On March 14, 2009, a 49-year-old career Lieutenant (LT) responded to a brush fire as a “paid on-call” fire fighter. Once on-scene, he worked with hand tools for approximately 50 minutes to bring the fire under control. Approximately 10 minutes after the fire was reported under control the LT collapsed. Fellow firefighters began cardiopulmonary resuscitation (CPR) and moved the LT to the roadway where an automated external defibrillation (AED) was available. One shock was delivered without a change in the LT’s clinical condition. An ambulance crew arrived on-scene approximately 15 minutes after the collapse, followed 5 minutes later by an air flight ambulance. The LT was intubated prior to transport and advanced life support (ALS) measures continued during the flight to the hospital’s emergency department (ED). The LT arrived in the ED at 1534 hours, and ALS continued without change in the LT’s condition. Approximately one hour after his collapse, the LT was pronounced dead and resuscitation efforts were discontinued. The death certificate listed “myocardial infarction [heart attack]” as the cause of death with “atherosclerotic coronary vascular disease” as a contributing condition. NIOSH investigators agree with this assessment and conclude that the heavy physical exertion associated with fighting the brush fire triggered the LT’s sudden cardiac death.