S5E8 - The Climate Emergency & what you can do about it
Welcome back to another episode of The Case.Report! This month we’re shaking things up a little as NCHDs Callum and Johnny work hard stabilising not just one patient, but an entire planetary ecosystem. Planet Earth has come to TCR resus in a critical condition and there’s no time to waste. With toxic levels of air pollution, rising global temperatures, escalating extreme weather events, threats to global food and water security, and a rapidly closing window to act - this is a health emergency beyond any doubt.
Our adult in the room this month is the outstanding Professor Hugh Montgomery - Professor of Intensive Care Medicine at University College London, Consultant in Cardiology and General Internal Medicine, Co-chair of The Lancet Countdown on Health and Climate Change and the founder director of Real Zero Ltd. He has OBE from the Queen for services to Insensive Care and to the Climate Crisis and has published over 600 scientific papers with several appearing in Nature. If that wasn’t keeping him busy enough he is also a seasoned ultra-marathon runner, mountaineer and holds the world record for playing the piano underwater! With expertise in resuscitation, intensive care and planetary health, there is no one better placed to weigh in with some high impact expert advice.
In this episode, we also take a dive and discuss how the climate emergency will impact emergency departments around the country and look at how we can all be more sustainable and fight for a better future using The Royal College of Emergency Medicine’s GreenED Framework.
If you haven’t had the chance be sure to check out last month’s juicy episode on Nitrous Oxide Toxicity. This might be just a tad more likely to present to your local ED than planet Earth…
Listen now on Spotify, Apple Podcasts or wherever you get your podcasts, and as always check out our Bluesky, Instagram, Facebook and X to keep updated with all things TCR.
Without further prelude, let’s get stuck in!
PRE-ALERT!
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PRE-ALERT! 〰️
The pre-alert sounds and there’s a 4.5 billion-year-old planet presenting with a worsening fever and general decline over the last 180-years.
We get a set of vitals over the phone and we learn that there are high levels of air pollution, contaminated water systems, declining nutrient cycles, significant loss of biodiversity and a fever reading 1.5ºC above the pre-industrial age.
Straight away Callum is concerned. This sounds like a very sick planet. He makes some room in resus and gets his team ready to go. He mentally goes through his ABC assessment, knowing that these will be a bit different having to assess a planet.
Like any emergency, lets start with our ABCs…
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This contains the air we breath, and the energy within it makes the weather and climate.
The average global temperature is now 1.5ºC above mean
2023 and now 2024 have been the hottest years ever recorded.
We’re at 430 ppm of CO2 (and counting) - Trapping 8 Hiroshima bombs of energy into the atmosphere every second.
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This is the living world, of which we are a part of and depend on entirely on for our food, water and survival.
17% of the amazon has been deforested.
We have lost over 182 million hectares of forest between 2016-2022 alone (an area of land the size of Russia and Brazil combined)
30% of all land is used for farming alone.
An area of land the size of North and South America is used just to produce livestock.
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The is all of the ice on the Earth.
Over 12.8 trillion tonnes of ice has been lost since 1994.
Current rates of warming – 30 million tonnes/hr from the Greenland Ice sheet alone.
On track to lose between one third to half of permafrost by the end of the century .
This may lead to sea level rises that will engulf many of the worlds major cities like London and New York. And, sadly, Dublin too
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This is our land and how its used
A global average temperature rise of 1.5 or 2 degrees makes regions like the middle east and India endure several degrees or temperature rise, leaving 3-billion people living outside ‘survivable climate conditions’.
Another 2/3 million people will be under the high tide mark
This will lead to mass migration with the UN estimates 200 million people will be forcibly displaced by 2050
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This is our oceans and freshwater.
Oceans have absorbed 90% of additional heat and have increased by 0.9ºC in the last 180-years.
In 2023 alone they absorbed enough heat to bring 1 trillion Olympic swimming pools from 0ºC to boil
They have also Absorbed 20-30% of atmospheric CO2 and acidified by 30%.
This is devastating ocean ecosystems and causing mass coral reef bleaching.
Rivers are warming, drying up and becoming severely polluted.
Collateral history
While the resuscitation begins, we get a quick collateral from the world's scientific community and astronauts visiting neighbouring planets.
Earth has had multiple climate changes in the past with 5 mass extinction events but this one seems a bit different.
For the past 12,000-years the Earth has experienced a very stable climate and life, particularly human life has flourished in this period. This period is termed the holocene. In the last 180-years they’ve noticed Earth complaining of a fever which seems to be increasing.
They’ve noticed her polar ice caps and glaciers melting away, rising sea levels, increasing severity and frequency of storms, typhoons, heat waves, droughts, wildfires, and rapidly losing wildlife and biodiversity. Coral reefs have been bleaching, oceans becoming more acidic, deserts are spreading and they’re worried that these processes are only speeding up.
They report that a species of humans have been on Earth for circa 200,000 but since the industrial revolution and the discovery of fossil fuels as an energy source, things have changed drastically.
Humans have been using fossil fuels x180-years and exponentially so in the last 32-years. They have also been:
Destroying rainforests
Overfishing
Farming cattle
Abusing plastic
Polluting water ways
Our impression so far:
“This planet has a destabilised climate with collapsing ecosystems that are now reaching a critical tipping point with a significant threat to the health of all life on the planet. This is all secondary to human activities”
Management
Recognising that this is a critically sick planet, Callum and Johnny call for senior help immediately and put out a climate-health emergency call activating our major global emergency network.
We’re going to need a lot of hands on deck – pretty much every single person on the planet to do their part.
Like any good resuscitationist they act immediately to simultaneously address the ABCs.
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Pull the emergency break and immediately stop pumping more toxic greenhouse gases into the atmosphere – primarily by immediately ceasing fossil fuel use.
Protect ecosystems that capture carbon and urgently begin reforesting and rewilding all habitats to suck carbon out of the atmosphere.
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Protect species, rewild and reforest.
Cut down on plastic use and disposal endangering ocean and land life.
Switch to plant based diets to reduce the amount of land used for farming and to free up land for nature restoration.
By limiting global warming we’re going to reduce the occurrence and severity of droughts, heatwaves and forest fires and so protect natural habitats. This will prevent turning net carbon sinks like forests into net carbon emitters when trees are burned as forest fires rage.
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We need to eliminate fossil fuel use and the release of greenhouse gases.
Work on huge scale nature restoration and reforesting to absorb much of the carbon we have released.
The atmosphere is going to stop warming and this will slow the rate of glaciers melting and prevent them reaching critical points from which there is no return.
Limiting warming will protect permafrosts and keep these as carbon sinks and not convert them to carbon sources!
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As we get the temperature of the planet back under control from ceasing fossil fuel use we’re preventing the forecasted spread of zones with intense heat which are extremely harsh and inhospitable for humans.
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Stop fossil fuel use will slow our ocean’s warming any further.
Less CO2 in the atmosphere is going to prevent any further acidification and consequently cause less damage to marine ecosystems.
Cooler and less acidic oceans will lower the risk of further coral bleaching events and help safeguard healthy oceans.
We need to tackle farm pollution and plastic use which will create healthier rivers and prevent algae blooms in lakes.
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Next we’re going to have to call our colleagues in intensive care and get this planet up to the critical care unit where more long term changes are going to be made to prevent the planet warming any further, to keep rebuilding our ecosystems and allowing life to flourish.
Time for discussion.
So how does the health of our planet impact the health of our patients? Lets start with a definition of planetary health:
“Planetary health is defined as the health of the human civilisation and the state of the natural systems upon which it depends”
In other words, the health of our species is entirely dependent upon the health of the natural world around us, and as we know from the case, Earth’s health is in a critical condition. In fact, in 2023 a group of scientists came together to assess the Earths vital signs, or earth system boundaries (ESBs). They found that we had breached 7 out of 8 safe and just ESBs.
Patient Earth is in multi-organ failure.
The Earth’s vital signs (Earth System Boundaries) mapped onto an Early Warning Score (EWS) chart equivalent.
Taken from Safe and just Earth system boundaries.
With the Earth this sick, and because we know that human health is dependent on the health of our planet, it comes as no surprise that The Lancet Medical Journal has identified the climate crisis as the greatest threat to global health of the 21st century.
Recapping over the basics of the Climate Crisis
Burning fossil fuels for energy, buildings, steel and transport releases greenhouse gases into the atmosphere causing the greenhouse effect.
This traps more of the suns heat and energy in the atmosphere leading to a rise in global temperatures.
Other contributors include farming, deforestation, biodiversity loss, resource extraction for consumerism and pollution.
Rising global temperatures leads to:
Melting glaciers and polar icecaps -> Sea level rise and flooding
More heat and energy in the atmosphere leads to increasing severe and frequent extreme weather: storms, typhoons, hurricanes, droughts, heatwaves, forest fires & flash flooding
Losing wildlife and biodiversity weakens our ability to be resilient to these changes.
Think of a stable climate as a healthy human body, well able to resist disease and meet the various challenges it may meet. This is like your young fit patient, who exercises regularly, is a non-smoker and without co-morbidities.
Compare this to a destabilised climate, which is more like your elderly patient with a high BMI, who has a significant smoking pack-year-history and has co-existing COPD, CKD and heart failure. In this patient any tiny insult can cause huge harm.
The Climate Crisis is a Health Crisis.
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The Climate Crisis is a Health Crisis. 〰️
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99% of the world live in areas that fails to meet the WHO’s air quality guidelines
Globally there are 7-million premature deaths each year from air pollution alone
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Damage to infrastructure and direct mortality (hospital and private) from storms, forrest fires, hurricaines & typhoons
Heat stroke & heat exhaustion
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Mosquito will thrive at a warming climate being able to survive at higher and lower latitudes, bringing with them vector borne diseases e.g. Malaria
Increased risk of zoonotic infections
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Extreme weather such as droughts and heat waves and damage crops
Microplastics infiltrate plants causing reduced photosynthesis and lower crop yield
Contaminated river and lakes making drinking water less available
Droughts impacting river flow and causing water shortages
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Increasing rates of:
Anxiety
Depression
PTSD
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The UN are predicting 200-million climate refugees by 2050.
This will put increased burden on countries less affected by the climate crisis but who’s health systems may already be under pressure.
We have a narrow window to take meaningful action
The Earth’s climate is resilient, but only to a certain point. We are now dangerously close to crossing these tipping points. Tipping points from which we will initiate irreversible chain reactions, setting us on certain path for climate catastrophe and causing significant harm to human health.
Thankfully, although walking on a cliff edge, we have not crossed those thresholds just yet.
We do have time but we have to act now.
What is the role of healthcare in all of this?
Helathcare is not without harm and the delivery of healthcare in Ireland is responsible for 4-5% of our countries carbon footprint
If global healthcare was ranked as a country in terms of its emissions we would be the 5th largest emitter.
As physicians we are advocates for patient health and this is the biggest threat to global health of the century
We have a responsibility to “do no harm”
Healthcare makes up roughly 12% of GDP meaning we have significant purchasing power to influence economies.
Where do our emsissions come from within healthcare?
Scope 1, 2 and 3 emissions.
From the NHS - Delivering a ‘Net Zero’ National Health Service
Sources of carbon emissions by proportion.
From the NHS - Delivering a ‘Net Zero’ National Health Service
The Four Principles of Sustainable Healthcare
What’s the GreenED?
The GreenED is about delivering the highest quality of care to patients while being efficient with resources and limiting harm caused to the environment and hence ourselves.
This was created by the Royal College of Emergency Medicine’s Environmental Specialist Interest Group. It’s a framework of actions designed to help ED staff improve environmental sustainability at work as easily, efficiently and effectively as possible. You can achieve Bronze, Silver or Gold accreditation based on how many actions you and your ED implement.
You can learn more about the full criteria here.
Some changes you can make at home to help!
The most important thing to remember is that every little bit counts and no action is too small. Every molecule of carbon saved is pushing us closer to safety and away from critical irreversible tipping points. Whether you can go vegetarian one day per week or 5, every time we chose lower carbon alternatives we are choosing a better healthier future.
Cycle or walk where possible to work/school/groceries/town/everywhere you can
Use public transport if active transport isn’t an option
Eat less meat and dairy and particularly eat less red meet
Try second hand clothes shopping or when you do buy new clothes, buy clothes that will last!
Use less plastic and generate less waste. Bring keep cups for coffee, resuable water bottles etc
Fly less. Consider choosing one holiday aboard per year instead of several. Explore Ireland and boost our economy.
Install solar panels or move power supplier to 100% renewable energy
“But I’m just a drop in the ocean, we need system change”
The truth is we need both!
We are in an emergency and we need to use every method we can. Make the changes that you can make. Control what you can control and use your voice. How can we expect politicians to make bold decisions about climate policy if they don’t think the public will back them?
Research has shown that it only takes one in four people to change their behaviour to change a whole culture.
Don’t wait for someone else.
“System change doesn’t come out of nowhere, it comes when people demand it”
Take home messages from Callum and Johnny
Educate yourself. Read about the crisis. If you want to make meaningful change you’re going to have to understand it.
No action is too small. Every time you take the bike over the car, eat vegetarian over meat you’re putting us on track to a better future. Take all of those as small wins.
Don’t despair, don’t give up! Remember that you’re not alone and there are so many people all around the world fighting for a better healthier future.
Critical Messages from Professor Hugh Montgomery
“I’m 62, since I was 8, the world’s population of vertebrates has dropped by nearly 75%. This has been the greatest rate of extinction since the dinosaurs.
“We are currently on representative concentration pathway 8.5, heading for 4.5 degree celsius rise, which is a mass extinction event.
“The IPCC in 2022 has warned us; any further delay in action means we miss a brief and rapidly closing window to secure a liveable future. So they are warning us that our planetary patient will die. And we ourselves as part of that planetary organism, so we too will die. If we don’t take action.
“We have to take action. All of us. You and me. It is too late to leave it for anyone else.
“And just as any other emergency situation, when the crash bleep goes off, we attend and do what’s necessary. Lets do that now.”
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Main case:
Dr Callum Swift
Dr Johnny Collins
Adult in the room
Prof Hugh Montgomery
TCR Innovation Team-Show notes / infographics / website design / social media
Ms Sinéad Kelly
Dr Johnny Collins
Dr Genevieve Callander
Dr Liam Loughrey
