On July 23, 1998, a 56-year-old male Captain responded to a fully-involved structure fire. After stretching a 250-foot section of 2.5-inch hoseline and attacking the fire, the Captain experienced crushing substernal chest pain. He walked to the on-scene ambulance, where paramedics initiated treatment for a heart attack and transported him to the hospital. Shortly after arriving at the hospital, the Captain had a cardiac arrest. Cardiopulmonary resuscitation (CPR) and advanced life support (ALS) resuscitation efforts were successful, and an intravenous thrombolytic agent (tissue plasminogen activator) was given. The next day the Captain underwent a cardiac catheterization which showed severe coronary artery disease (CAD) and a stent was placed in the left anterior descending (LAD) coronary artery. He was discharged 5 days later to undergo coronary artery bypass surgery at some point in the future. On August 4, 1998, at approximately 1800 hours, the Captain had a witnessed cardiac arrest while recovering at home. Despite CPR and ALS administered by the ambulance paramedics and by hospital personnel in the emergency department, the Captain died. The death certificate, completed by the County Coroner, listed myocardial infarction (otherwise known as a heart attack) as the immediate cause of death, due to severe atherosclerotic cardiovascular disease. The autopsy, performed by the Deputy Chief Medical Examiner, showed a large heart (cardiomegaly), severe coronary artery disease (CAD), and evidence of old and recent myocardial infarctions. Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests among fire fighters. This strategy consists of (1) reducing physical stress on fire fighters, (2) screening to identify and subsequently rehabilitate high-risk individuals, and (3) encouraging increased individual physical capacity. Issues relevant to this Fire Department include: Fire Fighters should have mandatory annual medical evaluations and periodic physical examinations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; Exercise stress tests should be incorporated into the Fire Department's medical evaluation program; Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.