New NIOSH Resources in Recognizing Rhabdo in First Responders

The National Institute of Occupational Safety and Health (NIOSH) has developed two sets of factsheets — one for structural firefighters and their healthcare providers and another for wildland firefighters and their healthcare providers, to increase awareness about the signs and symptoms of rhabdomyolysis (commonly referred to as “rhabdo”) and help firefighters get early treatment to prevent more serious medical problems.

Firefighting, both structural and wildland, involves tasks in environments that place firefighters at increased risk for rhabdomyolysis. Rhabdomyolysis is a breakdown of muscle tissue that releases proteins and electrolytes into the bloodstream and can cause heart and kidney damage. If left untreated, severe rhabdo may be fatal or result in permanent disability. Heat exposure and intense physical effort are just two of many known risk factors for rhabdo.

NIOSH also developed wallet cards for both types of firefighters that remind healthcare providers that firefighters have an increased risk for rhabdo.

Symptoms of rhabdomyolysis may include:

  • Muscle cramps, aches, or pain that are more severe than expected;
  • Exercise intolerance – unable to complete a usual workout routine;
  • Abnormally dark (tea- or cola-colored) urine; and
  • Weakness.

Symptoms may not appear for up to several days after a firefighter was physically active or exposed to heat. Rhabdo symptoms may look similar to heat cramps and dehydration. The only way to tell for certain if rhabdo is occurring is to have a healthcare provider draw blood to check for creatine kinase, an enzyme inside of muscle tissue that is released when muscle is injured or dies.

Early diagnosis and start of treatment for rhabdo is essential and can ensure recovery from rhabdo without any lasting effects.