On December 5, 2002, a 51-year-old male career Captain responded on his Engine company to a working fire in the attic of a two-story dwelling. After assisting with fire extinguishment on the second floor, he suddenly collapsed. Crew members carried him down the stairs and into the front yard, assessed him, and found him to be unresponsive, not breathing, and pulseless. Approximately 46 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The autopsy revealed atherosclerotic and hypertensive cardiovascular disease. The death certificate listed "atherosclerotic and hypertensive cardiovascular 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) Provide mandatory annual medical evaluations consistent with NFPA 1582 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) Consider incorporating exercise stress tests into the Fire Department's medical evaluation program; 3) Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA); 4) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. Although unrelated to this fatality, the Fire Department should consider this additional recommendation based on safety and economic considerations: Discontinue the routine use of annual chest x-rays.