On February 7, 2001, a 65-year-old male Fire Fighter responded to a fire in a double-wide mobile home. On the scene, after setting up a change area for self-contained breathing apparatus (SCBA), operating the pump panel, and replacing a SCBA on the apparatus, he collapsed. Despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered by crew members, ambulance paramedics, and personnel at the local hospital's emergency department (ED), the victim died. The death certificate, completed by the Medical Examiner's Office, listed "hypertensive and arteriosclerotic heart disease" as the immediate cause of death. Pertinent autopsy results included an enlarged heart (concentric left ventricular hypertrophy), coronary atherosclerosis, four vessel bypass, pulmonary edema, and cerebral edema. Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests among fire fighters. This strategy consists of: 1) minimizing physical stress on fire fighters; 2) screening to identify and subsequently rehabilitate high risk individuals; and 3) encouraging increased individual physical capacity. Issues relevant to this Fire Department include: 1) Provide mandatory preplacement 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; 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) Incorporate exercise stress tests into the Fire Department's medical evaluation program for ALL fire fighters; 4) Provide automated external defibrillators (AEDs) as part of the basic life support equipment for fire apparatus; 5) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; 6) Perform an annual physical performance (physical ability) evaluation.