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On March 31, 2010, a 53-year-old male career Lieutenant (LT) reported for duty as the officer on Squad 91. During his shift he participated in the Fire Department's (FD) annual self-contained breathing apparatus (SCBA) endurance evaluation. After completing the first evolution in about 15-20 minutes, the LT complained of shoulder pain and sat down to rest. Shortly thereafter, both on-duty crews were dispatched to separate emergency calls. The LT did not respond with Squad 91, and crew members assumed the LT was either taking a shower or had responded with the other crew. Upon returning to the fire station about 1 hour later, crew members found the LT unresponsive in his bunkroom. Cardiopulmonary resuscitation (CPR) and advanced life support were begun, and the LT was transported to the local hospital's emergency department (ED). Advanced life support continued in the ED for an additional 10 minutes when he was pronounced dead by the ED physician. The autopsy, completed by the County Coroner, listed the cause of death as 'acute thrombus of left anterior descending artery' due to 'hypertensive atherosclerotic cardiovascular disease.' Given the LT's underlying coronary artery disease (CAD), NIOSH investigators concluded that the physical exertion involved in performing the SCBA endurance training triggered his acute heart attack and subsequent cardiac death.