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Driven by strong winds and dry conditions, the blaze dubbed the Camp Fire swept through the town of Paradise, burning part of the local hospital and possibly destroying over a thousand homes and other structures, county and city officials said.
"We have received reports of some fatalities. Those reports have not yet been verified," Butte County Sheriff Kory Honea told a news conference.
Butte County Fire Chief Darren Read said there were multiple injuries among civilians and firefighters. The town of Chico, population 93,000, was potentially threatened as 56kmh winds drove the blaze westward, he added.
A Paradise resident who escaped on his motorbike, told local TV channel Action News Now: "We had to ride through flames to get here."
With limited escape routes from the town, traffic accidents turned roads into gridlock, with residents abandoning vehicles and running from the flames carrying children and pets, officials said. One woman stuck in traffic went into labor, the Enterprise-Record newspaper reported.
"It’s very chaotic. It’s a very bad fire,” Officer Ryan Lambert of the California Highway Patrol said of the evacuation.
The blaze began early on Thursday and quickly charred 18,000 acres (3,237 hectares), forcing the evacuation of the 27,000 residents of Paradise, about 150 miles (240 km) northeast of San Francisco, the California Department of Forestry and Fire Protection (Cal Fire) said in a statement.
Butte County supervisor Doug Teeter said authorities used a bulldozer to push abandoned cars out the way to reach Feather River Hospital and evacuate patients as flames engulfed its old wing and the roof of the emergency department.
The Camp Fire was the fiercest of several wind-driven blazes that erupted across the state on Thursday.
California is experiencing one of its worst fire years ever, with 621,743 acres (251,610 hectares) burned through Sunday in areas covered by Cal Fire, nearly twice the amount during the same period of 2017 and nearly triple the five-year average.