The official death toll of the massive winter storm that plunged much of the United States into sub-freezing temperatures over Christmas weekend and dumped snow across the Great Lakes region continues to rise as rescue crews clear roads and search homes and vehicles inundated by snow and ice.

At least 60 people have died nationwide from the inclement weather, with the highest recorded number of deaths being in western New York, where a powerful lake-effect snowstorm claimed the lives of at least 35 people. Buffalo city spokesman Mike DeGeorge said more than half of the deaths occurred outside, a number involving people in their cars.

The New York National Guard has deployed 580 soldiers to aid search and rescue efforts, as of Wednesday. Conditions are so dire for some families that National Guardsmen have been going door to door to check on residents and bring necessary supplies like food and blankets.

According to a released statement, National Guardsmen rescued at least 86 people from “hazardous situations,” including a woman taken to a hospital just before giving birth.

According to Mark Polincarz, the executive of Erie County, 34 of New York’s deaths occurred in his jurisdiction, which includes the city of Buffalo. At a press conference on Wednesday, Polincarz confirmed that 26 of the deaths recorded in Erie County happened in Buffalo. Poloncarz said three people who died, two men and a woman, remained unidentified Wednesday morning. Officials also reported a storm-related death in neighboring Niagara County.

Of the storm-related deaths confirmed by the Erie County Medical Examiner’s Office, three people suffered heart attacks while shoveling snow, 14 people were found frozen to death outside and at least three residents died because emergency services were delayed by the deep snow.

Amid the frigid conditions, “people … got stranded in their vehicles and passed away in their cars. We have people that were walking during blizzard conditions and passed away on the street, passed away in snowbanks,” Buffalo Mayor Byron Brown told CNN. “And we have people that were found that passed away in their homes.”

Among those who perished in Buffalo’s storm was 56-year-old William Clay. His sister, Sophia Clay, told ABC News her brother died on his birthday. Sophia said he was on his way to a store on Friday when the storm intensified. Officials said Clay’s body was found frozen on the street.

Another life lost in the snowstorm was Anndel Taylor, a 22-year-old student nurse who was on her way home from a shift at Buffalo hospital Friday when she got trapped in her vehicle. While stuck, Taylor sent a series of updates to her family in North Carolina—including chilling videos showing how she was trapped in her car in ever-rising snow.

Taylor was found dead around 24 hours later by a family friend. According to her family, Taylor was last heard from when she said she would try to get some sleep while awaiting emergency services. Her family believes she died from carbon monoxide poisoning because her car’s exhaust pipe was clogged with snow.

The devastating impact of the storm is, in large part, due to the lack of preparedness on the part of the local government. Erie County authorities only issued a travel ban shortly before 9 a.m. Friday, giving residents less than an hour to seek shelter as many were in transit to or from work. Efforts to clear at least one lane on every street for emergency responders has been hampered by hundreds of cars stuck abandoned in the snow.

According to Poloncarz, Friday’s storm marked the first time the Buffalo Fire Department could not respond to emergency calls because of severe conditions. Two-thirds of the equipment dispatched to help clear winter snow during the height of the storm also got stuck, he said.

Moreover, the blizzard struck right before Christmas, when already short-staffed emergency services were further cut back for the holiday. Local officials also noted that the storm hit on a day many residents planned to buy gifts, food or supplies to prepare for the cold weekend.

In the meantime, Buffalo now faces a risk of flooding, as rising temperatures begin to melt the massive amount of snow and ice, with two inches of rain forecast through the weekend, according to the National Weather Service.