On January 12, 2000, a 48-year-old male volunteer Fire Fighter (the victim) responded to a fire in a two-story dwelling in which triplet children were trapped. The victim, wearing full turnout gear and driving a Tanker, arrived at a nearby hydrant and began to hook up supply lines when he collapsed. Another Tanker Driver/Operator found the victim. Immediate assessment found the victim to be unresponsive, with no pulse or respirations. Cardiopulmonary resuscitation (CPR) (chest compressions with mouth-to-mouth ventilation) was initiated. Despite CPR and advanced life support (ALS) administered by crew members, emergency medical technicians (EMTs), and hospital emergency department (ED) personnel, the victim died. An autopsy was performed; however, medical records were not available to NIOSH personnel at the time of this report. The following recommendations address preventive measures that have been recommended by other agencies to reduce, among other things, the risk of on-duty heart attacks and cardiac arrests among fire fighters. These recommendations have not been evaluated by NIOSH, but they represent published research, regulations passed by enforcement agencies such as the Occupational Safety and Health Administration (OSHA), consensus votes of technical committees of the National Fire Protection Association (NFPA), or products of labor/ management technical committees within the fire service. This preventive strategy consists of (1) minimizing physical stress on fire fighters, (2) screening to identify and subsequently rehabilitate high-risk individuals, and (3) encouraging increased individual physical capacity (fitness). Steps that could be taken to accomplish these ends include the following: 1. Institute preplacement and periodic medical evaluations. These should incorporate exercise stress testing, depending on the fire fighters age and coronary artery disease risk factors. 2. Provide fire fighters with medical evaluations to wear self-contained breathing apparatus (SCBA). 3. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.