On November 15, 2004, a 47-year-old male Battalion Chief (BC) arrived for duty at his office around 0700 hours. He performed administrative functions throughout the morning and was last seen working at his desk shortly before 0900 hours. At 0917 hours, he was found collapsed at his desk. Despite exhaustive cardiopulmonary resuscitation (CPR) performed at the scene, in the ambulance, and in the emergency department (ED) of the local hospital, the BC died. The autopsy, completed by the District Coroner-Medical Examiner, revealed an enlarged heart with left ventricular hypertrophy and 50%-75% occlusions of the left anterior descending and right coronary arteries. The death certificate, completed by the District Coroner-Medical Examiner, listed “atherosclerotic cardiovascular disease (CVD)” as the immediate cause of death. The NIOSH investigator concluded the BC’s underlying heart disease caused his sudden cardiac death (SCD). His death may have been avoided at this time if the fire department (FD) had followed National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments.