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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

NEW! Incident Performance and Training Modernization Story Map Now Available

Date: Aug 26, 2025
Questions? Please contact:
National Wildfire Coordinating Group

NWCG is excited to announce the launch of the Incident Performance and Training Modernization (IPTM) Story Map, a new interactive resource that showcases how NWCG is transforming wildland fire training and qualifications through a performance-based system.

Since its launch in 2023, IPTM has made major strides in updating how we manage incident positions:

  • 36 incident positions now have new Incident Position Standards and Next Generation Position Task Books available for field use
  • 6 more incident positions are nearing completion
  • 111 total incident positions are being analyzed through the IPTM initiative

The Story Map guides you through the IPTM process, highlights key accomplishments, and outlines what’s ahead. Whether you are a trainer or a trainee, this tool offers valuable insight into the modernization effort shaping the future of wildland fire training and qualifications.

This effort would not be possible without the contributions of NWCG staff, NWCG committees, and hundreds of subject matter experts across the wildland fire community.

References:

IPTM Story Map

Incident Performance and Training Modernization Webpage

NEW! S-290, Intermediate Wildland Fire Behavior (Blended) Available Now

Date: Aug 15, 2025
Questions? Please contact:
Fire Behavior Subcommittee

NWCG is excited to announce that the S-290, Intermediate Wildland Fire Behavior (Blended) training is now available on the Wildland Fire Learning Portal. S-290 (Blended) training combines online training and instructor-led training components that support individuals working towards any Single Resource Boss or Fire Effects Monitor incident qualifications.

This second course in the series collectively serves to develop fire behavior prediction knowledge and skills, and provides more detailed information on fuels, weather, and topography that affect wildland fire behavior for safety purposes.

Students are required to finish the prerequisite S-190, Introduction to Wildland Fire Behavior, before enrolling in S-290, Intermediate Wildland Fire Behavior (Blended).

References:

S-290, Intermediate Wildland Fire Behavior (Blended)

S-190, Introduction to Wildland Fire Behavior

Wildland Fire Learning Portal

NEW! S-271, Helicopter Crewmember (Blended) Now Available

Date: Aug 14, 2025
Questions? Please contact:
Interagency Helicopter Operations Subcommittee

The S-271, Helicopter Crewmember (Blended) is now available. Developed through the Incident Performance and Training Modernization (IPTM) effort, this training supports individuals working towards Helicopter Crewmember (HECM) incident qualifications. 

S-271, Helicopter Crewmember (Blended) training combines online training and instructor-led training components. This course is designed to provide students with the knowledge and skills necessary to perform the duties of the HECM position, as described in the NWCG Incident Position Standards for Helicopter Crewmember, PMS 350-22.

Any changes to qualification pathways will take effect with the next update of the NWCG Standards for Wildland Fire Position Qualifications, PMS 310-1, scheduled for January 2026.

References:

S-271, Helicopter Crewmember (Blended)

NWCG Helicopter Crewmember (HECM) Position Page

Wildland Fire Learning Portal

Incident Position Standards and Next Generation Position Task Books Now Available for FBAN and LTAN

Date: Aug 13, 2025
Questions? Please contact:
Fire Behavior Subcommittee

NWCG is excited to announce that Incident Position Standards and Next Generation Position Task Books are now available for Fire Behavior Analyst (FBAN) and Long Term Fire Analyst (LTAN).

The Performance Support Packages for these positions were developed as part of the Incident Performance and Training Modernization (IPTM) effort. These resources support trainees, qualified personnel, and evaluators in their respective roles.

Any changes to qualification pathways will take effect with the next update of the NWCG Standards for Wildland Fire Position Qualifications, PMS 310-1, scheduled for January 2026.

References:

NWCG Fire Behavior Analyst Position Page

NWCG Long Term Fire Analyst Page