On November 2, 2001, a 62-year-old male volunteer fire fighter collapsed at the scene of a vehicle fire as he was bringing a tool to the Chief. Despite immediate cardiopulmonary resuscitation at the scene and subsequent advanced life support in the ambulance and at the hospital emergency department, the fire fighter died. The autopsy showed "severe coronary atherosclerosis," and the pathologist attributed death to "acute coronary thrombosis with ischemic arrhythmia." The death certificate, completed by a deputy county medical examiner, listed "cardiac arrhythmia" as the immediate cause of death and "CAD" (coronary artery disease) as the underlying cause. 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 they represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups. 1) Institute preplacement and periodic medical evaluations. These should incorporate exercise stress testing, depending on the fire fighterís age and coronary artery disease risk factors. 2) Fire fighters should be cleared for duty and for respirator use 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 Associationís Standard on Medical Requirements for Fire Fighters and Information for Fire Department Physicians. 3) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 4) Consider including an automatic external defibrillator as part of the basic life support equipment for fire department vehicles.