On May 19, 2005, a 22-year-old male career Fire Fighter Recruit collapsed while completing a class run in formation at the end of a training day. The training activities started at 0700 hours with fire fighter training occurring throughout the day. Frequent self-directed rest breaks were part of the training and a lunch break was taken at noon. At approximately 1600 hours, an instructor led physical training consisting of stretching, light aerobics, abdominal crunches, and a 2½ - 3 mile run. During the run the Recruit exhibited fatigue and complained of blurred vision, but did not stop until he stumbled and fell approximately 300 to 500 yards from the training offices at approximately 1719 hours. He was transported back to the office by one of the instructor's truck. The training staff started two intravenous access lines (IV), put on oxygen via a non-rebreather mask, elevated his extremities, and removed his clothes as a cooling measure for a possible heat-induced illness. The ambulance arrived at 1729 hours where an assessment found his skin warm, with normal color and moisture. The Recruit was placed on a stretcher and transported to the hospital emergency department (ED). The ambulance arrived at the ED at 1745 hours where a rectal temperature of 108.6 degrees Fahrenheit (°F) was measured. He was stabilized and transferred to the intensive care unit at 2100 hours. The Recruit never regained consciousness and died nine days later. The final diagnosis from the hospital and the cause of death listed on the death certificate was severe heat stroke with multisystem organ failure. No autopsy was performed. It is the opinion of the NIOSH investigator that the physical stress of the physical training, combined with the heat and humidity, caused the Recruit's death. NIOSH investigators also concluded that to minimize the risk of similar occurrences, the FD should take the following steps: 1. Formulate and institute a heat stress program. 2. Create a training atmosphere that is free from intimidation and conducive for learning. 3. Use physical training staff who have fitness training instruction and are knowledgeable about all aspects of a heat stress program. 4. Use trail vehicle and/or equip training instructors with portable radios for the off-site runs. Although unrelated to this fatality, the Fire Department should consider these additional recommendations based on health and economic considerations: 1. Phase-in a mandatory wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 2. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural fire fighting.