On January 18, 2001, a 52-year-old male career Lieutenant did not report to his Engine company when it was dispatched to an early morning call (0118 hours). Upon returning to the station, his crew members found him unresponsive, not breathing, pulseless, and cool to the touch. Due to his cool skin, fire fighters determined he had been dead for at least 1 hour, and no resuscitation measures were initiated. The death certificate, completed by the Assistant Medical Examiner, listed "arteriosclerotic cardiovascular disease" as the immediate cause of death, and the autopsy found significant coronary artery disease. 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 or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups. 1. Provide mandatory annual medical evaluations to ALL fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; and, 2. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. Although unrelated to this fatality, the Fire Department should consider this additional recommendation: Provide adequate fire fighter staffing to ensure safe operating conditions.