In august 2003, a heat wave took France by surprise and killed 15 000 people, especially in north part of the country. Paris has suffered the most and 1500 old or ill people died in 20 days from the 3 to the 21 of august.

Many of these losses of lives could have been avoided, if authorities did have knew, explored and been inspired by foreign experience, for example in Chicago, but also if they had better listened to the weak signals from some parts of it’s emergency system. Heath ministry, responsible for ruling ‘flu and pandemics was self blinded.

That what told the experts and an extra commission of French parliament, who decided to react and required each prefect of department and each city to devise a prevention and action plan. Studies help us to know here the danger comes from, but also who are more vulnerable to it. The problem is that they are numerous, changing, uneasy to reach and convince to act: old, disabled , weak or ill and isolated urban people.

We told at last workshop about the preventive aspect. We focus now on the reactive parts of the plan and try to expose how it manage to measure, analyse, warn and rescue a large and Evolutive part of urban population

The plan is divided in three parts

1. prevention measures dedicated to people

A quadrichromic couloured formular (2 pages – recto-verso), describing practical advices in case of serious heat, send up to :

• 135 500 more than 75 old and 19 500 handicaped persons (liste in authorised files hold by social welfare organisms responsbilble to help or pay health or national insurance benefits, and 28 600 old or weak people listed in files hold by local authorities of Paris, 16 000 old people becoming dépendant who are helped financiary and socially by local social services . Totally 200 000 persons, 10% of population in paris.
• Else send to health praticians (1000 pharmacists of Paris) and other takeholders in social life and places where old people usually go

This formular contents a proposal to register to a special file wich will be used to contact them in case of heat.. The person, but also his family or neighbour can register. 2000 persons did in 2004 but this summer was rainy and not hot enough to be a reference. Law on citizens rights against abuse of cybernetics and files protects precisely personal data and intimity.

1. Prevention measures dedicated to housing

Law and financial measures help and encourage to install in housing pannels protecting against sun effects and to install air conditioned equipments.

1. crisis action

A part of this chapter contains traditionnal definition for alert levels from meteorological parameters, detecting evolutions and analyse broadcasts.

A second part is more original and deal with the obligation to contact massive part of population in a minimum of time.

Paris contracted with a great call center to be ready to phone in 24 hours to 10 000 persons and ask them 10 questions prepared by medical experts. IN case of acting the plan, the center has to stop or reorganize his normal activity and start to work for the mayor of paris. His crew is already and every year formed for that hazardous, uncertain job. Paris pays for it 50 000 euros one shot and 15 000 euros every year.

The conversation is as important as the content : the person is supposed to be isolated and vulnerable : the call cuts this sentiment of isolation, and proves the person that somebody cares about him or her. But the content is also important because the employee has to follow a strict procedure in analysis of answers to questions. He register them in the file and comput: the computing gives three possible options :

• person is OK, she needs help to prevent stronger deasese, she needs rescue

The third part is organising the work in consequence of this computing :

• social visits with social workers and or volunteers
• medical emergency

Medical emergency obeys to classical procedures with hospitals or privacy medecin

Social visits are unusual at such a large scale and urgency. If you do your social work bad, usually people just go on to be unhappy and poor. But there, if you do it bad, people gets in danger.

So the plan created a new way of help people : in complement of usual advices (drink, go to airconditionned areas, see people, etc), it organise planified set up places air conditioned in order to bring there people unable to protect themselves , in order to prevent deshydratation. In each place employee play the host and provides commodities and “good times” (playing card etc..)

This part of plan is very new and problematic because authorities and public services take place of family and neighbourhood solidarity, but has been revealed necessary because reality of threat is in loneliness.

After a short presentation (20 mn maxi), the debate could take place around 2 questions: 1°) one system for every kind of crisis or as many adapted plans as required by situations ? 2°) where until public authorities have to act in place of individuals ?