title: Carbon footprinting of North American emergency medical services systems.
abstract: OBJECTIVE
  This study was undertaken to characterize the carbon emissions from a broad sample of North American emergency medical services (EMS) agencies, and to begin the process of establishing voluntary EMS-related emission targets.
  
  
  METHODS
  Fifteen diverse North American EMS systems with more than 550,000 combined annual responses and serving a population of 6.3 million reported their direct and purchased ("Tier 2") energy consumption for one year. We calculated total carbon dioxide equivalent (CO(2)e) emissions using Environmental Protection Agency, Energy Information Administration, and locality-specific emission conversion factors. We also calculated per-response and population-based emissions. We report descriptive summary data.
  
  
  RESULTS
  Participants included government "third-service" (n = 4), public utility model (n = 1), private contractor (n = 6), and rural rescue squad (n = 4) systems. Call volumes ranged from 800 to 114,280 (median 20,093; interquartile range [IQR] 1,100-55,217). Emissions totaled 46,941,690 pounds of CO(2)e (21,289 metric tons); 75% of emissions were from diesel or gasoline. For systems providing complete Tier 2 data, median emissions per response were 80.7 (IQR 65.1-106.5) pounds of CO(2)e and median emissions per service-area resident were 7.8 (IQR 4.7-11.2) pounds of CO(2)e. Two systems reported aviation fuel consumption for air medical services, with emissions of 2,395 pounds of CO(2)e per flight, or 0.7 pounds of CO(2)e per service-area resident.
  
  
  CONCLUSIONS
  EMS operations produce substantial carbon emissions, primarily from vehicle-related fuel consumption. The 75th percentiles from our data suggest 106.5 pounds of CO(2)e per unit response and/or 11.2 pounds of CO(2)e per service-area resident as preliminary maximum emission targets. Air medical services can anticipate higher per-flight but lower population-based emissions.
authors.affiliation: Alberta Health Services Emergency Medical Services (IEB), Calgary, Alberta, Canada. lawrence.brown@jcu.edu.au
authors.forename: Ian E
authors.initials: IE
authors.lastname: Blanchard
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Brown
mesh_terms: D000397:Air Pollution / Q000009:adverse effects / Q000706:statistics & numerical data*; D002245:Carbon Dioxide / Q000009:adverse effects*; D058572:Carbon Footprint / Q000706:statistics & numerical data*; D057231:Climate Change / Q000706:statistics & numerical data*; D003625:Data Collection; D006801:Humans; D015999:Multivariate Analysis; D009656:North America; D010360:Patient Transfer
chemical_list: D002245:Carbon Dioxide