On August 16, 2004, a 23-year-old male military Aircraft Fire Fighter (AFF) was ending a watch at the standby position on the airfield. The standby position, a staging area adjacent to the runway, is staffed by AFFs during flight operations. At approximately 2050 hours, while awaiting the arrival of his relief, the AFF collapsed. Crew members started cardiopulmonary resuscitation (CPR), administered oxygen via a bag valve mask, and alerted dispatch of a medical emergency. Fire fighters from the base's structural fire department (civil servants) arrived 18 minutes later and attached an automatic external defibrillator (AED). Several shocks were administered without a change in the AFF's condition. Paramedics from the county emergency medical service (EMS) arrived at 2126 hours. They inserted an airway management device, established an intravenous line (IV), and administered ALS medications. The AED monitored the AFF, and CPR continued. The AFF was transported to the local hospital emergency department (ED) by ground ambulance. Despite CPR and advanced life support (ALS), he was pronounced dead at approximately 2210 hours. The autopsy revealed the cause of death to be "acute myocardial ischemia secondary to a cardiac arrhythmia of unknown etiology." Myocardial bridging (MB) and findings consistent with hypertrophic cardiomyopathy (HCM) were also found during his autopsy. The NIOSH investigator concluded that the physical stress of responding to the AFF staging area, and the physical exertion the AFF performed there, may have triggered his sudden cardiac death (SCD). It is unlikely the following recommendation could have prevented this AFF's death. Nonetheless, the NIOSH investigator offers this recommendation to reduce the risk of sudden cardiac arrest among AFF and other fire fighters: 1. Provide mandatory annual medical evaluations to ALL fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2003 edition to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others.