On July 4, 1999, a 52-year-old male volunteer Captain (the victim) responded to a structure fire. The victim, one of the first fire fighters to arrive at the fire scene, found a double-wide modular home fully involved in fire. The victim, wearing turnout pants and boots, acted as the Incident Commander and an Engine's Pump Operator. Heavy smoke clung to the ground as the victim helped fire fighters don and doff their self-contained breathing apparatus (SCBAs) during the incident. Soon thereafter, the victim commented to a nearby fire fighter that he needed help and collapsed. Immediate assessment found the victim to be unresponsive, with no pulse or respirations. He was carried to an on-scene ambulance and cardiopulmonary resuscitation (CPR) (chest compressions with assisted ventilations via bag-valve-mask (BVM)) was initiated. Despite CPR and ALS administered by emergency medical technicians (EMTs), paramedics, and hospital emergency department (ED) personnel for 24 minutes, the victim died. The death certificate listed the immediate cause of death as a myocardial infarction (heart attack). An autopsy was not performed. The following recommendations address preventive 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, regulations passed by enforcement agencies such as the Occupational Safety and Health Administration (OSHA), consensus votes of technical committees of the National Fire Protection Association (NFPA), or products of labor/management technical committees within the fire service. This preventive 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). Steps that could be taken to accomplish these ends include: 1. Fire fighters should have 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. Provide fire fighters with medical evaluations to wear self-contained breathing apparatus (SCBA); 3. Perform an autopsy on all fire fighters who were fatally injured while on duty; 4. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by offering a wellness/fitness program for fire fighters; and, 5. Although this issue is unrelated to this fatality, fire departments should purchase personal alert safety system (PASS) devices and ensure that fire fighters wear and use them when involved in fire fighting, rescue, and other hazardous duties.