To the Editor: After a major heatwave in 2003 (1), indoor fans were installed in our ward, aiming to reduce mortality during summer. However, the evidence for such an intervention is not in, yet (2). We reviewed in retrospect all admissions from January, 2009 to December, 2011 (Table 1) and compared mortality with recorded average high temperature (as computed by Wolfram Alpha at http://www.wolframalpha.com, accessed 15 July 2012). The setting was a 53-bedded Internal Medicine ward of a city, non-teaching, Hospital in Livorno, Italy. Livorno is a coastal city with temperate climate. Patients were admitted almost exclusively from the Emergency Room and were elderly people (mean age, 78 years), and hospitalised because of acute medical conditions. Mortality during summer was higher than in the winter season, and patients admitted during hot months had an increased risk for in-hospital death (1) as compared with milder seasons. Furthermore, the mortality in August 2003 (being the hottest month of the year, with an average high temperature of 33 °C) was 15.6% and did not differ significantly with that observed in July and August months of the 3 years 2009–2011 (the highest mortality observed was 18% in August 2011, with an average high temperature of 38 °C; p = ns). Although we acknowledge that there is a clear need for evidence in health protection during heatwaves (3), we believe that the scientific community will hardly be provided with well-conducted prospective clinical trials in this field, because of logistic difficulties, financial constraints and, in our opinion, ethical uncertainty. Meanwhile, on the basis of our experience, we suggest air conditioning over electrical fans to protect admitted elderly people from excessive mortality. None declared.