On April 5, 2002, a 30-year-old male career fire fighter on duty at his fire station went to bed at approximately 1030 hours. On April 6, 2002, at 0550 hours, his engine company was dispatched to a forced-entry call. The victim did not respond to the alarm, and when crew members checked on him, they found the victim unresponsive, with no pulse and no respirations. Cardiopulmonary resuscitation (CPR) was begun immediately and an extra ambulance was requested. The ambulance arrived on the scene 5 minutes later. Approximately 29 minutes later, despite CPR and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The autopsy and death certificate, completed by the County Coroner, listed "cardiac arrhythmia due to mitral valve prolapse" 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. However, it is unlikely that any of these recommendations could have prevented the unfortunate death of this fire fighter. 1. Conduct mandatory preplacement and periodic 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. Follow provisions in the revised OSHA respiratory protection standard.