On December 15, 2002, at approximately 1750 hours, a 61-year-old male career Fire Fighter was at the scene of a fire in a single-family residence when he suffered a heart attack, medically known as a myocardial infarction. While awaiting coronary artery bypass graft (CABG) surgery, he suffered a second heart attack. Despite CABG surgery, his cardiac condition required extensive rehabilitation, and he was transferred to a long term care facility. Due to his deteriorating condition and poor prognosis, a do-not-resuscitate order was written. Twenty-three days later he suffered a cardiac arrest. Cardiopulmonary resuscitation (CPR) was not begun and he was pronounced dead on February 1, 2003. The death certificate listed "acute myocardial infarction" due to "atherosclerotic cardiovascular disease" as the immediate cause of death and "chronic obstructive pulmonary disease (COPD)" as a contributing factor. No autopsy was performed. 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. Consider requiring exercise stress tests (EST) for fire fighters with two or more risk factors for coronary artery disease (CAD); 2. 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; 3. Ensure fire fighters are physically capable of performing the essential job tasks of structural fire fighting; 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity; and, 5. Perform an autopsy on all on-duty fire fighter fatalities . Although unrelated to this fatality, the Fire Department should consider this additional recommendation based on safety and economic considerations: 1. Provide mandatory annual medical evaluations to ALL fire fighters consistent with NFPA 1582 to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others; 2. Discontinue the routine use of annual chest x-rays unless specifically indicated ; and, 3. Discontinue the routine use of annual electrocardiograms (EKG) unless medically indicated.