Link to full paper


It is commonly acknowledged that the most significant risk to global human health is the progressively worsening climate crisis.With greenhouse gas emissions representing the most impactful driving factor behind climate change (with the use of certain inhalation agents such as nitrous oxide and desflurane being the largest contributors within the anaesthetic practice), the UK National Health Service (NHS) and others have committed to dramatic healthcare-related carbon reduction plans. The NHS ‘Net Zero’ report pledged that the NHS would reach ‘Net Zero’ in directly controlled emissions by 2040 and indirectly controlled emissions by 2045. Beyond the UK, landmark publications from global organisations such as the World Health Organization and Health Care Without Harm have formed clear road maps towards global ‘Net Zero’ healthcare delivery.


In collaboration with the Advanced Life Support Group, we compared the carbon footprint of face-to-face and VR half-day adult tracheostomy safety courses run by the UK National Tracheostomy Safety Project. The project was funded by a UK Research and Innovation (UKRI) FastStart Innovation Grant (10046018, REC-ref: 2023-16428-28024). Alongside educational outcomes, and a core purpose of the grant awarded by the UKRI, we assessed the environmental impact and potential for carbon saving of moving towards VR skills courses in the context of tracheostomy safety.


Simply considering travel to the venue: 41% of participants travelled an average of 17.9 (SD14.9, range 1.5–56) miles by car, with only two participants car-sharing; 18% travelled by bus; 18% walked; 5% travelled by taxi; and two travelled by air (return flights from Dublin and Edinburgh to Manchester). We recorded the distance travelled and likely fuel source for all combustion engine transportation modalities. We then calculated the carbon footprint for travel of each participant using benchmark data from the website in consultation with the ‘Net Zero’ team at the Yorkshire and Humber Academic Health Science Network. Assuming 20 candidates and five faculty are required per face-to-face course, we calculate that the emissions generated from travel alone are 483.6 kg CO2e per course. Running one course per month generates an estimated 5.8 tonnes of CO2e annually. Even excluding those candidates who travelled by air, the saving is 1.3 tonnes of CO2e annually. Importantly, this calculation is for a single institution running tracheostomy courses for a year, with benefits rapidly multiplying if extrapolating across a region, nationally, or internationally. For context, the average carbon footprint of a UK person is around 5.2 tonnes yr−1 (or 5200 kg yr−1).


Whilst we acknowledge the complexities of the environmental impact calculation of different training methods, reducing travel for training of the healthcare workforce likely represents a scalable opportunity for overall improvement in carbon release. With the appropriate academic focus, we feel study in this area could significantly contribute to the ambitious carbon reduction goals committed to by the NHS and healthcare organisations globally, a task with paramount importance and implications across the planet.