title: Changes in travel-related carbon emissions associated with modernization of services for patients with acute myocardial infarction: a case study.
abstract: BACKGROUND
  Little attention has been paid on the carbon footprint of different healthcare service models. We examined this question for service models for patients with acute ST elevation myocardial infarction (STEMI).
  
  
  METHODS
  We estimated carbon emissions associated with ambulance (patient) transport under a primary percutaneous coronary intervention (pPCI) care model based in tertiary centres, compared with historical emissions under a thrombolysis model based in general hospitals. We used geographical information on 41,449 hospitalizations, and published UK government fuel to carbon emissions conversion factors.
  
  
  RESULTS
  The average ambulance journey required for transporting a STEMI patient to its closest care point was 13.0 km under the thrombolysis model and 42.2 km under the pPCI model, producing 3.46 and 11.2 kg of CO(2) emissions, respectively. Thus, introducing pPCI will more than triple ambulance journey associated carbon emissions (by a factor of 3.24). This ratio was robust to sensitivity analysis varying assumptions on conversion factor values; and the number of patients treated.
  
  
  CONCLUSIONS
  Introducing pPCI to manage STEMI patients results in substantial carbon emissions increase. Environmental profiling of service modernization projects could motivate carbon control strategies, and care pathways design that will reduce patient transport need. Healthcare planners should consider the environmental legacy of quality improvement initiatives.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Institute of Public Health, Robinson Way, Forvie Site, Cambridge CB2 0SR, UK.
authors.forename: Alexis
authors.initials: A
authors.lastname: Zander
authors.forename: Aphrodite
authors.initials: A
authors.lastname: Niggebrugge
authors.forename: David
authors.initials: D
authors.lastname: Pencheon
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002245:Carbon Dioxide; D058572:Carbon Footprint / Q000706:statistics & numerical data; D004562:Electrocardiography; D004739:England; D005843:Geography; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D013222:State Medicine; D015912:Thrombolytic Therapy; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014195:Travel
chemical_list: D002245:Carbon Dioxide