On June 18, 2001, a 28-year-old male volunteer fire fighter responded to a wildland fire involving 20 acres of grassland. The victim drove a tanker to the fire scene and stretched 150 feet of wildland fire hose before collapsing. Seeing him fall, crew members came to his assistance and found him unresponsive, with no pulse and no respirations. Cardiopulmonary resuscitation (CPR) was begun immediately, and an ambulance was requested. The ambulance arrived on the scene 11 minutes later. Approximately 1 hour later, despite CPR and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The autopsy and death certificate, completed by the County Coroner, listed "probable cardiac dysrhythmia due to fibrosis of the conduction system of the heart" as the 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 avaluated by NIOSH, but they represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups. However, it is unlikely that any of these recommendations could have prevented the unfortunate death of this fire fighter. 1. Conduct mandatory preemployment medical evaluations consistent with NFPA 1582 to determine a candidate's medical ability to perform duties without presenting a significant risk ot eh safety and health of themselves or others. 2.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. 3. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582. 4. Follow provisions in the revised OSHA respiratory protection standard. 5. Incorporate exercise stress tests into the Fire Department's medical evaluation program. 6. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 7. Provide automated external defibrillators on all fire apparatus.