On February 21, 2005, a 37-year-old male career Wildland Fire Fighter (WFF) conducted mop-up/overhaul operations at two wildland fire sites. Later that day he returned to the district office where he vigorously exercised at the end of his shift and departed for home complaining of indigestion. Later that evening, while talking to a neighbor, the WFF collapsed at approximately 1817 hours. When the neighbor drove his car to notify emergency medical service (EMS), he encountered the WFF's wife less than a minute from the home. She returned home to find her husband unresponsive, and she called 911. Non-EMS trained bystanders attempted chest compression until EMS arrived at 1831 hours and found the WFF unresponsive with no breath sounds, pulse, or blood pressure. He was ventilated using a bag valve mask, placed on a heart monitor, and found to be in ventricular fibrillation (a rhythm incompatible with life). A defibrillation (shock) was immediately delivered, but his heart rhythm converted to asystole (no heart beat). Despite ALS provided by ambulance paramedics on scene and en route to the hospital, and by the hospital emergency department (ED) staff, the WFF died. The death certificate and autopsy, completed and performed by the Chief Medical Examiner listed "left anterior descending coronary artery thrombosis" as the immediate cause of death. The physical stress of conducting mop-up/overhaul operations and his vigorous physical fitness training, coupled with his underlying atherosclerotic coronary artery disease (CAD) contributed to this WFF's sudden cardiac death. It is unlikely that programs such as those recommended here could have prevented the WFF's death. Nonetheless, the NIOSH investigators offer these recommendations to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. 1. Provide mandatory pre-placement and annual medical evaluations to ALL fire fighters consistent with the most recent edition (2003) of NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. 2. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 3. Perform an annual physical performance (physical ability) evaluation to ensure all fire fighters are physically capable of performing the essential job tasks of wildland fire fighting.