On December 14, 2001, a 68-year-old male volunteer fire fighter responded to a call of a chimney fire. The victim responded from his home in his personal vehicle to the nearest fife station. As one of the fire department's drivers, he began to drive the 2,200-gallon tanker to the fire scene. At approximately 1457 hours, less than 1 mile from the fire station, the tanker left the roadway and slid down a 100-foot embankment, hitting several trees along the way. Emergency medical technicians and paramedics reached the victim several minutes later, finding the victim unresponsive. Initial assessment found the victim in the driver's seat, lap belt buckled, with some head trauma (lacerations to his forehead. and the bridge of his nose) but no chest trauma. Some reports were conflicting as to whether the victim initially had a peripheral pulse, but this quickly degenerated into no pulse and no respirations. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed at the scene, in the flight-for-life helicopter, and at the hospital emergency department, the fire fighter died. Based on the fire fighter's clinical history and the post mortem examination, his death certificate, completed, by the Chief Deputy County Coroner, listed heart failure as the immediate cause of death due to arteriosclerotic heart disease. 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, sudden cardiac arrest, and sudden cardiac death among fire fighters. While some of these strategies could be used at this Fire Department, it is unlikely any of these measures could have prevented this victim's untimely death. These selected recommendations have not been evaluated by NIOSH, but represent published research, consensus votes of technical committees of the National Fire Protection Association (NFPA), or fire service labor/ management groups. 1. The medical decision regarding when, or if, to return to duty a member with medical conditions should be made by the physician providing occupational health services for the fire department. 2. Expand the annual medical evaluation program currently required for "Active Retired Members" to include all members of the fire department. The frequency and content of this evaluation should be consistent with the National Fire Protection Association (NFPA) Standard 1582, Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians. 3. Members who perform active fire suppression should have medical clearance to wear a respirator. This clearance. procedure can be incorporated into the annual medical evaluation. 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.