On May 14, 2007 the Captain reported to duty at his fire station at 0800 hours. About an hour later, the Captain and the other crewmember assigned to his station (Engineer), changed into gym clothes and drove their Engine to a paved walking/jogging trail to participate in their Fire Department fitness program. The temperature was 80° Fahrenheit and sunny. The two began walking a ½ mile flat section of the trail followed by walking another ½ mile steep section (approximately 8% grade). At the top of the steep section, the Captain rubbed his chest and complained "my heartburn is killing me today." Shortly thereafter, the two started jogging on the flat portion of the trail, when the Captain collapsed. The Engineer notified dispatch and then began performing cardiopulmonary resuscitation (CPR) including the use of an automated external defibrillator (AED) from the Engine. About eight minutes after his collapse, ambulance paramedics arrived on-scene and administered advance life support which was continued in the hospital emergency department. Despite these resuscitation efforts, the Captain died. Both the death certificate and the autopsy report listed "acute myocardial infarction" (otherwise known as a heart attack) as the immediate cause of death due to "coronary artery disease." NIOSH investigators agree with these reports, and that the heart attack was probably triggered by the moderate to severe physical exertion associated with his fitness training. NIOSH investigators offer the following recommendations to reduce the risk of on-duty heart attacks and sudden cardiac deaths in this and other fire departments across the country. It is unlikely, however, that implementation of any of these recommendations would have prevented the Captain's sudden cardiac death. 1. Provide annual medical evaluations to ALL fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Conduct symptom-limiting exercise stress tests on some fire fighters based on their risk for a coronary heart disease event. 3. Discontinue biannual chest X-rays for the Hazmat team unless specifically indicated for an individual. 4. Conduct annual respirator fit testing. Secure funding from the governing municipality to upgrade the current fitness-wellness program.