Project Leads: Kay Anne Mak (Speciality Registrar), Laura May (Consultant), Elizabeth Fitzhugh (Sustainability Lead, Department of Anaesthesia and Perioperative Medicine) and Elana Lynes (Consultant) at University Hospitals Coventry and Warwickshire NHS Trust.

Climate change is a public health emergency recognised by the NHS, with anaesthetic gases being responsible for a significant amount of NHS carbon emissions. A notable contributor is Ethyl Chloride, a hazardous air pollutant that can last over a month in the atmosphere before degrading and cause serious neurological effects if inhaled.

University Hospitals Coventry and Warwickshire NHS Trust introduced reusable Cool Sticks (refrigerated plastic sticks with a metal tip) in their obstetrics department for testing sensory levels following neuraxial blocks.

The financial and environmental impact of using Cool Sticks compared with Ethyl Chloride spray was assessed. Following a trial of 6 months, feedback was collected from obstetric anaesthetists via a survey. The latter assessed ease of use of the sticks, any problems encountered, and whether Ethyl Chloride sprays should be replaced with Cool Sticks in the long term.

The above evaluation projected yearly savings of over £15,000 should the trust switch to reusable Cool Sticks. The projected yearly level of carbon emissions was also significantly lower than Ethyl Chloride. 86% of survey respondents found Cool Sticks easy to use, and 81% would be happy to use Cool Sticks instead of Ethyl Chloride. Clinicians commented that Cool Sticks were ‘more pleasant for patients’ but also observed that Cool Sticks ‘can warm up between cases’ and that some patients can struggle to differentiate between cold and touch.

Overall, the project demonstrated that Cool Sticks are a feasible alternative to Ethyl Chloride spray for assessing sensory levels after neuraxial blocks and can lead to a significant positive financial and environmental impact. UHCW aim to lead a trust-wide initiative and introduce the use of Cool Sticks in other clinical areas such as general theatres, high dependency units, and enhanced care units, supporting the NHS net zero initiative.

Design for Life