On March 16, 1999, a 56-year-old male fire fighter had just finished dressing for his work shift when he and his crew were toned out for a nearby motor vehicle accident. The victim never joined the response. Approximately 20 minutes later, as fire fighters returned from the incident to the fire station, they found the victim unresponsive, without a pulse or respirations. Despite cardiopulmonary resuscitation (CPR), including the use of semi-automatic external defibrillators (SAED) administered by fire fighters, and advanced life support (ALS) administered by ambulance paramedics and hospital emergency department personnel, the victim died. The death certificate, completed by the Certifying Physician, listed "asystole" as the immediate cause of death, due to "coronary artery disease." No autopsy was performed. Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty heart attacks, cardiac arrests, and sudden cardiac death among fire fighters. This 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. Issues relevant to this fire department 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. The Department and Union should negotiate the content and frequency to be consistent with NFPA 1582; Provide fire fighters with medical evaluations to wear self-contained breathing apparatus (SCBA); Recommend to the Medical Examiner /Certifying Physician that an autopsy should be performed on all on-duty fire fighters whose death may be cardiovascular-related; Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by phasing in a mandatory wellness/fitness program negotiated between the Fire Department and the Union.