On September 12, 2007, a 56-year-old male volunteer Fire Chief was awakened at his residence at approximately 0100 hours by a civilian notifying him of a fire in a nearby structure. The Chief exited his house and verified the information. The Chief reentered his home to retrieve his portable radio when he collapsed. The Chief's daughter came downstairs, saw her father had collapsed, and ran outside to summon help from the responding fire fighters. Cardiopulmonary resuscitation (CPR) was started as the ambulance arrived shortly thereafter. Paramedics began advanced life support and transported the Chief to the hospital's emergency department where CPR and advanced life support treatment continued. Approximately 57 minutes after his collapse, the Chief died. The death certificate and the autopsy completed by the County Medical Examiner listed coronary artery disease as the cause of death. Given the Chief's underlying CAD, the physical stress of performing firefighting duties probably triggered a heart attack or a cardiac arrhythmia resulting in his sudden cardiac death. The NIOSH investigator offers the following recommendations to address general safety and health issues. Had these recommended measures been in place prior to the Chief's collapse, his sudden cardiac death may have been prevented. 1. Provide preplacement 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. Incorporate exercise stress tests following standard medical guidelines into the Fire Department's medical evaluation program. 3. Ensure fire fighters are cleared for return to 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. 4. Phase in a comprehensive wellness and fitness program for fire fighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity. 5. Perform an annual physical performance (physical ability) evaluation to ensure fire fighters are physically capable of performing the essential job tasks of structural firefighting. 6. Provide fire fighters with medical clearance to wear a self-contained breathing apparatus (SCBA) as part of the Fire Department's medical evaluation program.