The urban heat island effect exacerbates independent climate change-induced shifts toward longer, stronger, and more frequent heat extremes. Environmental inequity, driven by a history of racially motivated urban planning policies, has led particular demographics to bear the worst impacts of urban heat exposure and thus also climate change. These impacts cause adverse health outcomes in the form of heat emergencies. Through a novel demographic and spatial analysis of heat-related illness Emergency Medical Services data from Richmond, Virginia, this study investigates the relationships between heat health emergencies and intra-urban heat islands quantified through three heat exposure metrics. We also evaluate the accessibility of built refuge from urban heat in the form of public transit infrastructure, libraries, and government cooling centers in relation to these emergencies. We found that heat emergencies are inequitably distributed among racial, age, and socioeconomic groups in Richmond, particularly among residents identified as Male, Black or African American, 50+ years old, and experiencing mental health, intoxication, and/or homelessness. We found significant associations between the location of these heat emergencies and urban heat islands as estimated from remotely-sensed surface and community science-derived air temperature metrics, but not a co-estimated heat index. We also found that available refuge facilities are insufficiently located to protect individuals with reduced mobility across areas with the highest number of heat-related health emergencies. Community involvement in the mitigation and management of extreme heat threats, especially for those disproportionately impacted, is necessary to decrease the number of summertime heat illnesses. In a process called the urban heat island effect, urban areas experience higher average temperatures compared to nearby rural areas, largely due to the lack of cooling provided by trees and the heat-trapping ability of buildings and paved surfaces. While human-caused climate change is driving average global temperatures to rise, some communities and neighborhoods in Richmond, Virginia experience hotter temperatures than others. This is largely due to a historical lack of government investment in Black and low-income neighborhoods. Hotter, less resourced neighborhoods experience more heat-related health emergencies like heat stroke and heat exhaustion. This study found significant relationships between the location of heat-related illness Emergency Medical Services data from Richmond, Virginia and areas which are measurably hotter. We also found that Richmond has insufficient publicly accessible places for people with limited mobility to escape the heat, including bus stop shelters, libraries, and government cooling centers. Richmonders bear the brunt of heat emergencies unequally, with a higher proportion of heat emergencies among residents identified as Male, Black or African American, 50+ years old, and experiencing mental health, intoxication, and/or homelessness. Impacted community members should be prioritized as cities like Richmond addresses the everyday impacts of climate change and urban heat. Heat-related health emergencies are inequitably distributed in Richmond, Virginia across demographics Remotely-sensed surface temperature, community science-derived air temperature metrics are strong predictors of heat-related health impacts Built refuge is essential for extreme heat management, inequitable access persists for low mobility and vulnerable residents
