On December 13, 2002, a 29-year-old male volunteer Fire Fighter completed the written examination portion of his Emergency Medical Technician (EMT) certification. After turning in the examination he excused himself to the restroom. After approximately 10-15 minutes, he was found lying on the restroom floor unresponsive with no pulse and no respirations. Cardiopulmonary resuscitation (CPR) was begun immediately and an ambulance was requested. Approximately 56 minutes later, despite CPR and advanced life support (ALS) administered on the scene and at the hospital, the victim died. The death certificate, completed by the Justice of the Peace listed "acute myocardial infarction" 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 they represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups. While these recommendations could be used at this Fire Department, it is unlikely any of these measures could have prevented this victim's untimely death: 1) Conduct pre-placement and periodic medical evaluations to determine the fire fighter's medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2) Fire fighters with two or more risk factors should have an Exercise StressTest (EST). 3) Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting and the various components of NFPA 1582 and the results of the exam are discussed with the fire fighter. 4) Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 5) Designate a City employee to administer the pre-placement and annual medical evaluations and their outcomes. 6) Perform an autopsy on all on-duty fire fighter fatalities. 7) Although unrelated to this fatality, the Fire Department should consider these additional recommendations; provide fire fighters with medical evaluations and clearance to wear SCBA.