Abstract: At approximately 5:30 p.m. on May 16, 1990, Employee #1 was using an airline respirator supplied by grade D breathing air from a compressed air cylinder while he prepared to spray paint. At approximately 3:10 p.m., Employee #1 switched to a full compressed-air cylinder. This change was witnessed by at least one other employee. Approximately 5 to 10 minutes later, Employee #1 was found unconscious. Two employees and paramedics performed CPR on the employee, but he died. The cylinder that Employee #1 was using was later analyzed and found to contain less than 1 percent oxygen and more than 98 percent nitrogen.