On September 28, 1998, a 60-year-old male District Chief served as Incident Commander at a structure fire. After commanding fire scene operations for almost 3 hours, he complained of a headache and was noted to have an elevated blood pressure. The next day, the victim's wife found him unresponsive in their home. Subsequent medical evaluation and treatment revealed the victim had suffered a massive stroke, from which he died on September 30, 1998. The death certificate, completed by the attending physician, listed "intracerebral hemorrhage due to hypertension, essential" (otherwise known as a "stroke") as the immediate cause of death. No autopsy was performed. The following recommendations address some general health and safety issues. While this list includes some preventive measures that have been recommended by other agencies, these measures would not have been able to prevent this District Chief's death due to a stroke. These selected recommendations have not been evaluated by NIOSH, but represent published research, consensus votes of technical committees of the National Fire Protection Association (NFPA), or fire service labor/management groups. 1. Fire Fighters should have mandatory annual medical evaluations and periodic physical examinations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Exercise stress tests should be incorporated into the Fire Department's medical evaluation program. 3. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 4. Perform an autopsy on all on-duty fire fighter fatalities. 5. Provide adequate fire fighter staffing to ensure safe operating conditions.