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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

Last Modified / Reviewed:


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NWCG Latest Announcements

Great Basin Cache Upgrading to New Inventory System

Date: May 7, 2025
Questions?  Please contact:
Great Basin Cache
Phone: (208) 387-5104
Fax: (208) 387-5573

The Great Basin Cache (GBK) is transitioning to a new inventory system to better serve the wildland fire community. During this upgrade, GBK will be unable to process standard orders from Part 1: Fire Supplies and Equipment and Part 2: Publications between May 8-20, 2025, with exceptions made for emergency fire orders. Orders will be accepted through close of business May 7.

To browse the latest available items, please refer to the National Fire Equipment System (NFES) catalogs. 

References:

NWCG NFES Catalog-Part 1: Fire Supplies and Equipment, PMS 449-1

NWCG NFES Catalog-Part 2: Publications, PMS 449-2

NEW! Air Operations Summary (ICS 220 WF) Now Available

Date: May 2, 2025
Questions?  Please contact:
National Interagency Aviation Committee

The Air Operations Summary (ICS 220 WF) provides the Air Operations Branch with the number, type, location, and specific assignments of helicopters and air resources. The new ICS 220 WF also includes medical extraction capabilities and air resources tracking.

Understanding the capabilities of aviation assets is critical for effective medical and extraction responses. Coordination with the Medical Unit Leader is essential to ensure alignment and consistency between the ICS 220 WF and the Medical Plan (ICS 206 WF). 

References:

Air Operations Summary (ICS 220 WF)

National Interagency Aviation Committee

Incident Command System (ICS) Forms

Incident Position Standards and Next Generation Position Task Book Available for Firing Boss, Single Resource

Date: April 30, 2025
Questions?  Please contact:
Fuels Management Committee

NWCG is excited to announce that the NWCG Incident Position Standards for Firing Boss, Single Resource, PMS 350-105, and the NWCG Position Task Book for Firing Boss, Single Resource (FIRB), PMS 311-105, are now available. 

These resources, part of the Performance Support Package developed through the Incident Performance and Training Modernization (IPTM) effort, support trainees, qualified personnel, and evaluators. 

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

 

References:

NWCG Firing Boss, Single Resource Position Page

NWCG Incident Position Standards for Firing Boss, Single Resource, PMS 350-105

NWCG Position Task Book for Firing Boss, Single Resource (FIRB), PMS 311-105

Incident Position Standards and Next Generation Position Task Book Available for Helicopter Crewmember

Date: April 28, 2025
Questions?  Please contact:
Interagency Helicopter Operations Subcommittee

NWCG is excited to announce that the NWCG Incident Position Standards for Helicopter Crewmember, PMS 350-22, and the NWCG Position Task Book for Helicopter Crewmember (HECM), PMS 311-22, are now available.

These resources, part of the Performance Support Package developed through the Incident Performance and Training Modernization (IPTM) effort, support trainees, qualified personnel, and evaluators.

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

References:

NWCG Incident Position Standards for Helicopter Crewmember, PMS 350-22

NWCG Incident Position Standards for Helicopter Crewmember, PMS 350-22

NWCG Position Task Book for Helicopter Crewmember (HECM), PMS 311-22