On August 12, 2000, a 51-year-old male career Deputy Chief was on duty at his fire station. At 1518 hours, after lying down for approximately 1 hour, the victim arose from his bunk and collapsed. Hearing him fall, crew members came to his assistance and found him unresponsive, with a pulse and shallow respirations. After crew members obtained the medical kit and oxygen equipment, the victim ceased breathing and became pulseless. Approximately 64 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered on the scene and at the hospital, the victim died. Although no autopsy was conducted, the death. certificate and the coroner's report listed "acute myocardial infarction" 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 they represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups. 1. Provide mandatory annual medical evaluations to ALL fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Fire fighters should be cleared for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582. 3. Provide fire fighters with medical evaluations and clearance to wear SCBA. 4. Incorporate exercise stress tests into the Fire Department's medical evaluation program. 5. Provide exercise equipment in all fire stations. 6. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 7. Perform an autopsy on all fire fighters who were fatally injured while on duty. 8. Provide automated external defibrillators on all fire apparatus. Although unrelated to this fatality, the Fire Department should consider this additional recommendation based on safety considerations: 1. Provide adequate fire fighter staffing to ensure safe operating conditions.