The turning point for Susanne Koch came when the basement of her house in Berlin-Frohnau flooded in the summer of 2018 after heavy rain. After she had drained it again, “I wanted to know exactly what the connection with climate change is,” says the energetic doctor from the Charité Berlin. »When I read it, man, I realized how urgent the climate crisis is. We’re actually up to our necks in water!”
The personal shock also turned into a professional one: Koch, originally a neurologist, had trained as an anesthesiologist and learned during her research on the climate crisis that inhaled anesthetic gases are among the most harmful climate gases of all. “If I am anesthetized with desflurane for seven hours in the operating room,” says Koch, “it’s just as damaging to the climate as if I drive from Berlin to West Africa in a car.” The 16 million anesthetics that are administered in Germany every year on average , correspond to the emission of 600,000 tons of CO2-equivalents in the atmosphere. During studies, anesthetic gases were found far away from operating rooms, for example in the Himalayas and in the Arctic.
When it comes to medical interventions, patients primarily think about the fact that everything is safe and not so much about the CO2-Footprint of the procedure. For Susanne Koch, both belong together: “A stable climate is essential for our health and our survival.” In fact, the health system is one of the CO2-most intensive sectors and is for almost five percent responsible for global greenhouse gas emissions. “Moreover, it is also a major consumer of resources such as water and energy and leads to the pollution of the environment with pharmaceuticals and toxic substances,” he writes Association of Anesthesiologists. “Not only anesthesiology, but all medical care has a climate problem,” confirms Jodi Sherman, anesthesiology professor and director of the sustainability program at Yale University. “Healthcare emissions cause as many deaths as preventable medical errors, and we should take them just as seriously.”
Susanne Koch was appalled that her job is so damaging to the planet. The doctor was particularly annoyed that she had never heard a word about it during her anesthesiology studies. For example, on the dangers of desflurane, by far the most climate-damaging – and most expensive – of all anesthetic gases – its greenhouse effect is 2,600 times more pronounced than that of carbon dioxide. Because of its extremely long atmospheric lifetime, laughing gas (nitrous oxide) is the second most harmful, and it also damages the ozone layer. A simple solution was therefore obvious to Koch: “We simply left out the desflurane. Instead of inhaling anesthetic gases, we use regional anesthetics or intravenous ones such as propofol. It wasn’t ordered from above, we just did it like that.”
Susanne Koch is a doctor at the Berlin Charité, the largest university hospital in Germany. There she is committed to sustainability in healthcare.
Young anesthesiologists are taught anesthesia with desflurane as a standard because it makes it very easy to control the patient’s awakening, says Koch. »But with a little experience you can do it just as well with propofol. In addition, people are less prone to nausea after propofol anesthesia.« Thanks to this measure, the emission of climate-damaging gases in the anesthesiology department of the Charité has been reduced to a tenth since 2016, »simply because we take propofol.« The Yale New Haven Clinics in the US state of Connecticut ended the use of desflurane on Jodi Sherman’s initiative in 2013. At that time, the clinic was the first healthcare organization in the world to no longer use a drug for purely ecological reasons. Sherman calculated that Yale thereby more than $1.2 million costs and 1600 tons of CO2-Equivalents saved.
Because halogenated hydrocarbons (which also include anesthetic gases) have an immense global warming potential, a global reduction was agreed in 2005 as part of the Kyoto Protocol and in 2016 a global waiver by 2035 was signed. In fact, however, the use of climate-damaging anesthetic gases is steadily increasing worldwide, partly because of improved medical care in emerging developing countries and because people in industrialized countries are living longer and therefore need more operations.
The EU also recommended that its member states Reduction of inhalative anesthesia and even considered a ban on desflurane, which from 2026 should only be used in exceptional medical cases, but failed due to opposition from interest groups. Other countries are already further along. In the UK, for example, the National Health Service (NHS) created a Sustainable Development Department in 2008 which, among other things, monitors the CO2-Measuring emissions in the healthcare sector. The UK’s health service was the first in the world to commit to becoming carbon neutral by 2040 and has already reduced emissions of greenhouse gases by compared to 1990 26 percent. »The evidence that the climate crisis is also a health crisis is overwhelming«, says Nick Watts, the sustainability chief of the NHS. “Health professionals need to treat the symptoms now.”
“We need to set ambitious, science-based emissions targets to become carbon neutral by 2050”
Jodi Sherman, Yale Professor
For Jodi Sherman, measuring and transparently communicating healthcare emissions is the necessary first step to finding solutions. “In England, these results are regularly updated and improved,” she praises. Among other things, the Yale professor developed an environmental protection app for anesthesiologists Yale Gassing Greener App. This allows anesthetists to see at a glance how much environmental pollution they are avoiding by choosing less harmful anesthetics. Sherman, like Koch, is convinced that it is a doctor’s job to avoid damaging the climate as much as possible. »This is the new challenge when it comes to patient safety.«
The Biden administration announced at the United Nations Climate Change Conference (COP27) that more than 100 healthcare providers had pledged to reduce their emissions by 50 percent over the next eight years. However, Sherman believes such promises are ineffective. “Voluntary measures are not enough,” she told the US Congress, instead demanding: “Health care providers have an obligation to protect health. We need to lead by example and set ambitious, science-based emissions targets to become carbon neutral by 2050.”
Koch’s employer, the Charité, is currently analyzing the biggest problem areas. »Compared to the base year 2016, we were able to reduce the CO2-Reduce emissions by 21 percent,” says Simon Batt-Nauerz, who has been responsible for infrastructure and sustainability at the Charité since May 2022. However, they are still around 105,000 tons per year, which corresponds to the annual value of a small town with 10,000 inhabitants.
Interestingly, the head of sustainability first saves in the non-medical areas. The 20,000 employees of the Charité can take advantage of the “Jobrad” bicycle program and have their bikes serviced free of charge in the Charité’s own bicycle workshop. Further potential for CO2-The university hospital sees savings in the new medical staff clothing. 8,000 clinic employees will soon be dressed in smocks, cassocks and trousers made from organic Tencel, a wood fiber from regional cultivation, instead of the previous cotton-polyester mixture. Batt-Nauerz is particularly proud of having saved 85 tons of food waste last year. This corresponds to around 216 tons of CO2. But he also knows: »70 percent of the CO2-Emissions come from the supply chain.« And another big source is energy consumption. The Charité uses green electricity, but because some of the three clinic locations are listed buildings, a building renovation would cost many millions.
It’s easier for new buildings: the world’s first passive house clinic, Klinikum Höchst, has just been built in Frankfurt. The first doctors and patients moved in on February 4th.