On May 31, 2002, a 59-year-old male career Fire Fighter (FF) was scheduled for a “Pack Test.” The Pack Test is one of three work capacity tests (WCT) designed to simulate the physical demands of wildland fire fighting. The Pack Test requires an individual to complete a 3-mile walk within 45 minutes while wearing a 45-pound vest. Successful completion of the Pack Test within the 45 minutes allows fire fighters to participate in federal wildland fire fighting operations. The FF began the Pack Test at approximately 0910 hours and had completed about 1.3 miles of the test when he suddenly collapsed. Crew members (emergency medical technicians [EMTs]) witnessed the collapse and initial assessment found the FF unresponsive with no pulse or respirations. Cardiopulmonary resuscitation (CPR) was begun. On-scene ambulance paramedics quickly began advanced life support (ALS) measures. Despite these measures by crew members, ambulance paramedics, air ambulance paramedics, and hospital emergency department (ED) personnel, the FF died. The death certificate and autopsy, completed and performed by the County Chief Deputy Medical Examiner, listed “coronary atherosclerosis” as the immediate cause of death. The Medical Examiner further stated, “the death is attributed to a sudden cardiac arrhythmia during physical exertion as a result of myocardial ischemia due to longstanding coronary atherosclerosis.” The NIOSH investigator agrees with this conclusion. Additionally, the screening mechanism for coronary artery disease (CAD) is inadequate.