ESCONDIDO -- One day after Palomar Medical Center's Emergency Room was flooded with people worried they had swine flu -- spurred by Monday's first swine flu death in the county -- hospital officials established an outdoor triage center Thursday to screen patients arriving with flulike symptoms.

Thursday was "relatively calm" compared with Wednesday night when as many as 60 people descended on the Escondido emergency room fearing they had the potentially deadly though rare virus, said Andy Hoang, hospital spokesman.

"We hope the message is getting out that people shouldn't panic," Hoang said, emphasizing that only those with severe flu symptoms should go to the emergency room.

Health officials advised those with mild symptoms to stay home and call their primary physician.

The panic over the disease, also called the H1N1 virus, comes after a 20-year-old San Marcos woman died of it Monday, hours after she was brought to Palomar Medical Center. Adela Chevalier was brought to the hospital suffering from severe muscle aches, a cough and a low-grade fever, officials have said.

By midafternoon Thursday, a half dozen patients with flu symptoms had been kept outside the ER to prevent the possible spread of the disease. Each wore a blue mask and was assessed by nurses and physicians at the outdoor triage.

"We're just taking precautions," said Dr. Jaime Rivas, an emergency medical physician, standing next to one of two small purple and white tents set up right outside the ER.

Swab samples from all patients with the flu were sent to county officials to be tested for the H1N1 virus, hospital staff said. That testing takes about a day or so, they said.

At roughly 3 p.m., a young woman seated in a wheelchair with her head slumped to the side and clearly sick was rushed inside the hospital to an isolation room for treatment, said Cathy Prante, the hospital's director of emergency services.

The hospital's spokesman did not know that woman's exact condition or how many people with severe flulike symptoms had been hospitalized Thursday night.

A woman seated at the triage who declined to give her name said she was there Thursday night because she had had direct contact with the woman who died this week.

In a statement released Thursday, San Diego County Public Health Officer Wilma Wooten called the county's first swine flu death tragic and expressed condolences to Chevalier's family. She warned that this probably won't be the last local death from the swine flu.

" … I need to remind the public that each year about 36,000 people in the United States die from the seasonal flu. It's unfortunate to see a death related to H1N1 influenza, but we expect more cases here and throughout the U.S."

As of Thursday, there had been eight swine flu deaths in California. Countywide, there were 290 confirmed H1N1 cases and 25 people hospitalized with the virus, Wooten said.

Health officials continue to urge people to cover their coughs and sneezes, wash their hands frequently and stay home if they feel sick. A poster telling people to cover their coughs is fixed to the front door of Palomar's ER.

Prante, the hospital's director of emergency services, said staff regularly train for events like a disease outbreak. Still, Wednesday's large number of patients strained the hospital's resources, officials said.

County officials ask that only those with severe flulike symptoms visit emergency departments. Such symptoms would include difficulty breathing, a change in behavior such as irritability or lethargy or a refusal to drink liquids or inability to keep liquids down.

Spokespersons for Tri-City Medical Center in Oceanside, Vista Community Clinic, which operates clinics across Vista and Oceanside and other parts of the county, and Neighborhood Healthcare, which has clinics in Escondido and Temecula, said they had not see an increase in patients with flulike symptoms this week.

Call staff writer Chris Nichols at 760-740-5426.