Ambulance Services unite in carbon reduction

The critical nature of an emergency response vehicle poses obvious challenges for carbon reduction. But this has not held back ambulance services across the country from greening their fleets. Alexis Keech, environmental and sustainability manager for Yorkshire Ambulance Service NHS Trust, reports

Ambulance services in England have united in their quest to reduce carbon emissions and turn their blue lights ‘a lighter shade of green’. As predominantly vehicle-based organisations, the ambulance services have a very different carbon footprint to the rest of the NHS.

Together across the country, they use 150,000 litres of diesel on a daily basis and the national ambulance fuel bill has increased by up to £26 million annually year-on-year for the past few years. These facts show that financially this is an unsustainable situation and with the classification of diesel as a carcinogenic substance (ref. BMA), alternative sources of fuel which are less polluting have to be found.

The NHS employs 1.3 million people making it one of the largest employers in Europe. The service is responsible for five per cent of the traffic on the road at any one time and is one of the largest direct and indirect producers of CO2 in the UK.    

The whole of the NHS has been tasked with cutting carbon emissions by 10 per cent by 2015 and 80 per cent by 2050.
    
Reducing the carbon footprint is more than just planting trees at ambulance stations, although the Trust is already doing this across the area it covers as part of the NHS Forest scheme. And, the logistics of reducing carbon emissions are not as simple as getting staff to drive slower or less frequently – obviously this is not really an acceptable solution in an emergency response vehicle – or turning off building lights when operating a 24-hour emergency service.

Yorkshire Ambulance Service
Despite the obvious challenges, Yorkshire Ambulance Service, along with many other ambulance services across the country, is working to reduce its carbon emissions through a variety of measures. Green equals black when it comes to the bank balance so initiatives are also driven by cost savings and generally have fast pay-backs with long term additional health impacts from less emissions in the environment.
    
Yorkshire Ambulance Service was the first ambulance service in the country to employ an Environmental and Sustainability Manager in 2010 to work with fleet, estates and procurement departments to reduce the impact that the service has on carbon emissions. Estate emissions have gradually been decreasing through the introduction of more efficient lighting and boiler upgrades, but the fleet emissions are more difficult to tackle with a fleet which needs to reach destinations across 6,000 square miles as quickly as possible.
    
On average the Trust consumes 4.5 million litres of diesel each year at a huge cost of around £7million. There are some simple ways in which Yorkshire Ambulance Service has been working to reduce its fleet carbon tyre-print as well as tackling more significant reductions to eliminate carbon emissions.
    
Eco-driving training programmes have been introduced by the Trust for staff who operate vehicles in both the emergency service and the non-emergency Patient Transport Service (PTS). Applying these skills can result in more economic and safe driving and can result in savings of between five per cent and ten per cent on Trust fuel bills.  
    
The Trust also changed its car lease policy two years ago, so those staff entitled to a vehicle now have to select one that emits under 130g per km and is taking it a step further to ensure that there is a continuous reduction in CO2 emissions by actively encouraging staff to choose electric or hybrid vehicles.

Aerodynamic ambulances
Working with Leeds University, YAS has been looking at the potential savings available through aerodynamic ambulances. Initial studies have identified that by changing from box-shaped body ambulances to van conversations, a potential saving of 20 per cent could be made (purely on aerodynamics) with a further potential of 9.5 per cent on drag by incorporating an aerodynamic blue light bar into ambulance designs. This could equate to a saving of 12 per cent in fuel efficiency.

On stand by
Yorkshire Ambulance Service has also been working to tackle the problems associated with frontline staff on standby ready for allocation of a 999 call – a challenge for all blue-light organisations. The nationally-set target for all ambulance services requires the Trust to respond to 75 per cent of all potentially life‑threatening incidents within eight minutes and, to achieve this emergency vehicles are strategically placed in locations across the county. Due to the electrical requirement of the vehicles to avoid draining the battery staff must leave the engine running whilst waiting to be allocated to an emergency and this can sometimes be required for up to 65 per cent of a shift. This has led to the Trust trialling a methanol fuel cell which turns on when power is required for all of the electrical equipment and is currently looking to see how it can trial this with a hydrogen fuel cell.  
    
Yorkshire Ambulance Service has recently carried out a ten-month trial with a pure electric Nissan Leaf as an integral part of its non-emergency Patient Transport Service fleet and is currently testing a hybrid Vauxhall Ampera in York which will be integrated as part of the low emissions zone strategy that the City of York Council is looking to implement. This is a frontline rapid response vehicle and is the first hybrid car to be used as part of an emergency service fleet. Its electric transmission is backed up by a petrol engine so it is a safe option for use in an emergency service.
    
The Trust’s Fleet department is also looking to run some trials with some brake regenerative technology, which will recharge the on-board batteries and has also been investigating greener tyres with better rolling resistance.
    
A Carbon Champion programme has been implemented at every ambulance station and workplace across the region to raise awareness of what is being implemented.  These champions pass on information, distribute literature and provide feedback to the management teams in relation to any issues and developments. This has proved essential in providing staff with the power to change their organisation from within and has also helped staff to understand the potential savings through having a greener ambulance service.

The rest of the country
Many of the ambulance services in England have looked at their carbon footprint in order to understand where their direct carbon emissions come from. In Scope 1 and Scope 2 emissions’ (direct/purchased emissions) assessments, it was established that over 60 per cent of emissions come from their fleets and the remaining 40 per cent coming from their estates. Through new and innovative technologies, as well adjusting the way that their organisations operate, many ambulance services are already reaping the rewards of lower fuel bills and lower utility bills.
    
Many are just starting on their carbon reduction journey and others are further along the route of embedding sustainability in their fleet, ambulance stations and offices. Most are working hard to reduce the main bulk of carbon emissions if not eliminate them through a variety of innovative developments.
    
Cycle response teams in busy town and city settings across the country play an important part in reaching patients quickly with paramedics using specially adapted and equipped bicycles which are capable of responding quickly within built-up and pedestrian areas. As well meeting the needs of patient care in congested city centres, the human-powered response helps to reduce the emissions in polluted city centres. London Ambulance Service, which originally started the cycle response unit initiative, has made an estimated saving of £2.7 million per year.
    
The ambulance service in Scotland has commissioned and welcomed a pure electric ambulance into its non-emergency Patient Transport Service fleet, the first in the country. East of England and South Central ambulance services have trialled the Vauxhall Ampera as a workable answer for marked managers’ cars or as part of their PTS fleet.  
    
South Central Ambulance Service has rolled out solar panels on the roofs of their rapid response vehicles to see if they can trickle charge their auxiliary batteries to reduce the need for the engine to be run whilst on standby waiting for emergency calls.  
    
East of England Ambulance Service’s key carbon reduction project is linked to its long term Integrated Service Model Strategy and like many others advanced clinical triage. This new model of care aims to improve service quality by offering a more appropriate response to patients and could mean providing an alternative to an emergency ambulance response such as telephone advice (hear and treat), care from a specialist falls service or being directed to a different service based closer to home.
    
In addition, tyre valve pressure indicators are being fitted on all East of England ambulances so that you can see when they are 10 per cent below recommended levels, as fuel efficiency is greatly impaired by under-inflated tyres.
    
Nationally, trials have been run on blue light speed limiters where speed is limited unless the blue lights and sirens are turned on for an emergency response.

A network of green ambulances
Yorkshire Ambulance Service set up the Green Environmental Ambulance Network (GrEAN) which is now a national network of ambulance trusts who are working to become more sustainable through carbon reduction programmes. GrEAN was set up in May 2011 as it was identified that ambulance services across the country are very different to the rest of the NHS. Being predominantly fleet-based organisations, the ambulance services face many different challenges in relation to carbon reduction and GrEAN is endeavouring to reduce the carbon footprint nationally.
    
The group has worked to unite the ambulance trusts in sharing information on trials and the value of different technologies, ensuring that vital information is passed around the country. The GrEAN group has put together a ‘Green Passport’, a guide for all ambulance service personnel to find out what they can do to reduce their carbon footprint at work and at home and provide a resource for carbon management education. The group has also carried out a national carbon footprint assessment to identify differences in the carbon emissions of each service.

In addition, GrEAN has taken up the challenge to work with ambulance manufacturers to produce a frontline vehicle for the future that will ensure a sustainable and low emission fleet on a national scale.  
    
By developing an ambulance fleet which is relevant to the service required and resilient to changes in the future, we can ensure that the NHS is sustainable and available for future generations.  
    
Vehicle technologies on trial across the country include: methanol fuel cell; hydrogen fuel cell; solar panels on the roofs of vehicles; electric vehicles; hybrid vehicles; aerodynamic assessments; brake regenerative technologies; telematics; duty cycle analysis; tyre technologies; tyre pressure indicators; next generation green ambulance design..

Further information
Alexis Keech, Yorkshire Ambulance Service

Tel: 07500 607531
alexis.keech@yas.nhs.uk