On February 26, 2003, a 52-year-old male career Fire Fighter went to the vehicle bay for a brief walk. Approximately one-hour later, he was found lying on the floor, unresponsive with no pulse and no respirations. Cardiopulmonary resuscitation (CPR) was begun and an ambulance was requested. After approximately one-hour of CPR and advanced life support (ALS) the fire fighter was pronounced dead. The death certificate, completed by the Coroner listed "myocardial infarction" as the immediate cause of death, although 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. 4. Phase in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 5. Designate an employee to administer the pre-placement and annual medical evaluations and their outcomes. 6. Perform an annual physical performance (physical ability) evaluation. 7. Perform an autopsy on all on-duty fire fighter fatalities. Although unrelated to this fatality, the Fire Department should consider these additional recommendations: 1. Provide fire fighters with medical evaluations and clearance to wear SCBA, and, 2. Provide adequate fire fighter staffing to ensure safe operating conditions.