title: Sustainable emergency medical service systems: how much energy do we need?
abstract: OBJECTIVE
  Modern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems.
  
  
  METHODS
  Input-output-based energy requirement multipliers for the US economy were applied to the annual budgets for a random sample of 19 metropolitan or county-wide EMS systems. Calculated per capita energy requirements of the EMS systems were used to estimate nationwide EMS energy requirements, and the leading energy sinks of the EMS supply chain were determined.
  
  
  RESULTS
  Total US EMS-related energy requirements are estimated at 30 to 60 petajoules (10(15) J) annually. Direct ("scope 1") energy consumption, primarily in the form of vehicle fuels but also in the form of natural gas and heating oil, accounts for 49% of all EMS-related energy requirements. The energy supply chain-including system electricity consumption ("scope 2") as well as the upstream ("scope 3") energy required to generate and distribute liquid fuels and natural gas-accounts for 18% of EMS energy requirements. Scope 3 energy consumption in the materials supply chain accounts for 33% of EMS energy requirements. Vehicle purchases, leases, maintenance, and repair are the most energy-intense components of the non-energy EMS supply chain (23%), followed by medical supplies and equipment (21%).
  
  
  CONCLUSIONS
  Although less energy intense than other aspects of the US healthcare system, ground EMS systems require substantial amounts of energy each year.
authors.affiliation: Mt. Isa Centre for Rural and Remote Health, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, QLD, Australia. Electronic address: lawrence.brown@my.jcu.edu.au.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Brown
authors.affiliation: Alberta Health Services Emergency Medical Services, Calgary, Alberta, Canada; University of Calgary, Department of Community Health Sciences, Alberta, Canada.
authors.forename: Ian E
authors.initials: IE
authors.lastname: Blanchard
mesh_terms: D004560:Electricity; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004736:Energy-Generating Resources / Q000706:statistics & numerical data; D005579:Fossil Fuels / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D059206:Natural Gas / Q000706:statistics & numerical data; D059205:Renewable Energy; D014481:United States
chemical_list: D005579:Fossil Fuels; D059206:Natural Gas