The short but intense heat wave in mid-July 1995 caused 830 deaths nationally, with 525 of these deaths in Chicago. Many of the dead were elderly. and the event raised great concern over why it happened. Assessment of causes for the heat wave-related deaths in Chicago revealed many factors were at fault, including an inadequate local heat wave warning system, power failures, questionable death assessments, inadequate ambulance service and hospital facilities, the heat island, an aging population, and the inability of many persons to properly ventilate their residences due to fear of crime or a lack of resources for fans or air conditioning. Heat-related deaths appear to be on the increase in the United States. Heat-related deaths greatly exceed those caused by other life-threatening weather conditions. Analysis of the impacts and responses to this heat wave reveals a need to 1) define the heat island conditions during heat waves for all major cities is a means to improve forecasts of threatening conditions, 2) develop a nationally uniform means for classifying heat-related deaths, 3) improve warning systems that are designed around local conditions of large cities, and 4) increase research on the meteorological and climatological aspects of heat stress and heat waves.