By Jon Peterson
It’s 0815. You’ve barely had time to finish your first cup of coffee when a structure fire drops. You throw on your gear and head out to job town. The heat hits hard. The adrenaline kicks in. An hour or two later you realize something’s off, you haven’t used the bathroom since before shift. You’ve been chugging water, maybe some Gatorade or an electrolyte mix, but your body’s sending a message: You’re dehydrated.
For most firefighters, this scenario is all too familiar. Whether it’s a full day of training, a 90-degree day in full PPE on a natural gas leak, or a long wildland incident, dehydration is a constant, and often ignored, companion in the fire service.
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But at the Medford (Oregon) Fire Department, that reality sparked a transformation. What began as a simple question — Why are we always playing catch-up on hydration? — grew into a groundbreaking hydration and rehabilitation treat-in-place protocol that now serves every agency in Jackson County.
The hidden threat: Starting the shift behind
Ask any firefighter: Have you ever been drinking fluids all day but still felt sluggish, foggy or overheated? The answer is always yes. In fact, many firefighters arrive for duty already behind on hydration. Caffeine, poor sleep, stress and inconsistent morning routines mean mild dehydration is the baseline, and it only gets worse once the work starts.
Once dehydration sets in deeply, it can cause your heart to beat faster or even an irregular heartbeat or palpitations. In addition, dehydration makes your blood thicker and constricts your blood vessel walls. This causes high blood pressure and extra strain on your heart. Simply drinking water or electrolyte drinks isn’t enough. Full rehydration can take up to 24 hours and possibly hospital treatment to recover from advanced dehydration. But the job doesn’t wait a day for recovery.
So, Medford Fire started asking new questions:
- How can we fix dehydration fast?
- How do we keep crews safe during back-to-back incidents?
- Can rehab be more than shade, water and a 20-minute cooldown?
- What if hydration wasn’t left to chance or individual habit?
- What if the department had a formal, evidence-based hydration policy that would guide preparation, support operations and ensure consistent practices?
The answer came in the form of a tool fire departments have but rarely use for firefighters themselves: IV rehydration. With that simple idea, the department began building a framework to protect its personnel from an entirely preventable hazard.
The game-changer: IV rehydration
After a series of brutal, hot-weather incidents, Medford Fire initiated a bold directive: If conditions warrant, every firefighter entering rehab gets an IV before heading back to the station or returning to duty.
The results were immediate. Energy returned faster. Vitals stabilized faster. Crews were safer heading back into service. And most importantly, heat-related symptoms dropped significantly. IV fluids were no longer reserved for downed or transported firefighters; they became an operational health tool.
Over time, Medford Fire identified clear “trigger points” for IV treatment:
- Working fires where personnel use two or more SCBA bottles.
- Extended technical rescue incidents.
- Hazmat incidents requiring encapsulating suits.
- Extended wildland incidents.
- Any event lasting more than 1 hour with a heat index above 90 degrees F or windchill
- index below 10 degrees F.
- Any call where exertion and heat combine long enough to risk heat stress.
- Training burns and extended training exercises.
- As requested by the incident command or safety officer.
These decisions weren’t made casually; they were supported by the county’s physician advisor and integrated directly into county EMS protocols.
Building a countywide system
With the foundation laid in Medford, the protocol expanded into a full Responder Rehabilitation – Treat in Place policy for all agencies in Jackson County. This wasn’t just about IV bags, it was about developing a complete, standardized approach to hydration, rest, nutrition and medical evaluation.
The policy breaks rehab into three essential layers.
1. Personal responsibility — hydration starts before the call: Every firefighter is expected to arrive hydrated and self-sufficient for up to six hours. Rehab can’t solve problems that start at home, so education and personal accountability are built into the system.
2. Level 1 rehab — quick, crew-based recovery: For smaller incidents or short training evolutions, company officers manage basic rehab, oral hydration, temperature control, food intake, and a simple physical assessment. It’s fast, practical, and prevents small issues from becoming big ones.
3. Level 2 rehab — full medical monitoring and intervention: This is the gold standard for major incidents. Level 2 is activated from our trigger points. This level includes a dedicated rehab area away from heat, smoke and exhaust; weather protection; ALS/BLS staffing; nutrition and hydration stations; full vital sign monitoring; and IV therapy when indicated. In other words, the days of “grab a bottle of water and get back in there” are over.
A system built for the modern fire environment
Wildland seasons are longer. Heat waves are hotter. Wildland-urban interface incidents grow more complex every year. Today’s firefighters need more than tradition; they need medically driven protocols designed for a changing operational world. Medford Fire Department’s hydration and rehab policy acknowledges that reality. It protects firefighters not only from emergencies but also the cumulative wear of multiple shifts, long calls and intensifying environmental conditions. It also sends a clear message: Ensuring firefighter health is not optional; it is operationally essential.
Leading the way forward
From its origins at Medford Fire to its countywide adoption, this program represents a modern approach to firefighter wellness. It blends common-sense hydration practices with advanced medical intervention and standardized rehab procedures. More importantly, it challenges the old mindset that dehydration and heat stress are just “part of the job.” Dehydration is preventable. Heat injuries are preventable. Fatigue-driven mistakes are preventable. Medford Fire shows exactly how.
For fire departments across the country looking to update their practices, the message is simple: Hydration is operational readiness — and readiness saves lives.
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ABOUT THE AUTHOR
Jon Peterson is a captain with the Medford (Oregon) Fire Department. He serves as the department’s PPE specialist, health and safety officer, swiftwater rescue lead, and on the department’s REM team. He is also an Oregon district representative for the Firefighter Cancer Support Network. Peterson has a bachelor’s degree in health and physical education. Contact Peterson.
