On June 27, 1998, a 43-year-old male Captain lost consciousness enroute to the hospital after serving as Incident Commander at the scene of a motor vehicle crash. The Captain was assisting injured civilians and assisting with clean-up operations when he complained of heartburn and stomach pain. Witnesses noted his excessive sweating during these activities and attributed this to the high temperature and high humidity. Approximately 50 minutes into the response, the victim began completing response paperwork inside the Engine's air conditioned cab. While sitting in the officer's seat (passenger side), he activated the Engine's manual siren to signal for help. As two fire fighters approached the Engine, he said "I need to go to the doctor," without mentioning any particular symptoms. Approximately 1 minute into the 4 minute ride to the hospital, he lost consciousness, but maintained a pulse and respirations. Approximately 45 seconds from the hospital, he went into full cardiac arrest. Upon arrival at the emergency room, cardio-pulmonary resuscitation (CPR), followed by advanced life support (ALS), was performed in the hospital emergency department. After approximately 45 minutes, resuscitation measures were discontinued. The death certificate listed cardiopulmonary arrest as the immediate cause of death, as a consequence of acute coronary insufficiency due to myocardial infarction. The autopsy report listed the final diagnosis as acute myocardial infarction secondary to thrombosis of severely compromised coronary arteries. The following recommendations address health and safety issues in general. These recommendations rely on a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests among fire fighters, as proposed by other agencies. 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. Steps that could be taken to accomplish these include: Provide adequate fire fighter staffing to ensure safe operating conditions Provide fire fighter medical evaluations that are consistent with the content and frequency as those required by OSHA and recommended by NFPA, and the International Association of Fire Fighters/International Association of Fire Chiefs Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by phasing in a mandatory wellness/fitness program for fire fighters.