On January 14, 2006, a 28-year-old male volunteer Fire Fighter (FF) responded to two alarms. The first alarm was cancelled when the FF reported to the station and the second involved strenuous physical activity at a grass fire. The FF then returned home, cleaned up, and left with his family to run errands. A call for a second grass fire was received. The FF called the fire station and was told there was no room for him on the apparatus. He continued with his errands and less than 50 minutes after responding to the first grass fire, the FF collapsed in his personally owned vehicle (POV). The Emergency Medical Service (EMS) was notified and arrived 4 minutes later to find cardiopulmonary resuscitation (CPR) being conducted by an off-duty nurse. Despite prolonged life support performed at the scene, in the ambulance, and in the emergency department (ED) of the local hospital, the FF died. The autopsy (completed by the Deputy Coroner-Medical Examiner) stated the FF's cause of death was "Probable heritable cardiac arrhythmia (Brugada Syndrome)." The NIOSH investigator concluded an arrhythmia caused by Brugada Syndrome probably caused the FF's sudden cardiac death (SCD). It is also possible that the strenuous levels of physical exertion during the grass fire triggered his SCD. If the fire department (FD) had been performing annual medical evaluations consistent with the National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, perhaps his heart condition would have been diagnosed and treated, thus preventing his death at this time. NIOSH investigators offer the following recommendations to prevent similar incidents: 1. Provide mandatory pre-placement and annual medical evaluations to ALL fire fighters consistent with NFPA 1582 to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Ensure fire fighters are cleared for duty by a physician knowledgeable about the physical demands of firefighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582. Although unrelated to this fatality, the Fire Department should consider these additional recommendations based on health and safety considerations: 1. Provide fire fighters with medical clearance to wear self-contained breathing apparatuses (SCBAs) as part of the FD's medical evaluation program. 2. Phase in a 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 for ALL fire fighters to ensure they are physically capable of performing the essential job tasks of structural firefighting.