On May 16, 2001, a 30-year-old male career Captain on-duty at his fire station, retired for the evening at approximately 0200 hours. Between 0630 and 0640 hours, the Captain missed two verbal wake-up calls. When the oncoming crew members arrived at approximately 0650 hours and checked on him, he was unresponsive, pulseless, not breathing, cyanotic, and mottled. Due to his clinical (deceased) appearance, cardiopulmonary resuscitation (CPR) was not begun and no ambulance was requested. The death certificate, completed by the County Coroner, listed "asphyxiation due to probable seizure" 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 sudden death 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. However, it is unlikely that any of these recommendations could have prevented the unfortunate death of this fire fighter: 1. Provide mandatory preplacement and annual medical evaluations for ALL fire fighters, not just career personnel, to determine a fire fighter's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 2. Ensure fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582, the National Fire Protection Association's Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians; 3. Follow provisions in the revised OSHA respiratory protection standard; 4. Perform an autopsy on all deceased fire fighters; and, 5. 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 this additional recommendation: Provide adequate fire fighter staffing to ensure safe operating conditions.