On May 14, 1999, a 47-year-old male fire fighter collapsed while assisting with command at a trench rescue. After being on scene for approximately 60 minutes, the fire fighter collapsed. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered by crew members, ambulance service personnel, and in the hospital's emergency department, the victim died. The death certificate, completed by the victim's personal physician, listed "acute myocardial infarction" (MI), commonly known as a heart attack, as the immediate cause of death. Pertinent autopsy results included the presence of a thrombosis (blood clot) in one of his coronary arteries, coronary atherosclerosis (plaque), and fibrosis consistent with remote (old) heart attacks (MIs). 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 individuals at higher risk; 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. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.