A 10-day intensive curriculum on climate change and emergency medicine

According to the National Aeronautics and Space Administration (NASA) and National Oceanic and Atmospheric Administration (NOAA), 2020 tied with 2016 as the hottest year on record and July 2021 was the hottest month on record. The last decade was officially the warmest ever recorded. As global temperatures continue to rise, the life-threatening impacts of climate change will be an increasingly important reality for clinicians.

Climate change is a threat multiplier, making the most vulnerable and disadvantaged facets of society also the most threatened by the health impacts of our changing climate. While inland and coastal floods, wildfires, heat waves, and droughts may be the most obvious threats that come to mind, the ways in which climate change affects health are much more complex than they might initially appear. Starting in 2006, for instance, Syria went into an extreme multi-season drought. This set the foundation for the most severe set of crop failures experienced in the region. By 2011, an estimated 2-3 million people had significantly impacted livelihoods and over 1 million were forced into food insecurity. There was a large migration of rural communities into cities, which escalated urban unemployment and tipped an already tenuous social and economic balance into a multi-year civil war with more than 400,000 deaths. To be competent clinicians with the realities of climate change, it is important to understand a bit of the complexity in which climate change affects the health of individuals and populations in our local and global communities. Effective climate and health solutions are reliant on addressing structural factors and multiple determinants that contribute to poor health. As you will learn, many committed clinicians, health systems, and country leaders have already successfully implemented solutions that advance health and justice.

As emergency medicine clinicians, we are trusted leaders in society and are privileged to hear our patients’ stories. We witness adverse health impacts to patients and are at the unique intersection of research, education, and policy interventions.We have an immense opportunity to connect the dots on the climate crisis as a health emergency for others. We have a responsibility to anticipate and apply best evidence-based practices to caring for patients during times of increased demand or staff or supply chain disruptions. We also have an opportunity to step into leadership roles and aid our communities in rapidly mitigating and adapting to the harmful effects of climate change to optimize health and well-being not just for some, but for all.

The curriculum that follows was developed to give an in-depth set of tools for those interested in becoming climate-educated clinicians. Our first goal is to aid emergency medicine clinicians in understanding how their practice will be affected by climate change and how we can continue to adapt our clinical practice to provide high quality, timely patient care. Our second goal is to inspire and empower those who want to take their climate change skills to the next level by providing resources that will allow the application of knowledge to action within an emergency medicine and public health context. We hope you add a slide into your next presentation on climate change or choose a quality improvement project that addresses the environmental impact of health services that we provide. The material is not comprehensive but rather serves as a foundation to exploring the wealth of resources available across disciplines with the goal to advance global health equity for our communities, patients, and each other.

Learning Objectives

  • To introduce emergency medicine clinicians to climate science pertinent to health
  • To understand how climate change is affecting the health of patients in the U.S. and globally
  • To elucidate the complexity of ways in which climate change can affect access to care, health service delivery, and demand for care
  • To provide the foundational tools to improve healthcare resilience and sustainability strategies
  • To provide the tools and resources for those interested in education and policy to empower and create lasting change

Climate Change and EM Team

  • Lead Author: Caitlin Rublee, MD, MPH
  • Secondary Authors: Catharina Giudice, MD; Katelyn Moretti, MD, MS; Kyle Martin, DO, MA, MPH; Andrew Musits, MD, MS
  • Contributors: Joseph Leanza, MD; Christine Baek; Nikhil Ranadive, MD, MS
  • Sponsor: Medical College of Wisconsin
  • Curriculum design consultant: Simiao Li-Sauerwine, MD, MSCR with the ALiEM Education Research Lab and Incubator (ERLI)

This section will provide an in-depth review of the history of climate science, the mounting evidence behind climate change, and an introduction into our role as clinicians.

TopicReading Material
Mitigation, adaption, and resilience: These 3 words are key to describing climate action, but what do they mean?23rd Conference of the Parties (COP23) to the United Nations Framework Convention on Climate Change
What is the difference between weather and climate? National Snow and Ice Data Center: Arctic weather and climate
History of climate science: In 1958, scientists proposed the idea that we might be causing irreversible change to our planet’s climate. Here you will find a brief narrative of climate science which has led us to our current understanding of climate change.University Corporation for Atmospheric Research (UCAR): History of climate science research
How do we know climate change is anthropogenic? Dive into data that supports one conclusion: climate change is influenced by human activities, primarily the burning of fossil fuels and land use changes (deforestation, urbanization). 97% of scientists agree.NASA Global Climate Change: The causes of climate change

Institute of Physics (IOP) Science: Consensus on consensus: a synthesis of consensus estimates on human-caused global warming

What are greenhouse gases?U.S. Environmental Protection Agency: Overview of greenhouse gases

World Resources Institute: World Greenhouse Gas Emissions: 2016

Attribution studies: Linking various weather phenomena to climate change is a challenging scientific feat. Attribution science helps understand how complex weather phenomena are being directly impacted by climate change.Carbon Brief: Mapped: How climate change affects extreme weather around the world

Nature: The burden of heat-related mortality attributable to recent human-induced climate change

Annual state of the climate report: Various tools and metrics are used to track the global impacts of our changing climate known as global climate indicators. From surface temperature to glacier ice loss, these tools help create a comprehensive picture how our planet is changing. This report also summarizes annual weather events and how various regions of the world are being affected over time.World Meteorological Organization: State of the Global Climate 2021
History of the Intergovernmental Panel on Climate Change (IPCC): Scientists from a variety of disciplines came together to create a powerful and robust summary of the human impacts of anthropogenic climate change.IPCC: Organization History
What is the Paris Agreement? In this landmark international agreement, nearly 200 countries committed to reducing greenhouse gas emissions. But how does it work?United Nations Climate Change: The Paris Agreement
Critical role of health professionals: As emergency clinicians, we are already seeing the effects of climate change on the health of our patients. What is our role in the grand scheme of action?Journal of Climate Change and Health: Health professionals, the Paris agreement, and the fierce urgency of now

American Journal of Public Health: The critical roles of health professionals in climate change prevention and preparedness

The imperative of climate action to protect human health: It is this simple — climate action, whether through research, advocacy, education, or simply by understanding how to best provide climate-informed patient care, will improve the health of our communities.New England Journal of Medicine: The imperative for climate action to protect health

Optional Reading

In this section, we will start exploring the health impacts of climate change, with an emphasis on U.S. populations. As we dive into different case studies and articles, take note of how some health impacts may be more direct and predictable while others are indirect with potentially unexpected consequences.

TopicReading Material
Climate Change and Human Health: Present and Future Risks: Here we will begin our journey into understanding the health impacts of climate change and the challenges of predicting what the future holds.
U.S. Global Change Research Program
Climate change and human health: Provides a broad overview of how climate change is impacting health in the U.S. Explore resources ranging from webinars, videos, and publications.
Clinical impacts for emergency medicine: How are the patients we see in the ED and health systems operations being affected by climate change?
Heat waves and heat-related illnesses
Drought and dust
Displacement and migration
Infectious diseases and toxins
Other consequences of extreme weather events
While we are all being affected by climate change, the effects of climate change disproportionately impact specific groups. Populations that have contributed the least to greenhouse gas emissions are the ones who suffer the most from the effects of climate change. This is true across zip codes, cities, states, nations, and the world. This module will focus on the most vulnerable populations affected by climate change and provide various examples of how environmental justice needs to be central to our approach to policies and interventions that advance global health equity.

TopicReading Material
How are climate change and environmental justice an issue? 
Climate change and low-wealth communities in the U.S.
Black, indigenous, and people of color
People who are housing insecure
People in the criminal justice system
Older adults
Disasters Discriminate, A Global Trend

While climate change is predicted to affect healthcare across the world, no two countries will suffer climatic stressors in the same way. In this section, we will explore the wide-ranging interactions between climate change and global health, focusing on direct climate impacts, impacts mediated by the natural environment, and impacts mediated through human society. Given the heterogeneity of climatic, social, political, economic, and health factors across the globe, this section is intended as a primer into global health and climate change. As you proceed, consider how local lessons may be more broadly applicable and how lessons in other practice settings and countries apply to your local context. Think about supply/demand mismatches that are accentuated by climate-related events.

TopicReading Material
Health impacts of a warming and changing climate
Other considerations

COVID-19 has posed an unprecedented challenge to health care systems. How do we adapt and reallocate resources when confronted by a widespread and a novel threat? There are many parallels that can be made between the global response to COVID-19 and the challenges we will face as we mitigate and adapt to the health impacts of climate change. Here we will explore how such threats are not mutually exclusive and, as we have seen in 2020, how climate change can make the response to other health threats like COVID-19 exponentially more complex and vice versa.

Building resilience is central to improving the morbidity and mortality associated with various climate change health threats in the short and long-term. How does a hospital maximize their ability to remain operational during and after tropical storms? How do we secure resource mobilization to rapidly treat heat stroke during a heat wave? To understand healthcare resilience, we first have to understand local threats and be able to translate it to operational changes. From an emergency care standpoint, building climate resilient emergency care systems is and will be increasingly essential to ensuring timely, high quality care globally. Let’s dive in!

TopicReading Material
Core reading
Framework and vulnerability assessments, and opportunities

The U.S. healthcare sector emits 8.5% of the country’s total emissions. Hospitals are a substantial part of this. Not only are we tasked with responding to the many health impacts of climate change, but we are also contributing to the problem. Each one of our hospitals and organizations has an immense opportunity and responsibility to reach carbon neutrality. Kaiser Permanente and Gundersen Health System have already acted. In this module, we will explore the environmental impact of healthcare and dive into what solutions are already being implemented.

TopicReading Material
A call for clinical action
  • Health Care Without Harm is one of the main global organizations dedicated to reducing the environmental impact of healthcare.
  • Practice Greenhealth is membership organization that provides information, tools, data, resources, and expert technical support on sustainability initiatives that help hospitals meet sustainability goals.
Understanding healthcare’s carbon footprint
Environmental impacts of the U.S. healthcare system and how it affects public health
Decarbonizing the U.S. health sector
National experts speak on the approach to healthcare sustainability in the U.S.
Emergency departments
Reusable versus single-use disposable laryngoscopes
Green teams in healthcare
Waste generation and hospital emissions of a hospital kitchen
Making sustainable procurement decisions in a global landscape
Road map for health care decarbonization

Optional Reading

Reading Material

Emergency medicine has a unique stance to engage in climate change education, especially given our critical frontline role in responding to increasing demands related to climate-sensitive conditions and supply chain and personnel shortages. Climate education can be broken down into 3 main facets:

  1. How do we educate our patients to help mitigate health risks?
  2. How do we educate our colleagues on ongoing health threats of our changing climate?
  3. How do we educate rising doctors (and future climate leaders) and give them the necessary tools to practice in an ever-changing environment?

This module will dive into ways in which climate change education can be implemented in medical school and residency curricula as well as patient care or across operations as part of a system to address local climate threats and, most importantly, the patients affected.

Optional Reading

The term “policy” refers to a set of principles that drive actions, whether at an individual, institutional, or governmental level. Throughout history, local and national policies have played substantial roles in improving public health, from tobacco control to occupational safety laws or seatbelts. Health professional engagement as educators and stakeholders to guide evidence-informed policy is a critical step. In this module, we will review basic elements of the policy process and ongoing climate policies.

TopicReading Material
Core reading
National (United States)

Optional Reading

TopicReading Material
Impact of historical housing policies (redlining)
Refresher on the U.S. health system and how it compares with other countriesCommonwealth Fund: International Health Care System Profiles | United States
How does health spending in the U.S. compare with other countries? What does that mean for outcomes?Organisation for Economic Co-operation and Development: Health spending

At this point in the curriculum your mind may be firing with ideas of how to bring institutional, social, and political change in the arena of climate change. Central to advocacy is our ability to communicate and engage with interested parties. In this section, we will focus on climate communication, our role as climate advocates, and explore ongoing organizations focused on climate advocacy.

TopicReading Material
Introduction to health advocacy
Effectively talking about climate change
Challenges of communicating science to the public 
  • This is an in an era of “infodemics… an overabundance of information that makes it hard for people to find trustworthy sources and reliable guidance when they need it.”
Greatest health opportunity of our time
Tools of help with effective science and climate communication
Opinion pieces are a powerful way to reach your audience
Climate data: exploring visual ways to communicate science
Climate and health advocacy organizations
Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD