On November 2, 1999, a volunteer fire fighter sustained a traumatic head injury after falling off a responding open-cab ladder truck. This injury led to his death the following day. The victim was part of a volunteer crew of six personnel which also included a driver, an officer, and three other fire fighters. The crew was responding to provide mutual-aid assistance to an adjoining community. As the ladder truck was leaving the station, the victim was reported to be standing behind the officer and Fire Fighter #1 in the open crew compartment of the vehicle. None of the responding personnel reported wearing seat belts. Shortly after the ladder truck left the fire station and completed the second turn, Fire Fighter #1 realized the victim was missing and signaled to have the ladder truck stopped. The crew dismounted the ladder truck and ran back to the victim, who was lying in the roadway. They gave him emergency medical care, and he was transported to a local hospital where he died the following day. NIOSH investigators concluded that, to minimize the risk of similar occurrences, fire departments should: 1) ensure that the emergency fire apparatus are equipped and functional to provide adequate safety for the riders and drivers/operators; 2) ensure that all fire fighters who ride on emergency fire apparatus are seated and secured by seat belts.