On December 31, 2008, a 54-year-old male volunteer fire fighter (FF) was dispatched to a residential fire. On scene, he stretched 200 feet of uncharged 1¾-inch hoseline to the front door of the residence, operated the engine’s pump panel, and carried a portable ventilation fan to the front porch of the residence. After discussing pump panel operation with a crew member, the FF collapsed. Finding the FF unresponsive, without a pulse, and not breathing, the crew began cardiopulmonary resuscitation (CPR). Despite CPR and advanced life support (ALS) administered on scene, en route to the hospital, and at the hospital, the FF died. The death certificate, completed by the coroner, listed “cardiopulmonary arrest due to atherosclerotic cardiovascular disease” as the cause of death. No autopsy was performed. Given the FF’s probable underlying heart disease, NIOSH investigators conclude that the physical stress of driver operator duties probably triggered his sudden cardiac death.