Suspected Heat Stroke at a Wildland-Urban Interface Fire
At 13:20, crews are working a wildland-urban interface fire in 96°F heat, 18% relative humidity, and 14 mph wind. The rehab tent has shade, water, and a misting fan, but no EMS and no electrolyte replacement. A 34-year-old firefighter has been working for 2.5 hours with one rest period. He is now confused, has stumbled, and has hot, dry skin. His pulse is 138, respirations 28, blood pressure 100/60, and core temperature 104.6°F. The crew leader wants him to sit in the shade, drink water, and return to the line after a 15-minute break. Two other firefighters report muscle cramps and dizziness but are alert. The IC asks the ISO whether the rehab area is adequate and whether the crew can continue.
1. Recognize the medical emergency and state the immediate actions the ISO should require.
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Recognition. Confusion, hot skin, a temperature of 104.6°F, pulse 138, and hypotension after heavy work in 96°F heat indicate exertional heat stroke until proven otherwise. This is a medical emergency, not heat exhaustion. The crew leader's plan to sit him in the shade and return him to work is unsafe.
Immediate actions. Remove the firefighter from the hot environment, begin aggressive cooling with cold water immersion or ice packs to the neck, axillae, and groin, and call EMS for transport. Do not give fluids by mouth if he is confused. Notify the IC and the rehab manager, and assign someone to stay with him. Record the time, vital signs, and cooling measures. If EMS is delayed, continue cooling and monitor the airway. The two firefighters with cramps and dizziness should be assessed, cooled, and hydrated, but they should not return to work until cleared.
Command decision. The ISO should recommend that the crew not continue without adequate rehab and EMS coverage. This is not a disciplinary issue; it is a physiological limit. The IC should adjust work-rest cycles, request additional medical support, and document the decision. After the incident, review the rehab plan, heat index, and crew rotation.
2. What should an adequate rehab plan include, and what return-to-duty criteria should the ISO apply?
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An adequate rehab plan should include a designated rehab area away from the fire line, shade, cooling, water and electrolyte replacement, and EMS or medical monitoring. NFPA 1584-style rehab is triggered by strenuous work, heat, or SCBA use; vital signs should be checked and abnormal findings referred for medical evaluation. The plan should also include a rest schedule, a way to track crews, and a return-to-duty decision made by a medically responsible person, not by peer pressure.
Return-to-duty criteria should include normal mental status, a pulse and blood pressure that have returned to the firefighter's baseline or an acceptable range, no dizziness or nausea, and medical clearance after heat stroke. A firefighter with heat stroke should not return to duty at that incident. The two firefighters with cramps and dizziness should be cooled, hydrated, and reassessed before return; if symptoms persist, they should be transported. Document all assessments, cooling measures, and return-to-duty decisions. The ISO should also verify that the rehab area can handle multiple patients and that EMS response time is acceptable for the incident.