An Italian network for the prevention of the health effects of heat waves was established in 2003. The network coordinated by the National Department for Civil Protection in collaboration with a centralised data elaboration center, involves experts from epidemiological departments, local health authorities, and regional agencies for the environment. At the municipal level, local centers (municipality, local health authority) coordinate the workload. Weather forecast data for each city are transmitted daily from the Italian Air Force Meteorological Service to the centralised data center and elaborated. An informative bulletin, graded by the severity of the warning, is then transmitted to the National Department for Civil Protection and published on their website. At the same time, the data elaboration center transmits a city-specific bulletin to the local coordinating center, which is responsible for the local dissemination of the information and, in case of an alarm, the activation of a city-specific prevention programme. This programme is defined based on the guidelines developed by the National Institute of Health and take into account local conditions. Information regarding the warning is transmitted to local health authorities and social services, public and private hospitals, nursing homes, general practitioners, and social centres for the elderly and to the general public via the media. Preventive measures especially aimed at the elderly and other susceptible groups include a telephone help-line, a network of social services, volunteers, street units trained for emergency situations and a campaign to inform the population of air conditioned public facilities. Hospitals are urged to provide air conditioning for patients at risk and to postpone non-emergency surgeries. Specific guidelines are drawn up by the Association for General Practitioners for the general population, and for patients suffering from specific diseases which then are distributed at the beginning of the season. Brochures are distributed to local pharmacies and physicians.
In the summer 2003 the HHWWS was experimented in four Italian cities, namely Turin, Milan, Bologna and Rome. Preliminary results comparing the predicted alarms and the observed excess mortality showed a good ability of the system to predict major peaks in mortality in Rome, whereas an underestimation was observed in Milan and Turin, which can be partly attributable to the extreme meteorological conditions in the summer 2003. In summer 2004, the project will be extended to other cities in order to cover the major urban areas throughout Italy.