On January 13, 2001, a 42-year-old male Fire Fighter responded to a fire in a five-story apartment building. On-scene, wearing full turnout gear and his self-contained breathing apparatus (SCBA) (not on air), he climbed his aerial ladder, performed roof ventilation, and then entered the fire building to search for fire victims and perform overhaul. After approximately 15 minutes on the fire floor, he returned to ground level where he conversed with crew members, walked to the rehabilitation unit, and rested on his apparatus. At this time he began to feel lightheaded. Crew members administered oxygen while ambulance personnel on the scene were summoned. Just as the paramedic arrived he collapsed. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered by crew members, ambulance paramedics, and personnel at the local hospital's emergency department (ED), the victim died. The death certificate, completed by the Medical Examiner's Office listed "hypertensive and arteriosclerotic heart disease" as the immediate cause of death and "smoke inhalation" as an other significant condition. Pertinent autopsy results included an enlarged heart (cardiomegaly with concentric left ventricular hypertrophy), coronary arteriosclerosis with superimposed coronary thrombosis (blood clot), generalized visceral congestion with pulmonary edema, and smoke inhalation. Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests 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. Issues relevant to this Fire Department include: 1. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; 2. Ensure that fire fighters use self-contained breathing apparatus (SCBA) during operations (ventilation, overhaul, etc.) in smoke-filled environments; and, 3. Ensure that fire fighters receive rehabilitation on a scheduled basis.