On August 9, 2000, a 30-year-old female volunteer Fire Fighter (the victim) responded to a reported kitchen fire in a one-story, two-unit, multi-family dwelling. The resident of the apartment involved had extinguished the fire before the Fire Department's arrival, but smoke remained in the structure. Wearing full bunker gear, the victim removed a smoke ejector from the pumper, carried it to the dwelling, and walked back to the pumper. Soon after, while conversing with crew members, she collapsed. An Emergency Medical Technician-Intermediate (EMT-I) assessed her and found her to be unresponsive, with shallow breathing, and a pulse. After placing her into the ambulance, she soon stopped breathing, became pulseless, and cardiopulmonary resuscitation (CPR) was begun. Approximately 80 minutes later, despite CPR and advanced life support (ALS) administered on the scene, en route, and at the hospital, the victim died. The death certificate, completed by the Acting Medical Examiner, and the autopsy record, completed by the Forensic Pathologist, listed "hypoxia due to pulmonary edema due to cardiomyopathy" as the 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. While these recommendations could be used at this Fire Department, it is unlikely any of these measures could have prevented this victim's untimely death: Institute preplacement and periodic medical evaluations. These should incorporate exercise stress testing, depending on the fire fighter's age and coronary artery disease risk factors; 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, the National Fire Protection Association Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians.; Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA); Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.