ED Sustainability: Small Changes, Big Impact

It is getting hot in California, which has us thinking about the massive carbon footprint of healthcare. The emergency department is famously resource-heavy, but can we save lives and reduce waste? Dr. David Barnes joins us to explain how going green isn’t just about being a “tree hugger”—it’s about saving money, cutting waste, and making our hospitals resilient against supply chain chaos.

Defining Healthcare Sustainability

• Balancing Safety and Footprint: Sustainability in healthcare means delivering efficient, affordable care that minimizes resource waste while remaining clinically safe and meaningful.
• The Power of Resiliency: A sustainable healthcare system is inherently a resilient one. Reducing reliance on single-use items and utilizing local renewable energy sources (like microgrids) protects hospitals from supply chain disruptions caused by geopolitical conflicts or weather-driven power grid failures.

The Three Scopes of Emissions

• Scope 1 (Direct): Emissions directly produced by hospital operations, such as idling fleet vehicles and leaking anesthetic gases.
• Scope 2 (Indirect): Purchased energy used to power and heat the facilities (e.g., local electricity and steam lines).
• Scope 3 (Supply Chain): The largest bucket, making up 60% to 80% of healthcare emissions. This includes employee commutes, medical waste incineration, manufacturing of disposable devices, and food production.

Clinical Traps: Where We Waste the Most

• Pre-packaged Kits: Studies show 75% to 80% of items inside specialized kits (like central lines) go completely unused and are thrown away.
• Over-Preparation: Opening multiple single-use items (like various ET tube sizes) or donning full trauma PPE for minor injuries creates an immediate, unnecessary trash stream.
• Pharmaceutical Waste: Standard packaging size leads to heavy drug wasting (e.g., using 5 mL from a 100 mL propofol bottle). This regulated medical waste is costly and energy-intensive to incinerate.
• The Glove Epidemic: Glove overuse skyrocketed during COVID-19 and became a habit. Most routine encounters carry no contamination risk, making glove use clinically unnecessary.

Shifting the Culture

• “Take What You Need, Leave What You Don’t”: Avoid opening supplies you may not need or bringing extra gauze or syringes into a room. Due to infection safety protocols, these often end up in the trash.
• Watch Where You Toss: Keep coffee cups and paper out of the red biohazard bins. Regulated medical waste costs six times more to process and must be incinerated, creating massive greenhouse gas emissions.
• Embrace Reprocessing & Reusables: Support partnerships with companies that safely clean and reuse devices historically labeled “single-use” (like EKG leads or waffle mattresses). Swap disposable plastic gowns for reusable cloth gowns that survive 90 washes.
• Model the Behavior: Culture change takes patience and persistence. Instead of finger-wagging or shaming colleagues, visibly adopt sustainable habits to drive grassroots practice changes.

Key Takeaways for the ED Clinician

• Speak up on bad design: Clinicians are on the front lines of waste. Advocate for local sustainability initiatives to grab the attention of hospital executives who handle major purchasing contracts.
• Normalize virtual alternatives: Protect staff well-being and slash commuting emissions by offering Zoom or Teams options for short, solitary administrative meetings.
• Keep it in perspective: Healthcare sustainability is about finding the sweet spot where clinical safety, resource utilization, and environmental impact meet.

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guest:

Dr. David Barnes, Professor of Emergency Medicine, Director of ED Sustainability, and Member of the Sustainability Committee at UC Davis Health

Resources:

Practice Greenhealth

Health Care Without Harm

Green ED (Royal College of Emergency Medicine)

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.