On August 8, 2006, a 49-year-old male career Fire Fighter-Emergency Medical Technician (FF-EMT) was participating in the Fire Department's voluntary physical fitness program. The FF-EMT had walked on the treadmill for approximately 20 minutes when he suddenly collapsed. Crew members in the fire station found him unresponsive, not breathing, and without a pulse. Approximately 38 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support administered on-scene and at the hospital, the FF-EMT died. The death certificate and the autopsy (completed by the County Medical Examiner) listed "atherosclerotic cardiovascular disease" as the cause of death. The NIOSH investigator concludes the FF-EMT's exercise on the treadmill, coupled with his underlying atherosclerotic coronary artery disease, triggered his sudden cardiac death. The NIOSH investigator offers the following recommendations to address general safety and health issues. It is unlikely these recommendations would have prevented the FF-EMT's sudden cardiac death. 1. Develop a structured comprehensive wellness/fitness program to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 2. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural firefighting. 3. Eliminate or reduce the frequency of periodic chest x-rays in asymptomatic fire fighters, unless clinically indicated.