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Chapter 13: Emergency Medicine in the Era of Climate Change

The overarching purpose of this report is to catalyse system redesign to allow for better emergency care in the future. Climate change is the biggest global health threat of the 21st century, [2] and tackling it is our biggest health opportunity. [3] We exist within a global ecosystem in which the health of our patients and our future ability to treat it are inextricably intertwined with the world around us. [1]


Though emergency medicine has traditionally given little thought to our environment beyond illness resulting from extreme heat or cold, our very ability to do our job with the needed resources is now threatened by the potential for supply chain dysfunction, infrastructure challenges, and social disorder attributable to climate change. These challenges coexist with increased patient presentations for physical and mental health compromise related to wildfires, floods, emerging infectious diseases and much more. [4]


This situation is being met by an emergency medicine workforce that is significantly under-educated on climate-related health issues. Curricular surveys show most medical students are still not being taught about climate change or air pollution, [5] and while research has found that most physicians believe climate change is a health threat, they do not feel prepared to manage the situation. [6] Only a minority of those surveyed by our EM:POWER Task Force feel climate change is a very important (11%) or important (22%) issue facing the Canadian healthcare system overall [EM-POWER survey]. This rate of change in our thinking isn’t keeping up with what’s happening on our planet and is unlikely to achieve a viable outcome because just as time is brain, time is planet.

Figure 20. An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors. Climate change impacts health both directly and indirectly, and is strongly mediated by environmental, social and public health determinants. (World Health Organization Report, October 2023)


Emergency medicine must use the breadth and depth of its collective knowledge and skill—in science, education, disease management, bioethics, and advocacy—to address the challenges of this new era of altered planetary physiology: the Anthropocene. [7]


Table 6. Impact of climate change on health and health systems [8]*Findings replicated by the Canadian Climate Institute [9]


Priority Areas for Action and Recommendations

There are four priorities for emergency medicine as we reframe health and healthcare on a planet whose ecological foundations have become unstable:

  1. Adapt to emerging conditions, now and in the near future.

  2. Mitigate the trajectory of change.

  3. Educate ourselves, our patients, and our elected leaders.

  4. Do our part to make planetary health a societal priority.


Adaptation

Climate emergencies are already increasing in frequency and severity. There must be an understanding within emergency programs of local climate risks, along with adaptation of design and operational plans:

  • Emergency physician leaders should be familiar with patient population-health, and ED operational impacts of current climate change events, such as wildfires, prolonged heat events, floods, and population displacement.

  • Canada has a National Adaptation Strategy for climate change, [10] which hosts a Disaster Risk Reduction table. Much of this is relevant to emergency physicians and should be integrated into EM training (see Education below). Emergency medicine disaster experts should be integral parts of this conversation and sit at the table.


Mitigation

While measures to combat climate change are the foundation of our response to this crisis, it remains true that, whatever our response, some of the impacts of climate change will remain with us for years to come. Because of this, mitigation of potential immediate-term risks is critical:

  • ED directors must be aware of the temperature and precipitation projections for their region, plan for the consequent operational impacts, and work with climate-savvy architects and engineers to design infrastructure for a changing environment, and

  • Emergency medicine leaders must collaborate with governments and other healthcare stakeholders to ensure the necessary supply of pharmaceuticals and other products and mitigate their impact on the environment.


Education

Teaching of climate-related emergencies within a broader understanding of the Anthropocene should be part of residency training and continuing professional development. There is evidence that the general population underestimates the immediate risks of climate change on health—such as mental health, infectious diseases, and heat-related illnesses. [11] Physicians therefore have roles as both learners and public educators in climate change:

  • Because emergency physicians are familiar with treating patients impacted by extreme heat, wildfires, and floods, they should increase their role in public education related to climate change and climate emergencies, and

  • CAEP should harness its internal expertise in education, research, and public affairs—along with allies from other disciplines—to help illustrate and mitigate the health impacts of climate change.


Prioritization: Make Health and Wellbeing an Overarching Goal

It will be impossible to create a highly functional health ecosystem in any individual country within a destabilized global ecosystem. Currently, no country meets its population’s basic needs while keeping resource use at a sustainable level. [12] And modelling suggests that it will be difficult to continue to increase growth in GDP while decreasing its impact on the planet. [13] This puts us at risk of crossing global tipping points that could lead to runaway warming and vast destabilization, the so-called hothouse earth. [14] An urgent dialogue is necessary to reframe our social priorities, and as stewards of the health system, physicians must necessarily become stewards of the planet as well.


Conclusion

The foundations of human health and health systems are being destabilized by climate change. All health professions require a reframing of their priorities and redesign of their systems to include an evidence-based, values-driven response to the ecological emergency facing us. This includes expanded education and professional development, engagement in national and provincial adaptation strategies, and leadership in the public domain. It’s a daunting challenge, but if there’s any specialty with the skill and character to adapt to rapidly-changing conditions, it’s emergency medicine. A broad understanding of the urgency and complexity of the emergency before us is lacking, but there is no shortage of information—and no time to waste.


Additional Reading


References

  1. Chochinov A, Petrie DA, Kollek D, Innes G. EM:POWER: if not us, who? If not now, when? CJEM. 2023 Jan;25(1):11–3.

  2. WHO issues urgent call for global climate action to create resilient and sustainable health systems [Internet]. [cited 2023 Jun 29]. Available from: https://www.who.int/news/item/24-05-2023-wha76-strategic-roundtable-on-health-and-climate

  3. Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, et al. Health and climate change: policy responses to protect public health. Lancet Lond Engl. 2015 Nov 7;386(10006):1861–914.

  4. Romanello M, Di Napoli C, Drummond P, Green C, Kennard H, Lampard P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet Lond Engl. 2022 Nov 5;400(10363):1619–54.

  5. Omrani OE, Dafallah A, Paniello Castillo B, Amaro BQRC, Taneja S, Amzil M, et al. Envisioning planetary health in every medical curriculum: An international medical student organization’s perspective. Med Teach. 2020 Oct;42(10):1107–11.

  6. Kotcher J, Maibach E, Miller J, Campbell E, Alqodmani L, Maiero M, et al. Views of health professionals on climate change and health: a multinational survey study. Lancet Planet Health. 2021 May;5(5):e316–23.

  7. Redvers N, Faerron Guzmán CA, Parkes MW. Towards an educational praxis for planetary health: a call for transformative, inclusive, and integrative approaches for learning and relearning in the Anthropocene. Lancet Planet Health. 2023 Jan;7(1):e77–85.

  8. The Impact of Climate Change on Our Health and Health Systems [Internet]. 2022 [cited 2023 Jun 29]. Available from: https://www.commonwealthfund.org/publications/explainer/2022/may/impact-climate-change-our-health-and-health-systems

  9. The health costs of climate change [Internet]. Canadian Climate Institute. [cited 2023 Jun 29]. Available from: https://climateinstitute.ca/reports/the-health-costs-of-climate-change/

  10. Canada S. Canada’s National Adaptation Strategy: Building Resilient Communities and a Strong Economy [Internet]. 2021 [cited 2023 Jun 29]. Available from: https://www.canada.ca/en/services/environment/weather/climatechange/climate-plan/national-adaptation-strategy.html

  11. Casson N, Cameron L, Mauro I, Friesen-Hughes K, Rocque R. Perceptions of the health impacts of climate change among Canadians. BMC Public Health. 2023 Jan 31;23(1):212.

  12. Fanning AL, O’Neill DW, Hickel J, Roux N. The social shortfall and ecological overshoot of nations. Nat Sustain. 2022 Jan;5(1):26–36.

  13. O’Neill D. Beyond green growth. Nat Sustain. 2020 Mar 1;3:1–2.

  14. Steffen W, Rockström J, Richardson K, Lenton TM, Folke C, Liverman D, et al. Trajectories of the Earth System in the Anthropocene. Proc Natl Acad Sci. 2018 Aug 14;115(33):8252–9.

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