On October 9, 2002, a 49-year-old male career Captain (the deceased) responded to a fire in a two-story apartment building. On scene, acting as Incident Commander (IC), he was directing post-extinguishment ventilation when he collapsed. Crew members found him unresponsive, with no pulse, and no respirations. Cardiopulmonary resuscitation (CPR) was initiated immediately and continued until an ambulance arrived on-scene five minutes later. Despite CPR by crew members and advanced life support (ALS) administered by the ambulance crew and the hospital's emergency department, the victim suffered anoxic brain damage and died two days later. The death certificate, completed by the Cardiologist, listed "ventricular tachyarrhythmia" as the cause of death. No autopsy was performed. 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 and periodic 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. These should incorporate exercise stress testing (EST), depending on the fire fighter's age and coronary artery disease risk factors; 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 pre-placement and annual medical evaluations and their outcomes; 4. Provide automated external defibrillators (AEDs) as part of the basic life support equipment for fire apparatus; 5. Perform an autopsy on all on-duty fire fighter fatalities; and, 6. 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 these additional recommendations based on safety considerations: 1. Provide adequate fire fighter staffing to ensure safe operating conditions; and 2, Use a secondary (technological) test to confirm placement of the ET tube in the trachea.