On March 11, 2001, a 65-year-old male fire fighter collapsed as he finished a training exercise. Immediate cardiopulmonary resuscitation (CPR) and subsequent advanced life support (ALS) measures kept him alive; he was stabilized at the local hospital emergency room and transferred by air ambulance to a referral hospital. He never regained consciousness, however, and 3 days later he died. The autopsy revealed an acute myocardial infarction (heart attack) and bilateral coronary artery stenosis (blockage of the arteries of the heart) and the pathologist concluded that the cause of death was the myocardial infarction with "severe hypoxic brain injury" resulting from the cardiac arrest. The death certificate, completed by the cardiologist, listed" cardiac arrest" as the immediate cause of death, due to "myocardial infarction," with "coronary artery disease" as the underlying cause. The following recommendations address some general health and safety issues identified during this investigation. 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 represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups. 1. Institute preplacement and periodic medical evaluations. These should incorporate exercise stress testing, depending on the fire fighter's age and coronary artery disease risk factors. 2. Fire fighters should be cleared for duty and for respirator use by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582, the National Fire Protection Association's Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians. 3. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.