On December 24, 2009, a 44-year-old male volunteer fire Chief responded to a medical call for a non-life-threatening condition. At the scene, the Chief assisted in loading the patient onto the stretcher and into the ambulance for transport to the local hospital’s emergency department (ED). While assisting in the patient compartment of the ambulance, the Chief collapsed. A second ambulance (squad) was dispatched to assume care and transport of the first patient, while the ambulance crew turned its attention to the Chief. He was not breathing but had a weak pulse. The EMTs provided oxygen as they waited approximately 2 minutes for the second ambulance to arrive. The Chief’s condition did not change during transport, but as the ambulance arrived in the ED, the Chief suffered cardiac arrest. Cardiopulmonary resuscitation (CPR) and advanced life support were begun and continued in the ED for 40 minutes. At 1911 hours the ED physician pronounced him dead, and resuscitation efforts stopped. The death certificate and the autopsy listed “atherosclerotic coronary artery disease” as the cause of death with “cardiomegaly” as a contributory condition. Given the Chief’s underlying atherosclerotic coronary artery disease (CAD), NIOSH investigators concluded that the physical exertion involved in responding to the call and assisting in loading a patient onto a stretcher and into an ambulance triggered his sudden cardiac death