On May 22, 2002, a 28-year-old male first-year fire fighter responded to a medical emergency call at 0318 hours. The fire fighter and his crew found the patient in full cardiac arrest and initiated advanced life support (ALS) procedures, including cardiopulmonary resuscitation (CPR). After working on the patient for approximately 30 minutes, the patient was carried down some stairs and loaded into the ambulance for transport. Approximately one minute after the ambulance departed, the fire fighter collapsed. One of the crew members witnessed his collapse and initially believed he was joking around, but quickly realized he was unresponsive with agonal (gasping) respirations. A second ambulance was called as ALS procedures and CPR were initiated. Despite treatment on-scene for 32 minutes, during transport for 12 minutes, and in the hospital for 23 minutes, the victim died. The amended death certificate and the autopsy report completed by the County Coroner's Office listed "Complication of Hypertrophic Cardiomyopathy" as the immediate cause of death. A number of agencies have developed preventive measures to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters. This 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. This strategy has not been evaluated by NIOSH, but represents research presented in the literature, consensus votes of Technical Committees of the National Fire Protection Association (NFPA), or labor/management groups within the fire service. Most, if not all, of these measures are already being followed or are scheduled to be in place by this Fire Department (FD). Therefore, it is unlikely the FD could have prevented this fire fighter's untimely death. Nonetheless, potentially relevant safety issues applicable to this FD include: 1. Consider slightly modifying the preplacement, annual, and periodic medical evaluations to be consistent with NFPA 1582; 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, 3. Enhance the FD's current wellness/fitness program by implementing the proposed program.