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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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EMC Memo 25-001: Interim Rapid Extraction Module (REMS) Training and Qualification Requirements

Date: June 3, 2025
Questions?  Please contact:
Emergency Medical Committee

The Emergency Medical Committee has issued interim guidance for Rapid Extraction Module Support (REMS) teams. Until further notice, Type I and II REMS teams must designate a team leader qualified at Firefighter Type 1 Squad Boss (FFT1) or higher. This temporary change replaces the Single Resource Boss (SRB) requirement, which is currently not feasible due to administrative barriers.

This memorandum does not include any other changes to the NWCG Standards for Rapid Extraction Module Support, PMS 552. This interim change takes effect immediately and will remain in place until further notice.

References:

EMC Memo 25-001: Interim Rapid Extraction Module (REMS) Training and Qualification Requirements

NWCG Standards for Rapid Extraction Module Support, PMS 552

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Date: June 2, 2025
Questions?  Please contact:
Equipment Technology Committee

The Equipment Technology Committee issued Equipment Bulletin: 25-002 to address a manufacturing nonconformity affecting Forest Service specification, 6170-4K Chain Saw Chaps. The issue applies to chaps manufactured in 2024 and 2025 and distributed through FedMall. These chaps may have incorrectly bound edges that expose inner protective layers.

Independent purchasers should inspect all chain saw chaps received from FedMall beginning in 2024, prior to use. Review the full Equipment Bulletin: 25-002 for inspection criteria and recommended actions.

References:

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ETC Equipment Bulletin: 25-002

2024 Wildland Fire Emergency Medical Service Awards

Date: May 22, 2025
Questions?  Please contact:
Emergency Medical Committee

The NWCG Emergency Medical Committee (EMC) is proud to announce the recipients of the 2024 Wildland Fire Emergency Medical Service Awards. Each year, EMC recognizes individuals and groups who have demonstrated exceptional actions or accomplishments that go above and beyond their normal mission or job duties.

Congratulations to all the awardees and nominees. Through leadership and initiative, they have made significant contributions to the safety and well-being of the wildland fire community. These honors are well deserved.

References:

2024 Wildland Fire EMS Awards

NWCG Emergency Medical Committee

NWCG Welcomes the Incident Management Teams Association as an Associate Member

Date: May 21, 2025
Questions?  Please contact:
https://www.nwcg.gov/contact-us

The NWCG Executive Board is honored to announce that the Incident Management Teams Association (IMTA) has joined the National Wildfire Coordinating Group as an associate member.

IMTA is a dedicated group of incident management professionals committed to enhancing the profession by promoting standards and fostering collaboration across federal, state, local, Tribal, and private sector partners throughout all phases of incident management.

“Joining NWCG aligns with our mission to elevate incident management professionals nationwide,” said Dr. Randal Collins, President of IMTA. “This is a proud moment for all of us committed to advancing public safety.”

References:

Incident Management Teams Association

National Wildfire Coordinating Group