On March 17, 1999, a 44-year-old male Fire Fighter responded to a fire in the basement of an apartment building. While opening walls to search for fire spread on the second and third floors, the victim had an unwitnessed collapse. He was found by one of the renovation workers, who summoned help. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered by first responders, a paramedic of his engine company, ambulance paramedics, and emergency department personnel, the victim died. His carboxyhemoglobin level was 2.1%, indicating he was not exposed to significant levels of carbon monoxide. The death certificate, completed by the State Medical Examiner, listed atherosclerotic cardiovascular disease" as the immediate cause of death. No autopsy was performed. 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. Perform an autopsy on all on-duty fire fighters whose death may be cardiovascular-related.