On April 29, 1998, a 49-year-old male Driver/Operator/Fire Fighter responded to a fire in a high-rise apartment building. When the victim arrived on-scene he tested the hydrant, connected the pumper to the hydrant with a suction hose, and charged the pumper. He was wearing his uniform but no bunker gear or self contained breathing apparatus (SCBA). He then ran 464 feet to assist another Engine company hook up to a hydrant and stretch a supply line to the building. Hearing that his apparatus was interfering with a Ladder company's access to the fire building, he ran the 464 feet back to his Engine and then returned to assist the other Engine company. At that time, on-scene for a total of about 7 minutes, he notified the Battalion Chief (BC) / Incident Commander (IC) that he thought he was having a heart attack. Two on-scene Driver/Operator/Fire Fighters administered first aid and oxygen for 2 minutes, followed by treatment on-scene by ambulance paramedics for 11 minutes. During this time he was complaining of chest pain, but he was alert, oriented, and had stable vital signs. He was in stable condition during the two minutes in the ambulance, but upon arrival in the local hospital's emergency department, he had a cardiac arrest. Despite cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) administered by hospital personnel, the victim died. The death certificate, completed by the Medical Examiner's Office listed "hypertensive and atherosclerotic cardiovascular disease" as the immediate cause of death. Pertinent autopsy results included marked atherosclerotic coronary artery disease (CAD), a small scar consistent with a remote (at least 3 months prior) heart attack (myocardial infarction), an enlarged heart (left ventricular hypertrophy), and no evidence of blood clots (thromboemboli) in his lungs. 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: Although there is not consensus on the use of exercise stress tests to detect CAD in asymptomatic fire firefighters, their use could be considered for fire fighters with multiple CAD risk factors and could be incorporated into the Fire Department's annual medical evaluation program.