Case Study: Heat Illness on an Early-Season Wildland Fire Assignment

The Setting

You are working on a Type 2 initial attack handcrew in the Deschutes National Forest during the early part of fire season. It’s one of the first assignments of the year, and while conditions aren’t extreme yet, temperatures have climbed into the mid-80s°F with full sun exposure on a south-facing slope.

The crew has been hiking, digging line, and carrying tools for several hours. Many members are new and this is the crew’s second week together. Smoke from a nearby smoldering section of the fire is intermittently blowing across the line.

Around mid-afternoon, one of your crewmembers, a 26-year-old female named Taylor, begins to lag behind. You notice she looks flushed and is moving more slowly than earlier in the shift. When you check in, she says she’s feeling “off,” a little dizzy, and nauseated. She also mentions her eyes are irritated from the smoke and that her contact lenses are bothering her.

You are the crew’s designated Wilderness First Responder (WFR). You decide to stop and perform an assessment.

SOAP Report

Subjective

The patient is a 26-year-old female whose chief complaint is dizziness, nausea, and fatigue during exertion. Symptoms began gradually over the past hour while working on the fire line. She reports feeling overheated, lightheaded, and mildly nauseated. She denies chest pain, shortness of breath, or altered mental status.

She also reports eye irritation and dryness, likely related to smoke exposure and contact lens use.

The patient is alert and oriented.

Objective

TIME	15:30
LOR	A+Ox4
HR	96, strong, regular
RR	22, regular, easy
SCTM	Red, Warm, Sweaty
B.P.	radial pulse present
Pupils	PERRL
T°	Not taken

Patient Exam:
Patient is standing but appears fatigued and slightly unsteady. Skin is flushed, warm, and sweaty. She is moving slower than baseline and prefers to sit down. No signs of trauma. Mental status is intact. No ataxia beyond mild fatigue-related unsteadiness. Eyes appear mildly red and irritated. No respiratory distress noted.

Vital Signs

History

Symptoms:	Dizziness, nausea, fatigue, feeling overheated. Eye irritation and dryness.
Allergies:	No known allergies.
Medications:	Patient reports taking a prescribed stimulant medication for ADHD.
Pertinent Hx:	Patient reports she has not yet fully acclimatized to working in heat this year, having just finished up ski-resort work.
Last in/out:	Patient reports drinking approximately 1 liter of water over the past several hours. Ate breakfast and a light lunch. Urinated once earlier in the shift; urine described as dark yellow.
Events:	Symptoms developed during sustained physical work on a hot, exposed slope with intermittent smoke exposure.

What is your Assessment and Plan? Think about this before moving to the next page.

Assessment

• Heat exhaustion due to exertion, heat exposure, and lack of full heat acclimatization.
• Dehydration likely contributing
• Stimulant medication may be a contributing factor by affecting thermoregulation, hydration status, and perceived exertion.
• Smoke irritation causing eye discomfort; not the primary cause of systemic symptoms.

Plan

• Stopped work and moved the patient to a shaded area.
• Removed pack and loosened clothing to promote cooling.
• Initiated active cooling (shade, airflow, cool water on skin).
• Encouraged oral rehydration with water and electrolytes.
• Monitored mental status and vital signs for progression.
• Advised rest until symptoms improved.
• Addressed eye irritation:
  • Patient removed contact lenses
  • Switched to eyeglasses
  • Flushed eyes with clean water as needed
• Communicated with crew leadership to modify work assignment and reduce exertion for the remainder of the shift.
• Continued monitoring for signs of worsening heat illness (confusion, cessation of sweating, worsening vitals).
  

Anticipated Problems: 

• Progression to heat stroke if not managed appropriately
• Continued dehydration
• Reduced work capacity impacting crew operations
• Ongoing smoke irritation affecting comfort and vision

What Happened?

After 30–45 minutes of rest in the shade, hydration, and active cooling, Taylor reported significant improvement in her symptoms. Her heart rate decreased, and she felt less dizzy and nauseated. She was able to rejoin the crew in a reduced role with lighter duties and more frequent breaks.

Switching from contact lenses to eyeglasses improved her eye comfort significantly in the smoky conditions.

Over the next several days, the crew implemented more structured hydration, rest breaks, and heat adaptation strategies. Taylor continued to improve and did not experience further symptoms.

Comments

Heat illness is common early in the wildland fire season, when firefighters have not yet fully adapted to working in hot environments. Certain medications, including stimulant medications, can increase risk by affecting hydration, heat tolerance, and exertion levels. Awareness of these factors can help guide earlier intervention and prevention strategies.

Early recognition is key. Symptoms like dizziness, nausea, fatigue, and increased heart rate should prompt immediate intervention. Cooling, hydration, and rest are effective treatments when applied early, but continued exertion without intervention can lead to more serious illness.

Smoke exposure is another common factor on the fire line and can contribute to discomfort, especially for contact lens users. Simple interventions, like switching to eyeglasses and flushing the eyes, can improve comfort and function.

Monitoring trends and adjusting workload, hydration, and rest cycles are essential for prevention and management. Small changes early can prevent larger problems later. Having a reliable reference in the field can help reinforce recognition and treatment of heat illness under operational stress. Carrying resources like the NOLS Wilderness Medicine Field Guide allows you to review treatment priorities and decision-making guidelines when conditions are dynamic and demanding.