On February 15, 1999, a 50-year-old male volunteer Fire Fighter responded to a brush fire. The victim, serving as Driver/Operator, was operating the pump controls on his engine, assisting in pulling and moving hose, and connecting supply lines. Approximately 46 minutes into the incident, the victim collapsed. Prior to his collapse, the victim did not display any signs or symptoms suggestive of heart problems, although he had remarked to his Fire Chief that his "lunch had not agreed with him." Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered on scene, en route to the hospital, and in the emergency department, the victim died. The death certificate, completed by the County Coroner, listed the immediate cause of death as "a: occlusive coronary artery disease" due to "b: hypertensive cardiovascular disease." The autopsy, also completed by the County Coroner, listed "occlusive coronary artery disease with ischemic cardiomyopathy" as the cause of death. The following recommendations address preventive measures that have been recommended by other agencies to reduce, among other things, the risk of on-duty heart attacks and cardiac arrests among fire fighters. These recommendations have not been evaluated by NIOSH but represent research presented in the literature, regulations passed by enforcement agencies such as the Occupational Safety and Health Administration (OSHA), consensus votes of technical committees of the National Fire Protection Association (NFPA), or products of labor/management technical committees within the fire service. This preventive 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 (fitness). Steps that could be taken to accomplish these ends include: 1) 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; 2) Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by offering a wellness/fitness program for fire fighters.