When triple-digit temperatures hit the Pacific Northwest this summer, the emergency room at Harborview Medical Center in Seattle was ill-prepared. Doctors have rushed to treat illnesses made worse by heat in homeless people, elderly patients with chronic illnesses and drug addicts with overdoses.
“The scale of the exhibition was so far off the charts in terms of our historical experience,” said Dr Jeremy Hess, emergency physician and professor of environmental science and occupational health at the University of Washington.
For some health professionals, this growing toll has spurred a recognition of the role of the health care industry in global warming. US hospitals and medical centers use more energy than any industry except the food service industry, according to the US Energy Information Administration. Hospitals use an average of 2.5 times more energy per square foot than typical office buildings. They also produce mountains of medical waste and emit gases that are harmful to the atmosphere used in surgery and other procedures.
But the health sector is starting to react. The Department of Health and Human Services’ new Office of Climate Change and Health Equity, in addition to focusing on climate-related illnesses, said it would work to “reduce gas emissions greenhouse effect and air pollution across the health care sector ”. The office could help change regulations that restrict sustainability efforts, according to climate activists.
Already, many US hospitals have started installing solar panels, while others are trying to reduce surgical waste and phase out chemicals harmful to the ozone layer. Campaigners are pushing industry to reduce energy-consuming protocols, such as ventilation requirements that demand a high level of airflow, measured in air changes per hour. They say they could be reduced without harming patients.
“I think doctors recognize that climate change is likely to continue and get worse over time,” Hess said. “We don’t necessarily do everything we could otherwise to reduce our footprint and advance sustainability, and that’s where I’d like to see our health systems go.”
But the industry is moving cautiously to avoid harming patients – and legal liability. They “don’t want to make mistakes. And part of not making mistakes is resistance to change,” said Dr. Matthew Meyer, co-chair of the University of Virginia sustainability committee.
The University of Vermont Medical Center was one of the first US hospital systems to focus on sustainability initiatives. It has succeeded in reducing emissions by around 9% since 2015 by renovating and building structures to be more energy efficient and converting offsite medical centers to run 50% on renewable natural gas. . One of its hospitals has reduced its waste by over 60% through reuse and recycling.
The nonprofit Kaiser Permanente, meanwhile, has focused on greening its energy use. By September 2020, all of its 39 hospitals and 727 medical practices had achieved carbon neutrality. In most Kaiser Permanente hospitals, solar panels provide a quarter to a third of the energy needs.
Kaiser Permanente ultimately aims to generate enough electricity through solar technology to eliminate the need for diesel backup generators in its hospitals, which are heavily used in areas with strained power grids. In 2017 and 2019, the power company cuts in California forced the health network to evacuate its medical center in Santa Rosa and electricity was cut at its medical center in Vallejo.
“The fact that these facilities are down for a week or more is just not tolerable,” said Seth Baruch, national director of energy and utilities at Kaiser Permanente.
Increased energy sustainability has brought a small financial windfall. Kaiser Permanente saves about $ 500,000 per year in electricity costs through its grids and solar panels, said Baruch. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)
It can be difficult to reach consensus on emission reduction measures. It took seven months for Meyer, an UVA anesthesiologist, to persuade his hospital to phase out most uses of desflurane, a common anesthetic that damages the ozone layer and is a potent greenhouse gas.
Meyer argued that other drugs could replace desflurane. But critics have warned that the more common alternatives slow patients’ postoperative recovery, compared to desflurane. They said there were ways to neutralize the excess desflurane in the air of the operating room without stopping it completely.
The “do no harm first” philosophy of medicine can also be a barrier to reducing medical waste. The Joint Commission, which accredits more than 22,000 healthcare organizations in the United States, has in recent years pushed hospitals to use more disposable devices instead of disinfecting reusable devices.
The main goal of the commission is to reduce infections in the hospital, but more disposable items means less durability. According to a study, about 80% of emissions from the healthcare sector in the United States come from manufacturers, their suppliers and distributors, including the production of disposable single-use medical equipment.
To compound the problem, ethylene oxide – a chemical required by the Food and Drug Administration to sterilize many devices – has been classified as a carcinogen by the Environmental Protection Agency. In 2019, health concerns led communities to push for the shutdown of facilities using gas, which threatened to create a shortage of clean medical devices.
Maureen Lyons, spokesperson for the Joint Commission, said the private accreditor does not have the power to change regulations. The purchase of disposable versus reusable devices is a supply chain issue, “not an issue the Joint Commission is able to assess for compliance.”
For this reason, healthcare activists are pushing for sustainability through policy changes. Health Care Without Harm, an environmental group, is seeking to overturn state rules that impose what it sees as excessively energy-consuming ventilation, humidification and sterilization requirements.
In California, the group sought to change a statewide medical building code passed in July that will require a higher ventilation standard in healthcare facilities. The group says the new standard is unnecessary. While high circulation rates are required in intensive care units, operating theaters and isolation rooms, there is no evidence that such standards are maintained in a hospital, said Robyn Rothman, director. Associate of State Policy Programs at Health Care Without Harm. She cited a 2020 study from the American Society for Health Care Engineering.
Hospital groups have resisted sustainability commitments on the grounds that they will bring more paperwork and costs to their hospitals, Rothman said.
The American Society for Health Care Engineering, a professional group allied with the American Hospital Association, has developed sustainability goals to reduce emissions. But existing regulations make it difficult to achieve many of them, said Kara Brooks, the group’s sustainability program manager.
For example, the Centers for Medicare & Medicaid Services require that hospitals that treat Medicaid and Medicare patients have back-up diesel generators.
“Hospitals will not be able to phase out their use of fossil fuels based on current regulations,” Brooks said, but “we encourage hospitals to meet their targets within the given parameters”.