On February 25, 1998, a 62-year-old male Battalion Chief was found unconscious in his car shortly after performing a training exercise while wearing full turnout gear, including his self-contained breathing apparatus. Resuscitation efforts at the scene, during transport, and at the hospital were unsuccessful. The death certificate and autopsy listed coronary atherosclerosis as the cause of death. The following recommendations address preventative 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, consensus votes of technical committees of the National Fire Protection Association (NFPA), or products of labor/management technical committees within the fire service. This preventative 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). The Department where this Battalion Chief worked has already taken steps to implement these recommendations: provide fire fighters with lighter-weight protective equipment to reduce the physical demands placed upon fire fighters; implement an overall health and safety program such as the one recommended in NFPA 1500, Standard on Fire Department Occupational Safety and Health Program; providing fire fighters with periodic medical evaluations, including a exercise cardiac stress test for those employees above the age of 40 as recommended by NFPA 1582, Standard of Medical Requirements for Fire Fighters; and initiating a wellness/fitness program to reduce risk factors for cardiovascular disease and improve cardiovascular capacity such as the IAFF/IAFC Wellness-Fitness Initiative.