Firefighter fatalities are going down – that is the good news. The bad news is that every year firefighters across the world are still losing their lives in ways that could be avoided. It will come as no surprise within this professional community that very few lives are lost to burns – a testament indeed not just to the high level of training that is given but also to the effectiveness of the PPE that is worn by firefighters. What is perhaps less well understood is that a large proportion of fatalities, nearly 50% in the most recent figures to come out of the US, are caused by heart attacks brought on by over exertion and, significantly, by heat stress. It is a sobering figure that should remind everyone that PPE is not simply about protecting firefighters from the immediate threat of fire.