On December 18, 1998, a 55-year-old male volunteer Fire-Police Officer responded to a motor vehicle accident (MVA) in his privately owned vehicle. The victim's vehicle, equipped with emergency bar lights, stopped on the highway shoulder approximately 500 yards in front of the MVA scene, presumably to warn oncoming motorists. When his fire company was released from the scene, the victim did not respond to the radio message. Shortly thereafter, he was found unresponsive, slumped over the steering wheel, with his foot on the brake and the vehicle still in gear. Despite basic life support (BLS) and advanced life support (ALS) applied in the field, in the ambulance, and in the hospital's emergency department, the victim died. The death certificate listed the immediate cause of death as "sudden cardiac death" due to "coronary artery disease" due to "diabetes mellitus." No blood was sent for laboratory analysis; therefore, no carboxyhemoglobin levels, cardiac isoenzymes, or drug tests were available. No autopsy was performed. Eight years prior to his death, the victim had a myocardial infarction (heart attack) and subsequent coronary artery bypass surgery. Four months prior to his death, the victim was hospitalized for congestive heart failure (CHF) and, at that time, had a persantine/thallium stress test which showed a moderate amount of scarring from his previous myocardial infarction and a mild amount of myocardial ischemia (reduced blood supply to the heart). Approximately 5 weeks after discharge, with his CHF stabilized, the victim requested medical release to fire/ police duties. The following recommendations address preventative 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. These recommendations have not been evaluated by NIOSH, but represent research presented in the literature, consensus votes of technical committees of the National Fire Protection Association (NFPA), or products of labor/management technical committees within the fire service. In addition, they are presented in a logical programmatic order, and are not necessarily listed in order of priority. This preventative strategy consists of (1) minimizing physical stress on fire fighters, (2) screening to identify and subsequently rehabilitate high risk individuals, and (3) encouraging increased individual physical capacity (fitness). Steps that could be taken to accomplish these ends include: Individuals with medical conditions that would present a significant risk to the safety and health of themselves or others should be precluded from emergency response activities. Emergency response personnel 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. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by offering a wellness/fitness program for emergency response personnel. Carboxyhemoglobin levels should be tested on symptomatic or unresponsive emergency response personnel. Perform an autopsy on all on-duty emergency response personnel who were fatally injured while on duty.