Social EM

Climate Change is Killing Patients. Let’s Not Make it Worse

A climate assessment from November 2018 comprehensively measured the current and projected state of climate change and its effects on human health. It found what we as emergency physicians should already know: Those most at-risk are precisely the communities we care for.

Give us your tired, your poor, your huddled masses yearning to breathe free…

These are the words inscribed on the Statue of Liberty, penned by Emma Lazarus in 1883, yes - but are they also the emblem of the emergency physician?

In our careers, we care for the tired, the poor. The homeless, the mass casualties. The asthmatics and COPD flares. The indigenous, the wealthy, the healthy and unhealthy, the traumas and the sick.

In our careers, in caring for these groups, we advocate for preventative medicine, for safety belts and helmets and vaccines. We recognize the dangers of driving drunk, of injection drugs, of untreated HIV. We counsel on smoking cessation and blood pressure control. We do these things in the name of making our future jobs easier - of preventing health catastrophes. While we love our work, we would all love never to see another victim of a drunk driver, or another CHF exacerbation suffocating, or another hemorrhagic stroke. We advocate for preventative medicine because it’s better for our patients and our communities. 

Our Climate is Changing, Our Patients Are Suffering
The Fourth National Climate Assessment (NCA4), released last November, looked comprehensively at the current and projected state of climate change in the world, particularly in the U.S., and its effects on human and population health. It found what we should already suspect - those communities most at risk are precisely those communities we, as emergency physicians, are tasked with caring for. 

The very young and old are more severely affected by changing temperatures, particularly by increased heat related illnesses. Those with cardiopulmonary illnesses are disproportionately affected by draughts and decreasing air quality. Low income and coastal communities are devastated by flooding and food insecurity. We are all affected by decreasing phytonutrients and increasing vector-borne illness, contaminated food and water, increased mental health burdens of extreme weather events.4 

We’re Making it Worse
The NCA4 also found what we, as physicians, might not expect - how drastically the healthcare industry contributes to climate change. On a national level, health care contributes about 10% of U.S. greenhouse gas emissions each year.4 Hospitals generate thousands of tons of landfill waste a day. On every level, we, our employers, and our industry take thousands of actions a day that cumulatively create an incredible impact on the health of our communities and our world. Think of the landfill waste you generate in a day of caring for patients - the gowns and gloves, disposable lac trays, the IV bags and tubing. Think of the energy required to clean and power an OR for even the most routine case. Our careers, our livelihoods, have environmental impacts beyond even what we as individuals have in our daily lives. 

What Do We Do?
We, as doctors, know prevention is the best medicine. We know a changing global climate is destroying the health of already vulnerable populations. We know our careers, our industry, contributes to global climate change in a substantial way. Why, then, are we, the defenders of the defenseless, the last and only line of healthcare for so many of our fellow men and women, not more alarmed? 

We Can Make it Better
We, as emergency medicine residents, have a unique position to create change in our facilities and communities. Let’s use that position to shift the delivery of healthcare to a more sustainable model. By reducing our industry’s environmental impact, we can help protect our patients’ health, our community’s health, and our world’s health.

In a greening world, our industry is beginning to see that sustainability is key. Our hospitals are starting to go green as administrators realize not just the ethical and environmental advantages, but the financial advantages, of creating energy-efficient infrastructure.

But from our vantage point in the trenches, we can do even more.

How Can We Help?
We can advocate for reusable supplies - the reusable, sterilizable surgical instruments for your lac repair are not only a higher quality, but more sustainable, and potentially even more cost effective.

We can advocate for recycling in our facilities - while reducing our single use plastics will always be the most effective way of reducing landfill waste, a great deal of what we use in the emergency department is recyclable - notably, empty IV bags and tubing that are not contaminated with bodily fluids, pill bottles and containers, and plastic containers for tools and equipment are easily recyclable at almost any facility.

While you are advocating for recycling capacity at your facility - educate! Recycling is only effective when done correctly - avoid food, trash, and bodily fluid contamination.

The possibilities for improvement are endless, and beyond the scope of this brief letter - you need only to look. The most important thing, to start, is to recognize the problem.

Our careers save lives, every day. And our careers are damaging the earth. We must recognize our ability and our responsibility to maximize our impacts, change our careers and our practices, to best benefit our communities and the world.

Get More Involved
This article brought to you on behalf of the EMRA Social EM Committee. Want to learn more about SEM? You can connect with others interested in SEM topics by joining the Social EM Committee Basecamp on the EMRA website. 

1. Kaplan S, Sadler B, Little K, Franz C, Orris P. Can Sustainable Hospitals Help Bend the Health Care Cost Curve? The Commonwealth Fund. 2012.
2. Eckelman MJ, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS One. 2016;11(6):e0157014. 
3. Sadler BL, Berry LL, Guenther R, Hamilton,DK, Hessler FA, Merrit C, Parker D. Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities. Hastings Cent Rep. 2011;41(1):13-23. 
4. Fourth National Climate Assessment. U.S. Global Change Research Program. November 2018.

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