Module 8 – Beyond Your Limits
Narrator: Southern Nevada, August.
You and your crew IA’d the fire at ten o’clock, now it’s close to 1800.
The temperature has been over 100 since noon.
You’ve been running and gunning for almost eight hours straight without a break for food
or water.
The whole crew has been focused on punching line around the fire and hasn’t really thought
about breaks.
Only six more chains, we can hook it!
The crew is bunching up, line production is dropping like a rock.
You bump up to the lead saw to see what’s holding up the line diggers.
You ask him if he’s feeling okay.
Yeah, sure need to get around the fire boss, he replies.
His face is flushed, his legs are shaking and he has the thousand yards stare.
You notice that he still has two full canteens in his line pack and then suddenly, he passes
out.
Heat stroke.
Did you miss something?
Bill: If we’re not paying attention to the symptoms, we’re going to start seeing the
signs.
And what’s really key to that is, by the time the symptoms go away and we are seeing
the signs, we’re cascading down that hill at a lot faster rate.
Narrator: In this module, we will focus on heat related illness as it relates to you,
the wildland firefighter.
You will learn how to recognize symptoms, proper treatment and preventative measures
that you can take.
To lead our discussion on these topics are Bill Arsenault, a fireline paramedic and Dr.
Gary Brandecker, and emergency room physician at St. Luke’s hospital in Boise, Idaho.
Bill: We have three types of heat illnesses.
We have heat cramps, heat exhaustion and heat stroke.
Often times, we kind of just move on to the next one without even realizing it.
Narrator: Heat cramps are painful, brief muscle cramps that occur during exercise or work
in a hot environment.
Heat cramps can be cause be inadequate fluid intake and failure to replace electrolytes
like sodium, potassium, calcium and magnesium.
Bill: When you have someone that’s been working hard and they’ve been sucking water
but they’re still having cramps, it’s because the chemicals in their bodies are
off.
They need to replenish some their salts; they may be starting on the dehydration path.
Narrator: Heat exhaustion is a form of heat related illness that can develop after several
days of exposure to high temperatures and inadequate or unbalances replacement of fluids
and electrolytes.
Narrator: Heat stroke, unlike heat cramps and heat exhaustion is true medical emergency
and can be fatal if not treated promptly and properly.
The person’s cooling system stops working and the internal body temperature rises.
Dr. Brandecker: When you start reaching a body temperature of 105, 106 you can start
to break down muscle tissue, break down proteins, and if the temperature continues to increase,
you can start to create liver problems, and brain problems and cause brain swelling, altered
mental status, coma in those situations.
Bill: When we talk about heat cramps, we’re going to be looking for basic signs and symptoms-
leg cramps, stomach cramps.
When we talk about heat exhaustion-we’re talking about a person profusely sweating,
displaying to you through that the very red face, telling you that I have a headache.
You check their pulse and you notice that their heart rate is just racing, and then
the final progression in the death chain of heat illness is the heat stroke.
And that one in and of itself; if we’re at that stage, we’re already behind.
Narrator: Your body has numerous mechanisms when it senses danger.
The key to identifying heat related illness is listening to your body.
If you’re not feeling right, take a break and make a quick assessment of your condition.
Don’t feel like you have to “power on” through the symptoms of heat related illness.
Bill: The first thing is to have that person disengage.
Step away from the fireline if they can into a safe area.
The next part, start helping them dissipate some of that heat.
Whether it’s taking down their fire shirt and taking off their t-shirt, and getting
them some fluid.
The other key component of that is, once you recognize there’s a problem, don’t wait
to notify your leader.
If it’s already starting to happen, get the line EMT or the line paramedic who has
the IV fluid over to that situation.
Because as we all now sometimes, it’s not going to be a five minute response like it
would be in the city.
The key point behind all of this is stopping the emergency before it cascades into a worse
event and getting the resources that you need there to help you.
Bill: You and I working on the fireline can be working right next to each other for two
or three days straight, or ten days eating smoke together and I say to you, gosh Scott,
do you have any Ibuprofen?
I really have a headache.
And you think in your mind well I’ve got a headache too, we all have a headache.
But then here’s the difference.
A half hour later, I sit down, my face is extremely red and I’m sweating profusely.
You’re seeing the signs, because I’m red faced, I’m sweating profusely and now I’m
sitting down.
You missed the symptom of simply me saying I have really got a headache.
Bill: How much water have you drunken?
If I reach into my line gear and I feel I have two full jugs and its noon and I’ve
got one full jug over here on this side-that’s usually a four to five hour block of engagement
and I’ve still got three full ones?
I probably am not drinking enough.
Dr. Brandecker: The most important thing is to avoid fluids with caffeine.
Because fluids with caffeine are actually going to have a diuretic effect.
And what I mean by diuretic affect is that they’re going to cause you to urinate more
fluid then you’re probably taking in.
Dr. Brandecker: The way we acclimate to the heat, part of it is being in good physical
condition.
If you have underlying medical conditions, it will affect your ability to acclimate to
the heat.
Also probably getting used to a new environment slowly, you don’t want to go from being
in a relatively cool climate to a hot climate and right away try to exercise and also elevation
can be a factor too.
Bill: Two key point to walk away with today for heat illnesses.
One, make sure you take the time to look in your IRPG-wherever it is and review heat illnesses.
Heat cramps, heat exhaustion and heat stroke.
Recognize the signs and the symptoms in there, place them in your memory so the next time
you are out on the fireline and someone says, my muscles are really sore.
Or all of a sudden they start vomiting and you looking at them and their face is very
flushed.
You recognize that oh, I read that in my IRPG-we need to stop this emergency.
The next part is-taking the time to correct the incident before it becomes worse.
If that firefighter starts to tell you, I don’t feel so good.
This is the moment where they need to disengage.
Get them cooled off-either by taking down some of their clothing layers, patting them
with water, giving them slow sips of fluid and getting help coming.
You cannot do this by yourself, first of all and second of all, we don’t want the cascade
of events to become worse so get help coming.
Dr. Brandecker: I think to avoid these problems; prevention is going to be the key.
Probably in the off season to stay physically fit and active.
Don’t show up at the first day of any type of training camp and think that you’re going
to be at your peak performance.
I think you have to slowly work back into getting into shape.
Making sure that you’re well-hydrated and getting enough sleep and rest is also important.