The 2025 wildfire season set records across the United States and Europe. Longer burn periods, higher ambient temperatures, and expanding fire zones are putting firefighters at unprecedented risk of exertional heat stroke. The 2026 season has started. Here is what fire service medical officers and safety teams need to know — and deploy — right now.
Why firefighters face extreme heat stroke risk
Firefighters working wildland and structural fires face a combination of heat stress factors that no other profession matches:
Turnout gear and PPE covers more than 60 percent of body surface area, dramatically limiting evaporative cooling. The gear that keeps firefighters safe from flames traps heat against the body.
Sustained high-intensity exertion in already hot environments. A firefighter on the fire line does not control their exertion level the way an athlete does. The mission dictates the pace.
Unpredictable engagement duration. A fire can shift in minutes. Planned two-hour rotations can become four or six hours without warning.
Radiant heat from the fire itself. Active flame fronts generate intense radiant heat well beyond the visible fire perimeter. Firefighters working near the head of a fire are exposed to temperatures far above ambient.
Dehydration under operational pressure. During active suppression, hydration windows are limited. Cumulative dehydration accelerates the onset of heat illness.
Recognizing EHS on the fireground
The clinical rules are the same as in any other context, with one important addition: do not dismiss the diagnosis because ambient temperature seems manageable. A firefighter working a 70-degree morning fire can develop EHS within the first hour of a heavy suppression push.
Warning signs in order of severity:
- Sudden unusual fatigue, severe headache, muscle cramping
- Confusion, disorientation, unusual behavior — this is the key diagnostic flag
- Stumbling, loss of coordination (ataxia)
- Stopping sweating despite continued exertion — late sign, indicates severe heat accumulation
- Loss of consciousness, seizures — immediate life threat
Any firefighter showing neurological signs during or after a heavy work period is a presumptive EHS case. Begin cooling immediately. Do not wait for confirmation.
The treatment protocol on the fireground
The principle is "cool first, transport second."
Every minute of uncontrolled core hyperthermia increases the risk of multi-organ failure. Delaying cooling to wait for transport or advanced medical care is a documented cause of preventable death.
Step 1: Remove from the heat environment Move the firefighter to the coolest available location. Remove PPE, helmet, and as much clothing as the situation allows.
Step 2: Measure core temperature Rectal temperature is the reference standard. Begin cooling even if temperature measurement is not immediately available — do not wait.
Step 3: Immerse in cold water Full-body cold water immersion is the gold standard. Use the coldest water available. Add ice if available.
Step 4: Monitor Rectal temperature every 5 minutes. Continue immersion until core temperature reaches 102 degrees Fahrenheit. Do not stop early.
Step 5: Activate EMS and transport Call simultaneously with immersion. Transport to a hospital even after apparent recovery — complications including rhabdomyolysis and kidney injury can develop hours later.
The logistics challenge: equipment must be at the point of need
The Incident Medical Unit or Forward Medical Post must be able to deploy a cooling capability in under two minutes from the moment a firefighter goes down.
The operational constraints are real:
- Standard apparatus do not carry fixed bathtubs
- Water access at the fire perimeter is not guaranteed
- One medical officer may be managing multiple casualties simultaneously
- Terrain is often uneven, sloped, or debris-covered
This is exactly the problem the Kollder emergency cooling tub was designed to solve. It deploys in under 30 seconds by a single person, on any surface, and fits in any apparatus or support vehicle. It eliminates the gap between knowing the protocol and being able to execute it.
What fire service medical teams should have in place now
Equipment:
- A deployable cold water immersion device at every medical post supporting wildland or extended structural operations
- Ice supply integrated into operational logistics for multi-hour engagements
- Rectal thermometers as standard medical kit
Training:
- Every company officer should be able to recognize EHS and initiate cooling without waiting for a medic
- "Cool first, transport second" must be a standing protocol, not a decision made under pressure
Planning:
- Identify water sources at staging areas for all planned operational areas
- Build cooling capability into the Incident Medical Plan for all Type 1 and Type 2 incidents
- Establish rotation schedules that account for heat index, not just clock time
The 2026 season starts now
May through October is the high-risk window across most of the United States. Pre-deployment inspection and preparation happens before the first fire of the season, not during it.
Check your medical kit. Brief your crews. Position your cooling equipment. The protocol saves lives only if the tools are already there.
Kollder is the emergency cooling tub built for fire service operations. Deploys in under 30 seconds, fits any apparatus, works on any terrain.
Kollder is the emergency cooling tub that deploys in under 2 minutes, anywhere.
Request a quote