On October 15, 1997, a 54-year-old male Battalion Chief (BC) experienced chest pain while exercising during his work shift. An ambulance crew transported the BC to the emergency department where he was admitted to the hospital for an acute myocardial infarction (MI), commonly known as a heart attack. He underwent emergency coronary angiography, angioplasty with stent placement, followed by the intravenous (IV) infusion of a thrombolytic agent. Although the BC tolerated this first hospitalization and procedure well, over the next 5 months he underwent multiple diagnostic and therapeutic cardiac procedures with numerous complications. He ultimately died on April 29, 1998. The death certificate, completed by the State Medical Examiner, listed "Cardiogenic Shock due to Enterobacter sepsis due to Multi-organ Failure due to Ischemic Cardiomyopathy" as the immediate cause of death. No autopsy was performed. 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) minimizing 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: The Fire Department should modify the content and frequency of their fire fighters annual medical evaluations to match that recommended by National Fire Protection Association (NFPA) 1582 (Medical Requirements for Fire Fighters); The Fire Department physician, not personal or consulting physician, should have the responsibility of determining medical clearance for a fire fighter's unrestricted return to work status; Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by phasing in a mandatory wellness/fitness program for fire fighters; Perform an autopsy on all on-duty fire fighter fatalities; Leave doors to personal quarters unlocked in case of emergency.