Thursday, February 25, 2010

Exempt hospitals from carbon stupidity, because I am not going to resusc a baby by the light of my mobile phone...

Not content to just drag themselves down, the United Kingdom National Health Service (NHS) thinks Australia needs to follow them over the carbon reduction cliff.

I blogged about the NHS carbon reduction scheme last year (Yet another reason to be glad you're not English), and now the head of their Environmental Sustainability Unit, Dr. Pencheon, has co-authored a recent paper suggesting that Australian health services need a centralised and systematic approach to reducing their carbon emissions, a la the NHS.

So what has Dr. Pencheon done for Britons lately? Among his many triumphs was reducing the NHS carbon footprint by taking meat and dairy off the menu in UK hospitals. (Because clearly hospital food is so great you can afford to reduce the nutrition content even further.)

Another suggestion from Pencheon (same source) was:
for surgeons to travel to GP surgeries for follow-up consultations, to reduce the need for many patients to travel to outpatients departments.

Which, if you spend any time with surgeons, is so funny for SO many reasons. I'm sure the surgeons will go for that suggestion in droves. Not.
Other bright ideas from the NHS include reducing parking around the hospital so staff are forced to get mugged or raped at 3am walk.

David Pencheon then goes on to say:
"If you're going to get me radical I say the default place for health is in the home, and the person who delivers it is yourself: that's the ultimate low-carbon health service," he said

In other words, "if you malingerers just stopped going to hospital, we wouldn't have this problem." Self treatment aside, I actually agree that in an ideal world with more doctors than patients, we would treat everyone in their own homes. Unfortunately, we don't live in an ideal world, and the most effective way to allocate health resources, especially for high dependency care, is to cluster them together and funnel the patients through as per need.

Medicine is particularly resource intensive, and in some cases there really isn't much that can be done about it. Whether you use single use only equipment or have to re-sterilize, you're looking at a huge energy expenditure. We can't just reuse items without serious thought going into the consequences (infection control, anyone?). A trip to a hospital laundry facility (thanks very much touchy-feely-new-age medical school faculty) is a real eye opener in terms of energy and water expenditure, but the fact remains that you need clean linens, scrubs and towels, and you need sterile drapes, and it takes energy resources to do that.

In terms of electricity supply and heating and cooling, hospitals need vast amounts of reliable energy, carbon footprint be damned. If they don't get it, Bad Things Happen. Energy efficiency is laudable, but it should be pursued seperately to a carbon reduction agenda. According to Pencheon et al, carbon reduction is necessary because:
There is strong international scientific consensus about the consequences of the warming of the world's climate system, with a recent Lancet editorial arguing that "climate change is the biggest global health threat of the 21st century".

However, if you ask me, basic triage would dictate that the health and safety of the people in our hospitals now is more important than some ephemereal public health of the future informed by shonky pseudo-science and a mis-interpretation of the precautionary principle.

If you don't believe me, then you can watch some particularly disturbing footage of what happens in a neonatal intensive care unit during a power blackout when the backup generators fail. (Don't watch it, just take my word for it. Seriously, you don't want to see it.) The Egyptian doctors who tried unsuccessfully to save those babies had to work by the light of their mobile phones, and one used their phone to film the scene in a bid to stop the hospital covering up the blackout related deaths. (NB: Another reason to not watch the footage (as if you didn't have enough) is that this breach of confidentiality contravenes pretty much every medical ethic I can think of.)

Hospital blackouts aren't just limited to countries like Egypt, either. The NHS has it's share. As does Australia.

So if we can't assure ourselves that the power in our hospitals isn't going to go on the fritz right now, then why on earth would we rush into dodgy renewable sources with intermittent supply? Or maybe they just mean we should get Peter Garret to insulate the hospital ceilings? Even better.

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