On April 23, 2001, a 58-year-old male volunteer fire fighter participated in a search-and-rescue training excercise. Wearing full turnout gear, including self contained breathing apparatus (SCBA) with a black cover on the face piece (to stimulate impaired visibility), he and another fire fighter were attempting to locate a "victim" (a training mannequin) in an area of the fire station. After the searched one room and moved to the next, the ill fire fighter said he had to get out. He sat up against the wall, where others helped him remove his helmet and face piece. He soon stopped breathing. Desptite immediate cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed on the scene by crew members, medical first responders, and paramedics, and by hospital personnel in the emergency department, the fire fighter died. Bases on findings at autopsy, the death certificate, completed by the Medical Examiner, listed "acute myocardial infarction" as the immediate casue of death and "arteriosclerotic cardiovascular disease" as the underlying cause. The following recommendations address some general health and safety issues identified during this investigation. 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, consensus votes of technical committees of the National Fire Protection Association (NFPA), or fire service labor/management groups. The recommendations are: 1. Depending on the applicant's age and coronary artery disease (CAD) risk factors, include exercise stress testing (EST) in the preplacement medical evaluation. 2. Institute a periodic medical evaluation program. This program should incorporate EST, depending on the fire fighter's age and CAD risk factors. 3. Fire fighters should be medically cleared for respirator use by a physician knowledgeable about the physical demands of fire fighting and the personal protective equipment used by fire fighters. 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.