New network champions sustainable emergency medicine and climate advocacy
Emergency clinicians have a strong history of advocacy on many issues that impact our communities and our workplaces. Supporting marriage equality and safe housing, as well as addressing racism, sexism, bullying and harassment, are all examples that sit comfortably with the ethos and values that emergency physicians carry. Many people we see each day in our workplaces are impacted by experiences related to these issues, but there is a much greater issue which is impacting all of us, and I believe we need to act now – not ‘sometime’ in the future.
“Across Australasia, many ACEM members are championing programs across states and territories to reduce waste in our day-to-day clinical practices and embrace the Choosing Wisely ethos that we were all so engaged in pre-COVID. ”
Global science shows an irrefutable rise in temperatures and the consequences of climate impacts. These current and ongoing effects on our communities, economies, and our healthcare systems are the biggest challenges we all face.
It was at the Annual General Meeting (AGM) back in 2019 – under the banner of an event entitled The changing climate of emergency medicine – that ACEM officially became the first medical college to declare a climate emergency.
“The evidence is clear. Projections show that climate change will cause a significant rise in the number of overall ED presentations, an increase in the complexity of presentations, as well as surges resulting from climate disasters,” said ACEM Past President Dr John Bonning.
“With the research also showing that climate change will exacerbate existing health inequities, we have an obligation and responsibility as emergency doctors to speak up, take action ourselves and demand action from government.”
“EDs and hospitals also have important roles to play in mitigating climate change and improving sustainability, as our hospital systems are currently a significant* source of greenhouse gas emissions. We also recognise that emergency physicians have a role as resource stewards and advocates in their departments and healthcare organisations to reduce waste and emissions.”
“For the good of our patients, hospitals, communities and world, we must take urgent action on this population health emergency.”
Sustainable Emergency Medicine and Climate Advocacy Network (sEMCAN)
“To help achieve shared goals, sEMCAN is consulting with ACEM about how to explore ways in which we can work together with other relevant, high-profile organisations.”
To further these efforts in the years since, the ACEM board has now endorsed the establishment of the Sustainable Emergency Medicine and Climate Advocacy Network (sEMCAN).
Already, around 100 ACEM members have joined, with the executive team announced in early April 2024 and the first meeting set to be scheduled soon.
What does sEMCAN aim to do?
Bring together a community of practice in sustainable emergency medicine and climate advocacy, which will promote and advance the objectives and values of the College as they relate to these areas;
bring members and trainees together to share information and innovative ideas, to potentially collaborate on common projects, and to enable members to advocate for their interests in these areas;
facilitate and encourage education, mentoring, research, and meetings that focus on sustainable EM and climate advocacy;
provide information and resources through College committee channels to assist ACEM to continue to evolve and expand in the sustainable emergency medicine and climate advocacy area;
build awareness, across ACEM and the wider community, of specific workplace issues related to sustainable EM and climate health by establishing a broad community of practice;
collaborate with stakeholders, such as Doctors for the Environment, in furthering the goals and objectives of the network;
ensure that ACEM values and strategic intent are considered in all advice and recommendations.
International collaboration needed to address a global issue
Much of this work has already begun, with a keen executive team engaging with members through WhatsApp groups. Members of sEMCAN are also in discussions with the team from the United Kingdom’s Royal College of Emergency Medicine (RCEM) about the potential to pilot their GreenED program – an initiative to measure and reduce the environmental impact of emergency departments in the UK – into Australian and New Zealand EDs.
The opportunity to integrate the UK GreenED with other successful frameworks and programs in Australasia underpins the proposed development of a new regional framework based around the ‘Sustainable ED’.
Across Australasia, many ACEM members are championing programs across states and territories to reduce waste in our day-to-day clinical practices and embrace the Choosing Wisely ethos that we were all so engaged in pre-COVID.
Sustainable Healthcare lead Dr Brian O’Connell is doing some amazing work across networks in NSW, which he reports has resulted in an enormous reduction in pathology testing, leading to reduced Low Value care, cost-reduction, waste-reduction, and working towards a decrease in our carbon footprint – all laudable work that sEMCAN wants to support across all EDs.
An insight from personal experience
“I believe emergency physicians should be the strongest advocates for healthcare prevention – and sEMCAN aims to help emergency physicians who are front and centre in the adaptation and improved preparedness of community and health systems support the management of the inevitable changes we can expect to witness.”
His results are not published yet but Dr O’Connell says “an example of this work has been a 60 per cent reduction in blood gases and a projected 30 per cent reduction in invoicing costs, in one of the pilot sites”.
“We currently spend >$3.9 billion on pathology in Australia alone. If these successes are replicated across Australasia, there is potential to achieve annual savings in the multiple hundreds of millions of dollars,” he says.
“Other projects in development include the Rational Medications Program, Rational Cannulation Program and Rational Radiology Program,” says Dr O’Connell, adding that he believes wide-scale polypharmacy, over-use of peripheral cannulae, and increasing rates of imaging cost the Australian healthcare service millions of dollars and can be targeted to further reduce Low Value Care “with huge co-benefits in our emergency departments, and hospitals across Australasia”.
Exploring pathways toward a cleaner, greener ED
To help achieve shared goals, sEMCAN is consulting with ACEM about how to explore ways in which we can work together with other relevant, high-profile organisations. Advocacy for policy change, and for the governmental support needed to bring the big polluters and environmentally toxic industries into line, is a core part of what sEMCAN will endeavour to achieve with such support – and we look forward to the possibilities that can come from strength in numbers.
sEMCAN strongly supports actions that will see our healthcare systems shift to a more sustainable, cleaner future, but also wants to see an international move to stop the use of fossil fuels and other practices that pollute our natural environment, increase climate instability, and threaten the health of populations across the globe.
sEMCAN wants to champion and lead efforts to mitigate the impacts of climate change already being seen, and that we look set to continue experiencing.
We see the impacts every day of failed health policy, of systems that don’t work, of poor access or unaffordable care, and because it is clear that climate impacts will affect our communities in many ways, we will also see those impacts in our EDs.
I believe emergency physicians should be the strongest advocates for healthcare prevention – and sEMCAN aims to help emergency physicians who are front and centre in the adaptation and improved preparedness of community and health systems support the management of the inevitable changes we can expect to witness.
If I don’t act now, I know that I will not be able to face my kids and grandkids in a decade or two when they ask, “What did you do when we knew this was going to happen?”
If you feel the same, get involved, get active and join sEMCAN. We’ve been waiting for you.
*Malik A, Lenzen M, McAlister S, et al. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2:e27-e35 reported data that, at the time, the Australian carbon footprint of health care was seven per cent of national carbon emissions.
