On Friday, February 13, 2004, a female career Lieutenant (the victim) was shot while attempting to provide emergency care to a civilian shooting casualty. The victim died from her wounds before rescue personnel could reach her. The Lieutenant was a member of a crew that was dispatched to a report of a woman lying along a residential roadside with a possible gunshot wound. After staging the engine away from the scene, the crew approached the woman's location on foot. The victim and a fellow fire fighter/paramedic were performing an initial patient assessment when they were shot by a person who, it was later determined, had shot and killed the woman who was his wife. The victim sought cover from the gunfire behind a nearby tree. The exact whereabouts of the shooter was unknown for a time, and therefore attempts to reach the victim were hampered. Rescue personnel started emergency care as soon as police were able to safely reach and remove the victim from the incident scene. However, resuscitation attempts were unsuccessful and the victim was transported by ambulance to a local level-one trauma center where she was pronounced dead. NIOSH investigators concluded that, to minimize the risk of similar occurrences, fire departments should: 1. develop standard operating procedures (SOPs) for responding to potentially violent situations; 2. develop integrated emergency communication systems that include the ability to directly relay real-time information between the caller, dispatch, and all responding emergency personnel; 3. provide body armor or bullet-resistant personal protective equipment; train on, and consistently enforce its use when responding to potentially violent situations; 4. ensure all emergency response personnel have the capability for continuous radio contact and consider providing portable communication equipment that has integrated hands-free capabilities; 5. consider requiring emergency dispatch centers to incorporate the ability to archive location, or individual, historical data and provide pertinent information to responding fire and emergency medical services personnel; and, 6. develop coordinated response guidelines for violent situations and hold joint training sessions with law enforcement, mutual aid and emergency response departments. Although there is no evidence that the following contributed to this fatal incident, fire departments should consider implementing this recommendation based upon prudent workplace safety practice: 1. develop and implement a workplace violence prevention program that is designed to assess, and address, workplace violence risks.