The Sustainability Pledge (5 min read)
“The greatest threat to our planet is the belief that someone else will save it.”
“Global warming” – the phrase that gets eyes rolling. It’s already happening so why should I care?
I can still use water from the tap, make my morning coffee, take my kids to school and go on a holiday to Somerset to marvel at nature and wildlife.
The frightening thing is that all of the above IS being affected by global warming.
You can read more about that here -> https://www.wwf.org.uk/updates/10-reasons-why-we-should-all-care-about-climate-change
But that’s not why I wrote this article.
I stumbled across some fascinating data that made me think about what I do and why I do it. In the next 5 mins I’ll distil my 12 hours of research so you don’t have to!
Background
The UN commissions a body to assess the science related to climate change. They are called the IPCC (The Intergovernmental Panel on Climate Change) and are tasked with looking at world climate data.
One of their reports focuses on aiming for a rise in global temperature of 1.5°C by 2030.
To give some context – from the industrial revolution (1800s) to now i.e. 220 years, global temperature has increased by 1°C. That’s 0.005 degrees per year. As opposed to now till 2030, where it is predicted that temperature will rise by 0.05 degrees per year, ONLY if we can make the right adjustments!
Temperature is rising 10x as fast as it should be :O
https://www.ipcc.ch/sr15/ - read the full report here – if you like 😉
What do anaesthetists/critical care doctors have to do with this?
If global healthcare were a country, it would be the fifth largest carbon emitter on the planet.
Interestingly, many emissions from healthcare are from higher up in the supply chain i.e. manufacturing, shipping and transport.
There are fantastic campaigns such as NHS greener and NHS ocean who are doing things for higher up in the chain. And we have been able to reduce emissions by 40% in the power sector since 1990s.
But what about the lower part of the chain?
We have a unique place of authority in hospitals and CAN make very simple changes to reduce our own carbon footprint.
Remember the Hippocratic Oath “Do no harm”. Well, there’s a paper summarising main effects of global warming on public health.
The main points are summarised below (NB - WHO= World Health Organisation)
The UK diet contains 25% more saturated fat and less than 70% of the WHO recommended levels of fruits and vegetables. Matching our diet would reduce greenhouse gas emission by 17%! This would increase average life expectancy by 8 months and save 7 million years of life lost prematurely over the next 30 years.
Reducing carbon emissions from electricity production will improve health by reducing concentrations of harmful air pollutants
Reducing energy demand and improving energy efficiency in homes could lead to 2200 quality adjusted life years (QALYs) gained per 10 000 people over 50 years
Home working, reducing distance to work and “cleaner” transport plus walking/cycling could reduce all cause mortality by 11%. A modelling study found a 7.6% reduction in ischaemic heart disease plus reduced stroke, dementia, diabetes, depression, and cancers.
If that not enough to get you motivated – GMC guidance shows that we “must be able to apply the principles, methods and knowledge of population health and the improvement of health and sustainable healthcare to medical practice”.
Things to think about next time you are in the hospital
The principle of sustainability is meeting our needs without compromising the ability of future generations to meet their own needs.
So how can we as anaesthetists make a change towards sustainability?
Here’s 10 ideas towards more sustainable processes.
1. THINK ABOUT HOW YOU GAS
GWP = global warming potential. This was a scale created which relates to the ability of a gas molecule to react to infrared and therefore cause heat retention.
The table on the left ranks GWP potential of gases commonly found in anaesthesia.
It’s not difficult to understand why many hospitals have completely removed desflurane from their anaesthetic machines.
2. Think about that flow
Keep your flow to <1 L/min and use end tidal control
CO2 absorbers are exhausted quicker but financial cost is still reduced using this method, as well as only changing the absorber when there is a rising baseline on waveform capnography. Lowering fresh gas flow also increases the efficiency of scavenging.
3. TIVA is a more sustainable anaesthetic
Propofol has 1% of the GWP of sevoflurane. A study was done looking at the life cycle of inhaled anaesthetic vs propofol and found that the GWP of inhaled anaesthetics is 4 times more that a MAC equivalent quantity of propofol (with the plastic syringes, tubing, drug pump electricity). If you have a long case, you could also reuse the same propofol syringe.
4. Plastic Trays vs disposable
This has been proven – reusable trays have a lower financial and environmental footprint - including the cleaning!
5. Don’t throw the laryngoscope handle
Reusable laryngoscopes are less expensive and have a lower environmental footprint than single-use laryngoscopes. Perhaps get the cardiac arrest bag in hospital to have the reusable scope?
6. Minimal plastic syringe use
I remember when I started out I used to take great pride in preparing syringes in advance. However at the end of a list I would find myself throwing a way a whole tray of empty syringes.
Operating suites produce a quarter of all hospital waste, and a quarter of that is from anaesthesia!
Things we can do – don’t draw up emergencies like atropine/glycopyrrolate, but keep them handy. Draw up the minimum you need – arguably it will also reduce your risk of administering the wrong drug so it’s a win-win!
7. Pick the right bin bag and recycle where you can
Approximately one-quarter of theatre and 15% of critical care waste can be recycled.
“Recycling 11 tonnes of plastics, paper, etc. from a six-theatre operating suite produced approximately 15 tonnes less CO2e emissions p.a.117 (120 000 km driven)92 than the manufacture of new plastics. Recycling 1 ton of mixed plastics is equivalent to saving 16.3 barrels of oil, 30 cubic yards of landfill and 5774 kW h of energy (enough to power an average US household for 6 months)”
Remember the orange bag, the yellow and black, the clear bag and the plain binbag. Pay attention to what you dispose of in each.
8. Feeling cold? Don’t open another surgical gown!
Every time you open a gown for your warmth, you are increasing your carbon footprint. Get a warming jacket, wear some layers or even better, do a little walk up and down theatre to stay active - another win-win!
9. Get some reusable washable hats
This is such a simple fix, and also means you get to show a bit more of your personality (if you want). Just make sure you have a few so you can put them in a wash!
10. Challenge your colleagues on their practices
Arguably, one of the most important things is continuing the conversation. Things don’t change without you. By being open to discussions on sustainability, we can all grow and develop as a society.
Our sustainability pledge
At MOSCE-TO, we know that there is an impact to everything we do.
By keeping our courses online we have kept our carbon footprint to a minimum, through a reduction in mass travel as well as lighting and heating (if we had to hire building to host our courses.) We are mindful of the impact of videocalls on our carbon footprint, which is why our internal communications rely on audio calls where we can.
We also provide mark schemes and materials both to examiners and candidates in an online format, therefore reducing our paper wastage.
We will always be looking for more ways to be sustainable in our practices - please feel free to contact us if you have more ideas!
We are all responsible for the environment. Let’s do our part :)
References
https://www.wwf.org.uk/updates/10-reasons-why-we-should-all-care-about-climate-change
https://www.ipcc.ch/sr15/ - IPCC report regarding 1.5 °C
NHS Ocean - https://www.nhsocean.org
NHS greener - https://www.england.nhs.uk/greenernhs/
GMC - https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf
BMJ - Milner J, Hamilton I, Woodcock J, Williams M, Davies M, Wilkinson P et al. Health benefits of policies to reduce carbon emissions BMJ 2020; 368 :l6758 doi:10.1136/bmj.l6758
Milner J, Green R, Dangour AD, et al Health effects of adopting low greenhouse gas emission diets in the UK BMJ Open 2015;5:e007364. doi: 10.1136/bmjopen-2014-007364
Further reading
McGain, F., Muret, J., Lawson, C., & Sherman, J. D. (2020). Environmental sustainability in anaesthesia and critical care. British journal of anaesthesia, 125(5), 680–692. https://doi.org/10.1016/j.bja.2020.06.055
Shelton CL, McBain SC, Mortimer F, White SM. A new role for anaesthetists in environmentally-sustainable healthcare. Anaesthesia. 2019 Sep;74(9):1091-1094. doi: 10.1111/anae.14647. Epub 2019 Mar 28. PMID: 30919406.
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