Emergency medicine must play a leading role in mitigating against and responding to climate change. Speaking at CleanMed Europe 2018, Jonathan E Slutzman, MD explained why.
How can the skills and expertise of the emergency department be effectively engaged for climate change mitigation and response? And why should emergency physicians care about the climate change challenge? These questions formed the basis of an inspiring CleanMed Europe presentation by Jonathan E Slutzman, MD, an assistant in emergency medicine at Massachusetts General Hospital, US, and a keen advocate of healthcare without harm.
The relationship between emergency medicine and climate change
Slutzman began his presentation by outlining why he believes the emergency department must become more resilient to climate change and take a leading role in addressing related challenges.
Physicians, he said, look at healthcare in a disease-treatment-cure model, within which climate change can be thought of as a disease of:
- Increased infections as a result of greater vector-borne disease, higher temperatures leading to better breeding zones, and a rise in antibiotic resistance
- Respiratory stress due to increased air pollution and temperatures, which will exacerbate underlying pulmonary lung disease
- Food insecurity as a result of rising temperatures, which will enhance some crops but reduce their nutritional value
- More waterborne illnesses thanks to a rise in water temperatures, which will promote bacterial and algae growth
- Increased heat stress, largely among the elderly population and people with chronic diseases like kidney or heart diseases
- Mental illness due to people becoming more stressed, which will worsen underlying depression and anxiety.
All of this will contribute to “greater healthcare utilisation, greater healthcare costs [and] greater demands on the system that [take] away from taking care of everybody else,” said Slutzman.
Climate change is a disease of vulnerability and disaster response
He added that two themes run throughout this idea – vulnerability and disaster response, both topics that the emergency department deals with on a regular basis.
“We are the specialists in vulnerable populations,” he told CleanMed Europe. “I treat homeless people because nobody else does. I treat alcoholics because very few people do. I treat the downtrodden of our communities because we are the safety net – and we are disaster response.”
In fact, Slutzman said he nearly didn’t make it to the conference, because he was almost deployed to a disaster zone to respond to a crisis of what he described as “climate change and economic migrants in South America”.
Slutzman is a member of the Mass General Global Disaster Response Team, which calls upon doctors, nurses, pharmacists, therapists and others to provide an array of medical services in the wake of natural and manmade disasters – incidents which are becoming all the more common throughout the world.
In 2018 alone, a series of wildfires have ravaged the state of California, an earthquake and tsunami have devastated Indonesia, and torrential rain has wreaked havoc in Japan.
“One of my colleagues was actually just deployed last night as part of a federal disaster response team to go to Florida, where Hurricane Michael in the span of three days went from a mild tropical storm to a category 4 hurricane,” Slutzman added.
“The national weather service in the US went through its 150 years of records to try and find a similar storm striking a similar space in the US: it has never happened before.”
It is apparent from these examples alone that emergency physicians are the experts on disaster preparedness and management, and Slutzman thus urged doctors and healthcare professionals in the audience to leverage the expertise of the speciality to help them “in disaster planning, in resilience, and in discussing the impact and effect of climate change”.
Fail to plan, plan to fail
He added: “My recommendation is that you should not encourage your emergency departments or hospitals to plan for climate change. You should create a disaster plan, and it should be able to respond to all different hazards, including those related to climate change.”
This may sound easier said than done, but for Slutzman, the answer lies in making the economic case: healthcare organisations can either plan and prepare for disasters, or “they can close and not be able to take care of [their] population” or support their budgets.
“It’s going to cost you more to clean up afterwards than to prepare beforehand,” he continued, “particularly in Europe where the vast majority of care is provided in a somewhat publicly supported manner [and] budgets are severely constrained. You can either spend that money on taking care of people or you can spend that money on cleaning up from a disaster, and I think we all agree that we want to be taking care of our community.”
The reality is that healthcare causes harm
Slutzman then turned his attention away from healthcare as part of the solution to climate change and instead focused on healthcare as part of the problem. He outlined an ‘unvirtuous cycle’ whereby people experience poor health, seek healthcare, and then make use of services, treatments and interventions that improve their health – a process which leads to environmental degradation, climate change and environmental pollution, outcomes which in turn contribute to poor health.
Up until fairly recently, he said, healthcare has gotten a pass when it comes to its environmental footprint. Although this is now slowly changing, the emergency department is still largely being let off the hook, according to Slutzman, a fact which he is keen to see change.
For him, emergency medicine should play a leading role in healthcare’s response to climate change because it touches on every hospital discipline.
He explained: “We are probably the only specialty in the hospital environment who co-operates and collaborates with every other specialty. It’s rare that there’s a specialty that I don’t talk to in a week. I’ll admit that I almost never talk to a radiation oncologist, but I talk to internists multiple times a day. I talk to orthopaedists multiple times a day. I talk to a urologist at least a few times a week, a general surgeon multiple times a day, a cardiologist a couple of times a day, a neurosurgeon at least once a day, a neurologist multiple times a day, plastic surgeons and oral and maxillofacial surgeons at least once a day.
“The way I describe emergency medicine to lay people is I need to know more cardiology than everybody else in the hospital except for the cardiologists, and I need to know more orthopaedics than everybody in the hospital except for the orthopaedists. I need to know more about environmental impacts and climate change than everybody in the hospital except for the environmental engineers.”
In much the same way that emergency medicine extends to other hopsital specialties, Slutzman added, it also touches on purchasing and on energy, on transportation and on waste. “So I need to know all about that, and I need to work with the other professionals in the institution to improve all of these fields.”
Sustainable healthcare is resilient healthcare
It is at the intersection of all these areas that Slutzman sees the meeting of sustainable healthcare and resilient healthcare.
“If you are energy efficient, you need less generation in the event of a disaster; if you need less generation, your generators can last longer, so you’re more resilient,” he explains. “If you use more natural ventilation, [you] need less heating and cooling in the event of a disaster, so [you] can design to build [your] facility to be both more sustainable and more resilient at the same time.
“This is the business case. This is why I should care about my environmental footprint: because it leads to better healthcare, it protects my communities, but it also makes it easier for my disaster planners to maintain my facility in the face of these terrible outcomes.”
Slutzman drew his presentation to a close by making one last plea to any emergency physicians in the audience to advocate measures that effectively address the climate change challenge within both the emergency department and other specialties, contribute to the knowledge base around this topic, which has thus far been largely dominated by the work of anaesthesiologists, and begin to implement practical measures of their own to tackle environmental harm in healthcare, for instance by tackling single-use instruments for clinical exams or procedures, as well as the disposal of hazardous waste.
“We touch on everything, and we can contribute to the knowledge base and the research that is needed to convince the world that we can do better,” he concluded.
This article will appear in issue 7 of Health Europa Quarterly, which will be published in November 2018.