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How Green Are We?

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Review Of: Blanchard IE, Brown LH. Carbon footprinting of north american emergency medical services systems. Prehosp Emerg Care. 2011;15(1):23–29.

With 20 million ambulance transports annually in the U.S., EMS uses a large amount of fuel and, it would stand to reason, creates substantial carbon emissions. I applaud this author group for following up their October 2009 feasibility study with this next pioneer study: tackling a new method to measure the EMS carbon footprint.

This task is as complex as it is important. Many variables affect emissions: fuel type, speed, engine type, vehicle size, cargo weight, efficient of combustion (sea level versus high altitude), outside temperature and static or dynamic deployment.

The authors tried to generalize and estimate on the more conservative side. They also provided a result per capita, estimating the population in the EMS system’s service area.

Fifteen urban, rural, private and public EMS systems participated. Unfortunately, some weren’t able to provide complete data. This was a sample of convenience, so results may not be representative of North American EMS. The authors make excellent points about EMS being interested in the health of our communities and our own workforce. Vehicle fuel emissions are some of the most harmful to the environment. In particular, Diesel fuel has a high carbon-emissions rate and accounted for nearly 70% of the fuel involved in the study. Diesel use has been implicated in health problems experienced by EMS staff as well. This study also suggests that any effort to reduce emissions is positive and that EMS services should set voluntary targets to lower emissions and consider alternate fuel sources.

On a personal note, it’s great to see Lawrence Brown, a former author of this column, continuing to be active in EMS research as a co-author of this study. It’s also worth noting that this paper was published by Prehospital Emergency Care, the official peer-reviewed journal of the National Associations of EMTs, EMS physicians and EMS educators—a publication that all EMS clinicians and educators should keep current with, in my opinion, although it’s often “under-the-radar” to our ranks.

Bottom Line
What we know: carbon footprinting of EMS is complex and often not reported.

What this study adds: an initial methodology for measuring EMS carbon emissions and a call to begin reducing them.

Air Traffic Control for EMS
Review Of: McLeod B, Zaver F, Avery C, et al. Matching capacity to demand: A regional dashboard reduces ambulance avoidance and improves accessibility of receiving hospitals. Acad Emerg Med. 2010;17(12):1383–1389.

Overcrowding in hospital emergency departments (EDs) is an international issue, and much has been written about the problems with ambulance diversions that it causes. These diversions can delay care, threaten patient safety, put excessive pressure on the EMS system and increase cost.

This pre/post study was based in Calgary, Alberta (Canada) and measured the effect of introducing a real-time hospital status “dashboard” in a dispatch center. The Regional Emergency Patient Access and Coordination (REPAC) system takes current information from an existing ED information system to track hospital loads and ability to receive additional patients. It refreshes every two minutes and allows EMS providers to add an incoming ambulance patient to the receiving ED census.

The use of REPAC decreased the EMS avoidance (diversion) time by 78.7% over 18 months, despite significant increases in patient volumes for both EMS and EDs. This real-time electronic surveillance system has increased the ED’s functional status while also drastically reducing ambulance diversion status.

Bottom Line
What we know: Very few regional dispatch centers have a well-organized, real-time system that shows hospital availability across an EMS system. Those in existence often rely on ED self-reporting that may be greatly affected by the perception of the staff.

What this study adds: Evidence that bolsters the case for system-wide diversion to be based on real-time objective data that’s managed by a regional EMS communication center.

Glossary
Descriptive study: A project that tries to describe or learn more about a topic. The goal is to estimate or report new information. This is in contrast to studies that compare, value or test different theories or products.

Peer-reviewed journal: A more scientific publication that only prints an article if it has passed a rigorous review process.

Pre/post study: A project that measures an existing issue then applies an intervention and measures the effect of that intervention.

 

 

 

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