On January 10, 2002, a 39-year-old male career fire fighter (the victim) was injured from being struck by a civilian who jumped from a fourth-story window of an apartment building. The victim and two other fire fighters were raising a 35-foot extension ladder to a fourth-story window of the involved structure to rescue two trapped civilians when the incident occurred. The victim was bracing the base of the ladder when the first civilian jumped and landed at their feet. The second civilian jumped immediately thereafter, striking a van and the victim simultaneously. The victim was knocked to the ground but was able to continue rescuing trapped occupants and finished his shift. The victim experienced severe head, neck, and back pain from this incident and was admitted on January 26, 2002, to a hospital, where he lapsed into a coma until his death on February 7, 2002. NIOSH investigators concluded that, to minimize the risk of similar occurrences, fire departments should: 1. ensure that adequate numbers of staff are available to immediately respond to emergency incidents; 2. develop, implement, and enforce standard operating procedures (SOPs) to address the treatment of injuries on-site which include guidelines for evaluating injuries that are not obviously life-threatening. Additionally, municipalities and building owners should consider requiring older structures to meet new building codes and standards to improve safety of occupants and fire fighters.