• tobrien304

Beginning with the End in Mind: A Step Beyond Cradle-to-Grave Design

Updated: Mar 11

It was July of 1988 and a heatwave had descended upon the city, causing droves of New Yorkers to flock to nearby beaches. Quick to arrive and soon to leave, beachgoers were frightened by emerging reports indicating large amounts of medical debris washing ashore. Seventy syringes and two test tubes of blood found on Midland Beach in Staten Island, more on Rockaway Beaches, and some even on the upper stretch of Fire Island.


In the weeks to follow, similar reports surfaced across the east coast, from New Jersey to Connecticut to Massachusetts and Rhode Island. Having captured the public’s attention and stirred fear in coastline communities, then-President George H. W. Bush promised to leverage the weight of the FBI in tracking down and punishing the perpetrators, as well as pursuing plans to reform medical waste management.



This mysterious event – known to some as ‘syringe tide’ – prompted the EPA to establish the Medical Waste Tracking Act of 1988. This two-year tracking program, carried out in concert with impacted states, looked to formalize the definition for medical waste, establish a cradle-to-grave tracking system and standardize practices surrounding the handling and disposal of medical waste.


In the first-ever federal mobilization geared towards addressing medical waste, the EPA set out to design a scalable model for responsible medical waste management. Such efforts involved the study of waste treatment technologies like incinerators and autoclaves, building out a comprehensive record-keeping process, and establishing penalties for mismanagement.


While productive, the EPA’s direct control over medical waste management expired in 1991, leaving design and implementation largely to the state. That said, the EPA’s influence extended well beyond this time, as made clear by the continued reliance upon their publication, “Model Conditions for State Medical Waste Management.”


Perhaps the greatest relic to survive is the waste manifest, often referred to as shipping papers. Yes, the very same pen and paper approach to tracking medical waste popularized in the early 1990s lives on today. Does it work? Surely, but is it reflective of the needs of our time? The EPA thinks not. As seen in June of 2018, the EPA launched the ‘e-manifest’ with the hopes of “modernizing the nation’s cradle-to-grave hazardous waste tracking process.”



This decisive break from the industry’s paper-intensive past is certainly a much-needed step forward. But is it in the right direction? This is less clear. Modernizing the medical waste tracking system in it of itself is indicative of progress, but when used to uphold an increasingly obsolete approach like that of cradle-to-grave, the water then becomes murky.


Though today we have less medical debris finding its way onto our shorelines, we are not free from their lasting effects. With the vast majority of medical waste treated through incineration or autoclave, they are left to exist as carcinogenic dioxins in our atmosphere or microplastics that invade our land and aquatic ecosystems.


Moving forward, our approach must fundamentally change from one of cradle-to-grave to cradle-to-cradle. That is to say, we require a tracking system capable of identifying and isolating materials worthy of recirculation so that these valuable resources never become waste in the first place. A circular strategy such as this not only makes good environmental sense, it is foundational to realizing greater operational efficiencies and business opportunities within increasingly competitive markets like that of healthcare and the life sciences.



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