On January 31, 2002, a 48-year-old male career Master Fire Fighter (the victim) was on duty at his fire station watching television at approximately 0100 hours when he last spoke with crew members. At approximately 0720 hours, crew members found the victim sitting in the same chair, apparently asleep. When they tried to wake him, they found him unresponsive, with no pulse, no respirations, and cool to the touch. Since he was obviously expired for some time, cardiopulmonary resuscitation ( CPR) was not begun. He was transported by ambulance to the hospital where he was pronounced dead. The death certificate, completed by the Medical Examiner, and the autopsy, completed by the Chief Medical Examiner, both listed "ischemic heart disease" as the cause of death. The following recommendations address some general health and safety issues. 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. Conduct mandatory preplacement medical evaluations consistent with NFPA 1582 to determine a candidate's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582 and the results of the exam are discussed with the fire fighter. 3. Designate a City employee to administer the preplacement and annual medical evaluations and their outcomes. 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. Although unrelated to this fatality, the Fire Department should consider this additional recommendation based on safety considerations: Provide adequate fire fighter staffing to ensure safe operating conditions.