On May 3, 2006, a 37-year-old male career Fire Fighter (FF) conducted and participated in an 8-hour live-fire training class prior to beginning his shift at 1800 hours. In the early morning hours of May 4th, he responded to a residential fire. Wearing full turnout gear and self-contained breathing apparatus (SCBA), the FF participated in fire suppression and overhaul activities. Afterward, he complained of not feeling well and intermittent chest pain. On scene ambulance personnel evaluated the FF and despite normal vital signs, they transported the FF to the local hospital's emergency department (ED). An acute myocardial infarction (MI) was diagnosed in the ED by electrocardiogram (EKG) and cardiac enzyme tests. Despite treatment with intravenous (IV) medications (clot dissolving drugs), the FF's condition deteriorated and he was intubated and transferred to a tertiary care medical center. At that institution a cardiac catheterization showed a thrombus (blood clot) in his coronary artery which was partially removed by a specialized catheter (Rheolytic coronary thrombectomy with AngioJet Catheter). Although the FF survived this initial event, his condition deteriorated in the intensive care unit (ICU) over the next 40 days. Due to his poor prognosis, on June 15, 2006, life support was withdrawn and he was pronounced dead at 1945 hours. The death certificate and autopsy (completed by the County Medical Examiner) listed "hemodynamic failure" due to "healing and remote myocardial infarctions (MIs)" due to "atherosclerotic coronary artery disease (CAD)" as the cause of death. "Acinobacter septicemia" and "excessive physical exertion during firefighting activities" were listed as significant contributing conditions. It is unclear if any of the following recommendations could have prevented this FF's death at this time. Nonetheless, NIOSH offers these recommendations to improve the FD's overall health and safety program: 1. Ensure that fire fighters are cleared for duty by a physician knowledgeable about the physical demands of fire fighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582, Standard on Comprehensive Occupational Medicine Program for Fire Departments; 2. Provide fire fighters with medical evaluations and medical clearance to wear SCBA; 3. Develop a wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease (CVD) and improve cardiovascular capacity; 4. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural firefighting; 5. Discontinue routine annual resting electrocardiograms (EKGs) unless medically indicated; and, 6. Discontinue annual screening chest x-rays unless medically indicated.