This article is part of our new series Future of health care, Which investigates changes in the medical field.
As climate change shifts from a model of the future to the reality of the present, the health care system across the country is facing a difficult set of questions. What should doctors do when their ability to care for patients is threatened by wildfires, rising floodwaters or other natural disasters? How can these institutions be resilient to face these disasters?
For Rame Hemstreet, these are not abstract questions. Mr. Hemstreet is the vice president of operations and chief permanent resources officer of Saffron Permanente, a California-based health care system. The state is already dealing with the effects of climate change: During a wildfire in Northern California in 2017 and 2019, Kaiser Permanente had to evacuate more than 100 patients from a facility in Santa Rosa and take care of the surrounding communities Had to find a way.
“The climate crisis is a human health crisis, and we are already living in California,” Mr. Hemstreet said.
For the past decade, Mr. Hemstreet and his colleagues at the company have been trying to take it away from fossil fuels, primarily to reduce the company’s contribution to climate change. But, it has also become clear that relying on fossil fuels is a hindrance in providing health care, as the effects of climate change are increasingly part of many Americans’ life experiences.
Across the country, hospitals and health care systems are trying to answer the central question of how to care for patients when climate change threatens their ability to keep hospitals open. Many changes to improve flexibility are not smooth, tech-forward responses to the crisis. Rather, they often represent common-sense solutions: carrying technical equipment from the basement where floodwaters can damage it to higher floors; Organizing patient transfers before disasters; Energy efficiency improvements; Better air filter; More backup systems and redundancy, just in case.
Since 2012, Boston Medical Center has reduced its energy use by nearly 40 percent and reduced its greenhouse gas emissions by 90 percent from all sources of energy. Caring for more patients. Some of those reductions have come from a co-generation plant for electricity and heat, which operates 35 percent more efficiently than relying separately on electric utilities for their energy needs. The hospital has also purchased enough solar power for all its electricity from a solar farm in North Carolina.
BMC, New England’s largest safety-net hospital serving the uninsured and under-insured community in the Boston area, has also stepped up its sustainability efforts beyond renewable electricity and heating, including a rooftop garden at the hospital Which produces about 6,000 pounds of food. For its food stores, patient food and a hospital-based farmers market, and a biodigester that converts food waste into water.
Robert Biggio, an engineer who served in the Merchant Marine and is now the senior vice president of facilities and support services for the hospital, learned resilience on the high seas. “Being on a ship in the middle of the sea, people can’t meet you,” he said. “You have no choice about being flexible.”
Although it is often argued that stability and climate-friendliness are very expensive, all system upgrades – including a cogeneration plant and a cool-water loop cooling system, rather than an expensive new tower – result in significant amounts of BMC, an unprofitable, There is money left over.
“Reducing waste is more efficient and also improves flexibility,” Mr. Biggio said. “They go by hand.”
Health care in the United States is responsible for a significant amount of waste and a significant amount of greenhouse gas emissions. For every hospital bed, the American health care system produces approximately 30 pounds of garbage every day; Over all, it accounts for about 10 percent of national greenhouse gas emissions.
Apart from personal protective equipment, which is intended for single use only, the majority of waste comes from the shift towards single-use disposable items. Many hospitals are contracting outside companies to clean and reprocess many of these items; Kaiser Permanente committed to recycling, reusing, or composting 100 percent of its non-essential waste by 2025.
As far as greenhouse gas emissions are concerned, hospitals must have backup power, typically provided by diesel generators. These run on fossil fuels and produce microscopic particles, known as PM2.5, which contribute to asthma and other diseases. The air quality around hospitals, which have to test their generators regularly, is often poor.
a recent study Found that, compared to white people, people of color are Exposure to PM 2.5 from all sources, And black Americans are the most affected. As a result, these communities, which often lack access to health care, are more likely to suffer from the health consequences of this risk. PM 2.5 accounts for 85,000 to 200,000 additional deaths in the United States (according to the study), and Prolonged exposure to PM 2.5 is associated with hospitalization for Kovid-19.
During Fire season and heat waves, Power can go out or power utilities can turn off the power or create a systemwide blackout to avoid the spark, which means hospitals will have to run on their own generators.
Hospitals are partly responsible for this pollution, Mr. Hemstreet said, which is an unacceptable irony.
Kaiser Permanente has been purchasing utility-scale renewable energy since 2015, and in 2018 finalized a deal to purchase 180 MW of wind and solar power, as well as 110 MW of battery storage, which is being built. Since 2010, it has installed 50 megawatts of solar power at its facilities and is installing nine megawatt-hour batteries at the company’s Ontario, California, campus, which will allow most of the facility to be completely off the grid.
In New York City, space limitations and less abundant sunshine make ambitious installations more difficult, but heat waves present a similar challenge – the possibility of venting out air conditioning and rolling outages, some with higher temperatures Older adults and the sick endanger people, in particular.
Like BMC, NYU Langone Health has built a co-generation plant for electricity, heat and steam turbine-power air conditioning. According to Paul Schwabacher, senior vice president of facilities management at NYU Langone, it is 50 percent more efficient than utility power.
The cogeneration plant was in the construction process before Hurricane Sandy in 2012, an eye-opening experience for the hospital system. Flood water reached during the storm Lower floor of the hospital, Leaving 15 million gallons of contaminated water behind. More than 300 patients, including newborns in intensive care, had to be evacuated from the hospital, taken down several flights of stairs by doctors and nurses.
The hospital was closed for two months after the storm, during which around 100 electricians were working on repairs, Mr. Schwabacher said. “We made lemonade,” he said, adding that he did repair work that would have been more difficult during the hospital’s opening, such as cleaning all the air ducts. They also rebuilt and expanded emergency departmentWhich was swept away during the thunderstorm.
Since then, the hospital has constructed a new building, as well as restored the old ones.
NYU Langone’s greatest efforts towards resilience, however, are new flood barriers around the perimeter of the complex, which are intended to protect against storms seven feet above the level caused by Hurricane Sandy. The complex has a 12-foot-high steel storm barrier at the loading dock that can be lifted hydraulically or manually; Valves on drains and sewage lines to prevent flooding on outdoor roads; And steel gates and doors to keep flood waters back in critical locations throughout the facility.
But building walls will not remove the effects of climate change. This will come from the reduction of greenhouse gas emissions from society as a whole, Mr. Schwabacher said.
“We feel very, very confident that we will be safe, but we know that the next disaster will be different from the previous disaster.”