The purpose of this study was to assess the effectiveness of coronary heart disease risk screening as a primary prevention tool. Screening included a lipid screening and American College of Cardiology Framingham cardiac risk profile for volunteers 45 years and older desiring A (interior) or B (exterior) classifications. Health surveillance records from 1998 to 2003 were reviewed for all firefighters and emergency medical services personnel in a rural New York county. Of the 1,458 volunteers evaluated, 1,166 were men and 292 were women. Three hundred fifteen individuals were screened for coronary heart disease risk; 52 had scores indicative of substantially increased risk. Subsequently, a health care provider or cardiologist saw 39 of these individuals, 26 (67%) of whom received pharmacologic, surgical, or other health care intervention. Coronary heart disease risk screening is an effective intervention in this population, and provides volunteers and their primary care providers with added motivation to actively reduce the risk of coronary heart disease via early intervention.