On February 18, 2001, a 53-year-old male fire fighter responded to and staged at a shopping mall fire which was quickly controlled. After returning to quarters, he parked the engine-tanker he had driven and then a rescue truck in their respective apparatus bays. He was found approximately 1½ hours later, in the driver's seat of the rescue truck, in cardiorespiratory arrest. Due to his clinical appearance, resuscitation was not attempted. The death certificate listed "cardiac arrest" as the immediate cause of death, with hyperlipidemia and diabetes mellitus as contributing factors. No laboratory studies or autopsy were done. The following recommendations address general health and safety issues. Included are preventative measures that are recommended to reduce the risk of cardiovascular deaths among fire fighters. These selected recommendations have not been evaluated by the National Institute for Occupational Safety and Health (NIOSH) but represent published research, consensus standards issued by the National Fire Protection Association (NFPA) or fire service labor/management fitness and wellness initiatives. Recommendations are also made regarding the fatality investigative process. 1. Staff fire stations to ensure adequate emergency response capability for the community and safety of personnel. Staffing levels were probably unrelated to the victim's collapse. However, the extended time between his collapse and discovery precluded resuscitation and left the community unaware that it was missing a critical component of its fire-rescue system. 2. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 3. Supply Fire Department (FD) physicians with specific job descriptions for personnel at the time of fitness-for-duty medical evaluations. 4. Consider exercise stress testing (EST) for those fire fighters with risk factors for cardiac disease. 5. Follow any fire fighter line-of-duty death with a complete post-mortem medical examination.