On January 14, 2003, a 46-year-old male career Captain responded to a working fire in a 1 1/2-story, single family dwelling with possible entrapment. While wearing full bunker gear and self-contained breathing apparatus (SCBA) and breathing air from his SCBA, he and his crew members searched the residence and located the fire in the attic, then the Captain exited the structure to replenish his air supply. While sitting on Engine 6, he collapsed. Crew members began cardiopulmonary resuscitation (CPR) and ambulance personnel on the scene loaded him into the ambulance and transported him to the hospital. Advanced life support (ALS) measures were initiated en route to the hospital and continued inside the emergency department (ED) until 0221 hours, when he was pronounced dead. The autopsy and death certificate listed "cardiac arrhythmia" due to "heart disease" as the immediate cause of death and "exertion while fighting a house fire" as a contributing factor. 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 represent published research, or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups: 1. Conduct 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. Provide mandatory annual medical evaluations to ALL fire fighters consistent with NFPA 1582 to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 3. Incorporate exercise stress tests into the Fire Department's medical evaluation program; and, 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.