Reducing the impact of healthcare on climate change—is the ‘green whistle’ green after all?
Recent reports of the Lancet Countdown on health and climate change discuss the unequivocal contribution of ill-health and healthcare towards rising global temperatures and vice versa. The NHS has a target to reduce its carbon emission by 80% by 2032—a significant challenge for all practitioners. One part of the strategy is using pharmaceuticals with a less harmful impact on the environment.
Nitrous oxide (50% of Entonox) has a significant environmental impact if released into the atmosphere. Methoxyflurane, a similarly short-acting inhaled analgesic, is delivered through the Penthrox ’green whistle’ device and is believed to have a comparatively lower environmental impact compared with nitrous oxide.
This study aimed to carry out a life cycle impact assessment (LCIA) of Methoxyflurane, and then compare the climate change effect against nitrous oxide. The process involved two main phases: firstly, stripping back the device into its component parts and cross-referencing with data sent by the manufacturer; and then entering data into LCIA software using ‘flows’. The authors describe flows as consisting of all inputs and outputs to give a cradle-to-grave environmental impact. Inputs include raw materials, processes, transport and energy requirements, while outputs include waste disposal and excretion of drug.
The majority of the impact on climate change came from raw materials (34.4%) and the production process (29.81%), with disposal contributing a further 25.1%. The authors then compared methoxyflurane with an equivalent dose of Entonox and morphine sulphate. Results show that when Entonox is used, 117.7 times more carbon dioxide equivalents (CO2 e) is produced (raw value 98.89 kg CO2 e) compared with Penthrox (0.84 kg CO2 e). Intravenous morphine (7 mg) produces 0.01 kg CO2 e.
This suggests that if methoxyflurane provides the same analgesic effect, switching away from nitrous oxide in certain clinical situations could help the NHS to reach its carbon emission reduction target.
Electronic records saving the planet…well, maybe
The move from paper records to electronic patient records has been rapid in the UK and it confers numerous advantages. However, little quantitative data exists around the environmental impact of this move away from paper records. We probably consider that cutting trees and converting them into paper is less environmentally friendly than storing data electronically—but is this really the case?
This study aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement, electronic medical records (EMR) system, at a high-volume eye care facility in southern India. The authors sought to carry out a life cycle impact assessment (LCIA) to estimate the greenhouse gas (GHG) emissions of the facility's paper record-keeping system (2016) compared with its EMR system (2019).
Emissions from the facility's EMR system were 195 000 kg carbon dioxide equivalents (CO2 e) per year or 0.361 kg CO2 e per patient visit. This compares with emissions of 20 800kg CO2 e per year or 0.037 kg CO2 e per patient. Most (90%) of the EMR emissions were derived from the electricity used to run the systems. It is therefore reasonable to argue that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. The authors estimated that If the study hospital sourced all of its electricity from renewable sources rather than the Indian electric grid, their EMR emissions would drop to 24 900 kg CO2 e (0.046 kg CO2 e per patient)—a level comparable to the paper record-keeping system.
It is not entirely possible to translate these findings to the UK given the potential differences in energy production. However, the findings should give us cause to reflect on the decisions we make and whether or not there is an environmental impact. We need to consider how our actions impact the environment given the damage global warming is doing to health.