On December 7, 1997, a 52-year old male volunteer fire fighter succumbed to a heart attack 19 hours after fighting a fire in a 200 year-old renovated two-story log cabin. The fire fighting effort was made emotionally difficult by the fact that the 27-year-old female occupant of the dwelling burned to death in the fire, and physically difficult because the heavy timber construction of the log cabin made overhaul efforts laborious. After conducting fire fighting activities for over 4 hours, the fire fighter returned to quarters from the fire at 0445 hours on December 6. Later that day, he assisted with fund-raising activities, but left the fire station early because he was not feeling well. His wife found him in cardiac arrest when she arrived at home at approximately 2320 hours, December 6. He was pronounced dead at 0030 hours, December 7. No autopsy was performed. The cause of death listed on the death certificate was coronary artery disease as a consequence of fatigue/exhaustion. It is possible that the fire fighting activities conducted by this fire fighter 19 hours prior to his heart attack contributed to or triggered the fatal heart attack. A number of complicating factors, including the lack of an autopsy, make it difficult to assess the extent to which these activities increased his risk of a work-related incident. There were no periodic municipality-sponsored medical evaluations or cardiovascular/respiratory fitness programs for volunteer fire fighters in this department. A three-pronged strategy for reducing the risk of heart attacks among fire fighters has been proposed by other agencies. This 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. Steps that could be taken to accomplish these ends include: Implementing an overall health and safety program such as the one recommended in National Fire Protection Association (NFPA) 1500, Standard on Fire Department Occupational Safety and Health Program. Providing fire fighters with periodic medical examinations. Initiating a wellness/fitness program to reduce risk factors for cardiovascular disease and improve cardiovascular capacity.