Hattiesburg, Mississippi, is no stranger to natural disasters. The city, 70 miles north of the Gulf Coast, suffered major damage during Hurricane Katrina and again in 2013 when a powerful tornado tore through the region, destroying structures and injuring 82 people. People used social media to communicate with one another and with first responders, but response times were still slowed by blocked roadways, downed power lines and other after-effects of the storm.
“We asked the question, given the evolution of technologies, couldn't we do this better,” says Dr. Italo Subbarao, associate dean and disaster medicine specialist at William Carey University College of Osteopathic Medicine in Hattiesburg. “Could we not take a highly advanced drone and combine it with an innovative telemedical kit and fly it over the person’s house, get eyes on the scene, land and deploy this medical kit?”
The idea was to provide a bridge for victims until first responders could arrive on the scene, says Subbarao, who had already been studying disasters from a communication perspective.
It took Subbarao and his team about a year to develop their first prototype. Today, they have a medical drone with significant lift and capability, he says. The units are outfitted with a telemedical kit that includes diagnostics and medical equipment as well as video guidance and a holographic interface that allows physicians to speak to bystanders or victims virtually. There is also the ability to control locked medication bins.
“We feel we’re very close to a solution that can be used in the next hurricane season and, hopefully, in a variety of emergencies including tornadoes and mass shootings like we saw in Las Vegas, bombings and car accidents and remote wilderness types of emergencies,” Subbarao tells Healthcare Dive.
While still an emerging technology, the university's prototype points to where drones could assist and supplement medical care plans, especially during catastrophic events.
Abuzz over Africa
The potential benefits of interactive drones in healthcare are many. A study published this summer in JAMA found that drones reduced the response time in simulated heart attacks by about 16 minutes, compared with emergency medical services.
For more than a year now, San Francisco-area drone startup Zipline has been delivering blood and other essential medical supplies in Rwanda, in partnership with United Parcel Service and Gavi, a global nonprofit focused on access to immunizations. Since launching in October 2016, Zipline has dispatched more than 2,000 flights over 62,000 miles and delivered more than 4,000 units of blood, according to spokesman Justin Hamilton.
We feel we’re very close to a solution that can be used in the next hurricane season and, hopefully, in a variety of emergencies including tornadoes and mass shootings like we saw in Las Vegas, bombings and car accidents and remote wilderness types of emergencies.
Dr. Italo Subbarao
Associate dean and disaster medicine specialist, William Carey University College of Osteopathic Medicine
The company recently announced a partnership with the Tanzanian government to deliver critical medical supplies and life-saving medicines in the East African country. Starting in the first quarter of 2018, Zipline will make up to 2,000 deliveries daily to more than one thousand health facilities serving 10 million people. The on-demand service will have four distribution centers, each with 30 drones capable of making up to 500 flights a day. The drones can ferry about a little more than three pounds of cargo and cruise at about 68 miles per hour. Their round trip range is nearly 10o miles, according to the company.
Competition heats up
Other companies are eyeing the space as well. In March, Menlo Park, California-based startup Matternet received authorization to operate drone logistics networks over densely populated Swiss cities. The first Matternet Stations were launched in September to facilitate on-demand transportation of blood and pathology samples between hospital facilities. The company says its cloud-enhanced drone system can deliver critical medical supplies to any hospital within 30 minutes.
In October, Flirtey, a Reno, Nevada-based drone startup, teamed up with ambulance service provider REMSA to deliver lifesaving defibrillators to victims of sudden cardiac arrest.
Through the partnership, REMSA will respond to 911 calls by dispatching a Flirtey drone with an automated external defibrillator, providing a critical bridge for victims until an ambulance and emergency medical team arrives. The companies are currently working on Federal Aviation Administration approvals and a public education campaign about the service.
UPS has also tested using drones to deliver emergency medical supplies in a remote area off the coast of Massachusetts. More recently, the company teamed up with the American Red Cross and drone maker CyPhy Works on a pilot program to assess damage caused by Hurricane Harvey.
Elsewhere, German logistics giant DHL has been testing drone delivery of parcels to remote and hard-to-reach locations in the country, including delivering medications to an island in the North Sea.
Interact Analysis predicts 78% growth in disaster response applications for commercial drones over the next five years. Overall, revenues for the commercial sector are expected to reach $15 billion by 2022, up from just $1.3 billion in 2016. Technologies like geo-fencing and collision avoidance will enhance growth by making large-scale drone flight safer and more manageable.
Before the medical drone market can really take off, though, government restrictions need to be eased. While it may be possible to deploy drones in a disaster, under a special use exemption, day-to-day use of drones is still highly regulated.
One of the big challenges is that drones are required to fly by line of sight, which may not be possible if you’re trying to get to a remote area or use the fastest route, says Subbarao. There are other restrictions as well. The FAA requires drones to fly at or below 400 feet and weigh 55 pounds or less.
Subbarao and others say there are is a growing conversation at the national level to try and look more critically at some of the regulatory constraints around commercial drones, particularly for uses like medical and emergency response. “Recent moves by the FAA to allow states and cities to push forward with innovative solutions have been a step in the right direction,” Zipline’s Hamilton tells Healthcare Dive.
In the Arizona desert, researchers at Johns Hopkins, Mayo Clinic and the University of Arizona have been field testing drone transport of medical samples. In a series of three-hour flights, a drone carried chemistry and hematology samples from healthy volunteers to see if they remained stable over long periods and under ambient climate conditions.
A total of 19 specimen types were transported by drone in a custom-made active cooling box and then compared with samples that remained stationary. Seventeen of the analytes showed little change from the controls. However, glucose and potassium showed 8% and 6.2% bias, respectively, and met just two of four performance criteria. The study was published in the September issue of the American Journal of Clinical Pathology.
The results were not a total surprise, since both potassium and glucose are sensitive to heat, says Dr. James Hernandez, chair of the laboratory medicine division at Mayo Clinic in Arizona and a co-author of the study. “Even when we transport those by courier, we have to be able to get them to the laboratory very quickly,” he tells Healthcare Dive.
He says more validation studies are needed to test the samples under different types of climate conditions and with samples from different patient groups — for example, children, the elderly and patients with heart failure or cancer. “We have to study all those different types of specimens and make sure they maintain their integrity, and we have to do those under rigorous conditions,” he says.
A “force multiplier”
Back in Mississippi, Subbarrao’s team is testing a newly developed drone on flights that cover about 30 miles in 45 minutes carrying a 15-pound kit. Speeds range between 35 and 55 miles per hour, according to Subbarao, who is looking to increase the distance much farther. The project has attracted interest from around the world, both in governmental and commercial sectors, including hospitals, he adds.
Subbarao envisions a fleet of drones with a variety of capabilities — medical kits, search and rescue, survival — that could deploy at a moment’s notice from stations in strategic areas across the state.
By getting to disaster settings quickly and empowering individuals and bystanders with telemedical and other tools, drones have the potential be a “force multiplier” and save more lives, Subbarao says.
“It is a solution, a very powerful solution, that should fit within the integrated system of disaster response,” he says.