On April 10, 2002, a 56 year-old male career Captain, wearing full turnout gear and self-contained breathing apparatus (SCBA) (on air), finished igniting a training fire and exited the structure. After leaving his SCBA bottle with the Air Unit to be refilled, he walked by the stand-by ambulance to sit down on the ground. After telling nearby crew members that he was not well, he had a witnessed collapse. Approximately 29 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The Death Certificate, completed by the Medical Examiner, listed "ischemic heart disease due to coronary artery disease" as the cause of death. An autopsy, conducted by the Office of the Chief Medical Examiner, listed the cause of death as "probable cardiac arrhythmia secondary to ischemic heart disease caused by severe coronary artery atherosclerosis." 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) Use a secondary (technological) test to confirm placement of the ET tube in the trachea; 2) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; 3) Provide both strength and aerobic exercise equipment in all fire stations.