On April 3, 2006, a 40-year-old male Assistant Chief (AC) with an industrial facility Emergency Response Team (ERT) participated in live-fire training, which included industrial fire suppression. After the training, the AC complained of not feeling well and collapsed. Crew members began first aid as an ambulance was summoned. An ambulance arrived at the site three minutes later and paramedics found the AC unconscious and unresponsive. Advanced life support was begun and the AC was transported to the hospital's emergency department (ED). Inside the ED, despite advanced life support treatment, the AC died. The death certificate (completed by the attending physician) listed "brain death due to brain aneurysm" as the cause of death. No autopsy was performed. The NIOSH investigator concluded that the AC's death was due to rupture of a cerebral aneurysm, possibly triggered by the physical exertion associated with fire suppression training. NIOSH investigators, however, cannot definitively determine whether the physical exertion played a role in his death. The following recommendations would not have prevented this fire fighter's death. However, NIOSH investigators offer these recommendations to address general safety and health issues: 1. 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. 2. Discontinue routine annual electrocardiograms (EKG) unless medically indicated. 3. Discontinue annual screening chest X-ray unless medically indicated. 4. Phase in a wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease (CVD) and improve cardiovascular capacity. 5. Perform an autopsy on all on-duty fire fighter fatalities.