Climate change and emergency medicine: impacts and opportunities

Recognition of climate-related risks for prehospital emergency medical service and emergency department in Finland - A Delphi study

BACKGROUND

Emergency departments (ED) and prehospital emergency medical services (EMS) will experience new or increasing challenges due to the changing climate. The aims of this study was to add knowledge about these challenges in Finland and to help EMS and ED operators to prepare for the effects of climate change.

METHODS

A two-round Delphi study was conducted. Ten participants expressed their views of climate change-related challenges currently and in the future, and how to prepare for challenges ahead. First-round questions based on the literature search about the climate-related impacts on EMS and ED. The stage one data was analysed by thematic analysis, which generated the second-round survey where the probability of the statements was estimated.

RESULTS

Various climate change-related challenges were recognized such as negative health impacts, the increased workload, difficulties with the EMS operations and problems with the functions of society. Preparation of action plans was considered important in case for incidents and emergencies.

CONCLUSION

The study indicated that climate change may cause various challenges for EMS and ED in Finland. To meet the future challenges, it is important to identify potential future risks and create plans to manage them. Further studies are needed to create climate resilient healthcare systems.

Climate change and emergency care in Africa: A scoping review

Introduction

Climate change is a global public health emergency with implications for access to care and emergency care service disruptions. The African continent is particularly vulnerable to climate-related extreme weather events due to an already overburdened health system, lack of early warning signs, poverty, inadequate infrastructure, and variable adaptive capacity. Emergency care services are not only utilized during these events but also threatened by these hazards. Considering that the effects of climate change are expected to increase in intensity and prevalence, it is increasingly important for emergency care to prepare to respond to the changes in presentation and demand. The aim of this study was to perform a scoping review of the available literature on the relationship between climate change and emergency care on the African continent.

Methods

A scoping review was completed using five databases: Pubmed, Web of Science, GreenFILE, Africa Wide Information, and Google Scholar. A 'grey' literature search was done to identify key reports and references from included articles. Two independent reviewers screened articles and a third reviewer decided conflicts. A total of 1,382 individual articles were initially screened with 17 meeting full text review. A total of six articles were included in the final analysis. Data from four countries were represented including Uganda, Ghana, Tanzania, and Nigeria.

Results

Analysis of the six articles yielded three key themes that were identified: climate-related health impacts that contribute to surges in demand and resource utilization, opportunities for health sector engagement, and solutions to improve emergency preparedness. Authors used the outcomes of the review to propose 10 recommendations for decision-makers and leaders.

DXDiscussion

Incorporating these key recommendations at the local and national level could help improve preparedness and adaptation measures in highly vulnerable, populated areas on the African continent.

An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S

Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change.

BET 1: The clinical impact of policies aimed at reducing the carbon footprint of emergency departments

A short-cut systematic review was carried out to establish if strategies to reduce greenhouse gas emissions in the ED could succeed while maintaining comparable care standards. Of 2914 papers found in the searches, 40 were selected for full-text review and none were eligible for inclusion. The main reason for exclusion was article type. Given the wide-ranging proposals for reducing greenhouse gas emissions in healthcare, there is a dramatic paucity of evidence on the pragmatic effects on patient care.

Science Policy Training for a New Physician Leader: Description and Framework of a Novel Climate and Health Science Policy Fellowship

The accelerating health impacts of climate change are undermining global health, and the roles of the health sector in addressing the many challenges of climate change are being articulated by governments, multilateral institutions, and professional societies. Given the paucity of physician engagement on this issue to date, there now exists a clear need for health professionals to meet this new challenge with the development and cultivation of new knowledge and skill sets in public health, environmental science, policy, and communication. We describe a novel GME fellowship in climate and health science policy, designed to train a new generation of clinicians to provide the necessary perspective and skills for effective leadership in this field. This fellowship identifies available university resources and leverages external collaborations (government, medical consortiums, affiliate institutions in public health, and environmental science), which we describe as being replicatable to similar training programs of any number of medical specialties and likewise bring meaningful opportunities to their respective training programs and academic departments. The creation of this novel fellowship in climate and health policy provides a roadmap and potential path for similar programs to join us in addressing the defining health issue of this generation and many to follow.

Climate Change, Health and Existential Risks to Civilization: A Comprehensive Review (1989⁻2013)

Background: Anthropogenic global warming, interacting with social and other environmental determinants, constitutes a profound health risk. This paper reports a comprehensive literature review for 1989⁻2013 (inclusive), the first 25 years in which this topic appeared in scientific journals. It explores the extent to which articles have identified potentially catastrophic, civilization-endangering health risks associated with climate change. Methods: PubMed and Google Scholar were primarily used to identify articles which were then ranked on a three-point scale. Each score reflected the extent to which papers discussed global systemic risk. Citations were also analyzed. Results: Of 2143 analyzed papers 1546 (72%) were scored as one. Their citations (165,133) were 82% of the total. The proportion of annual papers scored as three was initially high, as were their citations but declined to almost zero by 1996, before rising slightly from 2006. Conclusions: The enormous expansion of the literature appropriately reflects increased understanding of the importance of climate change to global health. However, recognition of the most severe, existential, health risks from climate change was generally low. Most papers instead focused on infectious diseases, direct heat effects and other disciplinary-bounded phenomena and consequences, even though scientific advances have long called for more inter-disciplinary collaboration.

Projecting temperature-related years of life lost under different climate change scenarios in one temperate megacity, China

Temperature has been associated with population health, but few studies have projected the future temperature-related years of life lost attributable to climate change. To project future temperature-related disease burden in Tianjin, we selected years of life lost (YLL) as the dependent variable to explore YLL attributable to climate change. A generalized linear model (GLM) and distributed lag non-linear model were combined to assess the non-linear and delayed effects of temperature on the YLL of non-accidental mortality. Then, we calculated the YLL changes attributable to future climate scenarios in 2055 and 2090. The relationships of daily mean temperature with the YLL of non-accident mortality were basically U-shaped. Both the daily mean temperature increase on high-temperature days and its drop on low-temperature days caused an increase of YLL and non-accidental deaths. The temperature-related YLL will worsen if future climate change exceeds 2 °C. In addition, the adverse effects of extreme temperature on YLL occurred more quickly than that of the overall temperature. The impact of low temperature was greater than that of high temperature. Men were vulnerable to high temperature compared with women. This analysis highlights that the government should formulate environmental policies to reach the Paris Agreement goal.

Climate Change and Health under the Shared Socioeconomic Pathway Framework

A growing body of literature addresses how climate change is likely to have substantial and generally adverse effects on population health and health systems around the world. These effects are likely to vary within and between countries and, importantly, will vary depending on different socioeconomic development patterns. Transitioning to a more resilient and sustainable world to prepare for and manage the effects of climate change is likely to result in better health outcomes. Sustained fossil fuel development will likely result in continued high burdens of preventable conditions, such as undernutrition, malaria, and diarrheal diseases. Using a new set of socioeconomic development trajectories, the Shared Socioeconomic Pathways (SSPs), along with the World Health Organization’s Operational Framework for Building Climate Resilient Health Systems, we extend existing storylines to illustrate how various aspects of health systems are likely to be affected under each SSP. We also discuss the implications of our findings on how the burden of mortality and the achievement of health-related Sustainable Development Goal targets are likely to vary under different SSPs.

Assessment of the Public Health Risks and Impact of a Tornado in Funing, China, 23 June 2016: A Retrospective Analysis

(1) Background: Tornadoes are one of the deadliest disasters but their health impacts in China are poorly investigated. This study aimed to assess the public health risks and impact of an EF-4 tornado outbreak in Funing, China; (2) Methods: A retrospective analysis on the characteristics of tornado-related deaths and injuries was conducted based on the database from the Funing's Center for Disease Control and Prevention (CDC) and Funing People's Hospital. A change-point time-series analysis of weekly incidence for the period January 2010 to September 2016 was used to identify sensitive infectious diseases to the tornado; (3) Results: The 75 to 84 years old group was at the highest risk of both death (RR = 82.16; 95% CIs = 19.66, 343.33) and injury (RR = 31.80; 95% CI = 17.26, 58.61), and females were at 53% higher risk of death than males (RR = 1.53; 95% CIs = 1.02, 2.29). Of the 337 injuries, 274 injuries (81%) were minor. Most deaths occurred indoors (87%) and the head (74%) was the most frequent site of trauma during the tornado. Five diseases showed downward change-points; (4) Conclusions: The experience of the Funing tornado underscores the relative danger of being indoors during a tornado and is successful in avoiding epidemics post-tornado. Current international safety guidelines need modification when generalized to China.

Impacts of extreme heat on emergency medical service calls in King County, Washington, 2007-2012: relative risk and time series analyses of basic and advanced life support

BACKGROUND

Exposure to excessive heat kills more people than any other weather-related phenomenon, aggravates chronic diseases, and causes direct heat illness. Strong associations between extreme heat and health have been identified through increased mortality and hospitalizations and there is growing evidence demonstrating increased emergency department visits and demand for emergency medical services (EMS). The purpose of this study is to build on an existing regional assessment of mortality and hospitalizations by analyzing EMS demand associated with extreme heat, using calls as a health metric, in King County, Washington (WA), for a 6-year period.

METHODS

Relative-risk and time series analyses were used to characterize the association between heat and EMS calls for May 1 through September 30 of each year for 2007-2012. Two EMS categories, basic life support (BLS) and advanced life support (ALS), were analyzed for the effects of heat on health outcomes and transportation volume, stratified by age. Extreme heat was model-derived as the 95th (29.7 °C) and 99th (36.7 °C) percentile of average county-wide maximum daily humidex for BLS and ALS calls respectively.

RESULTS

Relative-risk analyses revealed an 8 % (95 % CI: 6-9 %) increase in BLS calls, and a 14 % (95 % CI: 9-20 %) increase in ALS calls, on a heat day (29.7 and 36.7 °C humidex, respectively) versus a non-heat day for all ages, all causes. Time series analyses found a 6.6 % increase in BLS calls, and a 3.8 % increase in ALS calls, per unit-humidex increase above the optimum threshold, 40.7 and 39.7 °C humidex respectively. Increases in "no" and "any" transportation were found in both relative risk and time series analyses. Analysis by age category identified significant results for all age groups, with the 15-44 and 45-64 year old age groups showing some of the highest and most frequent increases across health conditions. Multiple specific health conditions were associated with increased risk of an EMS call including abdominal/genito-urinary, alcohol/drug, anaphylaxis/allergy, cardiovascular, metabolic/endocrine, diabetes, neurological, heat illness and dehydration, and psychological conditions.

CONCLUSIONS

Extreme heat increases the risk of EMS calls in King County, WA, with effects demonstrated in relatively younger populations and more health conditions than those identified in previous analyses.

The emerging threats of climate change on tropical coastal ecosystem services, public health, local economies and livelihood sustainability of small islands: Cumulative impacts and synergies

Climate change has significantly impacted tropical ecosystems critical for sustaining local economies and community livelihoods at global scales. Coastal ecosystems have largely declined, threatening the principal source of protein, building materials, tourism-based revenue, and the first line of defense against storm swells and sea level rise (SLR) for small tropical islands. Climate change has also impacted public health (i.e., altered distribution and increased prevalence of allergies, water-borne, and vector-borne diseases). Rapid human population growth has exacerbated pressure over coupled social-ecological systems, with concomitant non-sustainable impacts on natural resources, water availability, food security and sovereignty, public health, and quality of life, which should increase vulnerability and erode adaptation and mitigation capacity. This paper examines cumulative and synergistic impacts of climate change in the challenging context of highly vulnerable small tropical islands. Multiple adaptive strategies of coupled social-ecological ecosystems are discussed. Multi-level, multi-sectorial responses are necessary for adaptation to be successful.

Adaptation and promotion of emergency medical service transportation for climate change

The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI.

Summertime acute heat illness in U.S. emergency departments from 2006 through 2010: analysis of a nationally representative sample

BACKGROUND

Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits.

OBJECTIVE

We aimed to describe acute heat illness visits to U.S. EDs from 2006 through 2010 and identify factors associated with hospital admission or with death in the ED.

METHODS

We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006-2010, defining cases as ED visits from May through September with any heat illness diagnosis (ICD-9-CM 992.0-992.9). We correlated visit rates and temperature anomalies, analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR).

RESULTS

There were 326,497 (95% CI: 308,372, 344,658) cases, with 287,875 (88.2%) treated and released, 38,392 (11.8%) admitted, and 230 (0.07%) died in the ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (Pearson correlation coefficient 0.882, p = 0.005). Treat-and-release rates were highest for younger adults (26.2/100,000/year), whereas hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03/100,000/year, respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4/10,000 (95% CI: 78.7, 120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death in the ED were higher among elders, males, urban and low-income residents, and those with chronic conditions.

CONCLUSIONS

Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death in the ED. Chronic disease burden exponentially increased this risk.

Is enough attention given to climate change in health service planning? An Australian perspective

BACKGROUND

Within an Australian context, the medium to long-term health impacts of climate change are likely to be wide, varied and amplify many existing disorders and health inequities. How the health system responds to these challenges will be best considered in the context of existing health facilities and services. This paper provides a snapshot of the understanding that Australian health planners have of the potential health impacts of climate change.

METHODS

The first author interviewed (n=16) health service planners from five Australian states and territories using an interpretivist paradigm. All interviews were digitally recorded, key components transcribed and thematically analysed.

RESULTS

Results indicate that the majority of participants were aware of climate change but not of its potential health impacts. Despite this, most planners were of the opinion that they would need to plan for the health impacts of climate change on the community.

CONCLUSION

With the best available evidence pointing towards there being significant health impacts as a result of climate change, now is the time to undertake proactive service planning that address market failures within the health system. If considered planning is not undertaken then Australian health system can only deal with climate change in an expensive ad hoc, crisis management manner. Without meeting the challenges of climate change to the health system head on, Australia will remain unprepared for the health impacts of climate change with negative consequences for the health of the Australian population.

A Statistical Modeling Framework for Projecting Future Ambient Ozone and its Health Impact due to Climate Change

The adverse health effects of ambient ozone are well established. Given the high sensitivity of ambient ozone concentrations to meteorological conditions, the impacts of future climate change on ozone concentrations and its associated health effects are of concern. We describe a statistical modeling framework for projecting future ozone levels and its health impacts under a changing climate. This is motivated by the continual effort to evaluate projection uncertainties to inform public health risk assessment. The proposed approach was applied to the 20-county Atlanta metropolitan area using regional climate model (RCM) simulations from the North American Regional Climate Change Assessment Program. Future ozone levels and ozone-related excesses in asthma emergency department (ED) visits were examined for the period 2041-2070. The computationally efficient approach allowed us to consider 8 sets of climate model outputs based on different combinations of 4 RCMs and 4 general circulation models. Compared to the historical period of 1999-2004, we found consistent projections across climate models of an average 11.5% higher ozone levels (range: 4.8%, 16.2%), and an average 8.3% (range: -7% to 24%) higher number of ozone exceedance days. Assuming no change in the at-risk population, this corresponds to excess ozone-related ED visits ranging from 267 to 466 visits per year. Health impact projection uncertainty was driven predominantly by uncertainty in the health effect association and climate model variability. Calibrating climate simulations with historical observations reduced differences in projections across climate models.

Ciguatera fish poisoning and climate change: analysis of National Poison Center Data in the United States, 2001-2011

BACKGROUND

Warm sea surface temperatures (SSTs) are positively related to incidence of ciguatera fish poisoning (CFP). Increased severe storm frequency may create more habitat for ciguatoxic organisms. Although climate change could expand the endemic range of CFP, the relationship between CFP incidence and specific environmental conditions is unknown.

OBJECTIVES

We estimated associations between monthly CFP incidence in the contiguous United States and SST and storm frequency in the Caribbean basin.

METHODS

We obtained information on 1,102 CFP-related calls to U.S. poison control centers during 2001-2011 from the National Poison Data System. We performed a time-series analysis using Poisson regression to relate monthly CFP call incidence to SST and tropical storms. We investigated associations across a range of plausible lag structures.

RESULTS

Results showed associations between monthly CFP calls and both warmer SSTs and increased tropical storm frequency. The SST variable with the strongest association linked current monthly CFP calls to the peak August SST of the previous year. The lag period with the strongest association for storms was 18 months. If climate change increases SST in the Caribbean 2.5-3.5 °C over the coming century as projected, this model implies that CFP incidence in the United States is likely to increase 200-400%.

CONCLUSIONS

Using CFP calls as a marker of CFP incidence, these results clarify associations between climate variability and CFP incidence and suggest that, all other things equal, climate change could increase the burden of CFP. These findings have implications for disease prediction, surveillance, and public health preparedness for climate change.

Climate change and levels of violence in socially disadvantaged neighborhood groups

The current study examines the link between climate change and neighborhood levels of violence using 20 years of monthly climatic and crime data from St. Louis, MO, USA. St. Louis census tracts are aggregated in neighborhood groups of similar levels of social disadvantage, after which each group is subjected to time series analysis. Findings suggest that neighborhoods with higher levels of social disadvantage are very likely to experience higher levels of violence as a result of anomalously warm temperatures. The 20 % of most disadvantaged neighborhoods in St. Louis, MO, USA are predicted to experience over half of the climate change-related increase in cases of violence. These results provide further evidence that the health impacts of climate change are proportionally higher among populations that are already at high risk and underscore the need to comprehensively address climate change.

Effects of extreme temperatures on years of life lost for cardiovascular deaths: a time series study in Brisbane, Australia

BACKGROUND

Extreme temperatures are associated with cardiovascular disease (CVD) deaths. Previous studies have investigated the relative CVD mortality risk of temperature, but this risk is heavily influenced by deaths in frail elderly people. To better estimate the burden of extreme temperatures, we estimated their effects on years of life lost due to CVD.

METHODS AND RESULTS

The data were daily observations on weather and CVD mortality for Brisbane, Australia, between 1996 and 2004. We estimated the association between daily mean temperature and years of life lost due to CVD, after adjusting for trend, season, day of the week, and humidity. To examine the nonlinear and delayed effects of temperature, a distributed lag nonlinear model was used. The model's residuals were examined to investigate whether there were any added effects due to cold spells and heat waves. The exposure-response curve between temperature and years of life lost was U-shaped, with the lowest years of life lost at 24°C. The curve had a sharper rise at extremes of heat than of cold. The effect of cold peaked 2 days after exposure, whereas the greatest effect of heat occurred on the day of exposure. There were significantly added effects of heat waves on years of life lost.

CONCLUSIONS

Increased years of life lost due to CVD are associated with both cold and hot temperatures. Research on specific interventions is needed to reduce temperature-related years of life lost from CVD deaths.

Integrating climate change adaptation into public health practice: using adaptive management to increase adaptive capacity and build resilience

BACKGROUND

Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems.

OBJECTIVES

We explored possible explanations for the lack of work on adaptive capacity, outline climate-health challenges that may lie outside public health's coping range, and consider changes in practice that could increase public health's adaptive capacity.

METHODS

We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity.

DISCUSSION

There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health's adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting.

CONCLUSIONS

Increasing public health capacity will be necessary for certain climate-health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change.

Incorporating sustainability into community-based healthcare practice

There is now irrefutable evidence that climate change and increasing environmental degradation negatively affect population health. Healthcare plays an important role in addressing these emerging environmental challenges, considering its core aim is to protect and promote health. Preliminary research in Victoria, Australia, suggests that healthcare practitioners are endeavouring to factor in environmental concerns into their practice. Health promotion, an integral part of the healthcare system, is considered an area of practice that can support action on sustainability. Based on five qualitative case studies and key stakeholder interviews, this article explores key barriers and facilitators to incorporating sustainability into community-based healthcare practice. The findings demonstrate that despite multiple barriers, including funding and lack of policy direction, health promotion principles and practices can enable action on sustainability.

Non-heat related impacts of climate change on working populations

Environmental and social changes associated with climate change are likely to have impacts on the well-being, health, and productivity of many working populations across the globe. The ramifications of climate change for working populations are not restricted to increases in heat exposure. Other significant risks to worker health (including physical hazards from extreme weather events, infectious diseases, under-nutrition, and mental stresses) may be amplified by future climate change, and these may have substantial impacts at all scales of economic activity. Some of these risks are difficult to quantify, but pose a substantial threat to the viability and sustainability of some working populations. These impacts may occur in both developed and developing countries, although the latter category is likely to bear the heaviest burden.This paper explores some of the likely, non-heat-related health issues that climate change will have on working populations around the globe, now and in the future. These include exposures to various infectious diseases (vector-borne, zoonotic, and person-to-person), extreme weather events, stress and mental health issues, and malnutrition.

Carbon footprinting of North American emergency medical services systems

OBJECTIVES

This study was undertaken to characterize the carbon emissions from a broad sample of North American emergency medical services (EMS) agencies, and to begin the process of establishing voluntary EMS-related emission targets.

METHODS

Fifteen diverse North American EMS systems with more than 550,000 combined annual responses and serving a population of 6.3 million reported their direct and purchased ("Tier 2") energy consumption for one year. We calculated total carbon dioxide equivalent (CO(2)e) emissions using Environmental Protection Agency, Energy Information Administration, and locality-specific emission conversion factors. We also calculated per-response and population-based emissions. We report descriptive summary data.

RESULTS

Participants included government "third-service" (n = 4), public utility model (n = 1), private contractor (n = 6), and rural rescue squad (n = 4) systems. Call volumes ranged from 800 to 114,280 (median 20,093; interquartile range [IQR] 1,100-55,217). Emissions totaled 46,941,690 pounds of CO(2)e (21,289 metric tons); 75% of emissions were from diesel or gasoline. For systems providing complete Tier 2 data, median emissions per response were 80.7 (IQR 65.1-106.5) pounds of CO(2)e and median emissions per service-area resident were 7.8 (IQR 4.7-11.2) pounds of CO(2)e. Two systems reported aviation fuel consumption for air medical services, with emissions of 2,395 pounds of CO(2)e per flight, or 0.7 pounds of CO(2)e per service-area resident.

CONCLUSION

EMS operations produce substantial carbon emissions, primarily from vehicle-related fuel consumption. The 75th percentiles from our data suggest 106.5 pounds of CO(2)e per unit response and/or 11.2 pounds of CO(2)e per service-area resident as preliminary maximum emission targets. Air medical services can anticipate higher per-flight but lower population-based emissions.