Extreme Heat and the “Terrible Twins”: What Fire Service Leaders Should Know

By: Robert Avsec, Executive Fire Officer

If you think it feels hotter than ever—you’re not wrong. According to NOAA, the three hottest years on record for the contiguous United States are:

  • 2012 – Still ranks first, with widespread drought and prolonged extreme heat.
  • 2016 – Characterized by persistent warmth throughout the West and Northeast.
  • 2023 – Recently made the top tier, with record-breaking heat and prolonged heat waves across the country.

Nine of the ten warmest U.S. years have occurred since 1998, reflecting a clear long-term warming trend. And if 2025 keeps up this momentum, it may be next in line for the record books.

With the Summer Solstice just behind us (June 20), meteorological summer is officially underway. And as daily temps soar into the 90s, so too does the risk of what we call the “Terrible Twins”—hyperthermia and dehydration—for firefighters.

Dr. Denise Smith is a leading expert in exercise physiology with a deep focus on firefighter health and safety and coined the term “Terrible Twins.” Based in Saratoga Springs, New York, she has served as a professor at Skidmore College and is currently the Director of the National Research and Data Division at the U.S. Fire Administration.

Her research centers on the physiological effects of firefighting, especially the cardiovascular strain caused by intense physical exertion, heat stress, and psychological pressure. She’s investigated how firefighting may alter blood clotting potential—an important factor in sudden cardiac events. Dr. Smith has also led numerous government-funded studies exploring strategies to reduce physiological strain during fireground operations.

Figure 1. Hyperthermia and dehydration – aka, the “terrible twins” of firefighter heat stress – can cause myriad physiological and behavioral problems for firefighters. Image/Robert Avsec

For more on the “Terrible Twins” and those physiological and behavioral problems see this article that features the work of Dr. Smith and her team at Skidmore College, 5 ways firefighters can manage heat stress.Sharpening the Saw—Even in the Heat

Training and drilling are essential opportunities to refine firefighting and rescue skills. Even when the temperature climbs, this work must continue—with an even greater emphasis on safety, hydration, and recovery. All firefighters and officers should be informed and educated about the 3 Factors in Firefighter Heat Strees (See Figure 2 below).

Figure 2. Research conducted by Dr. Denise Smith and her colleagues identified three common aspects of a firefighter’s job that contribute to heat stress both during training and on the fireground. Image/Robert Avsec

Update Your Training “Playbook”

Fire service leaders: now is the time to review your SOGs and procedures for conducting training, especially live fire sessions. Dust off your copy of the NFPA 1403 Standard on Live Fire Training Evolutions and review it with your team. This standard applies to all types of live fire training—not just those involving acquired structures.

Want to explore the broader set of guidelines? Here’s the complete list of NFPA Fire Service Standards.

📚 See also: 4 Steps to Safe, Realistic Live-Fire Training

Firefighter Rehab: Not Just for the Fireground

Does your department have a specific SOG addressing outdoor hot-weather training? If not, consider adapting a sample like this: Sample SOG for Training Activities During Hot Weather, developed during my time as Training and Safety Division Chief with Chesterfield County (VA) Fire and EMS.

Firefighter rehab during training isn’t just recommended—it’s essential. Use these sessions to:

  • Build a culture of rehab awareness among firefighters and officers
  • Test and refine your existing rehab SOGs
  • Experiment with new tools or equipment for efficient, effective rehab
Hot weather training

Because at the end of the day: your people will play the game the same way they practice.

For more resources, visit: Firefighter Rehab – An Introduction to NFPA 1584

Read Next: Hot-weather training guide: 10 ways firefighters can stay fit and safe in the summer heat

About Robert Avsec, Executive Fire Officer

Battalion Chief (Ret.) Robert Avsec served with the men and women of the Chesterfield County (VA) Fire and EMS Department for 26 years. He’s now using his acquired knowledge, skills, and experiences as a freelance writer for FireRescue1.com and as the “blogger in chief” for this blog. Chief Avsec makes his home in Charleston, WV. Contact him via e-mail, [email protected].