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Table of Contents
APPLICATION OF TECHNICAL ADVANCES
Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 61-65

Use of drones (unmanned aerial vehicles) for supporting emergency medical services in India


Department of Emergency Medicine, Apollo Hospitals, Hyderabad, Telangana, India

Date of Web Publication11-Mar-2019

Correspondence Address:
Imron Subhan
Department of Emergency Medicine, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_79_18

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  Abstract 


Background: Drone technology or correctly termed as unmanned aerial vehicles (UAVs) is the newest advancement of science which has taken the world by storm. India is yet to witness the fantastic work these exciting flying vehicles can do. There are innumerable applications within the domain of both private and public space, especially in health care and emergency medical response. Aerial professional drones are small, portable, and have advanced capabilities which include audio-video broadcast, GPS navigation capabilities, fully automated and predetermined flights, and use of artificial intelligence for decision-making. Methodology: A toy drone bought from an online retailer was fitted with a professional camera connected to portable tablet through WiFi. Two emergency physicians were trained to operate the drone and camera in a simulated disaster scenario, cardiac arrest scenario, as well as transportation of medicines and biological samples within the hospital. Proof of concept for three different applications of drone technology in emergency care was experimented. Observations: (1) Drone as the first response in disaster: The drone was able to fly unhindered, hover over the accident location, and relay details of the crash site, including type of accident, hazards present, number of injured victims, roads leading to/from the location, and the number of bystanders present. (2) Supervision of patient transfers in disaster: The drone was able to send live video feed continuously as each patient was being evacuated. The drone pilots were in constant touch with disaster command and control. (3) Cordoning the disaster site: Based on the drone video feed, the ingress/egress routes for the ambulance vehicles were identified and secured. (4) Basic life support: The drone was able to provide live views of arrest scenarios, get live visuals from the site to the copilot and helped in guiding the first responder for cardiopulmonary resuscitation in a victim of cardiac arrest. (5) Transport of samples: The drone was able to transport samples for the stroke patient from the emergency room to the laboratory in the hospital without any hindrance. (6) Intrahospital transport of medicines: The drones were also able to carry medicines from the inpatient pharmacy to the wards, which were immediate, effective, and with reduction in workforce. Conclusion: This project was clear example of seamless integration of flying drones into existing disaster response protocols. Drones can provide real-time video information about disaster/accident site to the disaster command and control. Drones can supervise the transfer of individual victims from the disaster zone. Emergency physicians can learn to fly drones and use them for supporting emergency medical services disaster response. The DGCA should facilitate the utilization of drones and UAVs for supporting emergency medical personnel when they respond to disasters (natural, chemical, biological, radiation, and nuclear), multicasualty incidents, road accidents, cardiac arrest victims, in hospital use for transport of medicines, samples, and out-of-hospital transport of organs for transplantation.

Keywords: Drones, drones in emergency medical services, emergency medical services, emergency medicine, unmanned aerial vehicle


How to cite this article:
Subhan I, Ghazi SS, Nabi S. Use of drones (unmanned aerial vehicles) for supporting emergency medical services in India. Apollo Med 2019;16:61-5

How to cite this URL:
Subhan I, Ghazi SS, Nabi S. Use of drones (unmanned aerial vehicles) for supporting emergency medical services in India. Apollo Med [serial online] 2019 [cited 2019 Mar 22];16:61-5. Available from: http://www.apollomedicine.org/text.asp?2019/16/1/61/253872




  Introduction Top


Drones are unmanned combat aerial vehicles, also known as pilotless aircrafts with camera and GPS tracking, is the newest advancement of science which has taken the world by storm. They are widely used by the military and paramilitary forces. The recent wars have seen an increase in the use of drone strikes against the targets.

Aerial professional drones are small, portable, and have advanced capabilities which include audio-video broadcast and GPS navigation capabilities, fully automated and predetermined flights, and use of artificial intelligence for decision-making.

India is yet to witness the fantastic work these exciting flying vehicles can do. There are innumerable applications within the domain of both private and public space, especially in health care and emergency medical response.

The significantly expanding health-care industry in India can be benefited extensively by the use of drones, specifically in the field of emergency medicine, to guide and provide immediate response and treatment, in situations such as prehospital care, multicasualty incidents such as road accidents, chemical, and nuclear disasters.[1] Drones can also be used for inter and intrahospital transportation of investigation samples, medications between laboratory and wards, pharmacy and wards, and much more. Drones can even be helpful for transporting live human organs during transplantations from one place to other, thereby saving time and organ.

The common use of drones in acute emergency care includes disaster scene assessment, wherein other means of assessment are severely impaired and restricted; the roads might be blocked; the phones might not work; providing food and medicines aid packages; providing vaccines, medicines, and other medical supplies to remote areas within minutes; and providing rapid access to automated external defibrillators (AEDs) for patients in cardiac arrest.

In the West, drones have been used in situations of cardiac arrest,[2] to provide better prehospital care through operator-led-cardiopulmonary resuscitation (CPR), wherein a drone equipped with AED and other necessary equipment along with microphone and speaker to give orders to the rescuer have been dispatched to the location after receiving input by emergency medical services (EMS). This basically involves the bystander getting instructions over the phone from the 911 operators. The operator relies on visual feedback from the drone to assess how the CPR is proceeding. The advantage being better chances of survival since medical equipment is delivered to the bystander and CPR is already started by the bystander before EMS arrives at the scene.

In India, there is very little chance of survival for a victim in cardiac arrest outside the hospital. Majority of the bystanders hesitate to intervene not only due to lack of training in CPR but also due to fear of doing something wrong to the victim.

Integrating technology into this process is the next step in the evolution of bystander CPR. With the newest technology advancements, the ease of flying and remotely controlling a drone, combined with the ease of mounting audio-video communication systems, potentially has many applications in the field of emergency prehospital care, especially in bystander-led CPR.

Drones can help reduce the time from planning till implementation of a particular medical service; it also reduces the workforce requirement.

It may also be capable of playing a fair role in providing health-care guidance in remote areas and villages using telemedicine technology.


  Drone Regulations in India Top


In India, Directorate General of Civil Aviation (DGCA) overlooks all the flying of objects and aircrafts in Indian air space, and hence, it controls the use of drones in the country. Back in 2014, it has banned the use of drones, due to lack of regulations and safety,[3] but permission and licensing were considered by DGCA after seeking request for aerial photography/remote sensing survey. In 2016, the DGCA released specific guidelines to fly a drone provided it was registered under an individual or an organization, and each drone will be given a unique identity number after fulfilling the criteria based on the purpose.[4] As of December 2017 regulations from DGCA, approval for flying drones is being granted with a prior intimation and application to DGCA.[5]

Along with the benefits of flying a drone, as with a machine, there are a few risk factors too which can be minimized by adequate training and regular maintenance.


  Technology Used for Project Top


Since import and use of professional drones were restricted in India by the DGCA, we decided to buy a toy drone from an online seller within India. A toy Quadcopter Drone Syma X8W [Figure 1] and [Figure 2], which had a maximum range of 70 feet along with maximum flight time of 8 min, was used for the project. The drone supplied camera was removed and replaced with a heavier GoPro Hero4 Silver Edition camera to record high definition video (1080p) and audio, as well transmit it in real time through secure WiFi. An emergency physician (pilot) was designated to fly the quadcopter through direct line of sight and after about 30 h of training. A second emergency physician (co-pilot) was designated to control the attached camera through the GoPro app installed on an Apple iPad [Figure 3].
Figure 1: Apollo Emergency Response Drone in Flight

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Figure 2: Apollo Emergency Response Drone parked on landing platform

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Figure 3: Co-pilot's receives live video from drone camera

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  Proof of Concept Applications Top


Drones used in

  1. Disaster
  2. Life support
  3. Intrahospital transportation of blood samples and medicines.


Considering the various extraordinary benefits of a drone in medical field, the emergency department at Apollo Hospitals, Hyderabad, is one of the first in the region and country, to experiment the use of drone in acute medical emergency in a disaster drill and has used drones to assist CPR in a simulated scenario.

Drones for coordinating disaster response

A disaster drill was conducted as a routine exercise on October 24, 2017, at Apollo Health City, Hyderabad.

We simulated a bus accident scenario inside our hospital premises, where 17 victims were scattered at the disaster site. Fourteen volunteers and three manikins were used as victims and they are categorized into different priorities. The pilot was tasked with only flying the drone. The co-pilot was responsible for the operation of the drone camera and to communicate with disaster command and control.

Observations

Drone as first responder

In a real situation, the crowds and public vehicles would immediately prevent access to ambulances, especially in areas with high density of traffic and people. Our drone was able to fly unhindered, hover over the accident location [Figure 4]a and [Figure 4]b, and relay details of the crash site, including type of accident, hazards present, number of injured victims, roads leading to/from the location, the number of bystanders present, etc. Disaster command received this information first from the drone.
Figure 4: (a) Drone hovering over disaster site. (b) Drone supervising a victim transfer

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Supervision of patient transfers

The drone was able to send live video feed [Figure 5]a continuously as each patient was being evacuated. Our drone pilots, who were emergency doctors, were in constant touch with disaster command and control. Victims who were at the edge of the disaster site and not noticed were informed to the medical teams through their cell phones [Figure 5]b.
Figure 5: (a) View of Disaster Site from Drone Camera. (b) Supervision of Victims via Drone Camera

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Cordoning the disaster site

Based on the drone video feed, the ingress/egress routes for the ambulance vehicles were cordoned off with the help of security, through disaster command.

Drone-assisted cardiopulmonary resuscitation

To test drone-directed CPR, we decided to simulate a cardiac arrest victim. An unconscious choking victim in cardiac arrest was simulated in an open area using a Laerdal Resusci Anne manikin. The hospital ambulance service was activated by a nonhealth-care volunteer who called our EMS call center from his mobile phone. The drone was preplanned to reach the victim first, as this would be the case in a real scenario.

Observations

Emergency medical services activation

As soon as the ambulance call center received the call, the drone pilots were notified of the location and an ambulance dispatched. The mobile number of the volunteer was sent to the drone co-pilot. The drone took off, approached the designated location, and hovered in front of the victim. The pilot was tasked with only flying the drone. As soon as the scene came into view on the iPad screen, the co-pilot contacted the volunteer on his mobile and advised to begin the steps of CPR.

Hands-only cardiopulmonary resuscitation

The volunteer was able to switch his phone to loudspeaker and started chest compressions after listening to a short explanation from the co-pilot. He was able to deliver hands-only CPR for about 3 min under the direct supervision of the drone co-pilot (who was a certified AHA BLS Instructor). In the simulated scenario, the volunteer's hand position was incorrect and rate of compression was low, this was subsequently corrected – this would not have been possible otherwise or with just a mobile phone directed CPR. In addition, the volunteer had no hesitation in starting CPR after realizing that the supervising doctor could actually see him through the drone camera.

Basic life support

The drone continued to supervise the resuscitation, as two doctors arrived on scene to take over from the volunteer [Figure 6]. Basic life support was started by them using bag-mask ventilation. In the simulated scenario, the doctors faced a problem with the bag-mask [Figure 7]a and [Figure 7]b and they did not have a defibrillator. The co-pilot, after looking at the doctor, was able to inform the ambulance team to be prepared with a bag-mask immediately. Professional drones can carry a portable defibrillator which would be immediately accessible to the doctors.
Figure 6: Basic life support for Cardiac Arrest Victim

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Figure 7: (a) Drone hovering over victim. (b) View from drone camera

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Drones for transport and delivery

The drone was tested to transport the blood samples of acute stroke patient from the Emergency Room of Apollo Hospitals to the laboratory for immediate testing so that the blood results can be reported immediately to proceed with thrombolysis [Figure 8].
Figure 8: Drone carrying blood samples to laboratory from emergency room within the hospital

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The drone was also tested for transportation of medicines from the inpatient pharmacy of the hospital to the wards after the medicine was indented by the nurse [Figure 9].
Figure 9: Drone carrying Medicines from IP pharmacy to the ward

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Observations

In both the scenarios, it was observed that the drone was able to pass through the designated separate flight corridor saving the workforce and time hence by contributing toward a better patient care.


  Conclusion Top


Our project was clear example of seamless integration of flying drones into our existing disaster response protocols. Drones can provide real-time video information about disaster/accident site to the disaster command and control. Drones can supervise the transfer of individual victims from the disaster zone. Emergency physicians can learn to fly drones and use them for supporting EMS disaster response.

A flying drone can participate in initiating bystander CPR in those who are not trained. It can monitor quality of chest compression and allow the drone operator to suggest improvements. It can provide real-time information about the victim's environment and progress of resuscitation to both the EMS call center and the ambulance team. Emergency physicians can learn to fly drones and use them for supporting out-of-hospital cardiac arrest resuscitation.

Recommendation and additional application

The DGCA should facilitate the utilization of drones and UAVs for supporting emergency medical personnel, to take care of road accident and cardiac arrest victims without any restrictions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Claesson A, Fredman D, Svensson L, Ringh M, Hollenberg J, Nordberg P, et al. Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest. Scand J of Trauma Resusc and Emerg Med 2016;24:124.  Back to cited text no. 1
    
2.
Balasingam M. Drones in Medicine – The rise of the machines. Int Journal of Clin Pract 2017;71. Doi: 10.1111/ijcp.12989.  Back to cited text no. 2
    
3.
DGCA, GOI, Use of Unmanned Aerial Vehicle (UAV)/Unmanned Aircraft Systems (UAS) for Civil Applications 2014. Available from: http://dgca.nic.in/public_notice/PN_UAS.pdf. [Last accessed on 2014 Oct 07].  Back to cited text no. 3
    
4.
DGCA, GOI, Guidelines for obtaining Unique Identification Number (UIN) and Operation of Civil Unmanned Aircraft System (UAS) 2016. Available from: http://dgca.nic.in/misc/draft%20circular/AT_Circular%20-%20Civil_UAS(Draft%20April%202016).pdf. [Last accessed on 2016 Apr 21].  Back to cited text no. 4
    
5.
DGCA, GOI, Draft Regulation of CAR on Civil Use of Drones Announced 2017. Available from: http://pib.nic.in/newsite/PrintRelease.aspx?relid=173164. [Last accessed on 2017 Nov 02].  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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Abstract
Introduction
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