Employment of Drones in Medical, Emergency and Relief Settings

Introduction

            Poljak, M., & Šterbenc, A. (2020) Drones are uncrewed aerial vehicles. They get their names from the humming noise produced by male bees or drones, similar to the sound that one of the first drones, Fairy Queen, made. They can carry payloads and maybe autonomous or controlled remotely, without the need for onboard pilots. Initially, they were solely used by the military, but now they are becoming more widespread, from package delivery to photography, to map terrains, and to track storms. In our day-to-day lives, we face a plethora of emergencies, from a fall down the stairs to fires in buildings, accidents on the road and power outages. Children slip and fall into swimming pools and especially now, the coronavirus is spreading like wildfire. The integration of drones and remote technology in  emergency response could be paramount to improving response times and saving lives. Balasingam, M. (2017) Drones are of various kinds, ranging from insect-sized to drones of considerable wingspan, drones that fly to robotic, AI-equipped drones that operate on the ground. Drones have the advantage of being capable of taking off and landing in a variety of environmental conditions and on different kinds of terrains. They are capable of vertical flight and hovering and this allows them to hover, drop off packages and land in tiny spaces. Recently, in fields outside of healthcare, they’ve been used to assess the destruction in disaster struck areas, to monitor traffic, to make maps and deliver packages. In healthcare, they’re used for a variety of purposes, like transporting blood samples, vaccines and organs efficiently, they’re used to deliver medicines, testing kits and aid packages to remote locations, some are equipped with defibrillators and necessary equipment for bystanders to act as first responders with instruction via video conferencing from healthcare officials, reducing response time and increasing the likelihood that the patient will survive. They have even been used to transport organs. Outside of emergency healthcare, drones can be used to care for the elderly, fetching their medication, ensuring that their meals reach them, helping them navigate and performing chores about the house. Scalea, J. R. et.al. (2019) Despite advancements in science and technology, two major elements of organ transplants act as barriers that reduce access to transplants: geography and transport. Cold ischemia time is the time between when the organ is chilled and cut off from its blood supply and its blood supply is restored and is warmed up. Regular transportation makes use of commercial airplanes and couriers which increases delays, in turn increasing CIT which is detrimental to transplants. With kidneys, increased travel time increases delayed graft function (DGF). This increases the chances of rejection while the chances of graft survival decrease considerably. It was found, that compared with drone travel, the organ experienced more vibrations when transported by a fixed-wing aircraft, primarily during take-off and landing. We can also consider the possibility of having drones travel directly between hospitals, while doing so with airplanes and large aircraft is unfeasible. It is highly possible that by implementing drone transportation for organs, the number of transplants will increase, as the number of organs rendered decrepit post transportation, decrease.

The implementation of drone technology can thus, drastically improve the healthcare system, by reducing deaths, making the life-saving process more efficient, thus allowing for better care and by improving accessibility to ensure that no lives are lost due to lack of infrastructure. Dukowitz, Zacc (2019)  Drones are increasingly being used to aid in search and rescue operations. In January 2019, a 60 year old hiker in Utah, who was trapped on a ledge. Rescue teams used drones to light the area up. Around the same time, an 88 year old man in Texas who had gone missing, was found by a drone. Drones were used to find people trapped on a mountainside in Iceland and find the victim of a car accident after he’d been thrown out of his car, in the UK. Even outside the realm of healthcare, the use of drone technology can be the difference between a life saved and one lost.

Employment of Drones in Medicine

Balasingam, M. (2017) Drones boast many advantages with their ability to hover, take-off and land in tiny areas and their capacity for virtual flight. Equipped with artificial intelligence technology, ground-based drones are also becoming increasingly useful. Currently applications of drones include assessment of damages after natural disasters due to their ability to span gruelling terrains without risking human lives, delivery of aid packages to disaster-afflicted areas like Haiti after the 2010 earthquake, the northeast United States, Canada and the Carribean after 2012’s Hurricane Sandy, the Vanuatu islands after the category five cyclone Pam in 2015 and Nepal after the 2015 earthquake. Doctors Without Borders use drones to transport dummy tuberculosis test samples from a remote location in Papa New Guinea. Drones delivered HIV testing kits to Malawi, enabling quicker testing of infants. NASA tested drone usage for delivery of medical supplies to a clinic in rural Virginia, while in Rwanda, drones were used to deliver blood to remote regions and critical access hospitals, within 30 minutes. The drones made use of the Global Positioning System (GPS) and Rwanda’s cellular network to navigate. Potential applications of drones include intra-hospital deliveries, geriatric care with special thought given to adaptability to a lifestyle with drones, delivery of automated external defibrillators to reduce response time in cardiac arrests and use of drones equipped with sensors, infrared devices and the capacity for telemedicine. Google was granted a patent involving the development of a system, by means of which drones could be deployed in response to emergencies with just the touch of a button. Limitations are put in place to ensure the safety, security and privacy of people. Regulatory authorities have oversight of technical, safety, security and administrative issues regarding aviation. Drones need to meet the requirements that these regulatory authorities specify in these areas. Future innovations include the capacity for ultrasound imaging and telemedicine. Drones have the potential to transform healthcare in the 21^st century.

Effect of Deployment of Drones on Organ Transplants

Scalea, J. R. et.al. (2019) While improvements in technology have directly effectuated better transplant outcomes, geographic barriers and the actual transportation of the organ continue to hinder the process. To get from one place to another, in most cases, the organ must change hands multiple times. This adds time to the journey which is detrimental to the survival of the organ and the patient it was bound for. With the new KAS, access to kidneys for transplants has increased tremendously. However, the distance that the kidney must travel to meet the patient has also increased as less local and increased inter-regional sharing takes place. The authors of the paper used new technology to track the condition and location of the organ during the flight. They performed various tests, like accelerating the drone, making it hover and flying them over short distances. Biopsies were taken before and after which revealed no damage due to external forces. These findings were compared with those of fixed-wing flight where it was revealed that primarily during take-off and landing, the organ endures more vibration as compared to drone travel.  If drone travel were implemented the number of kidneys being transplanted could increase. In the United States, approximately 20% of kidneys are discarded. Reduced travel time could reduce CIT and increase survival rates of the kidney. The same could be applied to other organs.  Speed and federal regulations are obstacles that must be overcome before drones can take over organ transportation. Development of a faster drone capable of carrying an organ to the recipient hospital safely will be necessary.  

Impact of Implementation of Drone Technology in Africa and the Future of Drone Usage Around the World

Washington, A. N. (2018) Africa, having less stringent regulations about the usage of drones has seen great integration of drone technology into various activities, including archaeology and agriculture. They are used to provide aid in the form of food, water, medicine and other supplies to remote, otherwise inaccessible regions. In Rwanda, blood was delivered, on demand, to areas where traditional medical supply lines couldn’t reach. Orders were placed using the internet, phone calls, text messages and WhatsApp, following which delivery took place via drones with parachutes attached to the payload. More than 5,500 units of blood were delivered, aid was provided to over 5 million people and deaths due to anaemia following malaria and due to blood loss during childbirth were greatly reduced. HIV testing kits, TB tests, condoms, birth control, medical supplies, blood and DNA samples were delivered to rural areas of Malawi, Ghana and Madagascar, improving the quality of healthcare and living considerably for the inhabitants of those areas, women in particular. Drones were used to determine where the cholera hotspots were in Lilongwe, the capital of Malawi. Sleeping sickness is transmitted by the Tsete fly in Ethiopia. Drones were used to release sterile Tsete flies into particular regions on a weekly basis in hopes that sterile flies would mate with non-sterile flies to create more sterile flies, with the end result being the eradication of the species. Drives were used to aid genocide prevention, as part of the Sentinel Project. Here, drones were used to provide an estimate for when and where the next attack might occur, reduce the risk of incident and help communities get through them. They were also used to pinpoint the location at which atrocities were taking place, chronicle the ongoing ones and provide prior warnings to enhance response times to the incoming transgressions. Outside Africa, drones are used to assess damages incurred, to provide aid and to accelerate search and rescue operations in disaster-struck areas. Switzerland has an autonomous drone network used to deliver medical supplies in a variety of cities. Sweden has drones equipped with automated external defibrillators, which reduced response time in attending to cardiac arrest patients in rural areas, as compared to ground response teams. There is talk about using drones to help prevent and act in response to mass shootings in the U.S. The future of drone usage depends on the government decided regulatory framework put into place, engagement of the community, partnerships with companies to drive innovation, planning for repairs, maintenance and backups to ensure that the system doesn’t collapse and implementation of the best practices with regards to usage of drones. There should also be a system put in place to ensure that the implementation of this technology is not a free pass for the government to neglect the crumbling infrastructure of ground transport.

Drones used in Clinical Microbiology and Infectious Disease

Poljak, M., Šterbenc, A. (2020). Drones are used for transportation of biological samples. Transport at room temperature or cooler had no significant influence on the results of various analyses performed on the samples. Strict control of the environment that the samples are in during the transport must be implemented. Performing flipping manoeuvres to gently mix blood samples is invaluable ensure proper separation of plasma for testing. The effect of fixed-wing drone transport on microbiological samples was studied, taking time-to-growth and the number of colonies and their morphology, to be some of the factors compared between stationary and flown samples. In 2017, Switzerland allowed autonomous drones to fly over cities at any time, for healthcare purposes. A medical transport network was developed using quadcopter drones, with more than 3,000 successful flights. In 2016, UNICEF, in collaboration with the Government of Malawi, ran a test programme to assess the cost-effectiveness as compared to time reduced to obtain results for HIV testing in infants. Drones in Papa New Guinea were used to transport sputum samples from remote locations with little to no road access due to rains. In addition to transport of samples, drones have been used to deliver aid packages to disaster afflicted regions. Rwanda made use of battery-powered fixed-wing drones capable of making 1.5km round trips and carrying 1.5kgs of blood to deliver blood on demand. The orders were placed via text message. Delivery times went from 4 hours to 15-45 minutes, and as of August 2019, more than 18,000 flights had occurred. Tanzania implemented a successful drone transportation programme, with delivery of blood, vaccines, antiretroviral drugs and malaria drugs using biodegradable parachutes. Gavi, the Vaccine Alliance, announced the launch of drone delivery of blood, medicines and vaccines to upto 2000 health facilities across Ghana, in April 2019. In Vanuatu, an area accessible only via ‘banana boats’, where the lack of electricity means that vaccines cannot be stored properly, drones were used to deliver vaccines to three islands in 2018. For organ transportation, use of drones to make the journey quicker and more efficient, could reduce cold ischemia time, improving transplant outcomes. April 2019 saw a donated kidney be delivered by drone and then transplanted successfully at the University of Maryland Medical Centre. The use of automated external defibrillators to treat out-of-hospital cardiac arrests has improved bystander defibrillation rates. The concept of a lab-on-a-drone has been presented to overcome poor infrastructure and accelerate diagnosis and treatment time. A lab-on-a-drone would contain both the equipment necessary to prepare samples and to analyse them. It can be manufactured at a reasonable price and the on-board procedures were shown to be insensitive to tilts, thus enabling these drones to function in poor weather and perform manoeuvres as needed. There is vast potential for the use of drones in surveillance of vector-borne infectious diseases. Once equipped with sensors and AI, thanks to their scaling capacities, they can provide georeferenced data on temperature, salinity, vegetation and so on, and may one day, replace satellites. There is work to be done before drone technology is fully implemented, such as assessment of the cost-effectiveness of developing a drone-transportation system, rather than improving upon the ground-based system, boosting the ability of the drone to navigate through different weather conditions, working with regulations, building drones’ immunity to hijacking, the improvement of technology to reduce crashes and malfunctions and training specialists to operate these drones.

Water-related Disaster Management Supported by Drones

Restas, A. (2018) There are three different ways in which drones can supplement water-related disaster management, before, during and after the disaster takes place. The same can be applied to forest fires. Meteorological models can predict fire risk for different areas and make use of fire weather indexes. A higher index implies higher likelihood of a fire occurring as well as increased severity. Knowing the index in advance enables safety measures to be enacted, as well as actions to reduce the severity and area covered by the fire. Drones can also be used for quick fire detection to reduce response times and improve control of fires. The use of drones as patrols can serve to reduce the illegal activities that cause fires. During fire suppression, drones can survey the fire and give the fire brigade information about the location, size and pathway to the fire to put it out as quickly as possible. With regards to floods, drones are used to analyse the river basin, the structural integrity of the flood gates and dams and evaluate potential risks. Drones can also survey nearby bridges, reliefs, channels, pump-stations and the nearby vegetation. Growth of vegetation can be curbed if necessary, and thermal imaging can be used to check if engines in the pump stations are overheating. During floods, drones can make use of resolution mapping to provide accurate data about the flood and the area affected. They can scan the area for people trapped in houses and water leakage at dams or floodgates. Using this, the leaks can be managed before the situation escalates. Drone surveillance can be used to determine whether or not evacuation must occur when dealing with degradation of crucial elements of dams like flood gates. Drones can help first responders during floods by delivering first aid, finding trapped people and performing reconnaissance. It must be noted that drones are not suited for flight in unfavourable weather conditions. Post flood management to assess damages and then prepare for recovery, could make good use of drones to remap the area by taking high resolution photos. The required authorities can make use of these images to prepare for reconstruction or repairs of the necessary infrastructure, like dams and flood barriers. Drones can also be used to supplement the police to keep the area safe from crime.

Drone Ambulance Design

Krishna, V. V. et. al. (2018) This paper presents a prototype for a new and improved drone ambulance. As traffic on the roads increases, there are increasing delays in the time it takes for an ambulance to reach someone in need. Drones, traveling by air, can reach before ambulances. By equipping drones with a medbox, real time data about the patient’s condition can be transmitted to the ambulance and to the hospital. This allows them to make necessary arrangements in preparation fro the arrival of the patient, which can reduce mortality rates by a significant amount. Existing systems are only equipped to deal with a single type of emergency or monitor a single parameter. The proposed drone ambulance is a quadcopter equipped with a medbox. This medbox contains sensors, like ECGs, temperature sensors and heartbeat sensors. ECG electrodes convert the heartbeat into electrical signals. The drone is an Arduino based quadcopter with a variety of sensors to detect and measure the relevant data. The data is collected using Zigbee technology and can be viewed in the ambulance using LabVIEW software. During flight, a quadcopter experiences drag, lift, weight and thrust. In order for it to maintain its flight, all these forces need to be balanced. The quadcopter is made using an aluminium frame with 4 brushless DC motors on each rail. 4 Electronic Speed Controllers are installed on each rail, each connected to the battery. The propellors are attached to the motors in such a way that the two diagonally opposite propellors move in clockwise direction while the other two move in anti-clockwise direction. The medbox is equipped with the relevant sensors, a thermistor and some medicine. It comes with a user manual to enable passersby to make use of the in-built technology to help the patient. The drone makes use of a Li-Po battery to power the sensors, the ESCs and the flight stabilisation board. In the future, more advancements are possible like the addition of GPS to locate the target, integration of machine learning to calculate the shortest path to reach there, addition of cameras to allow the doctors and EMTs to have an idea of what the situation looks like and use of sturdier drones. The drone can even be made autonomous. There is great scope for research and development in this field.

Limitations of Drones

1. Unmanned Aerial Vehicles operate remotely and thus make use of a data link to connect with the control room. The data link can be intercepted and the control system accessed. This enables a hacker to not only control the drone, but also gain access to private files, corrupt them and leak important data. Drones used in medical settings would inevitably be at a high risk for these attacks as organs, vaccinations and blood are high demand payloads.
2. Legislature and regulations concerning drones are being developed and there is a long way to go before drones are allowed to operate with the freedom they require to attain their full potential in healthcare. While restricted movement of drones is allowed, there is a great amount of uncertainty in this regard. The development of less stringent regulations is hindered by the increased occurrence of drone misuse, including the use of drones to transport contraband and illegal substances, and their role in espionage.
3. The invasion of privacy is an additional cause for concern when developing regulations. In many cases, drones come equipped with cameras, rendering civilians unaware of whether they were being recorded or not. Furnishing drones with audio recording devices supplements this invasion of privacy. As drones are capable of flying high and hovering, they can even be used to look into people’s houses.
4. Malfunctions and software issues are widespread in drones and are known for causing misfires and crashes. The technology needs to be made safer in order to deliver invaluable organs and other medical necessities.
5. Drones are heavily dependent on the weather conditions for optimal operation. In poor conditions, their flight is disrupted and unfavourable for the transport of organs that need to be handled with care. Terrible weather conditions can even ground drones. When used in disaster relief, this can render them incapable of gathering reliable data and images.
6. Drones are vulnerable to collisions and attacks in nature. Large predators like eagles are known to attack flying drones, and there have been many collisions with trees. This also raises concern about drones acting as threats to wildlife.
7. In addition to collisions in nature, there have been occurrences of drones colliding with towers, walls and other aircraft, causing harm to property and deaths. To increase the utilisation of drones, they require a more advanced collision avoidance system.
8. Smaller drones that can cover larger distances and be used in more flexible manners, have restrictions on the size and weight of their payloads. Heavier payloads also slow drones down.
9. Equipping drones with the necessary medical equipment comes at a high price, on top of the cost of the drone itself.
10. The operation of drones requires specific training and a pilots license. A large number of people would need to be trained to fully implement drones in emergency medicine and organ transport. This further increases costs.

Conclusion

Drone technology has come a long way and its applications have spread far beyond solely military expeditions. Integrating drones into India’s medical emergency response systems and employing them in the transport of vital organs and medical supplies, has the potential to revolutionise the medical industry by increasing access to medical care , reduce response time,  notwithstanding their geographic location, reduce response time and improve the success rates as well as the number of organ and blood transplants. Armed with the ability to fly over any terrain, these indispensable little aircraft can reach remote locations and provide relief in the form of food, clean water, vaccines, etc. The deployment of drone ambulances in cities to reach victims of motor accidents, cardiac arrests will reduce response time and subsequently improve the patient’s chances of survival and longevity. Determining a means by which these drones can be used in an ethical, non-invasive manner will be instrumental to the attainment of their full potential.