On October 25, 1997, a 47-year-old female fire fighter from a volunteer Fire Department assisted a neighboring Fire Department fight a tire fire which generated a large amount of smoke. The victim's primary responsibilities during the incident consisted of spraying water on the burning tires. She was wearing full turnout gear including her self-contained breathing apparatus (SCBA), but had complained to her partner that an unusual hissing sound was coming from the SCBA. The victim used a single tank of air over approximately 25 minutes of fire suppression activities. At the fire ground's rehabilitation unit she did not complain of any chest pain, and her pulse and blood pressure were within acceptable limits. Total time "in service," which includes the time traveling to the fire scene, at the fire scene, and returning from the fire scene, was 3 hours and 10 minutes. A few minutes after returning to the fire station the victim complained of not feeling well, and while coworkers were evaluating her, she collapsed. CPR was immediately initiated by emergency medical technicians (EMTs) at the fire station, followed by advanced life support (ALS) administered by paramedics from the responding ambulance service. Despite ALS measures administered for a total of 21 minutes en route to the hospital, and for more than 2 and a half hours in the hospital's emergency department, the victim died. An autopsy report listed "coronary atherosclerosis, moderate, with hemorrhage into a plaque" as the final diagnosis. Subsequent testing of the SCBA revealed no malfunctions, and ante-mortem and post-mortem carboxyhemoglobin levels were not detected, indicating that the victim was not exposed to excessive concentrations of carbon monoxide prior to her death. A blood alcohol and drug screen were negative. The following recommendations address preventive measures that have been recommended by other agencies to reduce, among other things, the risk of on-duty heart attacks and cardiac arrests among fire fighters. It cannot be determined, however, whether these recommendations could have prevented the sudden cardiac arrest and subsequent death of this Fire Fighter. These recommendations have not been evaluated by NIOSH but represent research presented in the medical literature or of consensus votes of Technical Committees of the National Fire Protection Association (NFPA) or labor/management groups within the fire service. This strategy consists of (1) medical screening to identify and subsequently rehabilitate individuals at higher risk, and (2) encouraging increased individual physical capacity. Steps that could be taken to accomplish these ends include Fire Fighters should have annual medical evaluations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. As contained in the OSHA revised respiratory protection standard, provide fire fighters with medical evaluations to determine fitness to wear a self-contained breathing apparatus (SCBA). Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by offering a wellness/fitness program for fire fighters.