Rhabdomyolysis Risk in Firefighters

Firefighter wearing turnout gear and oxygen tank climbing stairs to enter building engulfed in flames

Firefighters are at an increased risk for rhabdomyolysis. Rhabdomyolysis, or rhabdo, is the breakdown of damaged muscles. This breakdown releases muscle cell contents (proteins and electrolytes) into the blood. This can damage the heart and kidneys, result in permanent disability, and can even be fatal! If treated early, most firefighters can return to work in a few days without lingering effects. Firefighters should learn the signs and symptoms of rhabdo and quickly seek medical care to prevent serious medical problems.

Why are firefighters at risk?

Anyone can get rhabdo, but firefighters (both structural and wildland) have increased risk due to their jobs. Job factors that can increase their risk include:

  • Elevated core body temperature from
    • exposure to fires
    • working in hot seasons or geographic area (e.g., summer in the U.S. south)
    • performing physically strenuous tasks (e.g., carrying chainsaws or heavy gear, victim rescue, climbing stairs or ladders with heavy equipment)
    • wearing personal protective equipment (turnout gear) that can trap body heat
  • Traumatic injuries to muscles (e.g., struck by collapsing structures or trees)
  • Overuse injuries from performing strenuous tasks for long periods

How can firefighters protect themselves?

 1.) Learn the signs and symptoms

  • Muscle cramps, aches, or pains that are worse than expected
  • Dark urine (tea- or cola-colored)
  • Feeling weak, tired, or unable to complete typical job tasks or workout routine

Symptoms might not appear until several days after injury. Rhabdo signs and symptoms may look like other heat-related illnesses or dehydration. Only a blood test can tell if rhabdo is happening.

Doctor with patient

2.) Get medical care immediately whenever you have any symptoms that could be rhabdo

Early diagnosis and treatment are crucial to prevent serious long-term effects. The only way to know if you have rhabdo is to obtain a blood test.

Firefighters should download this wallet card and give it to their healthcare provider. The card reminds providers that firefighters are at risk for rhabdo and how to check for it. If you are a firefighter and have any symptoms, do not hesitate to give this card to your healthcare provider.

3.) Find other ways to lower your risk

  • Take time to adapt to your physical activity level and heat exposure before working for long periods of time, or when returning from vacation or starting a new job in a different climate.
  • Gradually increase intensity and duration of new workouts or training programs.
  • Stay home from work when sick.
  • Be aware of medications that increase your rhabdo risk. These include over-the-counter cold and allergy medications and statins used to treat high cholesterol.

Supervisors and fire service leadership can help protect firefighters from developing rhabdo.

  • Have a heat stress management program that includes training in rhabdo risk factors, signs, symptoms and why to seek medical treatment.
  • Encourage firefighters to seek medical care when they have symptoms. Let them know they can return to work or training once they get cleared by their doctor.
  • Schedule training exercises on cooler months, at night, or in the morning.

Learn more about rhabdo

We encourage you to learn more about rhabdo and share these resources with others. NIOSH has developed factsheets on rhabdo for wildland firefighters and their healthcare providers, and for structural firefighters and their healthcare providers.

Page last reviewed: August 2, 2021