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Approximately 400 people die from extreme heat each year in the United States, and the risk of heat waves may increase as a result of global climate change. Despite the risk of heat-related morbidity and mortality, many cities lack written heat response plans. In a review of plans from 18 cities at risk for heat-related mortality, we found that many cities had inadequate or no heat response plans. This is an important area for further investigation and government attention.