Environmentally Friendly Fabrication

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By Judith Philipps Otto

It's Not Easy Being Green

There are dilemmas and conflicts of conscience to be faced when balancing business needs against concerns for the fate of the planet.

Unless you're a hermit in a cave, it's no longer possible to remain unaware of the pressure to protect and preserve our natural environment and its irreplaceable resources. The alarm bells have sounded and the word is out—on a global scale. On both personal and professional levels, most individuals, businesses, and community leaders are responding to the call to conserve, recycle, and dispose of unrecyclables responsibly.

But it's not easy being green in the field of O&P. Whether your fabrication is handled at an onsite lab or a central fabrication facility, there are dilemmas and conflicts of conscience to be faced when balancing business needs against concerns for the fate of the planet we hope to bequeath to our children. Financial survival and the ability to support your family today must be balanced against responsible stewardship of vital but vulnerable environmental treasures that some take for granted. It's a tricky proposition.

The Spirit Is Willing, but...


When The O&P EDGE contacted O&P practitioners and providers of central fabrication services, we found that, unsurprisingly, no one was a malicious enemy of the environment. All were ready to endorse and participate in programs to deal responsibly with the traditional detritus associated with laboratory creation of orthoses and/or prostheses.

The first problem, however, is that few who are being buffeted by the adversities of our "recessed" economy have the time to seek out such programs.

John Michael, MEd, CPO, FISPO, FAAOP, observes that "most practices are so focused on providing good patient care in the face of shrinking reimbursement and escalating unfunded mandates, there is not a lot of thought being given to this topic."


Tom DiBello, CO, FAAOP, agrees that in his travels around the country, he sees very little being done by other facilities, hears the same from colleagues, and admits that his own facility is similarly lacking. "Not that we haven't tried; the kind of recyclers O&P needs aren't easy to find. When we talked to local recyclers, they just were not interested."

Séamus Kennedy, BEng(Mech), CPed, co-owns and operates Hersco Ortho Labs, New York, New York, with his brother. Both of them, on behalf of their small children, feel a strong responsibility to the environment and try to reduce resource consumption wherever they can. But although Kennedy is concerned about the plaster waste generated from the hundreds of pairs of foot casts he processes weekly, his efforts to locate a recycling solution have also been disappointing.


"We've had a couple of people come in from the [New York] city government, specialists in recycling waste, but haven't found anyone who can reuse that plaster yet."

Since they have recently begun using a computer-aided design and manufacturing (CAD/CAM) system, more of their fabrication is done through direct milling rather than molding, eliminating much of the plaster disposal problem. However, the new milling process uses polypropylene—a high-density polyethylene plastic—creating the new problem of how to find a recycler for the abundant waste of uniform plastic chips the lab is now generating.

"They're hard to find, too," he admits. "We just started the process, again hoping that the city can help us."

The Problem: Not Enough Waste

Ironically, it seems that O&P fabrication produces too little waste—not enough, at any rate—to make it worthwhile for recyclers to handle.

"We are such small-scale manufacturers," Michael says, "that there is little or no market to recycle scrap plastics and metals in the typical lab. In today's world, we use much less metal alloy, and most thermoplastic recyclers will only deal in batches that weigh hundreds of pounds."

Michael Angelico, president, Advanced O&P Solutions, Hickory Hills, Illinois, has also discovered that many of the larger plastic recyclers demand truckloads. "Where do you store truckloads until they're full? Nobody has that kind of luxury. Some of the smaller operators are willing to take handloads of plastic; but whether you can find them in your area may be problematic."

Inspired by a news item about Nike's program for collecting used athletic shoes and reclaiming the soles for chipping and recycling, Cameron Renwick, CO(c), manager of Algonquin Orthopaedics, Huntsville, Ontario, Canada, and president of the Canadian Board for Certification of Prosthetists and Orthotists (CBCPO, Canada's O&P credentialing body), contacted them to see if waste EVA foam from O&P fabrication processes might be included in Nike's program, instead of dumped into Canadian landfills.

Nike, however, had been overwhelmed by consumer response to its program and was already dealing with as much (or more) material than it could feasibly handle; it wouldn't be possible to include anyone else's materials, he was told.

So Renwick pursued his own search, locating and striking a bargain with a recycling company in Indiana willing to collect and process EVA foam waste.

"My goal for the whole recycling of EVA foams was that people would bring back their orthoses to be chipped and that material would be turned back into EVA, which I would in turn use again—and that would be full-circle fabrication," Renwick says.

Since the process and agreement were essentially in place, Renwick's presentation at last summer's Canadian Association for Prosthetics and Orthotics (CAPO) conference in Winnipeg encouraged others in the industry to get on board and take advantage of this opportunity to recycle their EVA waste.

"Unfortunately, that was the beginning of the downturn with the economy," Renwick explains. "The value of the off-cut scrap material that had been quoted at 79 cents a pound suddenly plummeted, and it became no longer economically feasible for the recyclers to take this material."


Patrick Myrdal, RTPO(c), FCBC, had a similar experience and notes that in today's economy, even the community paper-and-plastics recyclers are struggling. "They're backpiling all of their collected recyclables. Here in Winnipeg, they're even starting to store it in our landfill area because there's so much of it and they can't afford to actually recycle it with the economy in the state it's in."

Nobody Wants It

Since waste can be loosely defined as stuff that nobody wants, it shouldn't be a surprise that there is no market for O&P's kind of leftovers; e.g., broken plaster casts and thermoset plastic scraps.

"It seems very odd," DiBello reflects. "I expected that when we looked into this a few years ago, it would be a slam-dunk. But it was not. Some colleagues that I spoke to about it a few years ago had also found that no one was interested."


Dennis Clark, CPO, president of the Orthotic and Prosthetic Group of America (OPGA), also notes that his investigations into materials recycling have been unsuccessful to date. "I would love to tell you that we recycle all of that urethane foam and waste plastic. But even though we fabricate a tremendous amount of orthoses and prostheses, we still don't create enough volume with our waste plastic to make it worthwhile for someone to come and recycle it. If they'd bring a dumpster to us, we'd be thrilled to do that."

The Cost/Quality Tradeoff: Can We Afford It?

Some say that since EVA, plastic, and plaster have potential value to the recycler, their owner should be reimbursed by the recycler; others disagree, considering free pickup and takeaway a fair trade. But even if we agree to ignore profitability for the sake of doing the "right thing" for our planet, can we justify the results of our overall recycling efforts?

"It really doesn't make much sense," Renwick says. "I can choose to buy recycled polypropylene, but it costs more than the virgin material. And my personal feeling is that until those two numbers reverse, we're never going to have anybody really jump on the bandwagon."

Myrdal notes that as a central fabrication facility that distributes to the industry, his company really doesn't want reground materials. "You want virgin materials in your production because they're just so much superior. Until they can improve the technology, most of the recycled plastic will end up in sewage tanks and plastic piping and shopping bags. In my opinion, our industry is not going to accept regrounds unless they can really refine the process. I know we wouldn't."

Small-Scale Solutions

Many offered green recommendations equally effective for any industry or business of any size looking to improve efficiency and save costs, from energy-saving light fixtures to motion-sensing light switches and programmable thermostats. Most have made strides toward paperless operations, some relying on Internet-based billing systems accessible from home.

Renwick, a committed advocate of environmental protection, pays about 40 percent more than the going rate for the electric power that runs his facility. "We use a company called Bullfrog Power, and they generate by using wind and sun. We decided to go green in every way we can.

"Although keeping costs down is important, the green aspect of any business these days is paramount," Renwick continues. "Our clients appreciate hearing about it. People want to feel good about what they're doing."

Kennedy reports that Hersco has been recycling gently used cardboard boxes routinely for several years, freshening them up with their own professional adhesive logo labeling. "We do central fabrication—so everything we work on comes in a box from the orthotist who sends us the cast. As much as possible, we reuse the boxes that the work is sent in. That means that new boxes don't have to get made for our product...and we're not filling up landfills with old cardboard boxes. We reduce our waste and reduce the need for the environment to produce a box."

Cost-Saving O&P-Specific Conservation Tips

Use materials with potential recycling in mind. Avoid additives whenever possible.

When he adds glue, Renwick chooses a water-based glue, which is safer for him and the environment. "It means that when the material is broken down for recycling, they don't have to worry that I have introduced a chemical that's going to cause problems with processing."

Myrdal suggests choosing biodegradable thermoplastics when purchasing materials. Myrdal's company distributes such materials, and he will be happy to provide leads to others.

Use materials more efficiently. Renwick recommends mak­ing a paper pattern before cutting into a piece of material. "Placing the pattern can help you use less material and create less waste than simply cutting a bigger piece and hacking away until you get the size you need."

Myrdal advises keeping records when mixing batches of resin. "Instead of mixing up too much and throwing out half of it, I'm suggesting people make note of how many grams of resin [is needed] for a cast of a particular size and refer to it as needed." (Editor's note: See the feature article "O&P-Specific Recycling: One Man's Solution" for more tips.)

Angelico describes ways to conserve and reuse EVA foam materials by recarving a second, smaller device from the same block originally used to carve a TLSO, for example.

"We also measure the blocks and cut them down to the size we need, and then glue the cut-down portions together to form new blocks. That allows us to use more of the materials and do more things with it."

Clark points out a tendency to use endoskeletal components inefficiently. "As you cut a section of tubing off, save that and use it for someone else, or reuse it in other places. All of that will help long term—driving your cost of business down and profitability up."

Conserve energy as well as materials. Renwick advises a strategic shift in creating fabricated items. "Arrange your schedule so that you can do all your work with an oven that's on for a couple of hours, and then turn it off, instead of leaving it on all day."

DiBello, who recently moved his business into a new 26,000-sq.-ft building, points out that the facility was designed with efficiency and conservation in mind, with double doors isolating the lab from patient and administrative areas, and an HVAC system with a large dust collector and filters that are changed weekly. Direct exhaust systems are at each gluing station and over the oven area in case overheating of foam or plastic creates harmful fumes.

Utilizing CAD has eliminated a lot of plaster waste, Clark says. "When we do take impressions, we utilize synthetic casting materials, and that, too, puts less of the plaster of Paris debris into our dumpsite and ultimately into our water supply. And on the fabrication side, we're carving polyurethane molds rather than utilizing plaster there."


Don James Edmondson, Jr., RTP, of Axis Prosthetics, Chattanooga, Tennessee, recommends using the smallest vacuum pumps possible. "We use large reservoirs, so we're able to use a couple of little 110 volt pumps instead of high-amperage pumps with a huge draw."

Making a Difference

What can O&P providers do to bring about change beyond their four walls?

Renwick advises putting gentle pressure on manufacturers. Manufacturers of printer cartridges, for example, encourage recycling of the empties by providing postage-paid envelopes for their return.

"Ask people that you buy from, 'What am I to do with waste and offcuts?' Awareness needs to work its way up the food chain so that the person in charge of manufacturing this material accepts some environmental responsibility. I think if enough people start to do that, it's going to ring a bell."

"We have to give our manufacturers the incentive to make those kinds of investments in their products for us," Clark agrees. "Is this the chicken or the egg?"

He also encourages supporting and patronizing those manufacturers who create environmentally friendly products, like the new Knit-Rite liner sock that eliminates the use of lining interface padding and adhesives by offering a washable, reusable, long-wearing alternative. "We need to recognize those kinds of products, not just for the patient benefit, but the ecologic benefit."

Utilizing central fabrication will itself be a green move, he points out. As central fabrication facilities gain business, their volume will grow large enough to make recycling feasible and profitable.

Fabrication through a central fab also reduces the likelihood that a thermopulling process will have to be completely started over. "Their experience also equips them to do a much better job of using the absolute minimum-sized piece of plastic," Clark notes. It's something that they're doing 20 and 30 times a day instead of one or two. And overall, their thermoforming setup is also more efficient, allowing better ventilation and utilization of air transfer for more far-reaching environmental effects."

Does O&P Fabrication Have a Green Future?

"I can't predict the future," Kennedy says, "but there are definitely opportunities there. We have all gotten a little too complacent and a little too wasteful over the last few decades. And there's a cost for that, financially and environmentally."

When the economic situation improves, however, so will prospects for recycling, most believe.

Already, future green fabrication technology hovers on the O&P horizon: A system already in use in other industries might soon allow printers to form 3-D sockets from ABS plastic, building them layer by layer, based on a CAD-created template, without plaster or foam, Angelico says.

Planning for the future, however, requires addressing today's issues.

"It's time that we think about these types of things," Clark says. "It's time to start working on our business and on our environment—not just in it."

Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.