On April 28, 1999, a 56-year-old male volunteer fire fighter responded to a structural fire in a three-story wood-framed building, where he was actively engaged in fire suppression duties for over 2 and a half hours. Approximately 20 minutes after leaving the fire scene he collapsed in his home. Cardio-pulmonary resuscitation (CPR) was initially administered by the victim's wife, and then by fire fighters trained as emergency medical technicians (EMT). EMTs also connected the victim to a semi-automatic external defibrillator (SAED) and a single shock (defibrillation) was successful in returning a weak peripheral pulse to the victim. Unfortunately, shortly after arrival in the local hospital's emergency department, the victim suffered a second cardiac arrest. Fifteen minutes of CPR and advanced life support (ALS) measures were again successful at reviving the victim, but he remained unconscious and in critical condition. He was flown to a regional tertiary hospital, where 4 days of intensive measures were unsuccessful, and he was pronounced dead on May 2, 1999. The death certificate, completed by the treating physician (Certifying Physician), listed "coronary thrombosis" as the immediate cause of death, due to "ventricular tachycardia," with "hypertension" being an "other significant condition contributing to [the] 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: 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; Fire fighters should be provided with medical evaluations to wear self -contained breathing apparatus (SCBA); All personnel entering a potentially hazardous atmosphere should wear an SCBA; Carboxyhemoglobin levels should be tested on symptomatic or unresponsive fire fighters exposed to smoke; Autopsies should be performed on all on-duty fire fighters whose death may be cardiovascular-related; Fire fighters experiencing signs and symptoms of heart attacks while on duty should report them to their supervisor/incident commander for prompt medical evaluation; Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.