On November 28, 2005, a 25-year-old male career fire fighter died from injuries he sustained after the engine he was driving collided with a tractor trailer. The victim was alone while driving an engine with lights and sirens operating to a dispatched medical emergency on a highway. He was following a rescue truck with an officer and a fire fighter who were dispatched from the same station. The victim was approaching an intersection as a tractor trailer pulled out in front of him. The victim struck the tractor trailer and the force of the impact pinned him in the driver's seat. Rescue crews extricated the victim and flew him to a local trauma center where he died as a result of his injuries. NIOSH investigators concluded that, to minimize the risk of similar occurrences, fire departments should: 1. develop and document an inspection, maintenance, and repair schedule that includes verification of appropriate vehicle operation prior to the apparatus being placed back into service; 2. ensure that all repairs are performed by a qualified technician; 3. provide training to driver/operators as often as necessary to meet the requirements of NFPA 1451, 1500, and 1002. This training should incorporate specifics on intersection practices; 4. ensure that adequate numbers of staff are available to immediately respond to emergency incidents. Although it is unclear if the following contributed to this incident, State and local authorities having jurisdiction should: 1. consider installing intersection control devices on all emergency vehicles and selected traffic lights; 2. consider developing programs to require and policies to facilitate emergency vehicle drivers obtaining a commercial driver's license.