An observational study of the carbon footprint of rural interhospital patient transfer

Abstract

Background: Extreme weather events associated with climate change have obvious impacts on emergency medicine systems. The impact of emergency medicine systems on climate change is less obvious. Patient transfers small rural hospitals to larger centres is an essential component of modern emergency care. Many of these transfers are unavoidable and lifesaving. However, numerous studies report unnecessary transfers and over triage. Objective(s): This study aims to examine emissions related to regional interhospital transfers to explore an aspect of emergency medicine's contribution to climate change. Method(s): Nine rural emergency facility's episode of care details were extracted from the Rural Acute Hospital Data Register for a 12-month period. Interhospital transfers were classified by transport mode. Trip distances between referring and destination hospital (and hospital to airfield distance, were relevant) were determined. Emissions were calculated using the emission factors of 0-40 kg CO2/km, 1-82 kg CO2/km, 5-73 kg CO2/km for ambulance, fixed wing and helicopter respectively. Result(s): Between 1/2/2017 and 31/1/2018 interhospital emergency transfers were initiated for 1283 attendances (2.2%) (Figure 1). 1095 road, 112 fixed wing and 76 helicopter transfers occurred. Transfers occurred more frequently from small urgent care centres (6%). An estimated 367 tCO2 emissions were generated from these transfers; 78 kg CO2 (road), 869 kg CO2 (fixed wing), and 2423 kg CO2 (helicopter) per patient. This is almost double the amount reported in previous studies (1,2). Conclusion(s): This study provides a snapshot of current transfer rates and their contribution to climate change. Consideration of transfer alternatives, such as telehealth, is one way emergency medicine may reduce carbon emissions.