Although not common in horses, fire and smoke inhalation trauma may require veterinary assistance at several levels. Most commonly, the equine clinician is called on to provide care of potentially complex and emotionally charged cases. Thermal injury, along with smoke inhalation, can cause local and diffuse lesions. Massive tissue edema may occur, which can be a challenge to manage as well as creating organ dysfunction at distant sites. Further complications of severely affected patients are varied and include life-threatening sepsis. This article reviews some of the important features of this type of trauma.