The death toll of recent heat waves in developed countries has been remarkably high, contradicting the common assumption that high levels of economic and technological development automatically lead to lower vulnerability to weather extremes. Future climate change may further increase this vulnerability. In this article we examine some recent evidence of heat wave-related mortality and we conclude that while economic wealth and technological capacity might be a necessary condition for adequately coping with adverse climate change effects, they are not sufficient. Questions of awareness, preparedness, organizational issues, and actor networks have to be addressed in a proactive and focused manner in order to avoid future heat wave damages. We propose some practical consequences for heat wave adaptation measures by adopting a risk governance framework that can be universally applied, as it is sufficiently flexible to deal with the multi-level and often fragmented reality of existing coping measures.