On April 1, 1998, a 34-year-old male Safety Officer was participating in a live-burn training exercise. Seconds after the training fire was lit, the Safety Officer complained of shortness of breath and exited the house. Once outside, he used an inhaler that he carried for asthma attacks, but its use did not improve his symptoms. A nearby fire fighter placed a self -contained breathing apparatus (SCBA) mask with flowing air over the Officer's face to assist his breathing. A few seconds later, the Safety Officer collapsed, and fire fighters initiated CPR. Seven minutes later, an ambulance arrived on scene with four emergency medical technicians (EMTs) who took over resuscitation efforts. The Officer was again found to be without a pulse and respirations. An automatic external defibrillator (AED) was applied to the Officer's chest, but a shock was not advised. He had a "combi-tube" inserted to provide ventilation, and then he was transported to the nearest hospital. Upon arrival at the local hospital's emergency department, the Officer was again found to be in full cardiac arrest and advanced life support (ALS) measures were instituted. After approximately 30 minutes of ALS in the emergency department, he regained a cardiac rhythm but was not able to maintain an adequate blood pressure. An electrocardiogram (EKG) at that time showed ischemic changes, and blood tests showed a normal blood count. Arrangements were then made for transfer to a tertiary care medical center. Care provided at the tertiary care medical center somewhat stabilized his cardiovascular status, but anoxic (without oxygen) brain damage had already occurred. On April 2, 1998, 12 hours after his collapse, life support machines were disconnected, and shortly thereafter, he died. The death certificate, completed by the county Deputy Coroner after an autopsy was performed, listed the immediate cause of death due to "(A) gastric (stomach) hemorrhage with shock, due to (B) gastro-arterial fistula, due to (C) Dieulafoy's lesion." "Arteriosclerotic and hypertensive heart disease" were listed as "other significant conditions contributing to death." The Deputy Coroner did not have access to the clinical and laboratory data from the medical centers involved with his resuscitation efforts. Specifically, blood counts on three different occasions, done by two different hospital laboratories, with two of the blood samples being taken after the Officer had received significant intravenous (IV) fluid (hydration), were normal. Subsequent discussions with the Deputy Coroner regarding this clinical data resulted in our agreement that this victim's immediate cause of death was a cardiac event with the gastric hemorrhage as another significant condition. The following recommendations address some general health and safety issues. It is unlikely, however, that any of these recommendations could have prevented the sudden cardiac arrest and subsequent death of this fire fighter. This list includes some preventive measures that have been recommended by other agencies to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. These selected recommendations have not been evaluated by NIOSH but represent research presented in the literature or of consensus votes of technical committees of the National Fire Protection Association (NFPA) or labor/management groups within the fire service. In addition, the recommendations are presented in a logical programmatic order and are not listed in a priority manner: Consider equipping fire department apparatus with AEDs; Fire fighters should have annual medical evaluations consistent with NFPA 1582 to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; Provide fire fighters with medical evaluations and clearance to wear SCBA; Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by offering a wellness/fitness program for fire fighters.