On August 13, 2001, a 34-year-old male volunteer Fire Fighter responded on the first alarm to a working fire in a three-story, 60-unit senior citizens apartment complex. After fire extinguishment and rehabilitation (Rehab), the victim was performing a walk-through survey on the third floor during overhaul when he collapsed. Crew members carried him down the stairway and outside the apartment complex where paramedics assessed him and found him to be unresponsive, not breathing, and pulseless. Approximately 43 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 and autopsy record, completed by the Associate Chief Medical Examiner, listed hypertrophic and arteriosclerotic cardiac disease as the immediate cause of death. 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 they repersent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups. While these recommendations could be used at this Fire Department, it is unlikely any of these measures could have prevented this victim's untimely death. 1. Conduct mandatory preplacement medical evaluations consistent with NFPA 1582 to determine a candidate's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Provide mandatory annual medical evaluations consistent with NFPA 1582 to determine fire fighters' medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 3. Incorporate exercise stress tests into the Fire Department's medical evaluation program. 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 5. Carboxyhemoglobin levels should be tested on symptomatic or unresponsive fire fighters exposed to smoke.