On July 29, 1999, a 49-year-old male Fire Fighter responded to a fire in a two-story dwelling. After extinguishing the fire and taking a short break, the victim had a witnessed collapse. After approximately 56 minutes of cardiopulmonary resuscitation (CPR) and advanced life support (ALS) on scene and at the hospital, the victim died. The death certificate and the autopsy, both completed by the City Medical Examiner, listed "arteriosclerotic cardiovascular disease" as the immediate cause of death and "heat stress" as a significant condition. Pertinent autopsy results included severe coronary artery disease and extensive subendocardial scarring of the left ventricle (consistent with remote [old] heart attacks). 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. 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. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by phasing in a mandatory wellness/fitness program for fire fighters. Carboxyhemoglobin levels should be tested on symptomatic or unresponsive fire fighters exposed to smoke.