On January 4, 2001, a 39-year-old male Fire Fighter collapsed while exercising in the fitness room of his firehouse. He was found approximately five to ten minutes later by a fellow crew member. The crew member noted the fire fighters cyanotic appearance, checked his vital signs, and found no pulse. He notified Emergency Medical Services (EMS) of a "down" firefighter, and initiated cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator (AED). Despite CPR and advanced life support (ALS) administered on scene, en-route, and at the hospital, the victim died. The death certificate, completed by the Medical Examiner’s Office listed "atherosclerotic cardiovascular disease" as the immediate cause of death. Pertinent autopsy results included: 1) marked atherosclerotic coronary artery disease (CAD), 2) focal fibrotic changes of the heart adjacent to its conduction fibers consistent with a remote (at least three months prior) heart attack (myocardial infarction), 3) myxoid changes of the mitral valve, and 4) no evidence of blood clots in the lung arteries (pulmonary emboli). 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 National Institute for Occupational Safety and Health (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. However, it is unknown if any of these recommendations could have prevented the unfortunate death of this fire fighter. 1) 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 considerations; 2) Use a secondary (technological) test to confirm appropriate placement of the endotracheal (ET) tube during emergency intubations.