necessity, but it would have been a financial shock he couldn’t absorb. He chose to gamble on a cough, and five days later, he lost — ending up in the ICU with bilateral pneumonia. He survived, but the cost of his “savings” was a nearly fatal hospital stay and a bill that will quite likely bankrupt him. He is lucky he won’t be one of the 55,000 Americans to die from pneumonia each year.
As a physician associate in primary care, I serve as a frontline witness to this failure of the American approach to insurance. Medical professionals are taught that the barrier to health is biology: bacteria, viruses, genetics. But increasingly, the barrier is a policy framework that pressures insured Americans to gamble with their lives. High-deductible health plans seem affordable because their monthly premiums are lower than other plans’, but they create perverse incentives by discouraging patients from seeking and accepting diagnostics and treatments — sometimes turning minor, treatable issues into expensive, life-threatening emergencies. My patient’s gamble with his lungs is a microcosm of the much larger gamble we are taking with the American public.
The economic theory underpinning these high deductibles is known as “skin in the game.” The idea is that if patients are responsible for the first few thousand dollars of their care, they will become savvy consumers, shopping around for the best value and driving down healthcare costs.
But this logic collapses in the exam room. Healthcare is not a consumer good like a television or a used car. My patient was not in a position to “shop around” for a cheaper X-ray, nor was he qualified to determine if his cough was benign or deadly. The “skin in the game” theory assumes a level of medical literacy and market transparency that simply doesn’t exist in a moment of crisis. You can compare the specs of two SUVs; you cannot “shop around” for a life-saving diagnostic while gasping for air.
A 2025 poll from the Kaiser Family Foundation points to this reality, finding that up to 38% of insured American adults say they skipped or postponed necessary healthcare or medications in the past 12 months because of cost. In the same poll, 42% of those who skipped care admitted their health problem worsened as a result.
This self-inflicted public health crisis is set to deteriorate further. The Congressional Budget Office estimates roughly 15 million people will lose health coverage and become uninsured by 2034 because of Medicaid and Affordable Care Act marketplace cuts. That is without mentioning the millions more who will see their monthly premiums more than double if premium tax credits are allowed to expire. If that happens, not only will millions become uninsured but also millions more will downgrade to “bronze” plans with huge deductibles just to keep their premiums affordable. We are about to flood the system with “insured but functionally uninsured” patients.
I see the human cost of this “functional uninsurance” every week. These are patients who technically have coverage but are terrified to use it because their deductibles are so large they may exceed the individuals’ available cash or credit — or even their net worth. This creates a dangerous paradox: Americans are paying hundreds of dollars a month for a card in their wallet they cannot afford to use. They skip the annual physical, ignore the suspicious mole and ration their insulin — all while technically insured. By the time they arrive at my clinic, their disease has often progressed to a catastrophic event, from what could have been a cheap fix.
Federal spending on healthcare should not be considered charity; it is an investment in our collective future. We cannot expect our children to reach their full potential or our workforce to remain productive if basic healthcare needs are treated as a luxury. Inaction by Congress and the current administration to solve this crisis is legislative malpractice.
In medicine, we are trained to treat the underlying disease, not just the symptoms. The skipped visits and ignored prescriptions are merely symptoms; the disease is a policy framework that views healthcare as a commodity rather than a fundamental necessity. If we allow these cuts to proceed, we are ensuring that the American workforce becomes sicker, our hospitals more overwhelmed and our economy less resilient. We are walking willingly into a public health crisis that is entirely preventable.
Joseph Pollino is a primary care physician associate in Nevada.
Insights
L.A. Times Insights delivers AI-generated analysis on Voices content to offer all points of view. Insights does not appear on any news articles.
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Perspectives
The following AI-generated content is powered by Perplexity. The Los Angeles Times editorial staff does not create or edit the content.
Ideas expressed in the piece
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High-deductible health plans create a barrier to necessary medical care, with patients avoiding diagnostics and treatments due to out-of-pocket cost concerns[1]. Research shows that 38% of insured American adults skipped or postponed necessary healthcare or medications in the past 12 months because of cost, with 42% reporting their health worsened as a result[1].
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The economic theory of “skin in the game”—which assumes patients will shop around for better healthcare values if they have financial responsibility—fails in medical practice because patients lack the medical literacy to make informed decisions in moments of crisis and cannot realistically compare pricing for emergency or diagnostic services[1].
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Rising deductibles are pushing enrollees toward bronze plans with deductibles averaging $7,476 in 2026, up from the average silver plan deductible of $5,304[1][4]. In California’s Covered California program, bronze plan enrollment has surged to more than one-third of new enrollees in 2026, compared to typically one in five[1].
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Expiring federal premium tax credits will more than double out-of-pocket premiums for ACA marketplace enrollees in 2026, creating an expected 75% increase in average out-of-pocket premium payments[5]. This will force millions to either drop coverage or downgrade to bronze plans with massive deductibles, creating a population of “insured but functionally uninsured” people[1].
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High-deductible plans pose particular dangers for patients with chronic conditions, with studies showing adults with diabetes involuntarily switched to high-deductible plans face 11% higher risk of hospitalization for heart attacks, 15% higher risk for strokes, and more than double the likelihood of blindness or end-stage kidney disease[4].
Different views on the topic
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Expanding access to health savings accounts paired with bronze and catastrophic plans offers tax advantages that allow higher-income individuals to set aside tax-deductible contributions for qualified medical expenses, potentially offsetting higher out-of-pocket costs through strategic planning[3].
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Employers and insurers emphasize that offering multiple plan options with varying deductibles and premiums enables employees to select plans matching their individual needs and healthcare usage patterns, allowing those who rarely use healthcare to save money through lower premiums[2]. Large employers increasingly offer three or more medical plan choices, with the expectation that employees choosing the right plan can unlock savings[2].
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The expansion of catastrophic plans with streamlined enrollment processes and automatic display on HealthCare.gov is intended to make affordable coverage more accessible for certain income groups, particularly those above 400% of federal poverty level who lose subsidies[3].
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Rising healthcare costs, including specialty drugs and new high-cost cell and gene therapies, are significant drivers requiring premium increases regardless of plan design[5]. Some insurers are managing affordability by discontinuing costly coverage—such as GLP-1 weight-loss medications—to reduce premium rate increases for broader plan members[5].
Science
Trump administration slashes number of diseases U.S. children will be regularly vaccinated against
The U.S. Department of Health and Human Services announced sweeping changes to the pediatric vaccine schedule on Monday, sharply cutting the number of diseases U.S. children will be regularly immunized against.
Under the new guidelines, the U.S. still recommends that all children be vaccinated against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella, better known as chickenpox.
Vaccines for all other diseases will now fall into one of two categories: recommended only for specific high-risk groups, or available through “shared clinical decision-making” — the administration’s preferred term for “optional.”
These include immunizations for hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), bacterial meningitis, influenza and COVID-19. All these shots were previously recommended for all children.
Insurance companies will still be required to fully cover all childhood vaccines on the CDC schedule, including those now designated as optional, according to the Department of Health and Human Services.
Health Secretary Robert F. Kennedy Jr., a longtime vaccine critic, said in a statement that the new schedule “protects children, respects families, and rebuilds trust in public health.”
But pediatricians and public health officials widely condemned the shift, saying that it would lead to more uncertainty for patients and a resurgence of diseases that had been under control.
“The decision to weaken the childhood immunization schedule is misguided and dangerous,” said Dr. René Bravo, a pediatrician and president of the California Medical Assn. “Today’s decision undermines decades of evidence-based public health policy and sends a deeply confusing message to families at a time when vaccine confidence is already under strain.”
The American Academy of Pediatrics condemned the changes as “dangerous and unnecessary,” and said that it will continue to publish its own schedule of recommended immunizations. In September, California, Oregon, Washington and Hawaii announced that those four states would follow an independent immunization schedule based on recommendations from the AAP and other medical groups.
The federal changes have been anticipated since December, when President Trump signed a presidential memorandum directing the health department to update the pediatric vaccine schedule “to align with such scientific evidence and best practices from peer, developed countries.”
The new U.S. vaccination guidelines are much closer to those of Denmark, which routinely vaccinates its children against only 10 diseases.
As doctors and public health experts have pointed out, Denmark also has a robust system of government-funded universal healthcare, a smaller and more homogenous population, and a different disease burden.
“The vaccines that are recommended in any particular country reflect the diseases that are prevalent in that country,” said Dr. Kelly Gebo, dean of the Milken Institute School of Public Health at George Washington University. “Just because one country has a vaccine schedule that is perfectly reasonable for that country, it may not be at all reasonable” elsewhere.
Almost every pregnant woman in Denmark is screened for hepatitis B, for example. In the U.S., less than 85% of pregnant women are screened for the disease.
Instead, the U.S. has relied on universal vaccination to protect children whose mothers don’t receive adequate care during pregnancy. Hepatitis B has been nearly eliminated in the U.S. since the vaccine was introduced in 1991. Last month, a panel of Kennedy appointees voted to drop the CDC’s decades-old recommendation that all newborns be vaccinated against the disease at birth.
“Viruses and bacteria that were under control are being set free on our most vulnerable,” said Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health. “It may take one or two years for the tragic consequences to become clear, but this is like asking farmers in North Dakota to grow pineapples. It won’t work and can’t end well.”
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