On June 19, 2004, a 39-year-old male reserve (volunteer) Fire Fighter (FF) assisted in forest fuel load reduction near a residential area. After about 6 hours of carrying and feeding trees and branches into a wood chipper, the FF suddenly collapsed. Crew members notified 911, who dispatched an ambulance and the fire department (FD) to the area. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) on-scene, in the ambulance, and in the local hospital's emergency department (ED), the FF died. The death certificate, completed by the Medical Examiner, and the autopsy, completed by the Forensic Pathologist, listed "atherosclerotic heart disease" as the cause of death. The NIOSH investigator concluded that the FF's sudden cardiac death was due to his underlying atherosclerotic coronary artery disease (CAD) possibly triggered by the physical exertion associated with chipping the wood and carrying the tree branches. NIOSH investigators offer the following recommendations to prevent similar incidents or to address general safety and health issues: 1. Provide pre-placement and 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. Consider conducting exercise stress tests (EST) for male fire fighters with two or more risk factors for CAD. 3. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA). 4. Ensure the District contract physician reviews all return to work clearances. 5. Use a secondary (technological) test to confirm appropriate placement of the endotracheal (ET) tube during emergency intubations.