Coda Change Coda Change

Ambulance Victoria has committed to become a more sustainable ambulance service. This includes achieving net zero emissions five years prior to the Victorian State Government commitment of 2050 with additional emissions reduction targets for 2025 and 2030. By fulfilling these targets, the carbon footprint for each patient cared for by Ambulance Victoria will be halved by 2030.
It is apparent that to meet these emission reduction targets, Ambulance Victoria's current model of care needs perpetual refinement. Reducing emissions from electricity and fleet start to look easy in comparison to reducing low value care. Delivering better care to a patients according to their particular healthcare needs suggests that our pre-hospital service needs to be reimagined to start prior to any patient picking up the phone to dial Triple 000. Ambulance Victoria are discovering new ways to offer best care for particular patient cohorts via new technologies such as telehealth and the Virtual ED and by partnering across our communities primary and secondary healthcare networks, to offer timely support to those for whom an ambulance doesn't offer the greatest benefit.
In 2021, Ambulance Victoria undertook a study to map the carbon pollution associated with its Triage Services and measure changes in carbon pollution resulting from the use of alternate patient care pathways. The analysis revealed interesting results that have implications for pre-hospital service design in the future. We hope that this study offers insight into new ways of thinking for decision makers and enables a triple bottom line approach to assessing the benefit of programs and keeping an awareness of how to serve the community in more environmentally sustainable ways.
Using a multipronged approach to improving healthcare sustainability at Ambulance Victoria can reduce the environmental impact of pre-hospital healthcare services and thereby minimise the health impacts from the sector that are associated with dangerous climate change.

CODA Change and Sustainable Healthcare.
Climate change is a pernicious environmental and health threat to humanity. Yet, healthcare itself pollutes, contributing to approximately 5% of total global anthropogenic emissions. What can be done to avoid this harm? Forbes McGain has spent 15 years undertaking research with colleagues to discover healthcare’s environmental footprint, with a particular emphasis upon practical efforts to reduce this environmental and economic burden. In this discussion we will hear of a series of micro, meso, and macro actions that each can contribute to reducing our carbon and other environmental footprints at work.

Mico: all clinicians have agency to avoid, reduce, reuse, and if none of these are possible, recycle. Further, efforts to provide excellent primary care such as preventing obesity, diabetes, and drug harms, and delivering vaccinations are integral to ameliorating healthcare’s environmental footprint. From titrating oxygen on the hospital wards to deliver enough, but no more for patients, to undertaking antibiotic stewardship (and switching from i.v. to oral preparations) there are actually many daily activities in healthcare that could reduce our environmental footprint whilst delivering ongoing safe patient care.

Meso: Collaboration is the key here! There are many low carbon healthcare activities that cannot be ameliorated without teamwork, for example at the GP clinic, hospital ward, or operating theatre level. A good example within hospitals are efforts to convert single use to reusable equipment. Although evidence is presented of the economic and environmental benefits of reusable anaesthesia equipment such information (and publications) has not lead to widespread adoption of such approaches. The importance of champions in each hospital and collaborating with clinical and non-clinical colleagues in hospitals is emphasized. Forming hospital environmental sustainability committees, and alliances with hospital executives and the board is vital.

Macro: Advocacy at the medical and nursing societal and colleges level to incorporate environmentally sustainable healthcare into routine clinical education, examinations, and research agendas is the work of concerted groups of clinicians. Influencing the various state, territory and national governments to develop/extend sustainable healthcare units will likewise form part of macro efforts. Joining the Doctors for the Environment, Australia (DEA), activating the ANMF and AMA to get involved in environmentally sustainable healthcare will augment such efforts.

Full Sails on Our Journey!

Climate change is now our lived experience. With no vaccine to reduce its impact on health, the only preventative strategy we have is to reduce emissions, including healthcare delivery. The greatest portion of healthcare’s emissions profile comes from the stuff we use, so we have to change what we do. But how?

Decarbonisation on the clinical floor is a look at every day work activities. It is bridging the gap between abstract concept and service delivery. It comes with triple bottom line wins – people, planet, and profit.

The future isn’t written yet. The things we do now are what make it. We have choices to make that matter. We need visionaries to show us the direction. We need practical examples that bridge the gap between ambition and action. We need to tell the climate story in a way that draws people in, that empowers them to take action and enables us to be part of the solutions.

Nick Watts
 
In today’s podcast, Nick Watts - chief sustainability officer at the NHS speaks about why - when the NHS says there are three things they want to implement over the next decade - their response to climate change is number two.
 
Watts explains that they understand the health implications of a rise in temperatures, they understand that it means a doubling of the number of high risk health facilities in flood zones, and a tripling of the average duration of fatal heatwaves and notes that they saw what that looks like for our healthcare system.
 
He talks about how while the average across a summer the UK face 2200-2400 excess deaths from heatwaves; the recent six-day heatwave saw 12800 deaths – six times the usual amount. That’s why the NHS cares deeply about this.
 
If the climate crisis is a healthcare crisis, Watts says that it’s important to face it head on. Principally, he says, acute care is responsible for the NHS’s emissions, while primary care also comes in strong due to its prescriptions and medicines.
 
He discusses how in order to cultivate real change, you don’t just run at one small part – turning off the lights and turning the temperature down simply isn’t enough - you need look at every single emission you can possibly think of. For the NHS it means net zero by 2045.
 
NHS reports publicly to both their board and 1.4million NHS professionals every single year. Watts says that it hit first year emissions target; he promises they’re going to hit their second. It will, however, start getting hard to hit their targets from year 5 onwards.
 
Transparency is critical. Milestones and scope need to be clear.
 
Watts explains that from 2027 onwards the NHS will no longer purchase from anyone that does not meet or exceed their commitments to net zero.
 
He says that while the NHS will do absolutely everything in their power, they can’t run at this alone. The challenge is too big, medicine is too complex. Thankfully the NHS isn’t alone. 14 other countries followed suit in committing to reaching net zero.
 
To end, Watts insists that it’s when other people take note, start taking this seriously, and when other healthcare systems start to engage that net zero stops becoming possible, and starts to become inevitable.
 

Sepsis in other words ‘life-threatening organ dysfunction’ in response to infection is a leading cause of death worldwide and a global health priority recognised by the World Health Organisation. In Australia, for adults with sepsis admitted to the intensive care unit, the in-hospital mortality is estimated as 18–27%. Early recognition of sepsis, prompt administration of antibiotics and resuscitation with intravenous fluids for those with features of hypoperfusion or shock are the mainstays of initial treatment. Emergency departments often being the first point of contact for patients presenting with sepsis, are required to prioritise sepsis as a medical emergency. The “Sepsis Kills” program implemented across the nation aims to reduce unwarranted clinical practice variation in management of sepsis.
 
In a recent Australian based study conducted across four emergency departments in Western Sydney Local Health District, among 7533 patients with suspected infection, a reduction in risk of in-hospital mortality was observed for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU. However, despite evidence showing mortality benefits, not all aspects of sepsis care have been given the needed attention. In the same setting, out of 4146 patients with sepsis, 45% of them did not receive intravenous fluids in the emergency departments within the first 24 hours. Younger patients with greater severity of illness and presented to smaller hospitals were more likely to receive fluids. 
 
The unanswered questions regarding the facilitators and barriers influencing intravenous fluid administration in sepsis are being explored using qualitative methods. Several emergency physicians and nurses have provided insight into aspects that influence their ability to provide appropriate fluid resuscitation such as constantly overcrowded emergency departments with chronic staff shortages of skilled health professional, failure to recognise sepsis early, the complexity of the presentations and lack of resources. Awareness of these challenges among stakeholders is the need of the hour. Leaving no one behind and not disregarding the critical aspects of sepsis care are crucial. Recognition of these factors and sustainable interventions are necessary to improve clinical outcomes for patients.
 
For more head to our podcast page #CodaPodcast

Physiotherapists form a key part of the multi-disciplinary team in the Intensive Care, focusing on both respiratory care and optimisation of function. This talk will discuss the role of physiotherapy across the continuum specifically in the management of an acutely unwell septic patient. I will discuss the focus of a physiotherapy assessment, main treatment aims, some of the barriers for the implementation of physiotherapy in ICU, while identifying strategies to enable appropriate application of physiotherapy techniques.
For more head to our podcast page #CodaPodcast