What if drones could save lives? While they were originally developed for military purposes, aerial drones are now being used for blood deliveries that can save rather than take lives.

A fix-winged drone, known as a Zip, takes off like a shot from a droneport in Rwanda in East Africa with a life-saving cargo.

The Zip, traveling at speeds of up to 60 miles per hour and using GPS for guidance, flies over washed-out roads and heads straight for a remote hospital in the mountains. The drone arrives in about 20 minutes and parachutes a blood bag to transfuse a woman who was bleeding after giving birth.

In the past, such bleeding often led to death. Now, lives are being saved thanks to the Zip. Currently available in western Rwanda, service to the eastern half of the country is expected to begin later in 2017 or early 2018, according to Justin Hamilton, spokesperson for Zipline, the Half Moon Bay, California startup that developed the service.
Local health workers request specific types of blood via text message, phone or on the company website. Zipline’s fleet of 15 drones can make 50 to 150 deliveries per day.

From Bomb to Blood Delivery

Zipline launched in 2014, backed by Sequoia Partners and Google Ventures, with funding from Paul Allen, a Microsoft co-founder. The Rwanda service began in the summer of 2016.

Drones were developed as weapons to drop bombs. Now they’re delivering supplies to saves lives in urban centers and isolated rural areas, regardless of weather.

Aidan O’Leary, a drone technology expert with PureFunds, a New York City-based research firm, explains the potential positive impacts of delivering blood and medical equipment by drone to hospitals and emergency rooms.

For instance, the quality of medical care may be increased, as drones can fly to remote destinations or through congested cities. Also, drones can carry rare antidotes or antibiotics or blood types, and they also have the ability to send organs or other lifesaving supplies both day and night.

Dr. Brian Burns, a drone advocate and emergency medecine doctor, is preparing to launch a proof-of-concept pilot for blood product delivery to accident scenes in rural New South Wales, Australia. He said drones have great potential in areas with vast spaces such as Australia and the United States.

[Drones] will increase equity in care and mitigate the tyranny of distance.

He also said drones can streamline delivery of medical supplies while reducing the risk to those who must bring drugs, blood products and vaccines to war zones or areas beset by epidemics or geopolitical disruption.

An Inspiring Idea

Courtesy of Zipline

Zipline is the first drone delivery service of its kind, but more are likely to follow as the potential of drones for peaceful purposes, especially emergency and disaster medicine, is proven. The company plans to deploy its service in remote regions of the developed world, as well as in underdeveloped countries.

Keller Rinaudo, Zipline founder and CEO, said the White House approached him to discuss the possibility of using the system in rural parts of the United States, including Maryland, Nevada, Washington, and on Native American reservations.

Dr. Burns noted that half of all trauma deaths occur in the first hour, and 90% of preventable trauma deaths result from bleeding. This means faster blood delivery can save lives.

Blood products are the currency that allow these patients to stay alive for longer until definitive hemorrhage control is achieved.

Traffic-clogged urban freeways also pose problems for emergency services. But drones just fly over surface congestion to deliver medical equipment and supplies. Swiss researchers demonstrated that a drone could fly over snow-blocked roads to deliver lab specimens in both urban and remote rural areas.

Ticino EOC, an eight-hospital medical group in Lugano, worked with Swiss Post and drone maker Matternet of Menlo Park, California. Drones successfully carried and airdropped laboratory samples between two of the company’s hospitals. The Swiss Federal Office for Civil Aviation has cleared the drones to fly at any time of the day.

Matternet’s M2 drone is a quadcopter that can carry parcels of up to 4.4 pounds (2 kilograms). It flies at 22 miles per hour (35 km/h) at 164 to 328 feet (50 to 100 meters) above the ground. It can travel 12 miles (19 kilometers) on a single battery charge.

Faster than Ambulances

Courtesy of Matternet

Researchers from Sweden’s Karolinska Institute reported in the Journal of the American Medical Association that a drone could deliver a defibrillator to an emergency scene more quickly than an ambulance.

The test dispatched drones from a rural fire station outside Stockholm to locations where cardiac arrests had occurred over the previous eight years. The median delivery of defibs by drone was less than five and a half minutes versus 22 minutes via ambulance. Presumably, bystanders would follow simple directions to jolt the patient’s heart back into action. Every lost minute decreases the odds of survival by 10%.

Zipline notes that inclement weather won’t stop its drones. But local regulations can hamper use. Drone expert O’Leary said that differing national rules complicate roll-out, especially for companies interested in serving multiple countries. For example, the U.S. Federal Aviation Administration requires drone pilots to maintain line-of-sight contact. An exemption would be required to operate such drone services in the United States. O’Leary also warned of the possibility of a massive cybersecurity attack against drones.

We don’t yet understand the implications of a lack of cybersecurity on driverless vehicles.

Zipline’s Hamilton said his company fared well in Rwanda.

We’re invited in by national governments to provide this service. So we work hand-in-hand with policy makers and regulators.

There also are technical challenges. Burns said limited battery power cuts drone range, but manufacturers are using electric car technology and solar batteries to improve performance. These constraints are being pushed further and further out, as drone companies continue to invest heavily into R&D.

Video laryngoscopy (VL) offers striking magnification for examining parts of the airway that are difficult to see with the naked eye. The technique is catching on in prehospital settings, to replace direct laryngoscopy (DL).

Dr. Marvin Wayne is medical director of Whatcom County Medic One, which provides paramedic services in and around Bellingham, Washington.

When you are working on the roadside, in a ditch or helicopter […] usual intubation becomes unusual and video laryngoscopy is better than direct laryngoscopy. Direct laryngoscopy is a dinosaur in search of a tarpit.

VL vs. DL

What wows Wayne are the dynamic, real-time views of the entire throat, superb on-screen magnification, video recording and customization permitting intubation of everyone from newborns to the morbidly obese.

Video laryngoscopy got its start in the operating theater, gaining favor with prehospital and emergency medical services only recently. Initially, VL was proposed for predictably difficult airways. But many paramedics have pushed for more widespread use because of its advanced technological capabilities, performance in difficult situations and excellence for teaching.

Studies of first-pass success comparing video to direct laryngoscopy abound. Many demonstrate that VL offers more successful intubation and that practitioners improve with experience.

Jeff Jarvis, medical director of the Williamson County EMS Services in Texas told Medical Expo e-magazine that he has been working hard to improve VL quality. In the training sessions he led, baseline VL intubation success rates were between 43% and 70%. After training, the rates climbed to 90% or higher, on a par with academic medicine.

David Olvera, clinical education manager at Air Methods in Aurora, Colorado said:

Within my own company, our success rates with video have gone up. This really should be front-line medicine in the prehospital industry.

A 2016 Cochrane Library review of the evidence concluded that “video laryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway.”

When Doubt Arises

But the review did not necessarily reassure manufacturers. The reviewers concluded that the evidence does not show that VL lowers the incidence of hypoxia or time required for intubation. Dr. Jarrod Mosier, associate professor of emergency medicine at the University of Arizona in Tucson, told Medical Expo magazine:

What we know now is that video is at least as good as direct laryngoscopy most of the time—and sometimes it can be better.

Medic One’s Dr. Wayne also admits that direct laryngoscopy is sometimes just as good, but that “When you see better, more and can record what you do, you want to use it.”

Choice of VL for emergency medical services will depend on personal preference, up-front and recurring costs.

A Tour of the Market

The following are among the video laryngoscopes currently on the market:

• The King Vision® video laryngoscope by Ambu uses three AAA alkaline batteries. It features three disposable, channeled blades, one standard disposable blade and a new pediatric blade. The blades are hyperangulated (more info on MedicalExpo.com).

• GlideScope® by Verathon has a low-profile blade with 60-degree curvature. The hyperangulation helps visualize the glottis in difficult airways, but it requires a specially designed rigid stylet to advance the tracheal tube to the laryngeal inlet. Company product manager Bob Ingram maintained that “The low-profile blades occupy less space in the mouth and make it more comfortable for the patient.” GlideScope also has MAC-style blades, single-use and reusable blades. It offers flexibility for use from neonates to large adults. (more info on MedicalExpo.com).

• Launched late 2016, Karl Storz Endoscopy’s C-MAC® Pocket Monitor features a 2.4” LCD monitor and power supply that can be attached to a wide range of blades, including adult and pediatric D-blade, MAC 4, 3 and 2, and Miller 2, 1 and 0. According to Michael Lyman, Storz director of sales and marketing, Airway Management, it also offers a monitor with two rotation axes, rechargeable Li-ion batteries and an exchangeable battery pack.