Most would agree that The National Health Service provides an excellent service in improving the health and well-being of the UK’s population, but how often do we question whether it contributes to ill health?
‘Primum non nocere’ - first, do no harm.
It doesn't taking much scratching at the surface to realize that in fact we are doing harm. On a daily basis. What better definition of doing harm do you have than actively contributing to the biggest global health threat of the 21st century? According to The Lancet, climate change is this threat, and the NHS accounts for around 5% of all the UK’s greenhouse gas emissions. As an organisation we put out more greenhouse gases than Heathrow Airport does each year. Why? Well it’s massive. With around 1.7 million employees, it’s the fifth biggest employer in the world, and with this comes this hefty carbon footprint in various shapes and sizes.
16% of the total output is on transport alone with up to 1 in 20 journeys on our roads being healthcare related (travel to work, conferences, logistics, emergency vehicles etc).
The biggest contributor is through the procurement of goods and services with the resultant gas emissions from the manufacture and supply of medicines and equipment. This accounts for over 50% of our carbon footprint.
The provision of anaesthesia is a large contributor. Volatile gases alone have a huge carbon footprint as potent greenhouse gases, with desflurane being the most culpable. It has been suggested that 1 hours usage of desflurane in theatre is the same as 230 miles traveled in a modern car.
We can't talk about anaesthetic agents without talking about the concept of CO2e (Carbon Dioxide Equivalent). This is a unit used for expressing the impact of each greenhouse gas in terms of the mass of CO2 (kg) that would cause the same amount of global warming. The equivalents are often based as a ratio called Global Warming Potential (GWP). This describes the warming potential of a greenhouse gas over a period of time (usually 100 years (GWP 100)) compared to carbon dioxide. We also need to look at the Tropospheric Lifetime (TL) of these gases, ie how long they will continue to have a greenhouse affect. This is demonstrated in an alarming way when we look at our beloved anaesthetic agents:
Sevoflurane (250mls): Isoflurane (250mls):
CO2e - 44kg CO2e - 190kg
GWP 100 - 130 GWP 100 - 510
TL - 1.1 years TL - 3.2 years
Desflurane (250mls): Nitrous Oxide (Size E):
CO2e - 886kg CO2e - 1054 kg
GWP 100 - 2540 GWP 100 - 310
TL - 14 years TL - 110 years
These shocking figures highlight the importance of low-flow anaesthesia and should make us look for alternative greener methods to looking after our patients during surgery.
Click on the return button to learn about the issue of waste and our planet and how healthcare plays an important role.