In the first 90 days after the Palisades and Eaton fires erupted in January, the caseload at Cedars-Sinai Medical Center’s emergency room looked different from the norm.

There were 46% more visits for heart attacks than typically occured during the same time period over the previous seven years. Visits for respiratory illnesses increased 24%. And unusual blood test results increased 118%.

These findings were reported in a new study published Wednesday in the Journal of the American College of Cardiology. The study, part of a research project documenting the fires’ long-term health effects, joins several recent papers documenting the disasters’ physical toll.

While other U.S. wildfires have consumed more acres or cost more lives, the Palisades and Eaton fires were uniquely dangerous to human health because they burned an unusual mix of materials: the trees, brush and organic material of a typical wildfire, along with a toxic stew of cars, batteries, plastics, electronics and other man-made materials.

There’s no precedent for a situation that exposed this many people to this kind of smoke, the paper’s authors said.

“Los Angeles has seen wildfires before, it will see wildfires again, but the Eaton fire and the Palisades fire were unique, both in their size, their scale and the sheer volume of material that burned,” said Dr. Joseph Ebinger, a Cedars-Sinai cardiologist and the paper’s first author.

The team did not find a significant increase in the overall number of visits to the medical center’s emergency room between Jan. 7, the day the fires began, and April 7. The department recorded fewer in-person visits for mental health emergencies and chronic conditions during that time compared to the same time period in earlier years, said Dr. Susan Cheng, director of public health research at Cedars-Sinai and the study’s senior author.

The increase in visits for acute cardiovascular problems and other serious sudden illnesses made up the difference.

The study team also looked at results from blood tests drawn from patients visiting the ER for serious physical symptoms without immediate explanation — dizziness without dehydration, for example, or chest pains not caused by heart attacks.

Their blood tests returned unusual results at a rate more than double that seen in previous years. These atypical numbers cut across the spectrum of the blood panel, Cheng said. “It could be electrolyte disorder, change in protein levels, change in markers of kidney or liver function.”

The rate of unusual test results held steady through the three-month period, leading the team to conclude that exposure to the fires’ smoke “has led to some kind of biochemical metabolic stress in the body that likely affected not just one but many organ systems,” Cheng said. “That’s what led to a range of different types of symptoms affecting different people.”

Joan Casey, an environmental epidemiologist at the University of Washington who was not part of the Cedars-Sinai team, noted that the study found health effects lasting over a longer period than similar studies have.

Three months “is a substantial length of time to observe elevated visits, as most studies focused on acute care utilization following wildfire smoke exposure find increased visit counts over about a weeklong period,” Casey said. Her own research found a 27% increase in outpatient respiratory visits among Kaiser Permanente Southern California members living within 12.4 miles of the burn zones in the week following the fires.

“The L.A. fires were such a severe event, including not only smoke, but also evacuation and substantial stress in the population, that effects may have lingered longer,” Casey said.

Thirty-one people are known to have died as a direct result of injuries sustained in the fires. But researchers believe that when taking into account deaths from health conditions worsened by the smoke, the true toll is significantly higher.

A research letter published earlier this year in the Journal of the American Medical Assn. calculated that there were 440 excess deaths in L.A. County between Jan. 5 and Feb. 1. That paper looked at deaths caused by a variety of factors, from exposure to air pollution to disrupted healthcare as a result of closures and evacuations.

On Tuesday, a team from Stanford University published itsprojection that exposure to the fires’ smoke, specifically, led to 14 deaths otherwise unaccounted for.

Wildfire is a major source of fine particulate pollution, bits measuring 2.5 microns or less in diameter that are small enough to cross the barriers that separate blood from the brain and the lungs’ outer branches.

Compared with other sources, wildfire smoke contains a higher proportion of ultrafine particles miniscule enough to penetrate the brain after inhalation, Casey told The Times earlier this year. The smoke has been linked to a range of health problems, including dementia, cancer and cardiovascular failure.

In the last decade, increasing numbers of wildfires in Western states have released enough fine particulate pollution to reverse years’ worth of improvements under the Clean Air Act and other antipollution measures.

Rashi Kaslow sat on the deck of a boat he bought from a friend for just $1 before the fire. After the blaze destroyed his uninsured home in the Palisades Bowl mobile home park — which the owners, to this day, still have not cleared of fire debris — the boat docked in Marina del Rey became his home.

“You either rise from the ashes or you get consumed by them,” he said between tokes from a joint as he watched the sunset with his chihuahua tucked into his tan Patagonia jacket.

“Some people take their own lives,“ he said, musing on the ripple effect of disasters. “After Katrina, a friend of my mom unfortunately did that. … Some people just fall into the bottle.”

The flames burn not only your house, but also your most sacred memories. Among the few items Kaslow managed to save were journals belonging to his late mother, who, in the 1970s, helped start the annual New Orleans Jazz Fest, which is still going strong today.

A disaster like the Palisades fire burns your entire way of life, your community, your sense of self.

The fire put a strain too big to bear on Kaslow’s relationship with his long-term girlfriend. The emotional trauma he experienced forced him to take a break from boat rigging, a dangerous profession he’s practiced for 10 years that requires sharp mental focus as you scale ship masts to wrangle a web of ropes, wires and blocks.

Some days, he feels kind of all right. Others, it’s like he’s drowning in grief. “You try to get back on that horse and do this recovery thing — the recovery dance,” Kaslow said, “which is boring, to say the least.”

Living on a houseboat comes with its own rituals; these largely keep Kaslow occupied. He goes to the boathouse for his ablutions, walks his chihuahua around the marina and rides an electric skateboard into the nearby neighborhoods for a change of scenery.

He’s not yet sure where he’ll end up. Maybe someday the owners of the Palisades Bowl will let him rebuild, but Kaslow is too much of a pragmatist to get his hopes up. Maybe he’ll eventually scrape together enough money to leave the city he’s called home for more than two decades and finally buy a regular old house — not a mobile home, not a boat.

As 2025 slogged on, Kaslow repeatedly watched leaders do little to help. The Los Angeles Fire Department had failed to put out the Lachman fire. Gov. Gavin Newsom’s state park had failed to monitor the burn scar for hotspots. The Los Angeles Department Water and Power had failed to fill the Santa Ynez Reservoir, meant to protect the Pacific Palisades. Police failed to protect his burned lot from looters. Mayor Karen Bass failed to force the owners of the Palisades Bowl to clear the lot of debris.

Kaslow imagines welcoming Bass and Newsom onto his boat — his life now — and sailing out into the sunset. “There should be some accountability,” he said. “I just want to look them in the eyes and ask them, ‘What the f— really happened?’”

Kaslow holds a ceramic vase he recovered from the rubble of his home.

It’s a sentiment shared by many from the Bowl, who Kaslow has dubbed the fire’s “great underdogs.” They’re among the Palisadians who’ve been essentially barred from recovering — be it due to financial constraints, uncooperative landowners or health conditions that make the lingering contamination, with little help from insurance companies to remediate, simply too big a risk.

“I don’t want to be a victim for the rest of my life,” Kaslow said. “I don’t want to let this destroy me anymore than it already has.”

As November’s beaver supermoon rose above the marina, pulling the tide up with it, he felt a glimmer of optimism — a foreign feeling, like reconnecting with an old friend.

Kaslow had received a bit of money from one of the various resident lawsuits against the Palisades Bowl’s owners, as well as a modest housing grant from Neighborhood Housing Services, a local nonprofit, that covered the rent for his spot in the marina.

But a week later, Neighborhood Housing Services ran out of money, and a federal loan that could finally help him to move on from simply trying to stay afloat to charting his future remains far off on the horizon.

Regardless, Kaslow cannot help but feel grateful, despite all he’s lost. He thinks of his elderly neighbors whose entire lives were upended in their final years. Or the kids of nearby Pali High, who pushed their way through the COVID-19 pandemic only to have their school burn in the blaze.

He thinks of the countless people quietly going through their own personal tragedies, without the media attention or outpouring from the greater community or support from the government: A messy divorce that leaves a young mother isolated; a kitchen fire in suburban America that levels a home; an interstate car crash that kills someone’s child.

“You start to appreciate things more, I think, when your whole life is shaken up,” Kaslow said, looking out at the moonlight glimmering across the marina. “That is a blessing.”