On September 16, 2006, a 19-year-old male volunteer Fire Fighter (FF) participated in a parade and an automobile extrication demonstration, which included wearing full bunker gear and cutting into an automobile with heavy hydraulic rescue tools. During the demonstration, the FF complained of not feeling well, passed the tool to a crew member, and collapsed. Crew members and on-scene ambulance paramedics began cardiopulmonary resuscitation (CPR) and advanced life support as they transported the FF to the hospital's Emergency Department. Inside the Emergency Department, despite advanced life support treatment for 13 minutes, the FF died. The death certificate and autopsy (completed by the Medical Examiner) listed "acute cardiac arrhythmia due to dilated cardiomyopathy associated with acute hemorrhage of the membranous septum of the heart" as the cause of death. It is unclear if the FF's sudden cardiac death was triggered by the physical exertion associated with the extrication demonstration. The following recommendations probably would not have prevented this fire fighter's death. However, NIOSH investigators offer these recommendations to address general safety and health issues: 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 firefighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582. 3. Develop a structured wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 4. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBAs).