Authors (including presenting author) :
Lam SC(1), Li YOL(1), Shih YN(1), Leung CS(1), Leung PSM(1).
Affiliation :
Accident and Emergency Department (AED), Princess Margaret Hospital
Keyword 1: :
video laryngoscope
Keyword 2: :
direct laryngoscopes
Keyword 3: :
environmental Sustainability
Keyword 4: :
Intubation Training
Keyword 5: :
medical waste reduction
Keyword 6: :
carbon footprint
Introduction :
The Emergency Department (ED) is critical for delivering immediate care to seriously ill patients, with intubation being an essential procedure for airway management. From January 2024 to October 2025, 524 intubations were performed in PMH AED, predominantly using disposable video laryngoscopes (VL), which, despite enhancing patient safety and procedural success, generate significant medical waste. To address this issue, we are implementing a “DL first” policy prioritizes the use of reusable direct laryngoscopes (DL) for appropriate cases. This initiative aims to reduce our environmental footprint and medical waste while maintaining high standards of patient care and safety in the department.
Objectives :
The initiative aims to reduce disposable VL usage and increase DL utilization by at least 30% in the first year, thereby minimizing medical waste and environmental impact. It seeks to maintain high patient care standards and consolidate clinician's intubation skill throughout the period, while achieving a 30% reduction in laryngoscope blade purchasing costs by adopting reusable equipment.
Methodology :
From 15/12/2025, PMH AED will implement the "DL first policy", prioritizing DL for most intubations, with VL reserved for challenging cases such as difficult airways or trauma. Staff, including clinicians, nurses, and patient care assistants, will receive targeted training in DL techniques, equipment handling, and airway management, with senior clinicians supervising onsite. A review after one month will assess laryngoscope usage, DL success rates, and staff feedback to evaluate policy effectiveness, guide adjustments, and inform a comprehensive report.
Result & Outcome :
Over two years (Jan 2024–Oct 2025), 524 intubations at PMH AED generated considerable waste and CO2 emissions. If disposable VL were used for all, waste would reach 262 kg and 389,376 kg CO2. Using the total intubation number from 2024 (which was 276) as a basis for projecting 2026, VL use would yield 138 kg waste and 205,584 kg CO2. Implementing the "DL first policy" (≥30% direct laryngoscope use) could cut waste to 96 kg and emissions to 155,370 kg CO2—a 30.4% and 24.4% reduction, highlighting the environmental benefits of sustainable clinical practices.
