On October 5, 1998, a 44-year-old male career Fire Captain collapsed after active involvement in forcible entry activities at a residential structure fire. This fire began as a wildland fire that covered a geographic area of 27,000 acres and burned residences in the wildland/urban interface area. The Captain had been committed to the fire fighting effort for approximately 10 hours and was involved in fire suppression activities at a residential structure fire when he collapsed. Just prior to his collapse, the Captain had trouble catching his breath and began using a resuscitator oxygen tank and mask from one of the fire trucks. The Captain collapsed while resting in a neighboring yard. Medics in the area immediately initiated cardiopulmonary resuscitation and advanced life support (ALS) protocols that were continued at the fire site, in the ambulance during transport, and in the hospital emergency department. He was pronounced dead approximately 37 minutes after he collapsed. The death certificate listed acute myocardial infarction due to thrombosed coronary artery and atherosclerotic cardiovascular disease as the cause of death based upon autopsy results. Autopsy carboxyhemoglobin results of 1% did not indicate smoke inhalation as contributory to his death. Other agencies have proposed a three-pronged strategy for reducing the risk of heart attacks among fire fighters. This strategy consists of (1) minimizing physical stress on fire fighters; (2) screening to identify and subsequently rehabilitate high-risk individuals; and (3) encouraging increased individual physical capacity. The following issues are relevant to this fire department: Fire fighters should have annual medical evaluations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. As a minimum, municipal fire fighters in California must be provided with medical evaluations to determine their fitness to wear self -contained breathing apparatus (SCBA). The Department should reinforce the requirement that personnel shall wear only the protective clothing issued by, or approved by, the employing fire department. The Department should review standard operating procedures (and related training) regarding self-treatment of chest pain or shortness of breath.