Drones as emergency medical assets

Drones have long since proved their worth as an aerial search tool and this year have grabbed headlines by assisting in rescues of swimmers in the surf. Could they also assist in responding to trauma calls alongside traditional HEMS crews? There are two distinct avenues being actively investigated in New South Wales (NSW), Australia.

Blood back-up

In July 2017, Sydney Helicopter Emergency Medical Service team, working with DroneAdvantage, successfully carried out proof-of-concept trials to assess the feasibility of using drones to carry emergency blood plasma products to the scene of an accident, explained Kelvin Morton, Managing Director and Airboss at DroneAdvantage. The concept, he explained, is for a UAV to fly in extra blood to top up what the HEMS crew carries onboard: “The HEMS team can only carry three units of plasma on the helicopter, but when they get out to the scene of a trauma, they may often require many more units if they need to carry out a transfusion or if there are many victims. When that happens, there is an emergency response involving ambulances, police and fire brigades to pick up more plasma and get it to the HEMS emergency team in the field as fast as they possibly can. Having access to a fleet of drones at the blood banks to take plasma to the scene would make a significant impact.”

The trials involved short-range flights to and from the helipad at the Royal North Shore Hospital with the drone kept within visual line of sight (VLOS), but the ultimate aim is to be able to fly further afield. Dr Brian Burns, a Prehospital and Retrieval Medicine Specialist and Emergency Physician who has worked on rescue helicopters, has been vocal in his support of the drone concept, speaking both to local media and to an international audience at a Social Media and Critical Care event in 2017. He suggests a range of aerial platforms could be used as required to respond to both short-range missions as well as long-range taskings, where they would fly beyond visual line of sight (BVLOS): “I would anticipate triaging the blood delivery request and using one of several UAV options depending on the distance, weather and local physical characteristics at the intended destination.” He added: “Whether we use the UAV in city or rural areas, in all cases the aim is to ultimately be flying BVLOS with remote monitoring from a central command and control unit.”

The idea of using UAVs to deliver blood is not new. In Rwanda, for example, the Ministry of Health has partnered with Zipline to set up a system where fixed-wing drones deliver blood products to regional hospitals on demand. However, whereas the Rwandan solution involves parachute drops to designated landing zones at the clinics, the concept tested in Australia would involve drones flying to the kind of accident scenes that HEMS crews attend. In these types of missions, said Dr Burns, pre-hospital blood products are the currency that allows providers to get patients to the trauma centre alive who would otherwise have died: “Efficient delivery of life-saving blood products by drone/UAV will allow stream-lined efficient rapid access to these life-saving products.”

Scouts

A second, entirely different, approach would see camera-equipped UAVs being used as scouts, arriving early on scene to gather information on, say, the number of victims and the nature of injuries. DroneAdvantage is in discussions regarding setting up trials to assess the feasibility of using drones as ‘forward scouts’ to assess the condition of trauma patients before the HEMS team arrives on scene, allowing triage decisions to be made even before the crew touches down. Morton explained: “The forward ‘scout’ concept seeks to build on a study carried out by two University of South Australia students, Ali Al-Naji and Asanka Perera, who developed an algorithm which uses the RGB spectrum on a standard drone to calculate a person’s heart rate using only a live video feed. The HEMS concept would try to take that ground-breaking work several steps further by using radiometric thermal sensors to detect the patient’s body temperature, as well as scan the area to identify the locations of patients prior to arrival so that no time is wasted when they land.”

Regulatory challenges

For either concept to become a reality, regulatory hurdles will need to be overcome, principally the need to make BVLOS flights. In the blood trials in Sydney, the drone was always in VLOS, said Morton, in compliance with standard Civil Aviation Safety Authority (CASA) regulations. The road to BVLOS begins with showing that the concept is effective and working with CASA, he explained: “We will first prove the viability of a concept and its potential to save human life, at which point we would then invite CASA into the [proof-of-concept trials]. Emergency response teams are exempted from compliance with standard regulations for ‘mercy flights’, so it’s just a matter of ensuring that we have appropriate CASA-compliant configuration of the drone to meet BVLOS standards and detailed SOPs.” DroneAdvantage has experience here, having worked with NSW Surf Lifesaving on the Little Ripper project that saw the first life being saved in the surf by a drone in January. Morton added: “Once we have carried out a range of VLOS tests and developed all of the SOPs, systems and fail safes, we would extend to BVLOS trials under the watchful eye of CASA.”

Another key step will be selecting the most suitable models of UAVs for real-life missions. While that can only happen further down the line when more work has been done to flesh out the concept, Morton commented that a larger, fixed-wing VTOL aircraft using hybrid propulsion ‘would work well for the rural areas’. And it’s those areas that could most benefit from help from above. Dr Burns noted that Australia suffers from the ‘tyranny of distance’ with a median pre-hospital time for severe trauma at around the 100-minute mark, well beyond the golden hour of treatment. Underlining the need to get blood products to such patients, he added that 90 per cent of preventable trauma deaths are due to exsanguination.

Interestingly, DroneAdvantage is not alone in exploring how to deliver blood in Australia by drone. Leaders at the country’s mail delivery service, Australia Post, have been looking into operating blood-delivery drones. And according to comments reported this August, Zipline has begun dialogue on replicating its Rwandan system for rural Australia. It may only be a matter of time before we see remotely piloted aircraft working alongside HEMS and lives being saved by a network of drones working across the country.