On June 23, 2000, at about 1800 hours 37-year-old male Firefighter/EMT was eating dinner when he reported feeling ill. At approximately 2140 hours, the Firefighter had a witnessed cardiac arrest. Despite CPR and ALS administered by the ambulance paramedics and by hospital personnel in the emergency department, the firefighter died. The death certificate, completed by the County Coroner, listed arteriosclerotic cardiovascular disease as the immediate cause of death. The autopsy, performed by the County Medical Examiner, showed mild coronary artery disease (CAD), softening or fibrosis of the myocardium, and evidence of old and recent myocardial infarctions. Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests among fire fighters. This strategy consists of: 1) reducing physical stress on fire fighters; 2) screening to identify and subsequently rehabilitate high risk individuals; and 3) encouraging increased individual physical capacity. Issues relevant to this Fire Department include: 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. Exercise stress tests should be incorporated into the Fire Department's medical evaluation program; and, 3. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.