On August 6, 2003, a 43-year-old career fire fighter/emergency medical technician [the victim] died after the ambulance he was driving was struck from behind and pushed into a straight truck. The victim and a lieutenant/paramedic were conducting a non-emergency transport between two hospitals. The ambulance was traveling through a highway workzone and as the ambulance driver slowed down to move around a line painting crew, a tractor semi-trailer struck the rear of the ambulance and pushed it into the straight truck (Photo 1). Although the victim was using the vehicle occupant restraint, the front cab sustained such extensive damage that he was fatally injured. The lieutenant/paramedic and a patient, who had been riding in the ambulance patient compartment, were also injured during the collision. NIOSH investigators concluded that to help prevent similar incidents: 1. state department of highways and highway construction companies should consider the use of signs and warnings supplemental to those specified by the Manual on Uniform Traffic Control Devices (MUTCD) when conducting mobile operations (such as line painting); and, 2. trucking companies should train drivers to maintain safe following distances and to be aware of work zone hazards and slowing traffic. Fire departments and emergency medical service (EMS) providers should: 1. ensure that EMS workers use the patient compartment vehicle occupant restraints whenever possible; and, 2. consider using shoulder straps with occupant restraints on patient cots to limit the movement of the patient from the cot during a vehicle crash. Ambulance manufacturers, EMS providers, and researchers should develop and evaluate occupant protection systems designed to provide crash protection for EMS workers and the mobility necessary to access patients and equipment within ambulance patient compartments.