On December 15, 2001, a 48 year-old male career Assistant Chief, was participating in a Fire Department (FD) standby at a local civic event. After he positioned the mini-pumper at a hydrant, he began to unroll the four-inch supply hose. Soon after unrolling the hose he collapsed. A crew member, just arriving at this location, initially thought the victim was checking something under the mini-pumper. The crew member asked the victim what he was doing, but quickly noted he was unresponsive with shallow respirations. After notifying dispatch of the situation, the crew member began cardiopulmonary resuscitation (CPR). Approximately 63 minutes later, despite CPR and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The death certificate listed "probable acute myocardial ischemia" due to "coronary atherosclerosis" due to "diabetes mellitus" as the immediate cause of death and a "history of previous myocardial infarction" as an other significant contributing condition. 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 represent published research, or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups: 1. Provide mandatory preplacement and annual medical evaluations to ALL fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 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; 3. Follow provisions in the revised OSHA respiratory protection standard, specifically providing medical evaluations and clearance to wear SCBA; 4. Ensure that the mandatory wellness/fitness program is accomplished; and, 5. Perform an autopsy on all on-duty fire fighter fatalities. Although unrelated to this fatality, the Fire Department should: Provide adequate fire fighter staffing to ensure safe operating conditions.