On January 21, 2002, a 48-year-old male career Assistant Chief responded to a structure fire involving a two-story condominium. The victim drove an engine to the fire scene and directed interior fire operations before collapsing. Seeing him fall, crew members came to his assistance and found him unresponsive, with no pulse and no respirations. Cardiopulmonary resuscitation (CPR) was begun immediately, and an ambulance arrived on-scene eleven minutes later. Approximately one hour later, despite CPR and advanced life support (ALS) administered on-scene and at the hospital, the victim died. The death certificate completed by the County Coroner and the autopsy conducted by the County pathologist both listed "arteriosclerotic cardiovascular disease" as the cause of death. Approximately two months prior to his death, as part of the Fire Department's annual medical evaluation, the victim had a cycle ergometer test with revealed ischemic changes (significant coronary artery disease). He was not cleared for fire fighting duties by the contract physician, however this information did not come to the attention of the Fire Department Chief or City Officials until after his 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. Designate a City employee to administer the FD pre-placement and annual medical evaluations and their outcomes; 2. Provide staff for FD clerical/administrative duties; 3. Provide mandatory pre-placement and annual medical evaluations for ALL fire fighters, not just career personnel, to determine a fire fighter's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 4. 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; 5. Follow provisions in OSHA's Respiratory Protection Standard and staff fire stations to ensure adequate emergency response capability for the community and safety of personnel; and, 6. Phase-in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.