On December 2, 1998, a 47-year-old male career Fire Fighter was performing aircraft rescue fire fighting (ARFF) training as mandated by the Federal Aviation Administration (FAA). Two teams of two fire fighters entered the Specialized Aircraft Fire Trainer (SAFT) (see photograph) to extinguish the training fire and "rescue" a 150-pound mannequin. As the victim lifted the mannequin and stood up, he had a witnessed collapse. Approximately 54 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The death certificate listed "Atherosclerotic Cardiovascular Disease" as the cause of death. The autopsy revealed moderate to severe coronary artery disease (CAD) and a remote myocardial infarction (heart attack). 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 death 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. 1. Provide mandatory annual medical evaluations to fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Incorporate exercise stress tests (EST) into the Fire Department's medical evaluation program. 3. Preclude from full-duty fire suppression those individuals with medical conditions that would present a significant risk to the safety and health of themselves or others. 4. Clear fire fighters for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582. 5. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 6. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA). 7. Ensure an ambulance is on the scene when conducting live-fire training. Although unrelated to this fatality, the Fire Department should consider these additional recommendations: 1. Provide automated external defibrillators on fire apparatus. 2. Provide adequate fire fighter staffing to ensure safe operating conditions.