Delivery by Drones

Technology takes flight in healthcare, though questions remain to be answered

Drones have proven to be stealthy workhorses in the most remote settings. They  have famously informed military strikes on enemy positions where manned aircraft dared not go, and have carried more benign camera lenses to dizzying heights, allowing sublime glimpses of the world from a bird’s-eye view.

A drone, also called an unmanned aerial vehicle (UAV) or unmanned aerial systems (UAS), is defined as an aircraft without a human pilot aboard. Originally designed for military usage, these devices have an approximate cost of $10,000, can fly at an approximate speed of 40-60 miles per hour, carry a 5-pound payload for 30 to 60 minutes of flight time, within a range of 20 to 60 miles.1

Healthcare innovators have realized that this technology could be invaluable in delivering diagnostics to people in the deepest reaches of undeveloped terrain, as well as carrying medications and supplies into impassable disaster zones. Initiatives by various organizations have already been launched to transform this “potential” into a reality.

Challenges to Implementation

But are healthcare drones “ready for prime time?” That was the question posed by researchers Prof. Giusppe Lippa, professor of clinical biochemistry at the University of Verona, Italy, and Camilla Mattiuzzi, Service of Clinical Governance, General Hospital of Trento, Italy. Writing in theAnnals of Translational Medicine1 in March 2016, they recounted the various as-yet unresolved issues of flying drones for shipping blood specimens. These included:

  • High risk of collision and crashes with birds and humans
  • Need for specific regulation for manufacturing, functioning and healthcare usags
  • Approval for usage by national and international regulatory bodies
  • Specific manufacturing entailing cooler or heater systems
  • Specific packaging of blood containers
  • Avoidance of excessive light exposure
  • Speed and injury control
  • Identification of safe take-off and landing areas

They concluded: “The many problems still emerging from the shipment of biological specimens highlight the need to place more efforts for improvement and standardization. The progress in healthcare cannot be disjointed from the use of emerging technology, and many healthcare organizations have already deployed industrial technology to improve their efficiency. The popularity of remote controlled aircrafts such as UASs is constantly increasing around the globe for recreational or civilian use, the latter including humanitarian response and disaster relief. The main concern here is that although shipping blood samples by drones can be seen as a fast and efficient means compared to current options, safety remains an unmet need. The risk that humans get injured or even contaminated by colliding with UASs carrying blood tubes is still too high to be affordable at present.”

Proof of Concept

Those caveats noted, programs continue to move forward to marry drones to healthcare applications.

Last year Johns Hopkins researchers performed a proof-of-concept study to determine if common and routine blood tests would be compromised after an aerial voyage of up to 40 minutes on a hobby-sized drone. They found that the tests were unaffected by the flight. The investigators, who earlier published their findings in PLOS One2 said this is “promising news for the millions of people cared for in rural and economically impoverished areas that lack passable roads. because drones can give healthcare workers quick access to lab tests needed for diagnoses and treatments. Most tests on blood samples and other fluids are done by dedicated laboratories that can be scores of miles from remote clinics.”

“Biological samples can be very sensitive and fragile,” said Timothy Kien Amukele, MD, PhD, via a Johns Hopkins news release. Amukele is a pathologist at the Johns Hopkins University School of Medicine, and director of a laboratory collaboration between Johns Hopkins and Uganda’s Makerere University. Of particular concern related to the use of drones, Amukele noted in the release, is the sudden acceleration that marks the launch of the vehicle and the jostling when the drone lands on its belly.

“Such movements could have destroyed blood cells or prompted blood to coagulate and I thought all kinds of blood tests might be affected, but our study shows they weren’t, so that was cool,” he said.

For the study, believed to be the first rigorous examination of the impact of drone transport on biological samples, Amukele’s team collected a total of six blood samples from 56 healthy adult volunteers at Johns Hopkins Hospital. The samples were driven to a flight site an hour’s drive from the hospital when the temperature was in the 70s. There, half of the samples were packaged for flight, to protect them for the in-flight environment and prevent leakage. Those samples were then loaded into a hand-launched fixed-wing drone and flown around for periods from six to 38 minutes. FAA rules dictated the flights be conducted in an unpopulated area, below 100 meters (328 feet), and in the line of sight of the certified pilot.

The other half of the samples were driven back from the drone flight field to the Johns Hopkins Hospital Core Laboratory, where they underwent the 33 most common laboratory tests that together account for about 80% of all such tests done. A few of the tests performed were for sodium, glucose and red blood cell count.

Comparing lab results of the flown vs. non-flown blood of each volunteer, Amukele said, “The flight really had no impact.” He and his team noted that one test – for total carbon dioxide (bicarbonate test) – did yield differing results for some of the flown vs. non-flown samples, however. The team isn’t sure why, but they said that the reason could be because the blood sat around for up to eight hours before being tested. There were no consistent differences between flown vs. non-flown blood, and it’s unknown whether the out-of-range results were due to the time lag or because of the drone transport itself.

With successful proof-of-concept study results, Amukele said the likely next step is a pilot study in a location in Africa where healthcare clinics are sometimes 60 or more miles away from labs. “A drone could go 100 km in 40 minutes,” he said. “They’re less expensive than motorcycles, are not subject to traffic delays and the technology already exists for the drone to be programmed to ‘home’ to certain GPS coordinates-like a carrier pigeon.”

Commenting on the JH study, Lippi and Mattiuzzi wrote, “Amukele and colleagues convincingly showed that the drones may be suitably used for transportation of laboratory specimens. Interestingly, no impact on accuracy of testing was observed for a vast array of routine clinical chemistry, hematology and coagulation analyses after flying blood samples with drones. Although it is undeniable that the shipment of blood samples through UASs under controlled conditions of time, temperature, speed, injury protection and sunlight exposure would not significantly impair the quality of the specimens, there are [the aforementioned] additional aspects that should be considered before routine implementation of these aircrafts for healthcare purposes. More specifically, the number of hazardous events caused by malfunctioning of drones.”1

Interest on the Increase
Still, the interest in medical drones is expanding as the cost of the technology continues to drop, due in part to highly available lithium polymer batteries and sensors already in use in smartphones. Air Medical Journal3 has reported on researchers from Mayo Clinic’s department of surgery, investigating the potential for drones to be used to deliver drugs and blood derivatives to clinics, disaster areas and remote places that are expensive and logistically challenging to reach, such as ships at sea and accident-prone offshore oil platforms.

According to the Mayo Clinic,4 “Cornelius A. Thiels, DO, general surgery resident at Mayo Clinic’s campus in Rochester, Minn., thinks drones will eventually be used to transport blood products to critical access hospitals, mass casualty scenes and even offshore ships with seriously injured passengers.”

“Blood is unique because it’s expensive and expires – platelets and thawed plasma last just five days – and the supply is very limited,” said Thiels. “.Instead of courier services or the highway patrol transporting blood to a hospital that needs it, a UAV could deliver the blood in advance, taking off as soon as the EMS call comes in.”

Thiels thought there are “. many more potential applications for drones – delivering defibrillators, for example, or tourniquets and other hemostatic supplies to people injured in mass shootings. I don’t know how realistic that is, but it’s exciting.”

Mayo’s website makes the additional point that drones could also deliver “expensive and rarely used drugs, such as antivenim for snake bites, as well as help meet the demand for blood products in the pre-hospital setting quickly and inexpensively.”

In recognition of the need to refine this emerging delivery system before pressing it into widespread use, the Mayo Clinic website states, “Although drones hold great promise for medical product transport, the field is still in its infancy. Risks need to be carefully assessed, including the potential hazards of thousands of small aircraft[s] flying, literally, under the radar. Coolers would be required to keep blood products at the proper temperature, and blood would need to be packaged to prevent inadvertent exposure or tampering during transit. Still, these obstacles aren’t insurmountable, and with Google, Amazon and several startups testing drone prototypes at warp speed, commercial UAV transport seems inevitable.”

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