On December 7, 2006, a 25-year-old male volunteer fire fighter responded to a restaurant fire. On-scene, the fire fighter helped remove part of a wall to access burning wires. Units returned to their station one hour later, and the fire fighter returned home for the evening. At 0111 hours on the next morning (December 8th), the fire department was dispatched to a residence for a gas odor. The fire fighter's roommates responded to the call, but he did not. Thinking the fire fighter had slept in, the roommates did not check on him when they returned home at approximately 0145 hours. The roommates left for work later in the morning, but the fire fighter still had not risen. When a roommate returned home at approximately 1840 hours, he and the fire fighter's girlfriend entered the house and the fire fighter's room and found him unresponsive. An ambulance and police were summoned, but the fire fighter was dead. The deputy coroner was notified and pronounced the fire fighter dead. The death certificate and autopsy (completed by the forensic pathologist) listed "sudden unexplained death in epilepsy" as the cause of death. NIOSH investigators offer the following recommendations to address general safety and health issues. If the fire company had implemented the following recommendations, perhaps the annual medical evaluation would have resulted in better medical compliance of his anti-seizure medication, and thus his death may have been prevented at this time. 1. Perform pre-placement and periodic medical evaluations consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for fire departments. 2. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582. 3. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBAs). 4. Develop a structured wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.