On July 21, 2003, a 50-year-old male career Fire Fighter had an unwitnessed collapse in the parking lot. After being down for approximately 10 to 15 minutes, he was found lying in the parking lot with agonal respirations and no pulse. Cardiopulmonary resuscitation (CPR) was begun and an ambulance was requested. After approximately one-hour of CPR and advanced life support (ALS), administered on the scene, in the ambulance and at the hospital, the fire fighter was pronounced dead. The death certificate, completed by the Physician, listed "myocardial infarction" as the immediate cause of death. 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 they represent published research or consensus votes of technical committees of the National Fire Protection Association (NFPA) or fire service labor/management groups: 1. conduct 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 for Coronary Artery Disease (CAD) should have an exercise stress test (EST); 3. ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting; and, 4. 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 these additional general recommendations: 1. perform an annual physical performance (physical ability) evaluation; 2. perform an autopsy on all on-duty fire fighter fatalities; 3. provide fire fighters with medical evaluations and clearance to wear SCBA; 4. discontinue routine use of x-rays of the lumbar spine; and, 5. designate an employee to administer the pre-placement and annual medical evaluations and their outcomes.