With Clean Air Day having just taken place on 20 June and with the NHS being the heaviest public sector contributor to climate change, it seems prudent to ponder what the NHS, and ambulance services in particular, can do to reduce their carbon footprint.
Encouragingly, carbon emissions from the NHS, public health and social care systems have reduced by 19% since 2007 despite activity increasing by 27%. However, targets are ambitious, with a goal to cut emissions by 34% by 2020, 51% by 2025, and 80% (using 1990 as a baseline) by 2050.
Needless to say, we have a long way to go and ambulance services face the unique challenge of being a part of the NHS that relies on vehicular transport to fufil its role. As is noted in an informative literature review on scoping ambulance service emissions on page 305 of the current issue of the Journal of Paramedic Practice (p. 305), vehicle fuel represents 80% of the NHS energy burden. The review suggests several organisational and even individual-level strategies to help reduce emissions, save money for the NHS and, importantly, improve public health. Preceding this on p. 302 is a comment outlining the Quality Standard from the National Institute for Health and Care Excellence (NICE) on the impact of outdoor air quality and road-traffic-related air pollution on health, and the relevance of this to ambulance service.
Alongside the important goal to reduce emissions, however, there are other ways in which the NHS and health professionals can contribute to reducing the UK carbon footprint. Earlier this year, NICE produced a patient decision aid to support people with asthma to choose ‘greener’ inhalers in line with their individual needs. This was pertinent as it marked the first time that NICE developed a tool highlighting the impact of a pharmaceutical or medical device on climate change. In terms of the difference this can make, a dry powder inhaler has an estimated carbon footprint of 20 g, whereas a metered dose inhaler has a carbon footprint of about 500 g—the equivalent to 9 miles driven in an average car. According to the NHS Long Term Plan published at the beginning of this year, a move towards low-carbon inhalers will deliver a 4% reduction in our carbon footprint.
On p. 296 of the current issue, Anthony Blinkhorn discusses the use of prehospital emergency anaesthesia. Interestingly, the NHS Long Term Plan also pointed out that the carbon footprint can be reduced by a further 2% if anaesthetic practices are transformed. Modern anaesthetic gases contain hydrofluorocarbons, sevoflurane and desflurane; the chlorofluorocarbon, isoflurane; and nitrous oxide. Use of sevoflurane via a modern anaesthetic machine is akin to driving 30 miles in a modern car; worryingly, use of desflurane, which is considered the most damaging of these agents, via the same machine is equivalent to travelling 230 miles.
So as you take your next ambulance journey on a shift, think about ways in which you might contribute to reducing your carbon footprint. This may take the form of asking your organisation what is being done within your trust towards this objective, or you may simply make the decision to reduce your engine idling time where possible. While UK ambulances are yellow and green, and the paramedic uniform is as green as it gets, it's worth asking yourself, how green are you really?