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Calling 911 On Climate Change: The Emergency Medicine Physician’s Responsibility

Emergency medicine can do more in education, research, and advocacy to protect patients from one of the greatest health emergencies of our time.
Crop flooding and other consequences of climate change can lead to serious health issues like food insecurity and personal injury.
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The oft-quoted mantra of emergency medicine providers is “Anyone, Anytime, Anywhere.” We are the front line and safety net of our healthcare system. We are trained to respond in any emergency, whether big or small. Climate change is a health emergency of growing urgency as the house of medicine increasingly recognizes it as not just an issue for scientists and politicians, but for our patients.

Natural disasters are a consequence of climate change and can cause serious health impacts such as traumatic injuries, food insecurity, insect-borne diseases, and exacerbations of chronic lung disease. These public health harms of climate change disproportionately affect the patients we see most in our EDs: children, the elderly, and those facing poverty and chronic diseases. It is our duty to protect their health and safety. As Renee Salas, MD has argued, “There are practical and ethical imperatives for academic emergency physicians to become climate and health champions.”

Boston Medical Center (BMC), the hospital where I work and the largest safety-net hospital for underserved patients in New England, is located in a geographic area in which a climate disaster could jeopardize our ability to serve the people who depend on us. The neighborhood is at risk for one climate impact in particular: storm water flooding. It is predicted that by the 2030s, 11% of the neighborhood will be flooded during storms. With just 40 additional years, the number goes up to 26%. While our leadership that has taken a proactive approach to protect our infrastructure in an emergency, I worry about the disparate impact the same vulnerability and risks could have on our local patients.

Related: Healthcare Leadership on Institutional Response to Climate Change »

But it turns out we don’t have to wait for a severe natural disaster. The patients I see every day in the ED — the elderly woman with no access to air conditioning who presents with heat stroke from a string of increasingly hot summer days, the homeless patients seeking shelter from a severe winter storm, the chronic asthmatic who presents in extremis on a day where Boston’s air quality levels are exceptionally low — these are the vulnerable patients already feeling the impacts of climate change.

It’s time for emergency medicine physicians to embrace the power we have to make a difference — if not in mitigating climate change itself, then in mitigating the impact on our patients, especially those with the fewest resources to protect them.

It's time for emergency medicine physicians to embrace the power we have to make a difference in mitigating the impact on our patients, especially those with the fewest resources to protect them. Click To Tweet

There is plenty of room for action. First, medical schools should include climate and health in their curricula to educate future physicians on climate change resiliency as an important social determinant of health. A review of the AAMC’s Curriculum Inventory reveals there are no listed curricula that explicitly address climate change and human health. Within medical school curricula, the current presence or variety of environmental health related content is unknown.

Similarly, the gap in formal medical education around climate change and health reveals a need for increased research on the topic, including how natural disasters will impact the delivery of care in our EDs and hospitals, specific climate-related health effects on our various patient populations and, for example, whether these effects impact the increasing numbers of ED visits around the country.

Finally, physicians are well-suited as advocates for action on climate change. We hold a unique and trusted position in the public sphere, and we have an obligation to use our voices to amplify the discussion around a public health crisis as significant and far-reaching as climate change.

As we work through the pandemic, climate change remains one of our biggest healthcare emergencies. Let’s get to work.

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Paige Machado, MD


Paige Machado is an emergency medicine resident at Boston Medical Center.