Evacuees were camped in the aisles and parking lot of the facility, as doctors and nurses on an upper floor aided evacuated nursing home residents.

Suzanne Casey left her Rancho Bernardo home and ended up at a hotel in Pacific Beach Monday. Like thousands of others, the 62-year-old at first made her way to the giant relief center at Qualcomm Stadium. But after moving on to the hotel and visiting a restaurant next door Monday evening, she took a tumble on some steps as she was leaving. The head trauma was fatal.

Casey was one of four older San Diego County residents to die after being uprooted as part of the massive fire evacuation effort involving more than 350,000 households across six Southern California counties. Two died while being moved to safer medical facilities, the others in or near hotels where they sought shelter, said Rick Poggemeyer, operations administrator for the medical examiner's office.

The deaths brought a grim human focus to the disruption caused by the evacuations, which are being called the largest in California history. No one knows how many people heeded the orders or where they might have gone. The people arriving at public shelters represented only a fraction of those ordered to leave their homes.

But hotels across San Diego County were full, and about 2,000 people were housed at the Del Mar racetrack, north of San Diego.

To the north, another large evacuation center at the National Orange Show grounds in San Bernardino swelled to 1,500 evacuees Tuesday, up from 900 Monday night.

The elderly were posing special challenges.

At least 11 nursing homes had to be evacuated as a result of the wildfires in San Diego County, officials said. Residents have been allowed to return to three of the facilities; but this evening, 578 nursing home residents were still displaced.

The priority for health officials has been identifying nursing home patients and ensuring they are "placed at the correct level of care, and that we respond very, very quickly," said Kathleen Billingsley, deputy director for the Center for Healthcare Quality at the California Department of Public Health.

"There are a significant number of people, of patients, of elderly that have been impacted...Basically these people have been displaced."

Another eight to 10 nursing homes may have to be evacuated if the fires head toward Fallbrook in San Diego County, officials said.

At about 2 a.m. Tuesday morning, 75-year-old Don Jenkinson found himself scrambling to leave his retirement home. He was told to grab three things: medication, identification and a change of clothes. Soon he and 120 other residents of the Mount Miguel Covenant Village Retirement Community in Spring Valley east of San Diego were lining up to board buses.

"We could see the flames," he recalled. "It was scary."

The facility was in the path of the Harris fire burning along the Mexican border. The buses moved residents to a high school gym in downtown San Diego.

Dr. Cesar Aristeiguieta, head of the state's Emergency Medical Services Agency, said he found 216 nursing home patients at Del Mar on Monday night. Many "had a fairly significant degree of medical need." He worked through the night with special ambulance strike teams to place most of patients in suitable nursing facilities, some out of San Diego County.

"The idea was to get them to a higher level of medical care than could be provided there at Del Mar," he said. Only about 40 remained at Del Mar this afternoon.

The scale of the relocations was most visible at Qualcomm, the 60,000-seat home of the San Diego Chargers. Cots lined concrete gangways. Tents were pitched near tunnel entrances, and the three-quarter-full parking lot ringing the arena was doubling as a campground. Mountains of disposable diapers, stacks of bottled water and other supplies were everywhere.

In three areas of the stadium's second floor, medical teams were treating 350 to 500 patients from nursing homes, assisted living centers and independent living facilities, said Dr. Mark Horton, director of the California Department of Public Health.

Indeed, the crowd in and around the stadium appeared to be represent a broad cross-section of San Diego County: Longhaired motorcycle riders and retired couples from Rancho Bernardo; working-class families and others clearly middle-class.

Authorities insisted all was going well and that they had adequate resources, even as San Diego Mayor Jerry Sanders sent out a plea early Tuesday for volunteer doctors and nurses to help evacuees, many of them elderly.

Edward and Cindy Sherlock spent the last two nights sleeping next to his brother-in-law's Mercedes on a Salvation Army-provided futon. The bed, with a gold-colored comforter, sits on the sidewalk outside the stadium. Cindy has been volunteering at the stadium.

"There's a lot of people hurting here," said Edward Sherlock, 54, a retiree. He and his wife fled their Ramona home Sunday with their three dogs.

"But there's a lot more helping. I can tell you there's no color barrier to pain. This is a life-changing event. You see and hear different languages and colors here, and none of this means anything because we're all hurting or helping." Sherlock said

A couple of rows of cars down, an elderly woman sat in a lawn chair in the shade of an SUV. She had her eyes closed, reciting the rosary.

More help was available or on the way, officials said. Asked about the mayor's appeal for medical help, U.S. Secretary of Homeland Security Michael Chertoff told a morning news conference that medical assistance teams were "ready to go if requested. They haven't been requested yet."

About 272 people, mostly from Fallbrook or Foothill Ranch, spent the night at El Toro High School's gym in Lake Forest on hundreds of blue, green and red cots set up by the American Red Cross. Tuesday, some were napping; others crowded around a TV, watching news coverage of the fires.

Most said they didn't have friends or family in the area. Several made themselves at home, walking about barefoot or in socks.

Many evacuees apparently paid for their emergency shelter. In San Clemente, the Days Inn was full by early afternoon Monday. Rooms range from $98 to $109 per night.

Desk clerk Lois Kraus said Tuesday she had turned away 20 walk-ins, including a man who cried when she told him they had no rooms. Some would-be guests were waiting in the parking lot to see if anyone left. "We are not taking any phone reservations, let me put it that way," she said.

Tables at the beach city's waterfront cafes were filled, and evacuees with dogs, cars and trailers stuffed with household possessions could be seen on every block.

"They have been coming in since yesterday," said Cindy Campbell, manager at the posh San Clemente Cove Resort condominiums , a time-share complex overlooking the ocean. Evacuees were paying $200 per night -- $25 less than normal -- and were allowed to bring their pets, she said.

Dave Henderson, 43, spent the night with his wife and 13-month-old daughter after leaving the Del Mar area to escape the smoke-filled air. The family got the condo for only one night and was heading farther north, where another hotel room waited in Laguna.

"It could be a lot worse," he admitted, as waves crashed at the pier nearby and people passed by with surfboards.