On January 29, 1999, a 64-year-old male fire fighter responded to a call involving smoke in an apartment building. At the scene the victim did not report symptoms of chest pain, nor was he in acute distress. After approximately 10 minutes on scene, the District Chief and the victim returned to the fire station in the Chief's vehicle. Upon starting to back the vehicle into the station, the victim slumped against the driver's-side door. The Chief, noting the victim's condition, attempted to shift the vehicle into park. However, the vehicle lurched backward and struck a parked fire apparatus (Engine 42). The Chief then shifted the vehicle's transmission into park, got out of the vehicle, and got help from crew members at the station. The victim was noted to be unresponsive in the passenger seat. Cardiopulmonary resuscitation (CPR) was begun as an engine company and an ambulance were requested for a suspected cardiac arrest. Upon arrival, paramedics with the ambulance service provided CPR and advanced life support (ALS) onscene for a total of 20 minutes before embarking to the hospital. ALS and CPR were continued enroute to the hospital and in the hospital's emergency department (ED). In the ED, the patient was found to be in cardiogenic shock After approximately 10 minutes in the ED, and treatment in the cardiac catheterization lab, the victim was pronounced dead, and resuscitation measures were discontinued. The death certificate, completed by the State medical examiner, listed "coronary sclerotic heart disease" as the immediate cause of death. The autopsy report, also completed by the State medical examiner, listed the final diagnosis as "occlusive coronary artery disease." Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests 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. Issues relevant to this fire department include the following: 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. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by phasing in a mandatory wellness/fitness program for fire fighters.