Experimental next generation wildland firefighter clothing. Photo by Ken
Researchers are field testing two upgrades for wildland firefighters — new specifications for fire resistant clothing and fireline lunches. Both of these topics are near and dear to the hearts of firefighters. If the clothing does not fit, or binds, or is too hot, or tears, it can make a 16-hour shift seem like 160 hours. And if the lunches they carry to the fireline suck, they may not get the nutrition and energy they need to combat the fire.
Clothing
The Department of Homeland Security has distributed for field testing 1,000 sets of next-generation fire-resistant clothing for wildland firefighters.
Personnel from the California Department of Forestry and Fire Protection (CAL FIRE), the U.S. Forest Service, and 11 local California fire departments that are fighting ongoing wildfires will test the new equipment. The Science and Technology (S&T) Directorate division of the DHS is conducting this wear trial in partnership with the U.S. Army Natick Soldier Research, Development & Engineering Center’s National Protection Center.
According to the DHS, the next generation of personal protective equipment will improve radiant thermal protection; reduce heat stress; improve form, fit, and function compared to existing garments; and meet National Fire Protection Association (NFPA) 1977 and 1975 standards.
The prototype garment system includes undergarments, socks, shirts, uniform pants, tactical pants, and over pants. The system has a shelf life of five years, allows for rapid donning in three minutes or less, is compatible with existing equipment, and accommodates the 5th to 95th percentile of male and female firefighters.
Lunches
For the last couple of years a new specification for lunches that firefighters carry onto the fireline has been tested. Reports are that there will be different configurations for the lunches that camp slugs dedicated individuals that work at the Incident Command Post are provided, versus the high-calorie meals given to firefighters.
Past studies of sack lunches found that they contained between 1,600 and 2,000 calories, while a Meal Ready to Eat (MRE) is loaded with 2,841 calories. The experimental fireline lunches used in 2011 had about 2,000 calories. We have heard that the new lunches are a little pricey, running between $20 and $24 each.
This year the new experimental fireline lunches have been spotted on at least two fires in California, the North Pass Fire on the Mendocino National Forest, and the Shockey Fire on CAL FIRE’s Monte Vista Unit in San Diego County. The photo below is an example of one of these lunches found on a fire a few weeks ago.
Three firefighters on a crew in California suffered first and second degree burns on the Likely Fire northwest of Likely, California (map) on September 5. They were members of the CAL FIRE Devils Garden Crew 4 constructing fireline when a wind shift caused numerous spot fires. The firefighters attempted to retreat into a previously burned area when their escape route was blocked by a barbed wire fence. They received burns on their faces and were transported by a ground ambulance to a hospital where they were treated and released.
A Joint Accident Investigation Team comprised of BLM and CAL FIRE subject matter experts will be investigating the incident.
According to the criteria published by Ameriburn.org all facial burns should be treated at a burn unit, so we hope the firefighters received appropriate medical treatment and were not simply treated and released at the Modoc Medical Center in Alturas as stated in the 24-hour report.
There have been at least two vehicle accidents involving firefighters working on two of the Idaho megafires we reported on Thursday. Both of them involved single vehicles which through driver error left the road surface and went down an embankment. There were no reports of extremely serious injuries, however the driver on the Mustang Complex was transported to a hospital.
On that fire a Strike Team Leader was following his strike team of engines on a very dusty dirt road and lost visibility in the dust. His vehicle left the road and rolled over, ending up against a tree. From the Facilitated Learning Analysis:
…He doesn’t remember much else after a brief moment of panic. He recalls being pulled out of his pickup with people telling him he had rolled his vehicle and then he can remember being in the ambulance as he was transported to the hospital.
Trinity Ridge Fire vehicle accident
On the Trinity Ridge Fire a Line Safety Officer suddenly became very sleepy, possibly as a result of taking some over the counter medication for “the crud” before going to sleep the night before. He planned to pull into a campground just ahead to rest or sleep, but didn’t make it that far. His vehicle left the road and went down the embankment a few feet and impacted some trees. More information is in the Facilitated Learning Analysis.
We wish both of these firefighters a speedy recovery.
During the past week we have experienced a fatality, an entrapment, and several close calls on wildfires. In an effort to draw attention to wildland firefighter safety, NMAC is requesting that all geographic areas redouble efforts to emphasize safety practices.
Firefighter safety is and continues to be our first priority. The commitment to and accountability for safety is a joint responsibility of all firefighters, leaders, managers, and administrators. Individuals must be responsible for their own performance and accountability.
Suggested areas of emphasis are:
Aggressive risk management is our primary means of maintaining safe wildland fire operations. Consistently evaluate fireline tactics and do not hesitate to adjust tactics as environmental and human factor conditions change — Review Risk Management Process in IRPG, Page 1.
Situational Awareness (SA) is a key component of risk management and must be maintained at all times. Conduct SA briefings to brainstorm and consider specific ways in which you can increase awareness of the hazards you face. Evaluate the hazards involved with your activities and mitigate for these hazards to reduce exposure to an acceptable level of risk for firefighters and others. Achieve and maintain good SA both individually, within your crew, and between different types of resources.
LCES must be maintained on every mission, including scouting and patrol assignments.
Rapid, unexpected changes in fire behavior kill wildland firefighters. Always identify the worst case scenario and be prepared for it by maintaining focused SA, setting realistic trigger points, and withdrawing when prudent. Do not hesitate to use your fire shelter when you feel the need exists.
Exercise extreme caution when working in timber canopy areas — assume every tree has some level of hazard associated with it. Review “PRINCIPLES OF HAZARD TREE RISK MANAGEMENT” at:http://www.nwcg.gov/teams/shwt/httf/training_education/s212/ht-risk-mgmt.pdf
Do not allow for a false sense of security in finer fuel types—many fatalities and entrapments have occurred in areas of fine and sparse fuels. Terrain and wind can produce extreme fire behavior in this fuel type.
Carefully consider your Medivac Plan. Ensure all personnel are familiar with the Dutch Creek Protocols, and ensure plans are realistic with adequate resources available to support them in a timely manner.
Dehydration, Hyperthermia, and Fatigue – constantly monitor firefighter’s water and electrolyte intake to avoid dehydration episodes. Dehydration and long work hours, coupled with poor air quality and high temperatures all impact fatigue — monitor and provide rest opportunities for firefighters and support personnel. Hydration alone may not be enough to prevent hyperthermia. Monitor core body temperature and provide breaks in the shade or in an air conditioned vehicle when needed
Driving standards and limitations must be applied and enforced. Drivers should not be exceeding 10 hours behind the wheel driving time (state CDL limitations may be more stringent). This applies to all drivers including agency employees, ADs, and contractors. Every effort should be made to avoid driving between 2200 and 0500 hours.
Communication is vital – resources must be briefed upon arriving at the fire. Communications during all phases of operations must be maintained. Incoming crews must be briefed prior to becoming available for fire assignment.
As the fire season remains active, be mindful of chronic fatigue issues and consider additional days off between assignments for fire personnel.
I ask that every fire manager take time to emphasize firefighter safety and appropriate risk management. We appreciate all the efforts of every firefighter and support personnel. Let’s do everything in our power to return everyone home safely this fire season.
Anne Veseth, a 20-year-old firefighter from Moscow, Idaho, was killed August 12 while working on the Steep Corner Fire near Orofino, Idaho. The U.S. Forest Service firefighter was struck when one tree fell and crashed into another tree, causing it to fall in a domino effect.
On August 11, the day before Veseth was killed, the Flathead Hotshots arrived at the Clearwater-Potlatch Timber Protection Association (CPTPA) station to work on the Steep Corner Fire. They were briefed, received a radio clone, and showed up at the fire about 2 p.m., where they located the CPTPA incident commander. He briefed them on tactical duties, according to the SAFENET report filed three days later, but “had to be prompted for specifics on everything else.” The hotshot report said there was no direct link to Grangeville dispatch, no information on EMS or weather, and no medical plan besides “call the county.”
The report listed a slew of other heads-up flags on the incident, including no mention of hazards and no direction other than “jump in the middle and work south.” The IC was wearing jeans, and the hotshots immediately noticed several other CPTPA personnel without PPE or shelters.
The Flathead superintendent told the IC that they’d go scout the fire before committing the crew, and the IC told him to head down the burned line through the middle of the fire. The hotshot foreman then briefed the crew, and they established their own LCES and posted the first lookout of the day on the fire. The scouting superintendent radioed back that no one should be sent down the burned line — which was still hot — through the middle of the fire because of snag hazards and previously cut log decks. Continue reading
When we’re talking about firefighter safety and preventing injuries, fatalities, or escaped prescribed fires, we often fall back on the hundreds of rules, regulations, standards, orders, lists, watch-outs, manuals, red books, 40-page Incident Action Plans or Prescribed Fire Plans….. the list is endless. While I would never say those resources are worthless, perhaps a deeper root cause of accidents on the fireline are the ingrained human behavior traits welded into our DNA or learned through years of exposure to a workplace culture. Some people are hard-wired to accept a level of risk others would not, or they may think their innate intelligence will enable them to outsmart a fire, or be able to successfully handle any unexpected emergency that is presented to them.
The most successful firefighters are not those who religiously follow every written rule to the letter, but those who recognize, accurately, their own skills and limitations. They take advantage of what they can do well, and mitigate the traits that could lead to an undesirable outcome. But not everyone is self-aware to that level.
The most dangerous firefighters are those who do not know what they don’t know. When they were teenagers, they thought they were 10 feet tall, bulletproof, and knew everything. Now after fighting fire a little here and there, and taking some stupid risks without getting seriously injured or at times not even knowing they were taking risks, they think it can continue. This can put themselves, and if they are a supervisor, those around them in precarious situations.
Bill Belichick
Bill Belichick, head coach of the New England Patriots, is often described as one of the best, or the best, football coaches of all time. He does many things well, of course, but one of his most interesting traits is accurately recognizing the skills and limitations of his players, and then modifying and customizing the game plan, putting his men in situations where they are likely to succeed. For example, the New York Jets allowed Danny Woodhead, the undrafted little 5-foot 8-inch running back, to languish on the sidelines. After the Jets released him Mr. Belichick hired him and now successfully uses him in specific plays and situations that take advantage of his skills. Mr. Woodhead was one of the stars in last season’s Superbowl.
Is it possible to learn something from Mr. Belichick and apply it to firefighting? What if we could identify the person who does not know what he or she does not know, or the over-the-top risk taker, and use them in positions where they can succeed without putting themselves or others at risk? Instead of using them in fireline positions, maybe they could succeed as a Ground Support Unit Leader. Or maybe they should not be promoted into a position where they would put firefighters at risk.
Neil LaRubbio recently wrote an article titled “Dead man working”. Here is an excerpt:
…From 1980 to 2010, an average of 17 firefighters died nationally each year, the majority in Western forests, six more on average than during the previous 30 years. Yet, no fire manager would say that safety awareness has become lax. No matter the agency’s culture, getting these roughnecks to act right in desperate situations can be the most maddening variable of all.
[…]
What kind of worker is most likely to choose risk over reason? Researchers at the University of Montana’s Department of Health and Human Performance have come to some conclusions. They found that 20 percent of wildland firefighters demonstrate symptoms of attention deficit-hyperactivity disorder, compared to a national average of 9 percent. The researchers discovered similar statistics in miners, suggesting that people with ADHD gravitate toward high-risk jobs. Research like this may help industry mold environments that accommodate the risky ways in which some people unconsciously approach dangerous work. For example, according to the University of Montana study, individuals with ADHD show higher rates of substance abuse, which may explain the unsparing quantities of alcohol my fire crew in Montana consumed, or the fairytale levels of meth that are said to circulate among oil field, short-haul truckers.
When we report on serious accidents or fatalities on wildfires, we always try to obtain a copy of the official investigation report from the jurisdiction involved. But for the incidents on federal land at least, and on other lands in most of the western states, the responsible organizations almost always make the report available freely and conveniently, usually on the internet.
The primary reason to distribute accident reports as widely as possible is to reduce the chance of similar accidents. We call these “lessons learned”. There are entire organizations and web sites devoted to this concept, such as the Wildland Fire Lessons Learned Center, the U.S. Army’s Center for Army Lessons Learned, and the Department of Homeland Security’s Lessons Learned Information Sharing site. We put together the document titled Infamous Wildland Fires Around the World, which is a partial list, by date of the year, of some of the more famous, or infamous, multiple fatality wildland fires around the world over the last 150 years. We hope that firefighters will remember these accidents and the lessons learned from them.
But it is much more likely that mistakes made on fires in Nebraska will be repeated.
When we searched for an official report about the triple fatality on the April 28, 2011 prescribed fire near Trenton, Nebraska, we came up with nothing. We linked to a pretty good newspaper report, and asked if our readers were aware of an official report on the incident. One them told us that there was a multi-step process that involved many exchanges via snail mail to get a copy of a fire accident report in Nebraska. And it usually takes about a month, they said.
We called Jim Heine, the Assistant Fire Marshal in Nebraska and asked him how to obtain a copy of a report. He said it was a “simple one-step process”. But it turns out that there are five six steps.
Complete an application form to request the report. The form can be downloaded from the Fire Marshal’s web site, printed, and completed by hand.
Send it to the Fire Marshal’s office by fax or by snail mail.
The agency’s legal counsel reviews the request. If it is approved….
The Fire Marshal’s office sends you an invoice.
You send the Fire Marshal’s office the payment for the report (a typical fee is $3.50).
The Fire Marshal’s office snail mails you the report.
We asked Mr. Heine why the reports were not available on the internet. He said “If you had a family member who died on a fire would you want the report to be public?”
We have heard of many family members who had loved ones that died on a fire who are vehement that the circumstances and lessons learned become public. They would like to prevent other families from losing a loved one and going through the same pain and suffering. Two recent examples that come to mind are the CR 337 fire in Texas last year and the Carson Helicopter crash in 2008 on the Iron Complex fire near Weaverville, California.
Lynette Hamm’s son, Caleb Hamm, passed away on the CR 337 fire in Texas last July. When told about Nebraska’s policy on accident reports, she said:
I can only surmise Mr. Heine has never lost a loved one before. If so, I believe he would want to get to the bottom of it, however it happened, and have those findings available for future training. If the firefighting community really wants to learn from past mistakes/accidents, wouldn’t we want those reports to be made available to everyone in the hopes of preventing another occurrence? I would think so.
Nina Charlson’s son, Scott Charlson, died along with eight other firefighters and air crew members in a helicopter crash on the Iron Complex (or Iron 44) fire in 2008. Ms. Charlson has been very active in following up on the investigations of the accident. When she and family members of other firefighters attended a National Transportation Safety Board forum in November, she released a statement that included the following:
…We cannot bring our loved ones back but if we can stand up for safety changes for future passengers – that is what we want to do.
When told about Nebraska’s policy, she replied in part:
I think it is reasonable that if the victims families did not want to have details made public (maybe their firefighter made a stupid mistake) they could request it – but still firefighters should have the information for future safety measures.
The purpose for any future actions of the Iron 44 families part is definitely for the purpose of safety.
Maybe I led a sheltered life as a firefighter, or perhaps I just worked around people who made safety number one, but until today I had never heard of filling a bladder bag (backpack pump) with a mixture of gasoline and diesel fuel and using it to apply the burn mix onto brush or slash piles that were to be burned, or were presently burning. But apparently it is a common practice on some U.S. Forest Service districts, according to a recently released “Lessons Learned” document. Below is an excerpt; the entire document is HERE. After the reported near miss, those practices may change.
I was walking down the hall of the district office with one of the district staff when we stepped into a conversation some of the crew leaders and assistant crew leaders where having about a near miss on some pile burning operations the previously day. There had been a flashback of flame toward one of firefighters while using a Fedco five gallon with fuel mix (piss bag/ bladder bag) to fuel the ignition on one of the piles. Some of the group was thinking it was no was big deal, some were trying to defend the action of using the Fedco as a firing tool, some were not sure and others thought it was not the right tool for the job. One individual said “we used to use them in region “X” and on my old forest all time in pile burning no big deal you have to just be careful with the flashback”.
I decided to bring it forward to the group that this is something we need to talk about, some were a little reluctant but everybody joined in. I had someone inform the rest of the folks waiting to go out pile burning that we all needed to talk about this issue and that “the piles would wait”. Someone pointed out “have you ever seen a dry piss bag on a fire and did you think there was fuel on the outside of the bag”?
The employee who had the near miss said his fire shirt had fuel on it. We talked how the drip torch had a spark arrest in it, and you are creating a fine mist at the nozzle when you pump the bladder bag which is also creating flumes which comes back and creates the flash that becomes a very unsafe operation.
The subject came up how to carry 5 gallon of fuel mix up the hill as the gas cans weight down on the arm. We asked those that did not think this was the right device to use, why did they not say anything. They felt that they were not going to use it and the person who filled it up was the senior leader of the group.
“What if this had not been a near miss but more serious we should have spoken up or at least talked about it.” We discussed, both as a group and one-on-one, the actions, planning and proper tools to use. We all need to have more training and discussions of proper tools, safety, and minimizing risks.
From the FLA. Employee’s left leg after 5 surgeries
I will have to admit that when the National Wildfire Coordinating Group’s Risk Management Committee distributed some information earlier this year about rhabdomyolysis, which is frequently referred to as “rhabdo”, I didn’t pay much attention. But today when the Wildfire Lessons Learned Center announced that a Facilitated Learning Analysis (FLA) for a severe case of rhabdo was available, I read it carefully and am now converted. The injury in the FLA occurred September 21, 2011 while a firefighter was taking the Work Capacity Test, or “pack test”. I have seen the light and realize how serious this condition can be.
Left untreated, or if not treated early enough, rhabdo can lead to irreversible muscle damage, permanent disability, kidney failure possibly requiring lifelong dialysis, and even death. Up to 8% of cases of rhabdomyolysis are fatal according to a NIOSH report. And all of this can be the result of exercising hard or engaging in a strenuous fire assignment if other risk factors are also present.
Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle contents (myoglobin) into the bloodstream which are harmful to the kidneys and may lead to kidney failure.
The link between rhabdo and “compartment syndrome”, the condition that is emphasized in the FLA, is certain, but it is not clear to me, having much more fire training than medical training, if compartment syndrome leads to rhabdo or vice versa, and my research found conflicting information. But that is not really important, in that both conditions are similar in that they are caused by damaged muscle tissue. Compartment syndrome occurs when the damaged muscle is inside an enclosed compartment in a fibrous sheath with other muscles, as is found in the arms and legs. Rhabdo can occur with any muscles, but both can lead to the same outcome, including death.
I was disappointed that the recently released FLA did not state the cause of the injured employee’s compartment syndrome/rhabdo, nor did it provide much useful information about how to prevent a similar occurrence, other than to “prioritize staying physically fit”, and the “incorporation of healthy lifestyle choices and better nutrition”. So I attempted to gather some information here in one place that will hopefully be useful for wildland firefighters, to increase their chances of avoiding rhambdo, or diagnosing it if it occurs. Continue reading
Above: Firefighter on the Shep Canyon fire in South Dakota, September 6, 2011. Photo: Bill Gabbert/Wildfire Today.
After reading our excerpt and later the full document from the the Serious Accident Investigation Factual Report for the hyperthermia fatality on the CR 337 fire in Texas, we heard from Dr. Brent Ruby, who has completed studies on this exact issue, even having studied wildland firefighters while they were working on fires. In one of his studies he was monitoring a wildland firefighter outfitted with a core temperature monitor, an ambient temperature sensor, and a special Camelback hydration system that monitored his water intake. This firefighter experienced a heat-related illness, heat exhaustion, and had to be evacuated off the fireline by a helicopter. That was a terrible thing to happen to a firefighter, and I’m sure the researchers thought the same thing, but it was probably a once in a lifetime cornucopia of incredibly useful data. Dr. Ruby sent us this message, reprinted here with his permission:
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. [*the abstract from the study is below]
Aggressive hydration strategies are over-preached and may provide a false sense of protection. It should be emphasized that the autopsy report as described in the fatality report indicated no signs of dehydration or electrolyte imbalance. I have tried to push these concepts to crews and safety officers when I get a chance to speak to them at meetings. I was bothered by this fatality knowing that it is seemingly directly linked to some of our research findings. I have tried to emphasize this to anyone that will listen in the world of wildfire.
You can certainly review our website to gain a better understanding of the publications we have done from research with the WLFF http://www.umt.edu/wpem. We have a great deal of physiological data, hydration, energy demands of the job, importance of supplemental feedings, etc. from all our work over the years. This peer reviewed research provides objective, scientific evidence that can be used to to change or influence policy to enhance safety on the line.
Let me know if you have any questions.
Regards, Brent Ruby
Brent C. Ruby, Ph.D., FACSM
Director, Montana Center for Work Physiology and Exercise Metabolism, The University of Montana
High work output combined with high ambient temperatures caused heat exhaustion in a wildland firefighter despite high fluid intake.
Cuddy JS, Ruby BC.
Montana Center for Work Physiology and Exercise Metabolism, The University of Montana, Missoula, MT 59812-1825, USA.
The purpose of this case study is to examine the physiological/behavioral factors leading up to heat exhaustion in a male wildland firefighter during wildland fire suppression. The participant (24 years old, 173 cm, 70 kg, and 3 years firefighting experience) experienced heat exhaustion following 7 hours of high ambient temperatures and arduous work on the fire line during the month of August. At the time of the heat-related incident (HRI), core temperature was 40.1 °C (104.2 °F) and skin temperature was 34.4 °C (93.9 °F). His work output averaged 1067 counts·min(-1) (arbitrary units for measuring activity) for the 7 hours prior to the HRI, a very high rate of work over an extended time period during wildfire suppression.
In the 2.5 hours leading up to the heat incident, he was exposed to a mean ambient temperature of 44.6 °C (112.3 °F), with a maximum temperature of 59.7 °C (139.5 °F). He consumed an average of 840 mL·h(-1) in the 7 hours leading up to the incident and took an average of 24 ± 11 drinks·h(-1) (total of 170 drinks). The combined effects of a high work rate and high ambient temperatures resulted in an elevated core temperature and a higher volume and frequency of drinking than typically seen in this population, ultimately ending in heat exhaustion and removal from the fire line.
The data demonstrate that heat-related incidents can occur even with aggressive fluid intake during wildland fire suppression.
Unfortunately, even though Dr. Ruby’s research is funded by taxpayers through the National Institutes of Health, the National Science Foundation, and the Department of Defense, taxpayers are blocked from seeing the full results unless they pay a fee to the privately owned company that published the paper. We have written before about the results of taxpayer-funded wildfire-related research being held hostage by private companies. Dr. Ruby told Wildfire Today that he will send a copy of his paper to individuals that write to him at brent dot ruby at mso dot umt dot edu
The combined information about the fatality of Caleb Hamm on the CR 337 fire and Dr. Ruby’s study on wildland firefighters, is shocking. From the abstract, again:
The data demonstrate that heat-related incidents can occur even with aggressive fluid intake during wildland fire suppression.
Working on a wildfire on a hot day can lead to heat exhaustion and hyperthermia, and can be fatal EVEN IF a person drinks plenty of water and is not dehydrated.
Symptoms and prevention
We asked Dr. Ruby for more information:
Exertional hyperthermia occurs when the metabolic heat production from hard work overwhelms the bodies ability to off load it to the environment. This unloading can be blocked by clothing and/or slowed due to high radiant heat from the sun or an adjacent fire.
The basic symptoms of heat exhaustion are commonplace and can include profuse sweating, weakness, nausea, sometimes vomiting, lightheadedness, headache and sometimes mild muscle cramps.
The best approach [to prevent heat exhaustion and hyperthermia] is to know thyself and thy physical limits. Establishing a pace schedule that allows temperature to come back down in between periods of work that result in a rise in temperature. The factors of importance are pace, fitness level for the task at hand, hydration behaviors and simultaneously electrolyte concentrations in the blood.
It is important for wildland firefighters to drink plenty of water, but this will not, by itself, totally eliminate all chances of heat-related illness.
Be careful out there.
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UPDATE October 27, 2011:
Dr. Ruby sent us the following list of other publications on similar topics that are in peer reviewed journals. I assume that most of them are not available to the public (don’t get me started on that again!) unless you pay the ransom fees at the private companies, or send a message to Dr. Ruby: brent dot ruby at mso dot umt dot edu
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UPDATE October 28, 2011:
The U.S. National Library of Medicine has an excellent article about heatstroke, which can follow heat cramps and heat exhaustion and is life-threatening. The article includes causes, symptoms, first aid, what not to do, when to call 911, and prevention (including “avoid exercise or strenuous physical activity outside during hot or humid weather”. Good luck with that one, firefighters.)
