On June 2, 1998, a 44-year-old male Driver/Operator died while asleep during the night while on duty. During his shift, he had responded to a fire in a garage and an outdoor rubbish fire. At both responses, the victim served as Driver/Operator of an Engine company. The death certificate, completed by the County Coroner, listed "probable arrhythmia due to hypertrophic cardiomyopathy, fibrosis of sinoatrial node" as the immediate cause of death. The following recommendations address some general health and safety issues. It is unlikely, however, that any of these recommendations could have prevented the sudden cardiac arrest and subsequent death of this Driver/Operator. This list includes some preventive measures that have been recommended by other agencies to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. These selected recommendations have not been evaluated by NIOSH but represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or labor/management groups within the fire service. In addition, the recommendations are presented in a logical programmatic order and are not listed in a priority manner. Issues relevant to this Fire Department include: 1. Fire fighters should have mandatory 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. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by offering a wellness/fitness program for fire fighters. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; 3. Exercise stress tests should be incorporated into the Fire Department's medical evaluation program; and, 4. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA).