Introduction: A major cause of weather-related deaths is increased frequency and intensity of heat waves, especially in urban areas because of a heat island effects. The negative impacts of the heat waves in urban areas can be exacerbate by trapped pollutants in the stagnant atmospheric conditions. Up to now the effect on morbidity of high temperature modified by air pollutants has not been evaluated in Bosnia and Herzegovina. The purpose of this study is to assess the temporary impact of extreme temperature associated with air pollution levels on emergency room visits during the Summer 2012 heat way. Methods: Day was the statistical unit in this an ecologic study of the relation between ER visits and environment condition. ER patients list were used to collect date of EMACS admissions. Meteorological and air pollution date were obtain by FHI. Statistical analyses were performed using the Statistical Package for Social Sciences software (version 13.0). Results: During the extremely hot days the most frequent health disorders were gastrointestinal (22.71%), cardiovascular (22.23%) and neuropsychiatric disorders (18.23%). There was a significant positive correlation between the values of maximum daily temperature and urological (p<0.01) admissions, relative humidity of air and cardiovascular (p<0.05) and neuropsychiatric (p<0.05) admission, and between the concentration of PM10 and neuropsychiatric (p<0.05) admission. Conclusion: Air quality during the heat waves may influence on ER visits in urban areas what should be considered by health relevant sectors.