On September 30, 1998, a 56-year-old male volunteer fire chief collapsed while monitoring pumper truck operations during a training drill conducted at a local nursing home. The fire chief was wearing full turnout gear but no self-contained breathing apparatus (SCBA). He was not engaged in strenuous activities at the time, but it was a hot and humid day. According to witnesses, the fire chief showed no signs of distress when talking briefly with fire fighters during the drill. Later he was seen walking to the rear of the pumper (without his bunker coat). Approximately 5 minutes later, he was seen walking around back toward the pumper panel when he suddenly collapsed. Within 2 minutes, on-scene emergency rescue personnel who were also participating in the fire drill reached the unconscious chief and initiated cardiopulmonary resuscitation (CPR) followed by advanced cardiac life support (ACLS) including cardiac defibrillations, external pacing, endotracheal intubation, oxygen, and multiple doses of medications. ACLS continued during the 1-hour trip to the hospital; however, after a brief initial weak heart beat during pacing, resuscitation efforts were unsuccessful, and the patient never regained consciousness. At the hospital emergency room, an initial assessment showed fixed dilated pupils and no cardiac electrical activity, and the patient was pronounced dead. The death certificate stated acute coronary insufficiency as the cause of death; no autopsy was done. The following recommendations address health and safety issues in general. It cannot be determined, however, whether these recommendations could have prevented the sudden cardiac arrest and subsequent death of this fire chief. These recommendations rely on a two-pronged strategy proposed by other agencies for reducing the risk of on-duty heart attacks and cardiac arrests among fire fighters. This strategy consists of (1) screening to identify and subsequently rehabilitate high-risk individuals; 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. Provide fire fighters with medical evaluations to wear self-contained breathing apparatus (SCBA). Perform an autopsy on all fire fighters who were fatally injured while on duty. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by implementing a wellness/fitness program for fire fighters.