The Development of a Surgical Care and Climate Change Matrix

摘要

Even as health care professionals face unprecedented challenges resulting from the SAR-CoV-2 virus and COVID-19, we must look toward a possibly even bigger threat. The global climate continues to undergo change that significantly impacts human and environmental health.1,2 Most of the associated priorities and implementation strategies relate to medical and not surgical conditions.3 However, a recent commentary highlighted some of the issues related to surgical care and climate change and noted, “the intersection of climate change and health is still an inchoate field of study, and how climate change and surgery intersect is even less explored.”4 To address this concern, a working group of surgical care providers developed a matrix to define the problem and identify priority areas of study and intervention. The Surgical Care and Climate Change Matrix, presented here, is based upon the Haddon Matrix developed for injury prevention interventions and a similar matrix developed for global surgery.5,6 SURGICAL CARE AND CLIMATE CHANGE MATRIX DEVELOPMENT AND IMPLEMENTATION A draft matrix was developed and circulated among the working group members and a consensus was achieved. The matrix considers the continuum of patient care from pre-hospital, in-hospital, and post-hospital locations, with interventions focused on prevention, readily achievable responses, and long-term responses at each location (Table 1). TABLE 1 - Proposed Surgical Care and Climate Change Matrix to Plan Interventions That Mitigate the Impacts of Climate Change on Surgical Practice Prehospital Hospital Posthospital Prevention (reduce/reverse) Electric vehicle transportEco-friendly packaging <LBREAK"/>-->Minimize packagingBiodegradable wasteRational expiration datesIncrease urban green spaces Eco-friendly packagingMinimize packagingBiodegradable wasteRational expiration datesShift away from vapor anesthetics, particularly desflurane.Minimize hazardous chemical use Electric vehicle-transportEco-friendly packagingMinimize packagingBiodegradable wasteRational expiration dates Readily achievable responses ResolutionsLED lightingUpgrade surge capacityReusable equipmentUnderstanding/duplication of critical supply chain ResolutionsLED lightingUpgrade surge capacityReusable equipmentMotion-sensor activated lighting and climate controlRationalize policies regarding room attire (eg, not everyone needs a mask)Food waste composting and water extraction ResolutionsLED lightingUpgrade surge capacityReusable equipment Long-term responses TelemedicineTask-shiftingRoboticsDronesArtificial IntelligenceLEED certificationBuild hospitals with access to public transportation Task-shiftingSolar/wind energyRoboticsArtificial IntelligenceLEED certificationWaste sorting TelemedicineTask-shiftingRoboticsDronesArtificial IntelligenceLEED certification LED indicates light-emitting diode; LEED, Leadership in Energy and Environmental Design. Prevention These items mitigate additional impacts on climate change through reduction or even reversal of carbon emissions. Alongside structural changes, we propose an extensive outreach and education effort to change cultural norms. Our efforts will focus on educating the public and all members of the surgical care team about the importance of environmental stewardship. These efforts should be developed at the relevant community level to include appropriate language, cultural, and resource considerations. In the prehospital setting, prevention strategies include use of electric vehicles; converting to compostable packaging; enhancing sterilization and/or reusing select supplies; modifying expiration date rules for items that do not expire; and recognition or conversion to biodegradable waste products. In the hospital setting, carbon emissions can be further decreased by powering down unused operating rooms and using alcohol scrub-in instead of water. Additional reductions in greenhouse gas emissions are possible by switching anesthetic formulations away fro