On November 7, 1998, a 50-year-old male volunteer fire fighter responded in a Department tanker to the scene of a reported structural fire with smoke showing. Upon arrival at the scene, there was no fire or smoke, only steam emitting from a dryer vent. While other members of the department began completing the run report, the Captain (victim) collapsed in the cab of the tanker. Once removed from the cab, the victim was found to be unresponsive, without a pulse or respirations. Cardiopulmonary resuscitation (CPR) was initiated by on-scene fire fighters and was followed by advanced life support (ALS) administered by the responding ambulance service. Despite ALS measures administered for a total of 19 minutes on-site, during the 6-minute ambulance ride to the hospital, and for 13 minutes in the hospital's emergency department, the victim died. The death certificate listed ventricular fibrillation due to coronary artery disease as the cause of death. No autopsy was performed. The victim had a previous history of coronary artery disease including coronary artery bypass surgery and coronary artery angioplasty. Four months prior to his death, the victim had an exercise stress test suggesting persistent ischemic heart disease. Despite this finding, the victim was released by his physician for volunteer fire fighting duties without restrictions. The following recommendations address preventative measures that have been recommended by other agencies to reduce, among other things, the risk of on-duty heart attacks and cardiac arrests among fire fighters. These recommendations have not been evaluated by NIOSH, but represent research presented in the literature, regulations passed by enforcement agencies such as the Occupational Safety and Health Administration (OSHA), consensus votes of technical committees of the NFPA, or products of labor/management technical committees within the fire service. This preventative strategy consists of (1) minimizing physical stress on fire fighters; (2) screening to identify and subsequently rehabilitate high-risk individuals; and (3) encouraging increased individual physical capacity (fitness). Steps that could be taken to accomplish these ends include Individuals with medical conditions that would present a significant risk to the safety and health of themselves or others should be precluded from fire fighting activities. Fire Fighters should have annual medical evaluations to determine their medical ability to perform duties without presenting a significant risk to the safety and health of themselves or others. Follow provisions in the revised OSHA respiratory protection standard. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by offering a wellness/fitness program for fire fighters.