On February 5, 2001, a 33-year-old male Fire Fighter began his shift at 0800 hours. At approximately 0900 hours, he began his routine fitness program that consisted of aerobic and strength conditioning. Around 1000 hours, he had an unwitnessed collapse. He was unconscious for up to 5 minutes before his crew member, a paramedic, found him unresponsive and pulseless. A cardiac monitor showed ventricular fibrillation which was unresponsive to several defibrillation attempts. Subsequently cardiopulmonary resuscitation (CPR) and advanced life support (ALS) were administered at the fire station for approximately 15 minutes by his crew, a responding engine company, and a private ambulance service. Despite this and continued CPR and ALS administered by the hospital emergency room for another 30 minutes, the victim died. The death certificate and the autopsy completed by the County Coroner's Office listed cardiac dysrhythmia associated with exertion due to dilated cardiomyopathy as the cause of death. Other agencies have proposed a three-pronged strategy for reducing the risk of cardiac arrest and sudden cardiac death among fire fighters. While some of these strategies could be utilized at this Fire Department, it is unlikely any of these measures could have prevented this victim's untimely death. 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: 1. The content of Candidate Fire Fighter's preplacement medical evaluations should be consistent with the National Fire Protection Association (NFPA) Standard 1582 (Medical Requirements for Fire Fighters and Information for Fire Department Physicians); 2. Incumbent Fire Fighters should have mandatory regular 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; and, 3. Incumbent Fire Fighters should have mandatory regular 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.