The United States has over 1,000 heat-related deaths annually according to the Center for Disease Control and Prevention.1 The older patient (>65 years old) is particularly susceptible to heat-related emergencies due to both physiologic and structural vulnerabilities.2 In fact, during the infamous Chicago heat wave of 1995, over half of the deaths were in patients over 75 years old.3 As temperatures rise in the summer and amidst global warming, identifying heat-related illnesses in the emergency department (ED) is critical for initiating timely treatment. Excessive heat and humidity disproportionately harm older adults, and the signs and symptoms of heat illness are more easily missed or misdiagnosed as people age. This article will focus on the emergency identification and management of heat-related emergencies in older patients.