On January 16, 1999, a 55-year-old male career Fire Fighter/Ladder Driver (the victim) and engine crew were dispatched at 1519 hours to a structural fire at a local church. Upon his arrival at the scene at 1530 hours, the victim exited the ladder truck, walked around the rear of the truck to the passenger's side, leaned against the vehicle, and began gasping for breath. An Officer at the scene noted that the victim looked ashen and asked how he was feeling. The victim responded that he felt dizzy and weak. The Officer notified paramedics in an ambulance on the scene that the victim required assistance, and at 1533 hours, the victim received oxygen via bag valve mask and peripheral intravenous (IV) medications for severe respiratory distress. The victim, who did not lose consciousness, was transferred at 1540 hours via ambulance to a local hospital. He was admitted for 5 days, and thereafter, discharged home. He did not return to work after this incident. After a succession of health events, including hospital re-admissions, the victim died June 9, 1999. The death certificate listed the immediate cause of death as an acute myocardial infarction (heart attack). No underlying or contributing conditions were listed on the death certificate. An autopsy was not performed. Other agencies have proposed a three-pronged strategy for reducing the risk of heart attacks 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. An evaluation of this Department suggests the following recommendations for his surviving colleagues: 1) Fire fighters should have preemployment and 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 phasing in a mandatory wellness/fitness program for the fire fighters; 3) Provide adequate fire fighter staffing to ensure safe operating conditions.