On January 31, 2008 the Captain was an instructor for fireground operations training at the City Training Academy. The following day, February 1, the Captain ran for approximately 1 mile on a treadmill at his home. Shortly after completing the run, he grabbed his chest and collapsed. An ambulance crew from the local volunteer fire department (FD) responded to his residence and initiated advanced life support (ALS). After being worked on for about 30 minutes, the Captain was transported to the local hospital emergency department. ALS measures continued in the emergency department for another 10 minutes without change in the Captain's condition and he was pronounced dead. The medical examiner listed the cause of death as "Hypertensive Atherosclerotic Cardiovascular Disease." NIOSH investigators agree with this assessment and conclude that the physical exertion associated with the Captain's physical fitness program triggered his sudden cardiac death. NIOSH offers the following recommendations to reduce the risk of heart attacks and sudden cardiac arrest among fire fighters at this and other FD across the country. 1. Provide mandatory pre-placement and periodic medical evaluations to all fire fighters consistent with the National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. 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. Develop a comprehensive wellness/fitness program for fire fighters to reduce risk factors for cardiovascular disease (CVD) and improve cardiovascular capacity.