On December 24, 2001, a 43-year-old male volunteer Fire Fighter responded to a mutual-aid call for a fire in a single-family dwelling. After leaving the fire station in a Fire Department vehicle (Battalion 61) at 1020 hours heading south, he drove approximately 2 miles and collapsed onto the seat. The vehicle traveled through the median, entered the northbound lanes, and crossed a bridge before crashing into cedar trees and a stone wall. A bystander saw the accident and went to assist the victim. He found the victim unresponsive with no pulse and no respirations. Cardiopulmonary resuscitation (CPR) was begun immediately and an ambulance was requested. Approximately 89 minutes later, despite CPR and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The death certificate and the autopsy, conducted by the Medical Examiner, listed "arteriosclerotic cardiovascular disease" 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. Conduct mandatory preplacement medical evaluations consistent with NFPA 1582 to determine a candidate's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. 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. Exercise stress tests should be incorporated into these periodic medical evaluations. 3. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582. 4. Provide fire fighters with medical evaluations and clearance to wear SCBA. 5. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.