On November 16, 1999, a 38-year-old male Fire Fighter awoke at 0100 hours due to severe upper abdominal pain. While being transported to a local hospital, the victim suffered a seizure, followed shortly thereafter by a cardiac arrest in the hospital parking lot. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered in the hospital's emergency department, the victim died. An autopsy of the victim revealed an enlarged heart and granulomatous lesions consistent with sarcoidosis in the victim's heart, lung, lymph nodes, liver, and spleen. There was no evidence of coronary artery disease or evidence for a heart attack (myocardial infarction). Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty sudden cardiac death among fire fighters. However, it is unclear if any of these recommendations would have prevented this Fire Fighter's death. 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 (FD) 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. The Department and Union should negotiate the content and frequency to be consistent with NFPA 1582; 2. Abnormal findings uncovered during annual medical evaluations should be medically evaluated. If this follow-up medical evaluation is conducted by the fire fighter's personal physician, results should be reviewed by the fire department physician to determine the fire fighter's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 3. As required by the OSHA Revised Respiratory Protection Standard, provide fire fighters with medical evaluations to determine fitness to wear a self-contained breathing apparatus (SCBA); and 4. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by phasing in a mandatory wellness/fitness program negotiated between the Fire Department and the Union.