On April 25, 2007, a 56-year-old male career Captain was participating in the Fire Department's annual "Fit Check" (physical fitness) evaluation. The Captain successfully completed the bench press, sit-ups, and sit-and-reach portions of the evaluation within the allotted time. During the aerobic capacity (3-mile walk) portion of the evaluation, he completed 6 of 12 laps around the ¼-mile track, when he suddenly collapsed. Crew members on the scene responded and found him unresponsive, not breathing, and with a weak pulse that stopped shortly thereafter. Approximately 29 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support administered on-scene and at the hospital, the Captain died. The death certificate and the autopsy, completed by the County Medical Examiner, listed "complications of atherosclerotic cardiovascular disease" as the immediate cause of death with "cardiomegaly" as a significant condition. NIOSH investigators offer the following recommendations to address general safety and health issues. However, it is unclear if any of these recommendations would have prevented the Captain's sudden cardiac death: 1. Provide mandatory annual medical evaluations to all fire fighters to ensure their medical ability to perform fire fighting duties without presenting a significant risk to the safety and health of themselves or others. 2. Incorporate exercise stress tests into the Fire Department's medical evaluation program. 3. Provide fire fighters with medical evaluations and clearance to wear self-contained breathing apparatus (SCBA). 4. Provide exercise equipment in all fire stations. 5. Ensure that all members participate in the Fire Department's mandatory wellness/fitness program.