On February 21, 2008, a 48-year-old male volunteer Fire Fighter Trainee participated in a State Fire Academy training activity known as the maze drill. The maze drill simulates a lost fire fighter crawling through restricted passageways. As required by one component of the drill, the Trainee exhausted his air bottle, unhooked his facepiece regulator, and exited the maze. Immediately after exiting the maze, he collapsed. Emergency medical technicians (EMTs) on the scene began medical treatment and an ambulance was dispatched. Advanced life support treatment was provided and the Trainee was transported to the hospital's Emergency Department, where he was treated and transferred to a regional hospital. He died the next day. The death certificate, completed by the attending physician, listed "cardiorespiratory arrest" due to "cardiogenic shock" as the cause of death. The autopsy, completed by the Medical Examiner, listed "atherosclerotic and hypertensive cardiovascular disease" as the cause of death. The NIOSH investigator concluded that the physical stress of performing the maze drill coupled with the Trainee's underlying coronary artery disease (CAD), probably triggered his sudden cardiac death. The NIOSH investigator offers the following recommendations to prevent similar incidents and to address general safety and health issues. 1. Provide mandatory pre-placement and annual medical evaluations to fire fighters consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. 2. Ensure fire fighters are cleared for duty by a physician knowledgeable about the physical demands of firefighting, the personal protective equipment used by fire fighters, and the various components of NFPA 1582. 3. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural firefighting. 4. Phase-in a comprehensive wellness and fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 6. Provide fire fighters with medical clearance to wear self-contained breathing apparatus (SCBA) as part of the Fire Department's medical evaluation program.