Formulating a researchable questions: A critical step for facilitating good clinical research. US National Library of Medicine. 2010. https// (accessed 24 June 2019)

Aveyard H. Doing a literature review in health and social care; a practical guide, 3rd edn. Maidenhead: Open University Press; 2014

Blanchard IE, Brown LH. Carbon footprinting of North American emergency medical services systems. Prehospital Emerg Care. 2011; 15:(1)23-29

Blanchard IE, Brown LH. Energy emissions and emergency medical services: policy matters. Energ Polic. 2012; 46:585-593

What are the differences between Scope 1, 2 and 3 Greenhouse gas emissions?. 2017. https// (accessed 24 June 2019)

British Heart Foundation. Tiny particles in exhaust fumes that cause big problems. 2017. https// (accessed 24 June 2019)

Brockway P. NHS at the forefront of carbon modelling. Health Estate. 2010; 64:(9)33-38

Brown LH, Canyon DV, Buettner PG, Crawford JM, Judd J. The carbon footprint of Australian ambulance operations. The Australian ambulance services emissions study group. EmergMed Austral. 2012; 24:(6)657-662

Buettner PG, Brown LH, Canyon DV. The Energy Burden and Environmental Impact of Health Services. Am J Publ Health. 2012; 102:(12)76-82

Carbon Trust. Yorkshire Ambulance Service NHS Trust – Carbon management. 2017. https// (accessed 24 June 2019)

Critical Skills Appraisal Programme. Making sense of evidence. 2006. http// (accessed 24 June 2019)

Department for Environment, Food and Rural Affairs. Air quality: economic analysis. 2015. https// (accessed 24 June 2019)

East of England Ambulance Service NHS Trust. Bespoke ambulances set to hit the road. 2018. https// (accessed 24 June 2019)

European Environment Agency. Emissions Inventory Report – Long-range Trans-Boundary Air Pollution (LRTAP). UNECE Convention. 2013. https// (accessed 24 June 2019)

Gizmodo. London's first fully electric buses are damn expensive. Aatif Sulleyman. 2016. https// (accessed 24 June 2019)

Green Environmental Ambulance Network. Green Passport. 2011. http// (accessed 24 June 2019)

Green Fleet. Electric BMW to be trialled by the East Midlands Ambulance Service. 2017. http// (accessed 24 June 2019)

Harmer L, Hignett S. Smaller, Lighter, Faster? Reducing the carbon footprint of ambulances. J Para Pract. 2018; 10:(3)112-117

Health Business UK. Addressing ambulance emissions. 2017. http// (accessed 24 June 2019)

Brown LH, Buettner PG, Canyon DV, Crawford JM, Judd J. Estimating the life cycle greenhouse gas emissions of Australian ambulance services. J Clean Prod. 2012; 37:135-141

Annual Report 2010–2011.London: London Ambulance Service; 2011

Lord Carter of Coles. Operational productivity and performance in English NHS Ambulance Trusts: Unwarranted variations. 2018. https// (accessed 24 June 2019)

NHS England. Next steps on the NHS five year forward view. 2017. https// (accessed 24 June 2019)

North West Ambulance Service. Ambulance service set to save millions with introduction of electric vehicles. 2017. https// (accessed 24 June 2019)

PRISMA. PRISMA 2009 Checklist. 2009. http// (accessed 24 June 2019)

Quora. Do electric/hybrid car engines have a longer or shorter life expectancy than gasoline engines? Matthew Roche, CEO, Extole. 2010. https// (accessed 24 June 2019)

Every breath we take: the lifelong impact of air pollution.: Royal College of Physicians and the Royal College of Paediatrics and Child Health; 2016

NHS England carbon emission carbon footprinting report.London: Sustainable Development Unit; 2008

Sustainable Development Unit. NHS England Carbon Footprint Report. 2012. https// (accessed 24 June 2019)

Sustainable Development Unit. Health Outcomes Travel Tool – V2.0. 2017. https// (accessed 24 June 2019)

Transport Business. Ambulance services unite in carbon reduction. Fleet management. 2017. https// (accessed 24 June 2019)

Vehicle Certification Agency. Cars and air pollution. GOV.UK. 2017. http// (accessed 24 June 2019)

Freedom of information request, 18 March 2014. 2014. https// (accessed 24 June 2019)

Wallace M, Wray A. Critical reading and writing for postgraduates. 3rd edn. SAGE study skills.London: SAGE publications; 2016

Williamson K. Fuel cell auxillary power proving efficient for Yorkshire emergency response vehicles. Fuel Cells Bulletin. 2011; 10:12-14

Yorkshire Ambulance Service NHS Trust. YAS Forum Annual Report. 2018. https// (accessed 24 June 2019)

Zander A, Niggebrugge A, Pencheon D, Lyratzopoulos G. Changes in travel-related carbon emissions associated with modernization of services for patients with acute myocardial infarction: a case study. J Publ Health. 2010; 33:(2)272-279

Scoping ambulance emissions: recommendations for reducing engine idling time

02 July 2019
Volume 11 · Issue 7


The NHS is a significant contributor to the UK's greenhouse gases and environmental pollution. The current review seeks to examine the degree to which ambulance services contribute to environmental pollution and provides quality improvement suggestions that may reduce emissions, save money and improve public health. A literature search was conducted to identify the English language literature for the past 7 years related to ambulance service carbon emissions and pertinent strategies for reducing harm. An average of 31.3 kg of carbon dioxide (CO2) is produced per ambulance response in the current box-shaped ambulance design. A number of quality improvement suggestions related to cost, emissions and public health emerge. Ambulance services should consider a range of system-level and individual-focused interventions in order to reduce emissions, save money and promote public health.

The UK road traffic volume is estimated to currently produce 5% of air pollution and greenhouse gases (Sustainable Development Unit, 2017), of which 16% has been identified to be linked to the NHS infrastructure and transport (Sustainable Development Unit, 2012). It is not clear what proportion of this comes directly from the UK NHS ambulance fleet.

With health costs resulting from exposure to air pollution totalling more than £20 billion and contributing to approximately 40 000 deaths per year (Royal College of Physicians, 2016), the NHS has developed environmental targets to reduce its carbon emissions by 80% by 2050 (Health Business UK, 2017). The UK Government intends to ban the sale of petrol and diesel engines by 2040 (Lord Carter of Coles, 2018).

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