On June 13, 1999, a 52-year-old male volunteer Fire Fighter responded in a Fire Department Engine to the scene of a reported structure fire with heavy smoke. On the way to the fire, the Fire Fighter (victim) collapsed in the cab of the Engine. Despite Advanced Cardiac Life Support (ACLS) measures administered on site, during the ambulance ride to the hospital, and in the hospital's emergency room, the victim died. The death certificate listed acute myocardial infarction (heart attack) due to coronary artery disease as the 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: 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 offering a wellness/fitness program for fire fighters; and, Perform an autopsy on all on-duty fire fighters whose death may be cardiovascular-related.