A key strategy in societal adaptation to climate change is using alert systems to prompt preventative action and reduce the adverse health impacts of extreme heat events. This paper implements and evaluates reinforcement learning (RL) as a tool to optimize the effectiveness of such systems. Our contributions are threefold. First, we introduce a new publicly available RL environment enabling the evaluation of the effectiveness of heat alert policies to reduce heat-related hospitalizations. The rewards model is trained from a comprehensive dataset of historical weather, Medicare health records, and socioeconomic/geographic features. We use scalable Bayesian techniques tailored to the low-signal effects and spatial heterogeneity present in the data. The transition model uses real historical weather patterns enriched by a data augmentation mechanism based on climate region similarity. Second, we use this environment to evaluate standard RL algorithms in the context of heat alert issuance. Our analysis shows that policy constraints are needed to improve RL's initially poor performance. Third, a post-hoc contrastive analysis provides insight into scenarios where our modified heat alert-RL policies yield significant gains/losses over the current National Weather Service alert policy in the United States.