On November 18, 1997, a 27-year-old male fire fighter collapsed while fighting a fire in a two-bedroom apartment located on the second floor of a multi-unit apartment building. The fire involved the bed and night table in the apartment's master bedroom and had generated a moderate amount of smoke. The fire fighter, who was wearing full turnout gear and a self-contained breathing apparatus (SCBA), was assisting an attack crew on the second floor landing in front of the apartment. According to witnesses, the fire fighter showed no signs of distress when he began to descend the stairway. Approximately, half-way down the 15-step stairway, he collapsed. Nearby fire fighters immediately initiated cardio-pulmonary resuscitation (CPR), followed by advanced cardiac life support (ACLS) from the responding ambulance service. Seventeen minutes after his collapse, he arrived at the hospital emergency department. Care provided at the emergency department eventually stabilized his cardiovascular status, but anoxic (without oxygen) brain damage had already occurred. On November 23, 1997, life support machines were disconnected and, shortly thereafter, he died. The autopsy report listed anoxia as the immediate cause of death. The following recommendations address health and safety issues in general, as well as problems uncovered during the NIOSH investigation. It is unlikely, however, that any of these recommendations could have prevented the sudden cardiac arrest and subsequent death of this fire fighter. These recommendations rely on a three-pronged strategy for reducing the risk of on-duty heart attacks and cardiac arrests among fire fighters 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: Provide adequate fire fighter staffing to ensure safe operating conditions. Implement a personnel accountability system such as one recommended by NFPA 1561, Standard on Fire Department Incident Management System, Section 2-6. Implement an incident management system with written procedures for all fire fighters. Provide fire fighters with annual medical evaluations for clearance to wear SCBA. These clearance evaluations are required for private industry employees and public employees in States operating OSHA (Occupational Safety and Health Administration) approved State plans All personnel entering a potentially hazardous atmosphere must wear a SCBA. The content and frequency of the fire fighter medical evaluations should be consistent with those required by OSHA and recommended by NFPA, and the International Association of Fire Fighters/International Association of Fire Chiefs. Reduce risk factors for cardiovascular disease and improve cardiovascular capacity by implementing a wellness/fitness program for fire fighters. When the function of a SCBA is questioned in a fire fighter's injury or death, NIOSH is available to perform objective, expert testing of the SCBA.