On February 11, 1998, a 48-year-old male Fire Fighter responded with his engine crew to a reported gas leak in a single-family dwelling. At the scene the victim was noted to be slightly short of breath but not in acute distress. After approximately 15 minutes on scene, the engine crew returned to the fire station where the victim was noted to be unresponsive in his cab seat. Cardio-pulmonary resuscitation (CPR) was begun as a second engine company and ambulance were requested for a suspected cardiac arrest. Upon arrival, paramedics with the ambulance service provided advanced life support (ALS) and CPR on scene for a total of 20 minutes before embarking to the hospital. ALS and CPR were continued en route to the hospital and in the hospital's emergency department (ED). After approximately 10 minutes in the ED, the victim was pronounced dead, and resuscitation measures were discontinued. The death certificate completed by the medical examiner listed "coronary sclerotic heart disease" as the immediate cause of death. The autopsy report, also completed by the medical examiner, listed the final diagnosis as "marked coronary atherosclerosis, cardiomegaly, and pulmonary congestion and edema." 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. Following are issues relevant to this fire department: Provide adequate fire fighter staffing to ensure safe operating conditions. 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.