The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.

Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists.

Hospital-oriented quad-generation (HOQG)—A combined cooling, heating, power and gas (CCHPG) system

Objective Are Australian hospitals moving towards renewable energy sources for their electricity, and aligning energy choices with core business, i.e. protecting and promoting health? Design Cross-sectional analysis of Australian state/territory amalgamated energy data Setting Healthcare’s carbon footprint is approximately 7% of Australia’s total carbon footprint. It is unknown if Australian public hospitals are decoupling energy needs from carbon emissions over and above state/territory based renewable energy targets. Participants 693 Australian public hospitals direct energy usage (renewable & non-renewable electricity [produced/purchased], natural gas, liquefied petroleum gas, for the three consecutive years from 2016/17 to 2018/19. Main outcome measures All direct energy produced/purchased and consumed (converted to kilowatt-hours). Results Australian public hospitals consumed 4,122 gigawatt-hours of energy in 2018/19. Electricity use was 2,504 (61%) GWh, natural gas 1,436 (35%) GWh and renewable energy 94 GWh (2.3%). Victoria and New South Wales combined consumed 2,494/ 4,122 GWh (60%) of total Australian public healthcare energy but each produced/purchased less than 1% renewable electricity. For Queensland, a Health GreenPower purchase comprised the majority (71/94 GWh; 76%) of renewable energy production/purchase by all Australian public hospitals. By comparison, individual tertiary education institutions produced/purchased more renewable energy than all Australian public hospitals combined (University of NSW 124 GWh/yr, Swinburne University 90 GWh/yr, 2018/19). Conclusions Australian public hospitals obtain approximately 2.3% of total energy from renewable electricity. One third of hospital energy use stems from fossil gas use. The Australian public hospital system has no documented plans to transition to renewable energy, contrasting with the University sector. The known Australian healthcare contributes approximately 7% of Australia’s total carbon footprint with public hospital energy use a major source of healthcare associated carbon emissions. The new Australian public hospitals consumed 4122 gigawatt-hours in 2018/2019. Approximately 2.3% (94/4,122 gigawatt-hours) of hospital energy was sourced from renewables, beyond state-wide renewable electricity penetration. The implications Australian public hospitals are large emitters of greenhouse gases. Hospital fossil fuel energy use and subsequent pollution continues unabated. Such increasing pollution is at odds with the ethos ‘first do no harm’.

Renewable energy use in Australian public hospitals

The high energy use of hospitals and healthcare facilities globally contributes to greenhouse gas emissions. At the same time, a large percentage of this energy use is attributed to space heating, cooling and ventilation, and is hence correlated to the climate. While the energy performance of Australian hospitals at the design stage is evaluated using historical weather data, the impact of the warming climate on Australian hospitals into the future remains unknown. The research question addressed is: What is the impact of future climates on the energy use of Australian hospitals built with the current design conditions? Two archetype hospital models were developed (a small single-story healthcare facility and a large multi-story hospital). DesignBuilder was used to simulate the performance of these models in 10 locations, ranging from the tropics to cool temperate regions in Australia. Current (1990–2015) and future climate files (2030, 2050, 2070 and 2090) were used. The results show that with the warming climate, the heating demand decreased, while the cooling demand increased for both hospital models for all sites. Cooling dominated climates, such as Darwin and Brisbane, were significantly impacted by the changing climates due to a substantial increase in cooling energy use. Heating based climates, such as Hobart and Canberra, resulted in an overall small reduction in total building energy use. In addition, the single-story facility was more impacted by the change in climate (in terms of energy use intensity) than the multi-story facility. The study highlights the importance of future climate files in building simulation and decarbonization planning.

https://www.mdpi.com/2075-5309/12/8/1275/pdf?version=1661229135

Impact of a Warming Climate on Hospital Energy Use and Decarbonization: An Australian Building Simulation Study

Between 2030 and 2050, climate change is expected to cause about 250 000 additional deaths per year.1 This does not include deaths from pollution, mental illness, extreme weather events and resultant migration and conflict, all of which carry significant morbidity and mortality risks. The medical profession has a responsibility to prepare practitioners and the health system for the escalating challenges of this health crisis.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.5694/mja2.51737

A planetary health–organ system map to integrate climate change and health content into medical curricula

/pdf/renewable-energy-use-in-australian-public-hospitals-25bdrcbyuj.pdf

Renewable Energy Use in Australian Public Hospitals

To the Editor: Congratulations to the Medical Journal of Australia for emphasising the role of health professionals in needing to lead by example towards a sustainable future. Talley’s editorial1 encourages health care professionals to reduce health care’s own carbon footprint and pollution, noting that, “With a concerted effort, the Australian health system could achieve zero net emissions and relatively soon, and we applaud all the ongoing state initiatives”.

Hayden Burch

Papers

Renewable energy use in Australian public hospitals

Renewable Energy Use in Australian Public Hospitals

A sustainable future in health: ensuring as health professionals our own house is in order and leading by example.

A planetary health–organ system map to integrate climate change and health content into medical curricula

Australian health sector leadership and roadmap for healthcare decarbonisation to net zero emissions