On February 13, 2000, a 48-year-old male Lieutenant participated in a structural drill at a three-story barracks. After exiting the structure and walking to the Engine, he sat down on the Engine's running board, and collapsed. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) performed on the scene by crewmembers and paramedics, and by hospital personnel at the emergency department (ED), the victim died. The death certificate, completed by the Attending Physician, listed "hypertensive atherosclerotic cardiovascular disease" as the immediate cause of death. The autopsy report, completed by the Assistant Medical Examiner, listed "hypertensive atherosclerotic cardiovascular disease" as the cause of death and "diabetes, hyperlipidemia, tobacco use, and hypertension" as contributing factors. The following recommendations address some general health and safety issues identified during this investigation. 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, consensus votes of technical committees of the National Fire Protection Association (NFPA), or fire service labor/management groups. Issues relevant to this Fire Department include: 1. Incorporate exercise stress tests into the Fire Department's periodic medical evaluation program; 2. Preclude from fire fighting activities those individuals with medical conditions that would present a significant risk to the safety and health of themselves or others; 3. Clear fire fighters for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582; 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; 5. Integrate all emergency services dispatching into one communication center; and, 6. Provide adequate fire fighter staffing to ensure safe operating conditions.