It's pretty clear that we must move away from combustion of fossil fuels. This guidebook has information on many ways to reduce loads - which should always be the first step - and alternatives to fuel-fired heating. But, for an existing hospital with a steam-based heating plant, there's on big step on the path to decarbonization - you have to transition to hydronic heating. Hot water is the medium for moving heat around and it can't be done with the steam piping system that runs around the hospital today. That's a big step that requires capital, space that may not exist, planning, and maybe time. To be clear - every large hospital will, we believe, have to make this transition, and sooner is better than later. But, there's no magic wand that makes the capital and space available to do this immediately.

So, if the transition to hydronics and all the benefits of heat recovery are in your long-range plan, what can you do in the short term to reduce your emissions? First, reduce your loads. There are a variety of ways to reduce both heating and cooling loads, with the added benefit of reducing your energy spend. This Guidebook has a chapter on load reduction. There are some things you can do in the plant to make incremental improvements, and we discuss some of those options in this chapter. These are incremental improvements and some require capital investment. You will have to judge whether the investment is worth the incremental gain - particularly in light of the need to transition away from boilers in relatively short order.

To be clear - if you're building a new healthcare facility, this chapter is not for you. This chapter is focused on incremental improvements in existing buildings -as an interim step toward eliminating boilers from your heating plant.