On September 19, 2002, a 51-year-old male career District Fire Chief (DC) responded to a fire in the basement and attic of a three-story, multiple family dwelling. While acting as incident commander (IC), he was exposed to heavy smoke from the fire. Approximately two weeks later, the DC responded to a hazmat incident as a member of the State Hazardous Materials Response Team. The hazmat incident involved a spill of 2-chlorotoluene, 2-butanone (methylethylketone), and 1,2,4-trimethylbenzene. Two days after the spill (October 4), the DC developed a cough for which he was evaluated by his primary care physician (PCP) the next day. His respiratory condition worsened and, on October 15, he was admitted into the hospital. Despite intensive hospitalized care, his respiratory function continued to deteriorate until October 24, when he died. The autopsy and death certificate listed "progressive respiratory failure and clinical history of adult respiratory distress syndrome due to inhalational injuries" as the immediate cause of death. The following recommendations address some general health and safety issues. 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) Ensure that fire fighters exposed to smoke have access to medical evaluations if they develop respiratory or any other unusual symptoms; and 2) Implement the annual medical evaluations mandated by the State in 1996.