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Exertional Rhabdomyolysis

 

Rhabdomyolysis, or “rhabdo,” is a medical condition where muscle tissue breaks down and the by-products of this process may lead to kidney failure and other complications. 

Rhabdo is commonly mistaken for heat illness or dehydration, so early recognition is critical. 

Exertional rhabdo can result from excessive exercise, physical training, or work. Wildland firefighters are engaged in strenuous activities and prolonged exertion often under harsh environmental conditions and difficult terrain–and so are at increased risk for exertional rhabdomyolysis. 

It is not possible to diagnose rhabdomyolysis in the field because specialized blood tests and a clinical evaluation by a professional are necessary. 

Contributing Factors:  

  • Sudden intense increase in physical exertion after periods away from activity such as occurs with poor conditioning and/or lower fitness levels.
  • Overexertion such as during high-intensity or long-duration activities without adequate recovery time.
  • Heat stress or working in extreme heat.
  • Excessive caffeine intake.
  • Dehydration.
  • Over the counter medications (decongestants, antihistamines, NSAIDs).
  • Prescription medications (antidepressants, statins).
  • Supplements such as creatine.

Treatment: Stop your current activity. Seek immediate care at the nearest hospital.

Rhabdomyolysis–Watch Out Situations:

Image
Plastic cup with very dark urine.
  • Extremely sore for more than 3 days.
  • Soreness extends beyond muscles that were exercised→ i.e., the full body. 
  • Soreness that feels out of proportion to the exercise done.
  • Stiffness and decreased range of motion.
  • Nausea, vomiting, headache, confusion. 
  • Swelling in the arms and legs. 
  • Dark, cola colored urine; gradually getting darker.
  • Extreme fatigue and/or weakness.

Key Recommendations:

  • Listen to your body!
  • Maintain your physical training program, nutrition, hydration, and rest.
  • Introduce new exercises slowly.
  • Keep open lines of communication about fitness, rhabdo, and other injuries/ailments.

Discussion Questions:

  • Given we have a very physical job, what would excessive pain, fatigue, and cramps look like to you?
  • What is your crew’s medical plan for rhabdomyolysis?
  • What are specific steps you and your crew can take to prevent and respond to this condition?

 

Category
Firefighter Health First Aid
References
Rhabdomyolysis in Wildland Firefighters (USFS)
Watch this video on rhabdomyolysis and wildland firefighters


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NWCG Latest Announcements

Updated NWCG Standards for Course Delivery, PMS 901-1 and NWCG Training Course Completion Certificate, PMS 921-1

Date: July 17, 2024
Contact: Training Delivery Committee 

The Training Delivery Committee (TDC) has updated the NWCG Standards for Course Delivery, PMS 901-1 to reflect changes in the standards for course management and delivery. These changes have been reviewed and approved by the members of TDC over the past year. Significant updates include additional delivery methods, updated definitions, and instructions for the use of digital signatures on training certificates. The NWCG Training Course Completion Certificate, PMS 921-1 has been updated to lock after an electronic signature has been applied.

References:

NWCG Standards for Course Delivery, PMS 901-1

NWCG Training Course Completion Certificate, PMS 921-1

IBC Memo 24-01: OF 297 Signature Order and 2024 Fire Season Use IBC Memo 24-02: Summary of Changes for SIIBM, PMS 902

Date: July 15, 2024
Contact: Incident Business Committee 

The NWCG Incident Business Committee (IBC) has recently released two memorandums. The first provides direction on the use of the Emergency Equipment Shift Ticket, OF 297 for the 2024 fire season. Due to delays in hard copy printing, both the 2024 revision and the older version of the Emergency Equipment Shift Ticket, OF 297 are acceptable for use during the 2024 fire season.

The second memorandum documents the updates of the newly revised NWCG Standards for Interagency Incident Business Management (SIIBM), PMS 902. The summary of changes attached to the memo covers the major updates and process changes from the 2022 version.

References:

IBC Memorandum 24-01: OF 297 Signature Order and 2024 Fire Season Use

IBC Memorandum 24-02: Summary of Changes for the NWCG Standards of Interagency Incident Business Management, PMS 902

IBC Memorandum 24-02 Attachment: Summary of Changes

NWCG Standards for Rapid Extraction Module Support, PMS 552

Date: July 10, 2024
Contact: Incident Medical Unit Subcommittee 

A new publication from the Incident Medical Unit Subcommittee is now available. The NWCG Standards for Rapid Extraction Module Support, PMS 552 will be used as a guide and as an opportunity to begin to build out Rapid Extraction Module Support (REMS) modules for the remainder of Fire Year 2024. These standards will be fully implemented as the minimum standard starting in January 2025.

NWCG Standards for Rapid Extraction Module Support outlines the roles, duties, qualifications, and equipment pertinent to REMS. A REMS team, strategically stationed at wildland fires, plays a pivotal role in prioritizing swift access and medical treatment to injured or ill firefighters for safe and efficient egress off the fireline. This ensures their rapid transport to definitive medical care in cases of emergency during firefighting operations, highlighting the invaluable contribution of the REMS team to firefighter safety and well-being.

References:

NWCG Standards for Rapid Extraction Module Support, PMS 552

National Wildland Firefighter Day

Date: July 2, 2024
Contact: National Interagency Fire Center 

The National Wildfire Coordinating Group (NWCG) would like to recognize July 2, 2024, as National Wildland Firefighter Day (NWFFD). Established in 2022, NWFFD honors the dedication of wildland firefighters and support personnel. This day falls within the 2024 Week of Remembrance (June 30 - July 6), providing an opportunity to renew our commitment to wildland firefighter safety while remembering those who have fallen in the line of duty.

NWCG continues to provide leadership to enable interoperable wildland fire operations among federal, state, local, Tribal, and territorial partners. NWCG standards and training establish common practices to contribute to safe, effective, and coordinated national interagency wildland fire operations.

References:

NWCG.gov

Week of Remembrance

National Wildland Firefighter Day