On November 26, 1997, a 69-year-old male volunteer fire fighter responded to a structural fire of a wood-framed trailer. The victim was directing traffic around the fire scene and was not engaged in fire suppression activities when he had a witnessed collapse. Almost immediately, on-scene emergency rescue personnel reached the unconscious fire fighter and initiated cardiopulmonary resuscitation (CPR), which was followed by advanced life support (ALS) administered first by ambulance paramedics and then hospital emergency department personnel. Despite 50 minutes of attempted resuscitation activity, the victim died. The death certificate listed "arteriosclerotic cardiovascular disease" as the immediate cause of death. Autopsy confirmed the presence of triple vessel coronary artery disease, listed an enlarged heart (left ventricular hypertrophy), and found evidence of a remote (old) heart attack (myocardial infarction). The following recommendations address health and safety issues in general. It cannot be determined, however, whether these recommendations, had they been in effect in his department, could have prevented the sudden cardiac arrest and subsequent death of this fire fighter. 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 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; Provide fire fighters with medical evaluations to wear self-contained breathing apparatus (SCBA); Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by implementing a wellness/fitness program for fire fighters.