On April 4, 2006, a 57-year-old male volunteer Fire Chief participated in a smoke drill. The Chief assisted with setting up the training site by loading, unloading, and setting up empty 55-gallon drums, bales of hay, and hose lines. After the drill, the Chief assisted with cleanup activities that included rolling and loading the hose lines. At about 2300 hours, the Chief went home. At some point after taking out his trash and taking a shower, the Chief suffered an unwitnessed collapse. A family member found him early the next morning (April 5th), obviously deceased. Although 9-1-1 was called and an ambulance responded, resuscitation measures were not performed due to the Chief's prolonged deceased status. The Coroner was notified, responded to the scene, and pronounced the Chief dead at 0557 hours. The death certificate (completed by the Coroner) listed "presumed sudden cardiac death" due to "coronary artery disease" as the cause of death. No autopsy was performed. Approximately 9 weeks later, a letter to the funeral director by the Chief's personal physician, stated "death was from plaque rupture in the coronary circulation leading to coronary thrombosis, myocardial infarction, and fatal arrhythmia." The NIOSH investigator concluded that the physical stress of moving the barrels and hay, and stretching, rolling, and loading hose lines, coupled with the Chief's underlying coronary artery disease (CAD), probably triggered his sudden cardiac death. The NIOSH investigator offers the following recommendations to prevent similar incidents and to address general safety and health issues. 1. Ensure all fire department members participate in Fire Department pre-placement and periodic medical evaluations. 2. Ensure fire fighters at risk for CAD receive exercise stress tests. 3. 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. 3. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural firefighting.