What is this new committee I keep hearing about?
In the past few months, a new committee has emerged from the College of Anaesthesiologists of Ireland to challenge the growing demands that anaesthesiology and healthcare place on the environment. The ‘College of Anaesthesiologists of Ireland Sustainability Committee’ (CAISC) is made up of consultant and trainee anaesthesiologists with an interest in sustainable healthcare. The committee is officially a sub-committee of the Quality and Safety Committee and is chaired by Dr Donall O’Croinin, anaesthesiology Consultant in the Mercy University Hospital.
Was there a Webinar recently?
CAISC held its first Sustainability Webinar on the twelfth of September 2020. It was a great success with high numbers attending, revealing a widespread interest among Irish anaesthesiologists in learning about sustainable practice. There were three distinguished speakers at the event, all anaesthesiologists with significant experience in sustainable healthcare.
Where does this interest come from? Why should anaesthesiologists in particular be concerned about the environment?
A recent report by the NGO Healthcare Without Harm estimated that globally the health industry emits 1.6 giga-tonnes of carbon dioxide equivalents* (CO2e) on an annual basis. Were the global health industry a country, it would lie fifth, sitting behind Russia, in terms of its CO2e emissions. We clinicians are part of a system that contributes significantly to global warming. We are therefore contributing to the global burden of climate change induced disease and to the plummeting levels of biodiversity which is leading to the collapse in ecosystems all over the planet.
Anaesthesiology places a disproportionately high burden on the environment through its reliance on pharmaceuticals, single use medical equipment and plastics - the manufacture and disposal of which require the burning of large amounts of fossil fuels. There are also the issues of theatre energy usage, waste disposal and anaesthetic gases.
Who spoke at the Webinar?
The first of our three speakers, Dr Tim Keady - an Irish trainee currently undertaking a fellowship in the UK - gave a beginner’s guide to sustainable anaesthesia practice. The focus here was on anaesthetic gases and how they impact the environment. These potent greenhouse gases are minimally metabolised and therefore the majority of used gases end up in the atmosphere. Here they trap infrared heat leaving the earth, tipping earth’s net energy into positive balance and contributing to global warming. Dr Keady showed data on anaesthetic gas consumption over one year in an Irish hospital and explained how, of the anaesthetic gases Nitrous Oxide is the greatest contributor to CO2e emissions. He highlighted aspects of our practice that with minimal effort could lead to a significant reduction in emissions without compromising patient care. A move towards intravenous anaesthesia as an alternative to inhalational agents is one example. The discontinuation of routine use of nitrous oxide and a preferential use of sevoflurane rather than desflurane which is particularly damaging, would also have a positive impact. Finally, a greater use of regional anaesthesia and nerve blocks would obviate the need for general anaesthetic agents in many cases. However he noted that 80-90% of the emissions from anaesthetic gases result from the use of Nitrous Oxide-Oxygen mixtures for labour analgesia. This area must be addressed if significant reductions in carbon emissions are to be achieved.
Who was the second speaker?
Dr Cathy Lawson, has recently completed the new Fellowship in Environmentally Sustainable Anaesthesia at Newcastle upon Tyne Hospitals. It was a privilege to hear Dr Lawson who is by all accounts a leading figure in sustainable anaesthesia practice in the UK having published numerous papers on this subject. She spoke about her experience as a sustainability fellow which brought her from embedding sustainable practices at a local level, to implementing the ‘Green Champions’ Network with the Association of Anaesthetists at a national level. Of particular interest was her involvement in a ‘Sustainable Operating Theatres Roadmap’ - an initiative that saw her and a group of engaged anaesthetists collaborate with a team of multidisciplinary students to develop a five year road map to embed sustainable practices within their department, certainly an initiative worth emulating in Ireland. Although she has completed her fellowship in sustainable anaesthesia, she continues to make an impact through her involvement in the establishment of e-learning modules around sustainable healthcare.
And the third…?
Dr Vincent Wall, a sixth year anaesthesiology trainee currently working in the Mater and representing Irish Doctors for the Environment, spoke emotively about the devastating effects already observed on our planet as a direct result of human resource consumption and waste production. Dr Wall soberly reminds us how human induced climate change is negatively impacting human health in a diverse fashion, through the effects of air pollution on the respiratory system, to the consequences of extreme weather phenomena, migration, food shortage and conflict. In a powerful and passionate presentation, he demonstrated how climate change is the biggest global health threat of the 21st century and how the onus is on the medical community to engage and to act, because it is our responsibility to do so.
What were the take home messages?
Dr Dónall O’Croinín who chaired the Sustainability Webinar, in his parting words, reminded us of our responsibility as anaesthesiologists to advocate for sustainable practice.
As doctors, we pride ourselves on our scientific method for developing an evidence base for improving patient health. Research from the Intergovernmental Panel on Climate Change concludes that limiting the global temperature rise to 1.5°C more than pre industrial times is imperative to prevent a cycle of events that could lead to drought, food shortages, mass migration and other health catastrophes. Currently we are not on course to achieve this target – and anaesthesia needs to play its part in addressing this existential challenge for humanity. We need to begin to think about the health and world of those future generations we will never meet - a mindset already described as ‘cathedral thinking’.
I missed the webinar but really want to view it now - is this possible?
The webinar is currently available for viewing on the College of Anaesthesiologists Website in the ‘Live Streams’ archive or can be accessed directly by following this link: https://www.anaesthesia.ie/education-events/live-streams-archive-2017/
“So I ask you to please wake up and make the changes required possible. To do your best is no longer good enough. We must all do the seemingly impossible.” ~ Greta Thunberg, Climate Activist.
*A CO2 equivalent is a way to express the impact of different greenhouse gases in terms of the amount of CO2 that would create the same amount of warming over a hundred-year time period.