On May 18, 2003, a 28-year-old male volunteer training/safety officer (the victim) was seriously injured when he fell from a moving pick-up truck. He had completed a three-day training course and at the time of the incident was being transported within the training grounds. The victim was riding on the lowered tailgate of a pick-up truck when he fell onto the road. He suffered severe head trauma and was treated at the scene by fellow fire fighter/emergency medical technicians (EMTs) and on-site emergency medical services. The victim was transported by medical helicopter to a local trauma center where he died from his injuries on May 24, 2003. NIOSH investigators concluded that, to minimize the risk of similar occurrences, fire service organizations should ensure that all personnel being transported when on-duty, be securely seated and restrained in approved vehicle passenger compartments. Although it is unclear if a medical or physical condition contributed to this fatal incident, fire departments should consider implementing these safety and health recommendations based upon the physical demands and medical requirements of fire fighting: 1. provide mandatory pre-placement and annual medical evaluations, consistent with NFPA 1582, for all fire fighters to determine medical fitness for duty and training exercises; and, 2. conduct periodic physical capabilities testing to ensure that fire department personnel meet the physical requirements for duty and training exercises.