Here Come the Drones

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 Illustration by Nicolet Schenck

by Michael Levin-Epstein

You receive a notification from a first responder who has just found out about a serious rock slide in the treacherous mountains about 35 miles from your hospital. The roads are blocked, and there seems to be no way to quickly reach the injured. And that’s not the worst of it. It’s unclear how many are injured, what their needs are, and ground vehicles cannot reach the site until the debris is cleared. Who you gonna call? How about your friendly neighborhood drone operator? It’s no longer a matter of “if” drones will play a significant role in telemedicine going forward, but a question of “when.”

Already, drones have been used in the aftermath of the earthquake in Haiti in 2015. And as we reported in this magazine (Issue #3), drones are expected to be deployed this year in the landlocked, hilly East African nation of Rwanda—a country lacking a sophisticated transportation structure—where the delivery of necessary medical supplies to remote areas has been a tortuous, if not impossible task. And in September, the first FAA approved drone delivery of medical supplies in the United States occurred in rural Virginia.

Unmanned aerial vehicles (or drones as they’re commonly called) are expected to proliferate significantly in the next few years, experts predict. Drones will be deployed as “ambulances” to deliver invaluable medical equipment, such as automated external defibrillators, that could potentially save those injured in a rock slide, for example. The logistics are straightforward: Using drones can decrease response time and increase survival rates. Drones have the ability to deliver supplies from landing bases, which can be deployed almost anywhere. And, as far as returning to home base is concerned, no sweat. The drone’s flight path can be preset to make a drop off and return back home on its own.

Three Stages of Drone Use
There are three stages in the progression of drone use for telehealth purposes, says Rishi Madhok, an emergency physician at the University of California at San Francisco hospital, who has been following telehealth drone development closely for the last several years. The first stage is “reconnaissance,” says Madhok, where drones provide aerial photography and a video feed of the scene of an accident or natural disaster to give emergency responders a better idea of the situation on the ground.

The second stage is “delivery,” where drones literally serve as the vehicle to transport needed medical equipment and drugs to administer to the injured at the scene, as happened in Haiti. The Mayo Clinic has suggested that blood products and antivenom for snake bites could be excellent candidates for drone delivery in the next several years.

The final stage, says Madhok, is “medical command,” where drones, through their video sensors, provide high fidelity data and two-way communication between providers and responders — or even lay people — on the scene.

Delta in Mississippi: A Potential Force?  
Does all this sound like science fiction? It’s not. If you live in Mississippi, for example, a telemedicine drone soon may be arriving at a town near you. At least that’s the aim of a physician named Italo Subbarao.

Subbarao, an associate dean at the William Carey University College of Osteopathic Medicine in Hattiesburg is developing a full-service medical drone with telemedicine capabilities. His motivation: To be able to deal better with the after-effects of natural disasters, such as the EF4-level tornado that levelled Hattiesburg three years ago. The damage in the surrounding area was so extensive that local ambulances had trouble reaching all the homes that had been affected. So Subbarao decided to move forward manufacturing a drone that could serve as an ambulance for emergency response or wilderness medicine.

That drone is still in the testing phase, but ultimately, it will be designed to incorporate integrated healthcare recovery capabilities, according to Subbarao. Here’s how it works: Guided by GPS, the drone drops a modular medical kit that contains diagnostic and treatment equipment for the patient’s situation, such as heart attack, trauma, or dangerous fever. Subbarao notes that the FDA already has approved an ECG recording device that attaches to a smart phone, which has a built-in thermal camera. “If we can send in that kit,” he explains, “we can take the patient’s temperature without having to do anything extra.”

There also will be a live video feed connecting the patient with a health care professionals who can guide them on how to use the medical kit. (The live video feed is encrypted to ensure patient information remains secure.)  “We think this has great relevance for disaster response and wilderness medicine, but it could also be used in the event of a terrorist event or a hazmat spill—the drone’s sensor could relay information about whether the area is contaminated,” explains Subbarao.

Matternet: Attempting to Master the Matter
Subbaro’s project is clearly worth monitoring. But a small Silicon Valley startup called Matternet has gotten a head start on drone use for telehealth. Matternet has been developing drone delivery technology for several years, and the company’s co-founder and CEO, Andreas Raptopoulos, recently gave a TED talk about drones that generated more than 200,000 views. Under Raptoulous’s leadership, Matternet designed a system of autonomous flying vehicles, pre-designated landing stations, and software that is able to cost-effectively transport packages, such as medical supplies. Matternet implemented pilot programs (including in Haiti and the Dominican Republic) to test the transportation of medical diagnostic samples from remote clinics to central hospitals where treatment can be more easily assessed.

Matternet was also recently invited to Bhutan, under the auspices of the World Health Organization, to help implement Prime Minister Tshering Tobgay’s dream of creating an advanced telemedicine system in his country. The dream is based on necessity: Bhutan has only 0.3 physicians per 1,000 people, according to World Bank data. And with only 31 hospitals, 178 basic health unit clinics and 654 outreach clinics serving a population of more than 700,000, access to quality health care is clearly an issue in the country. For the pilot project, Matternet used autonomous flying robots to connect the Jigme Dorji Wangchuck National Referral Hospital in Thimphu, Bhutan’s capital, with three small rural healthcare units.

To date, Matternet has flown over 100 missions, in five countries, at altitudes ranging from one to 3300 meters, in high winds and rain (often cited as a problem with drones), transporting goods from local hospitals to remote clinics. “From everything we’ve learnt through planning and implementing these pilot programs it’s clear to us that the vehicles that gain the greatest trust within a community are those that the community has greatest access to and control over. Our product has been designed ground-up to be owned and run by the communities it serves, and to be navigated by people who have little experience in piloting aerial vehicles,” Raptopoulos said in his TED talk. By establishing routes between clinics and local hospitals (the hub and spoke), he explained, Matternet is able to envision a cost-effective solution for transportation between communities (spoke to spoke), which, would fuel local trade.

The bottom line, according to Raptopoulos: “We believe that the business of building flying robots is at an inflection point. We believe it’s moving beyond the domain of the military, the hobbyist or enthusiasts to becoming a viable solution to the extreme needs of transportation, creating a new paradigm.”

The reason that many telemedicine experts and entrepreneurs are so bullish on unmanned aerial vehicles is that commercial drone use is expanding exponentially, led by Amazon Prime Air’s game plan for package delivery. But while you or your neighbor can pick up a drone at your local Radio Shack for under $100, drones used to deliver medical supplies — and receive Federal Aviation Authority (FAA) approval — will be far more costly. Indeed, the wild card in the future of telemedicine drone use may just be the FAA—the federal agency with jurisdiction over non-military unmanned aerial vehicles.

FAA Proceeds at Own Pace in Approving Medical Drones
In terms of regulatory oversight, drones are no different than 757s. Both are under the jurisdiction of the Federal Aviation Administration (FAA).

But despite a mandate from Congress to integrate UAVs into FAA’s overall monitoring and regulation of U.S. national space, the agency is proceeding with all deliberate speed. To be fair, experts say, it’s not easy to establish ground rules for drones, noting the near misses and actual accidents that have occurred with drones not just in the United States but globally.
Whether for medical purposes or not, the FAA has established a complicated, bureaucratic system that all drone operators and business utilizing drones — from big-time players like Amazon to the remotest urgent care facility — must follow in order to garner FAA’s approval to fly. Those rules include flying no higher than 400 feet above the ground, and always within the line of sight of human operators.

These operators can apply for an exemption, and that’s what health care organizations are now trying to do, and are expected to do even more going forward. In September, the FAA gave a Washington D.C.-based startup called Measure permission to fly 324 drones. But Measure won’t be using its drones to deliver medical supplies; it will be using its UAVs to collect data, which is a priority for the federal government. Measure is a drone consultancy and service business that focuses on the agriculture, oil and gas, insurance, and other industries in which aerial photography and other data is a valuable commodity.

While it’s unclear what the Measure approval will mean for telemedicine, there was concrete movement in this area last year when, in July, the agency approved drone delivery of medical supplies, including asthma, high blood pressure, and diabetes medications, to ill patients at a large, rural health clinic in Virginia.

Virginia Gov. Terry McAuliffe (D) was euphoric, to put it mildly: “It’s going to revolutionize the way we deliver health care. This is a Kitty Hawk moment.”

As Chris Hall, chief operating officer of Remote Area Medical, which put on the free clinic, noted at the time, in places like rural Virginia, it can take an hour for health care workers to get medicine and supplies to residents, but drones can fly them over in five minutes. “The future of this delivery technology could be tremendous, not only for Remote Area Medical (RAM) but for relief organizations worldwide,” said RAM founder Stan Brock. The Virginia drone deliver was organized by Flirtey, a drone delivery company founded in Australia.

Throw into the mix the fact that Congress is expected to put increasing pressure on the FAA to promulgate regulations. Sen. Ron Wyden (D-Ore) is honchoing a bipartisan effort to get the agency to take quicker action on drone regulation for commercial use. In a letter to the FAA, Wyden, joined by Sens. Jeff Merkley (D-Ore), Heidi Heitkemp (D-N.D.), John Hoeven (R-N.D), and Corey Booker (D-N.J), stated: “These (regulatory) delays force manufacturers and operators who play by the rules to sit on the sidelines while they wait for approval, while others chance fines and operate without any certification from the FAA, which raises serious concerns about public safety.”

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