title: Impact of the San Diego county firestorm on emergency medical services.
abstract: BACKGROUND
  In October 2003, San Diego County, California, USA, experienced the worst firestorm in recent history. During the firestorm, public health leaders implemented multiple initiatives to reduce its impact on community health using health updates and news briefings. This study assessed the impact of patients with fire-related complaints on the emergency medical services (EMS) system during and after the firestorm.
  
  
  METHODS
  A retrospective review of a prehospital database was performed for all patients who were evaluated by advanced life support (ALS) ambulance personnel after calling the 9-1-1 emergency phone system for direct, fire-related complaints from 19 October 2003 through 30 November 2003 in San Diego County. The study location has an urban, suburban, rural, and remote resident population of approximately three million and covers 4,300 square miles (2,050 km2). The prehospital patient database was searched for all patients with a complaint that was related directly to the fires. Charts were abstracted for data, including demographics, medical issues, treatments, and disposition status.
  
  
  RESULTS
  During the firestorm, fire consumed > 380,000 acres (> 938,980 hectares), including 2,454 residences and 785 outbuildings, and resulted in a total of 16 fatalities. Advanced life support providers evaluated 138 patients for fire-related complaints. The majority of calls were for acute respiratory complaints. Other complaints included burns, trauma associated with evacuation or firefighting, eye injuries, and dehydration. A total of 78% of the injuries were mild. Twenty percent of the victims were firefighters, most with respiratory complaints, eye injuries, or injuries related to trauma. A total of 76% of the patients were transported to the hospital, while 10% signed out against medical advice.
  
  
  CONCLUSIONS
  Although the firestorm had the potential to significantly impact EMS, pre-emptive actions resulted in minimal impact to emergency departments and the prehospital system. However, during the event, there were a number of lessons learned that can be used in future events.
authors.affiliation: University of California, San Diego Medical Center, Department of Emergency Medicine, San Diego, California 92103, USA. gmvilke@ucsd.edu
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.forename: Alan M
authors.initials: AM
authors.lastname: Smith
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Stepanski
authors.forename: Leslie Upledger
authors.initials: LU
authors.lastname: Ray
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Murrin
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
mesh_terms: D002140:California; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005390:Fires; D006801:Humans; D008485:Medical Audit; D019982:Organizational Case Studies; D012189:Retrospective Studies