On May 19, 2007, a 37-year old male career captain (the victim) was fatally injured when the engine he was riding in and a ladder truck collided at an intersection. Both apparatus were from the same department and were responding to a reported kitchen fire. A total of eight fire fighters were involved in the collision. According to the police report, the captain and the driver of the engine were not wearing seat belts. They were both ejected from the apparatus and suffered multiple critical injuries. The captain succumbed to his injuries three days after the collision and the driver remained hospitalized for several weeks. The six injured fire fighters were transported to local hospitals with non-life threatening injuries. Key contributing factors identified in this investigation include failure to stop at a red traffic signal and failure to wear seat belts. NIOSH investigators concluded that, to minimize the risk of similar occurrences, fire departments should: 1. Establish, train on and enforce standard operating procedures (SOPs) that require drivers to stop at red traffic lights and stop signs, and proceed through intersections only after ensuring it is safe to continue. 2. Enforce SOPs that require mandatory use of seat belts in all vehicles. Although there is no evidence that the following recommendations were contributory factors in this fatality, in accordance with prudent safety practice fire departments should: 3. Ensure their vehicle/apparatus maintenance program complies with applicable National Fire Protection Association (NFPA) standards and that all maintenance and repairs are performed by qualified technicians. 4. Review procedures for all vehicles travelling in an emergency response to ensure safe travel and eliminate any chance of confusion at roadway intersections. Additionally, governing municipalities (federal, state, regional, and local) should: 5. Ensure that adequate line-of-site is maintained at roadway intersections, with an emphasis on routes routinely traveled by responding emergency vehicles/apparatus. 6. Consider enacting legislation to include operators and occupants of fire department vehicles in existing seat belt legislation and/or repeal existing laws that exempt drivers and occupants of fire service vehicles from mandatory seat belt use.