On April 2, 2001, a 38-year-old male volunteer fire fighter was driving to work after returning home from a structural fire. He apparently passed out at an intersection, and his vehicle rolled across the road and into a fence. Police arrived approximately 3 minutes later, and the fire department and ambulance followed shortly. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed at the scene, in the ambulance, and at the hospital emergency department, and additional procedures in the hospitalís cardiac catheterization laboratory, the fire fighter died. Based on autopsy findings, the death certificate, completed by the Medical Examiner, listed "Acute Myocardial Infarction" as the immediate cause of death and "Severe Arteriosclerotic Coronary Vascular Disease - Right Coronary Artery" 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 are derived from published research, consensus votes of technical committees of the National Fire Protection Association (NFPA), or reports from fire service labor/management groups. Expand the periodic medical evaluation program to conform to the recommendations of the National Fire Protection Association (NFPA) Standard 1582, Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians. Depending on the fire fighterís age and coronary artery disease (CAD) risk factors, this program should incorporate exercise stress test (EST). The medical decision regarding an ill or injured fire fighter returning to duty should be made by the physician providing occupational health services for the Fire Department. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.