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On May 17, 2012, a 69-year-old male volunteer fire fighter ('the FF') was participating in ladder training as part of the state 70-hour, 11-component fire fighter introduction training program. The FF had completed 10 of the training components, with only the ladder training remaining. The ladder training involved climbing a 24-foot extension ladder to the second story window of the training building while wearing full turnout gear and a self-contained breathing apparatus (SCBA) (off-air), and carrying an ax. After entering the second floor window, the FF was supposed to descend an attic ladder to the first floor and exit the structure. After climbing most of the distance up the extension ladder, the FF became dizzy and climbed back down to the ground. Suddenly he became unresponsive and pulseless; crew members began cardiopulmonary resuscitation (CPR) and requested an ambulance (2050 hours). The on-site paramedic unit and an ambulance unit provided advanced life support (ALS) on-scene and en route to the local hospital's emergency department (ED). En route and in the ED, a total of three shocks (defibrillations) were administered without return of a heart rhythm or pulse. After 11 minutes of resuscitation inside the ED, the FF was declared dead at 1133 hours, and resuscitation efforts were discontinued. The death certificate listed 'acute myocardial infarction' as the cause of death. No autopsy was performed. Given the FF's probable underlying coronary heart disease (CHD), NIOSH investigators concluded that the physical stress of ladder training triggered a heart attack or an arrhythmia, which resulted in his sudden cardiac death.