On April 26, 2000, a 43-year-old male Lieutenant suffered a cardiac arrest at the scene of a fire in a 1½-story single-family dwelling. After a loose connection on his self-contained breathing apparatus (SCBA) caused the Lieutenant to lose air, he exited the structure to change air cylinders. While his air cylinder was being changed, he collapsed. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed on the scene by crew members and paramedics, and by hospital personnel at the emergency department (ED), the victim died 8 days later. The death certificate, completed by the Assistant Medical Examiner, listed "atherosclerotic coronary disease" as the immediate cause of death. An inspection report, also completed by the Assistant Medical Examiner, listed "myocardial infarct (based on circumstances, EKG changes, and serologic testing)" as the cause of death and "mild chronic obstructive pulmonary disease and hepatitis per history" as contributing factors. The following recommendations address some general health and safety issues. 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, consensus votes of technical committees of the National Fire Protection Association (NFPA), or fire service labor/management groups. 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. Mandatory preemployment medical evaluations consistent with NFPA 1582 should be conducted to determine a candidate's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 2. Fire fighters should have mandatory annual medical evaluations and periodic physical examinations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 3. Exercise stress tests should be incorporated into the Fire Department's medical evaluation program; 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; 5. Provide fire fighters with medical evaluations and determination of clearance to wear self-contained breathing apparatus (SCBA); and, 6. Provide adequate fire fighter staffing to ensure safe operating conditions.