On July, 18, 2000, at 1351 hours, Central Dispatch notified the local fire department of a structure fire at a single-family dwelling. As fire fighters conducted suppression activities near the rear of the structure, they became suspicious of arson. Two arson investigators were dispatched to the scene to conduct an "origin-and-cause" fire investigation. During this investigation, Arson Investigator #1, a 47-year-old, career fire fighter (the victim) lost his balance and fell, pinning his camera between the left side of his chest and a bed frame/slats. After being assisted to his feet by Arson Investigator #2, he rested for a couple of minutes, regained his composure, and resumed his investigation. Later that evening the victim sought medical attention for persistent, severe pain in his left lower chest area. Over the next 3 weeks, the victim was evaluated and treated both in and out of the hospital for complications resulting from the fall. These complications ultimately led to his death on August 9, 2000, at 1118 hours. Two autopsies were performed. The first autopsy, performed by the County Coroner, showed (a) "multiple organ system failure" due to, or as a consequence of, (b) "peritonitis with severe hypotension, ischemic necrosis of the liver and kidneys" due to, or as a consequence of, (c) "blunt force trauma of the left chest wall with splenic hematomas and a perforated stress ulcer." The second autopsy, performed by a forensic pathologist hired by the victim's widow, essentially confirmed these findings with two additional points mentioned. A left-arm contusion (bruise), a left-trunk contusion, and a left-10th-rib fracture were noted, suggesting the initial fall on July 18 was quite severe. A second point in this autopsy was that post-injury medications, in addition to chronic hepatitis C virus (HCV) infection and cirrhosis due to HCV, contributed to his liver failure. NIOSH investigators concluded that, to minimize the risk of similar occurrences the following recommendations should be considered: 1. Fire departments should ensure that fire fighters and EMTs have mandatory annual medical evaluations and periodic physical examinations according to the National Fire Protection Association (NFPA) 1582, Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians; 2. HCV infection, by itself, should not preclude or restrict fire-service employees from engaging in fire-service activities. Rather, fire-department physicians should determine if HCV liver disease is of sufficient severity to prevent employees from performing, with or without reasonable accommodation, the essential functions of the job without posing a significant risk to the safety and health of themselves or others; 3. Fire departments should update their written "Communicable Disease Program" to assure consistency with the NFPA 1581: Standard of Fire Department Infection Control Program and the OSHA Bloodborne Pathogens Standard [29 CFR 1910.1030; 56 Fed. Reg. 64004 (1991)].