On August 28, 2001, a 27-year-old male first-year fire fighter responded to a structural fire at an auto body shop. The victim donned his personal protective equipment weighing approximately 60 pounds and walked about 150 feet toward the fire building while re-positioning uncharged hose lines. At that time he apparently began to experience difficulty breathing. He did not notify crew members of his symptoms nor did he notify them that he was returning to their apparatus. When he arrived at the apparatus, a civilian witness noticed he was in severe respiratory distress as he climbed into the rig's cab. The incident was a three alarm fire eventually involving 138 fire fighters from 33 units. After several minutes in front of the fire building, the victim's Officer noticed he was missing. The Officer ordered a local search conducted by the victim's partner. After another few minutes of being unable to locate the victim, the Officer notified the Incident Commander who issued a "Mayday" alert. Approximately five minutes later, the victim was found unresponsive without a pulse or spontaneous respiration in the riding position of the rig's cab. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered by on-scene emergency medical service (EMS) personnel and hospital emergency department personnel, the victim died. The death certificate and the autopsy was completed by the Medical Examiner's Office listed "hypertrophic cardiomyopathy with myocardial arteriolarsclerosis" as the immediate cause of death with a "myxomatous mitral value" as a contributing 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 NFPA, or labor/management groups within the fire service. Most, if not all, of these measures are already being followed by this Fire Department (FD). Therefore, it is unlikely the FD could have prevented this fire fighter's untimely death. Nonetheless, potentially relevant issues applicable to this FD include: 1. Emphasize the importance of communication and accountability on the fire ground, particular to fire fighters with minimal fire ground experience; and, 2. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by emphasizing the Fire Department's mandatory wellness/fitness program.