On March 6, 2000 a 50-year-old male volunteer Assistant Chief, responded to a fire in a single-family dwelling. At 1355 hours, after ventilating the roof, the victim collapsed. A crew member, returning from checking hot spots, saw him lying on the roof, unconscious. Other crew members also came to his assistance and found him unresponsive, with no pulse and no respirations. Cardiopulmonary resuscitation (CPR) was begun immediately and an ambulance was requested. Approximately 65 minutes later, despite CPR and advanced life support (ALS) administered on-scene and at the hospital, the victim died. The autopsy, conducted by the County Coroner, listed "Cardiac Arrhythmia" as the cause of death. The death certificate, also completed by the County Coroner, listed "Cardiac arrhythmia " due to "cardiomegaly, left ventricular hypertrophy, and ischemic heart disease" as the immediate cause of death. 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) Conduct mandatory pre-placement medical evaluations consistent with NFPA 1582 to determine a candidateís medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2) Provide mandatory 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. 3) 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. 4) Provide fire fighters with medical evaluations and clearance to wear SCBA. 5) Incorporate exercise stress tests into the Fire Departmentís medical evaluation program. 6) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.