[NOTE: Firefighters Union (FBEU) considering media response to dangers of closing fire stations recently in same area]
UPDATE 8.50am: AS many as nine people have died and about 20 residents have been injured after a deadly blaze ripped through a nursing home in Sydney's northwest.
Emergency services were called out to the building in Hambledon Road, Quakers Hill, at 4.53am today.
Dozens of of the 100-odd residents were trapped inside the inferno when firefighters arrived at the scene.
Thick black smoke had engulfed the building, choking residents and compounding the problem for firefighters, who were forced to search the rooms by crawling on their hands and knees.
"This is a firefighter's worst nightmare," NSW Fire Commissioner Greg Mullins told reporters at the scene.
"(They) could not see their hands in front of their faces...
"Crews had to literally crawl on their hands and knees into every room in the complex, reach up under the beds, searching cupboards, anywhere where someone may have crawled away."
NSW Police said that "fewer than 10" had died in the blaze, but Mr Mullins warned there could be more deaths.
Many of the elderly people could not get "out of harms way" and the "roof was on fire above them", he added.
"It was a horrific scene," he said.
"This has been a very, very serious fire, a tragic scene - a lot of people injured. There have been some fatalities, there may be more."
All the residents have now been accounted for. Picture: John Grainger
Mr Mullins said the nursing home had been "searched from top to bottom".
The cause of the fire - one of the in Sydney worst in decades - is currently under investigation.
"No idea at this stage what caused the fire," he said.
"It's decades since we've seen a fire like this."
Quakers Hill Superintendent Gary Merryweather said the investigation was being assisted by homicide detectives and it was too early to say if the blaze was suspicious.
"The investigation is going to be quite lengthy," he said.
"We do ask anyone who may have family members here not to come to the scene because all of the patients from the nursing home are being transported to a
number of hospitals, including Mount Druitt and Blacktown."
Supt Merryweather said police hoped to confirm the number of people who have died later in the day.
He said the dead were believed to be residents and not carers.
Ambulance NSW said the residents had various degrees of injuries and most were suffering from smoke inhalation and minor burns.
"It has been a long, long time since I have seen something like this, something of this magnitude," a spokesman told reporters at the scene.
The Domain Principal Group, the company which runs the Quakers Hill Aged Care Facility, released a statement to advise they had been notified of the "serious fire".
But a spokeswoman said they were unable to provide any further comment until more information was available.
Confused survivors remain outside
Dozens of elderly people are lying on beds or sitting in wheelchairs outside the home, some of them being attended to by paramedics.
The driveway to the home has been turned into a makeshift triage centre.
Staff and what appears to be many concerned relatives are also waiting outside.
Dozens of ambulances and fire trucks have attended the emergency and remain on scene.
Mr Mullins said it would have been a horrific experience for the elderly people, many of whom are in wheelchairs and beds, huddled outside the burnt out building.
"They are confused... they are not sure what is going on," he said.
Police have asked families of residents to not go to the scene, and call 1800 227 228.
People have described the incident as an "absolute tragedy".
"The cost to human life is going to be very high," Srin Najaken, a 56-year-old nurse whose home neighbours Quakers Hill Nursing Home, told AAP.
"Somebody banging on my door woke up me up shouting 'there's a fire, there's a fire, get out'.
"Luckily for us the fire didn't spread but it is an absolute tragedy."
'It is just horrific'
Another neighbour, 60, who did not want to be named, said emergency services had told him up to seven people had died in the blaze.
"They told me it was up to seven dead," the man told AAP.
"I feel for everyone involved; those that've died, their relatives, the workers.
"It is a tragedy, there's no other word."
Sally Pearson, 30, lives in Quakers Hill and walked past the scene around 7.45am.
"You just imagine elderly people unable to move or really immobile as the fire took hold," she told AAP.
"I think of my own grandmother... You never want anything like this to happen to anyone."
Rod Young, CEO of the Aged Care Association Australia, said arrangements were being made to accommodate around 80 displaced residents.
"We've got a number of people making contact with all the nursing homes in the neighbourhood trying to see what's available and arrange for transfers as soon as possible," he told ABC Radio.
"It is just horrific, absolutely horrific," one neighbour told AAP.
"Tremendously sad that this has happened to gentle elderly folk."
The state coroner and arson and homicide investigators will attend the scene.
