On September 26, 2001, a 32-year-old male fire fighter reported a fire at his own house and initially assisted the responding fire fighters by pulling and holding hose. Half an hour later, he had chest pain and sought help from emergency medical service personnel at the scene. After being evaluated, treated with oxygen (which relieved the pain), and observed, the pain returned and he had a seizure, developed a cardiac arrhythmia (abnormal heart beat), and stopped breathing. Despite cardiopulmonary resuscitation and advanced life support, which began immediately and continued on the way to the hospital and in the emergency department, the fire fighter died. Based on autopsy findings, the death certificate, listed "acute thrombosis of coronary artery" due to "arteriosclerotic cardiovascular disease" as the cause of death. 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 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.