3.1.3. Protective Measures and Responses

Emergency plans specify administration structures during emergency situations, the tasks of participating institutions, and procedures for information exchange and for notifying the public in case of large-scale forest or landscape fires, storms, floods in densely populated areas, and epidemics [62–65]; heatwaves are excluded. Under the coordination of Health Board, health service providers are expected to deliver health services to those affected [59,61,64,65]. The weak capacity of the Health Board to manage emergency situations was mentioned by a representative of the Rescue Board (7 June 2015): "*Only the police and rescue services have a real operational capacity currently in Estonia, the rest who should run the situation, like the Health Board or Environmental Board, only do it declaratively since they have no capacity, experience or structure to speak of today*." Risk analyses compiled by the Health Board [66] noted that microclimates in hospital wards and work premises are likely to deteriorate as a consequence of warmer weather, because most hospitals lack air conditioners. An official from the Ministry of the Interior (29 April 2015) and one from the Health Board's medical bureau (25 May 2015) noted that hot weather plans as not being necessary because: "*We do not have such extreme conditions as a result of which hospitals should start rearranging their work*." Family physicians, hospitals, and ambulance services operate under private law, and their responsibilities and preparedness competences in case of emergency events, like extreme weather, have not been analysed nor regulated [62].

According the Internal Security Development Plan 2015–2020 [58], plans for managing emergency situations are not tested on a regular basis, as required by law (RT I, 2009, 39, 262). For example, during a national exercise "Snowstorm 2010" that took place in the January of 2010, Padaorg valley was mentioned as an area of greatest risk. In the end of the same year, when snowstorm Monica struck Estonia, hundreds of people were left to the elements in Padaorg. Although according to the law, the organisation of exercises and training should be the responsibility of the ministry that is responsible for the emergency, the reality is that national exercises have only been organised by the Ministry of Interior [67].

The interviews also revealed a need to address the issue of "grassroots level applications" to create possibilities for people to protect their health in everyday life. In the case of more frequent extreme weather in the future, the most vulnerable, including the elderly, the chronically ill, or mentally disabled, require special attention from social care and primary healthcare providers. Although social care professionals possess vital information on the location and specific needs of the most vulnerable, they have not been engaged in the process of adaptation (interview with an expert in social care 4 March 2015).

Response measures targeted at individuals during a crisis mainly focus on information-sharing on the web about health risks and preventative measures and instructions on behaviour, and do not consider practical arrangements or infrastructure (Table 1). Web-based information-sharing is limited because not all vulnerable groups have access. According to a Health Board official (7 May 2015), recommendations for the population, including risk groups, in the case of extreme hot weather, are published on the Health Board's website; however, there was no money for published brochures. An official from the Ministry of Environment (21 May 2015): "*What needs to be improved is the notification of the public, early warning of the climate change health risks*." A family physician (7 July 2015) criticised the whole information-based approach for adverse impact prevention: "*Let me give you an example, even if we have info on the radio on the dangerously high UV-factor, people still go to the beach to get tanned*."
