On April 11, 2000, a 46-year-old male "paid-call" Fire Fighter was performing search-and-rescue training in the basement of a three-story office building. Five minutes after completing a rigorous 20-minute training exercise in full bunker gear and self-contained breathing apparatus (SCBA), the victim had a witnessed collapse. Despite cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) administered on the scene and at the hospital, the victim died. The autopsy showed a large heart (cardiomegaly) and only moderate coronary artery disease (CAD). The death certificate listed "Cardiomegaly - Acute Cardiac Arrhythmia" as the immediate cause of death. The following recommendations address some general health and safety issues. This list includes some preventive measures that have been recommended by other agencies to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. These selected recommendations have not been evaluated by NIOSH but represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or labor/management groups within the fire service: fire fighters should have mandatory 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; exercise stress tests should be incorporated into the Fire Department's medical evaluation program; provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA); phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; the ambulance service, which is separate from the Fire Department, should provide defibrillator unit refresher training to its personnel; and provide adequate fire-fighter staffing to ensure safe operating conditions.