A crewperson on an Angeles National Forest hotshot crew had a close call in June with a heat-related illness. While engaged in strenuous physical activity, the firefighter developed severe cramps and had a temperature two degrees lower than normal. During a five-hour period he or she drank all the water from their 100-ounce Camelback once, and again later after refilling it, plus two Gatorades.
The EMTs on the crew who recognized the serious potential of the person’s condition arranged for transportation to a hospital. It turned out to be a mild case of rhabdomyolysis which, if not caught in time and treated can be fatal. The EMT that accompanied the firefighter to the hospital insisted that tests for rhabdo be done, even though the staff at the hospital had not planned on doing the tests.
The hotshot also had hyponatremia, which is a severe imbalance of water to salt. Drinking large quantities of water without enough fluids with electrolytes can cause hyponatremia.
Congratulations to the hotshot crew and the EMTs for making good decisions during this serious incident.
You can read the entire report here, but below are the Lessons Learned:
- Know yourself and know each other. Each person must monitor their water and sports drink intake. Supervisors must ensure all crewmembers are getting adequate electrolyte replacement.
- Recognize fatigue and take action early, before it can lead to a heat-related illness. This may require taking breaks due to environmental conditions.
- Do not count on observing classic heat-‐illness symptoms; patient may not present the symptoms you have been trained to look for.
- The patient is not the one who decides if he or she goes to the hospital. It is the decision of the first responder, EMT, or higher-‐ranking individual, due to the nature and/or severity of the injury/illness and/or agency protocol.
- If employees are treated for heat-‐related illness, the treating facility should be asked to check for rhabdomyolysis. The patient’s representative must insist that CPK, potassium phosphate, and myoglobin tests are done initially and on the follow up appointment.
In 2007 a California radio station held a contest to see who could win a Wii game console by drinking the most water without going to the bathroom. Jennifer Strange, a 28-year-old mother of three, died of hyponatremia after drinking about two gallons of water. A jury found the radio station liable, and awarded her husband $16.5 million.
We have written previously about the “Myth of drinking water”. Some may assume that drinking lots of liquids will prevent heat related illnesses, but that is not always the case. In the article, we quoted Dr. Brent Ruby, who has conducted research in this area. In the quote below he was referring to the 2011 Caleb Hamm fatality on the CR337 Fire in Texas. Mr. Hamm was a member of the Bureau of Land Management’s Bonneville Interagency Hotshot crew.
Dr. Ruby:
I was bothered by the findings of the CR337 fatality report from the investigation team. There are issues within this case that are very similar to a published heat exhaustion case study we published recently (Wilderness and Environmental Medicine 22, 122-125, 2011, http://www.ncbi.nlm.nih.gov/pubmed/21664560). In this report, we document drinking behavior, activity patterns, skin and core temperatures in a subject that suffered heat exhaustion and required evacuation. The lessons learned from this research clearly indicate that the best protection against a heat injury is reducing work rate…
Sports drinks in general are no better than soda pop for providing electrolytes.
The troops need to have access to high potassium snacks and food like bananas, apricots and V 8 juice.
Not eating (I know its hard to eat when it really hot) can attribute to heat illness.
Thanks for keeping this issue out there…..and a reminder also: when your crewmate mentions not feeling well, they are never to be left alone……….