In October 2003, many Southern Californian communities were ravaged by the worst firestorm in the state’s history. According to the California Department of Forestry and Fire Protection, San Diego suffered the most devastation of any community when the Cedar Fire destroyed more than 2,200 homes and burned approximately 80,000 acres of land. The tragedy caused 14 deaths, including one firefighter. During the fires, the San Diego Medical Services Enterprise (SDMSE) used FirstWatch to monitor incoming 9-1-1 calls related to breathing problems. FirstWatch was able to help track and respond to fire-related respiratory problems by alerting the appropriate emergency personnel to clusters of symptoms. As a result, the City of San Diego issued an alert to residents to stay indoors because of the hazardous air quality.