On November 12, 2002 at 1347 hours, a 38-year-old male Fire Fighter collapsed at his fire station. Despite cardiopulmonary resuscitation (CPR) and Advanced Life Support (ALS) administered at the fire station, in the ambulance, and in the hospital's emergency department (ED), the victim died. An autopsy revealed an enlarged heart and granulomatous lesions consistent with sarcoidosis in the victim's heart, lungs, lymph nodes, and liver. There was no evidence of coronary artery disease or evidence of a heart attack (myocardial infarction). This is the second NIOSH fire fighter fatality investigation of an on-duty sudden cardiac death due to sarcoidosis involving the heart. It is unclear whether fire fighters have an increased prevalence of sarcoidosis compared to the general population, however, the possible association warrants further epidemiologic study. Other agencies have proposed a three-pronged strategy for reducing the risk of on-duty sudden cardiac death 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 (FD) include: 1. Provide annual medical evaluations to fire fighters to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. The Department and Union should negotiate the content and frequency to be consistent with NFPA 1582; 2. Evaluate abnormal findings uncovered during annual medical evaluations. If this follow-up medical evaluation is conducted by the fire fighter's personal physician, results should be reviewed by a fire department physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582; 3. Ensure that fire fighters are cleared for duty, following an injury/illness, by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582; and, 4. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by phasing in a mandatory wellness/fitness program negotiated between the Fire Department and the Union. Although unrelated to this fatality, the Fire Department should consider this additional recommendation based on safety and economic considerations: 1. Discontinue automatic pre-placement screening x-rays of the lumbar spine; and, 2. Discontinue pre-employment/pre-placement exercise stress test for applicants under the age of 35.