On January 17, 2000, a 53-year-old male Sector Captain (the victim) was rendering assistance to a civilian when he collapsed. The civilian, certified in cardiopulmonary resuscitation (CPR), initiated CPR for approximately 1 minute before calling for emergency assistance. Engine company personnel within the Captainís sector and an ambulance staffed with emergency medical services (EMS) personnel arrived on scene simultaneously within 2 minutes of emergency dispatch. Upon arrival, fire fighters and EMS reinitiated CPR and initiated advanced cardiac life support (ACLS). Despite ACLS on scene, en route, and at a local hospital emergency department (ED), the victim died. The death certificate, completed by the Justice of the Peace, listed "myocardial infarction" (heart attack) as the immediate cause of death, and "diabetes" as a significant condition contributing to the death. An autopsy was not 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: 1. Fire Fighters should have periodic 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. The Fire Departmentís physician should approve, in a confidential, nondiscriminatory manner, all medical information and recommendations for return-to-work clearances from personal physicians. 3. Individuals with medical conditions that would present a significant risk to the safety and health of themselves or others should be precluded from fire fighting activities. 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.