Playbooks

Measure before you cut

• Set the boundary and baseline: twelve months of data, weather-normalised, by building and by system.
• Count Scope 1 and 2 using the GHG Protocol. Include refrigerant top-ups, anesthetic gas purchases, nitrous oxide, diesel and gas.
• Sub-meter the big loads: chillers, pumps, air handling units, steam or hot water, operating theatres, imaging, medical gas compressors.
• Run an ASHRAE Level 2 audit, then adopt an energy management system such as ISO 50001 so savings survive staff changes.
• Report to one KPI set: kWh per m² per year, kWh per occupied bed-day, tCO₂e per m².

Chilled water and air systems

• Sequence chillers on measured plant kW/ton, not on habit. Trim and respond chilled water supply temperature and condenser water resets.
• Fit or tune VFDs on pumps and fans, and remove throttling valves that waste the saving.
• Schedule and set back air handlers in non-critical areas using occupancy data. Leave pressure-controlled areas such as isolation rooms, pharmacy compounding and operating theatres to a documented, reviewed strategy.
• Fix control faults first: simultaneous heating and cooling, stuck dampers, failed sensors, overridden schedules. These are cheap and large.
• Use your BMS trend logs to prove each change, and keep a rollback path.

Anesthetic gases, nitrous oxide and refrigerants

• Inventory purchases of inhaled anesthetics. Desflurane has a far higher global warming potential than sevoflurane or isoflurane, so agent choice is a clinical decision with a large emissions effect. Involve anesthesiology leadership.
• Audit piped nitrous oxide for leaks, including manifolds and pipework, and decommission unused piped supply where clinically agreed.
• Keep a refrigerant register by asset: type, charge, top-ups, leak checks. Plan for the HFC phase-down under the Kigali Amendment when replacing plant.
• Prefer lower-GWP refrigerants and sealed systems at replacement, within the equipment manufacturer's and safety-code requirements.

Clean supply and resilience

• Reduce demand first so solar and storage are sized for a smaller load.
• Design PV and battery storage together with the critical power architecture. Storage can support resilience, but it does not replace code-required emergency power unless the design and authority having jurisdiction accept it.
• Check grid connection limits, protection settings and export rules early. They set the real constraint on size.
• Compare options on lifecycle cost: NPV, IRR and simple payback with the same assumptions, and include maintenance, degradation and tariff changes.
• Contract clean power where on-site generation is limited, and prefer additional capacity over unbundled certificates where possible.