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Could Drone Delivery Save Time And Lives?

By Paul Nicolaus

July 17, 2018 | In recent years, unmanned aerial vehicles have been used for everything from shooting movie footage to keeping an eye on endangered wildlife populations. There have also been signs, though, that drones could be put to good use in healthcare by speeding along the transportation of medical samples and supplies.

One example can be found in Switzerland, where hospital medical group Ticino EOC has collaborated with the country’s postal service and Menlo Park, California-based transportation technology manufacturer Matternet to carry blood and pathology samples between two hospitals in the city of Lugano.

In other instances, drones are flying into some of the world’s most remote and difficult-to-reach destinations. In late 2016, Half Moon Bay, California-based Zipline announced plans to launch a drone delivery operation in Rwanda to deliver blood and other emergency supplies to over twenty hospitals across the western half of the country. In the summer of 2017, the company revealed intentions to work with the government of Tanzania to provide blood transfusion supplies, emergency vaccines, HIV medications, antibiotics, surgical supplies, and more.

Since inception, Zipline has flown over 300,000 km and delivered roughly 7,000 units of blood over 4,000 flights in Rwanda, according to an April statement. And in Tanzania, the scale of the operation allows for up to 2,000 deliveries every day to over 1,000 health facilities. Now, the company is in the midst of standing up a second distribution center in Rwanda and four more in Tanzania.

The process begins when health care workers enter orders using text messaging. The supplies are loaded into a box with a parachute and put onto an autonomous plane. The deliveries occur when the drones descend close to the ground and drop the supplies to a designated spot near the health centers—typically in 30 minutes or less.

Along the way, these types of efforts are beginning to demonstrate the potential for speeding along the delivery of medical supplies and samples by soaring above snow-covered streets or reaching remote regions that lack roadways.

When he considers the landscape as a whole, Timothy Amukele, a pathologist at Johns Hopkins University School of Medicine, believes the most significant work to date has been carried out by Zipline and says the company has begun to reveal what the future might look like. *Editor’s Note: Amukele will be discussing this very topic at the 2018 Next Generation Dx Summit in Washington, DC.

And yet Amukele, who has studied healthcare-related drone delivery in recent years, pointed out that the technology isn’t where it needs to be just yet. Zipline’s drones take off and land at a distribution center, which avoids the need for additional infrastructure at the clinics served. But there are limitations to this sort of one-way delivery system that sidesteps landings.

“If you happen to be in this village and you happen to need a blood product to go into your vein but nothing else, then that works,” he explained. “But if you happen to be in the same village and you have a fever and you need to be tested so they know why you have a fever, then the system doesn’t work for you because there’s no way to get your sample on the drone.”

Lessons Learned

Amukele and colleagues have been researching the logistics of drone-delivered healthcare. How does drone flight impact samples? Does motion or temperature in flight compromise test results? At what limits? But even these questions are merely the beginning. “It’s been good work, but we’re not where we need to be,” he said. “We have answered questions about sample stability on a drone, but we haven’t implemented it. And so that’s what I’m working on is the next phase.”

This research direction, as Amukele pointed out, wasn’t his bright idea to begin with. It all stems from a question posed by one of his medical students about the possibility of using drones to deliver medications in India. When he thought of what people really needed there were plenty of other things that came to mind—clean water, for example, or bicycles to get around—but not drones. At the time, he couldn’t envision it.

He agreed to meet with that student, though, and in preparation for their talk he researched drones. The experience helped Amukele realize that the price points might just make sense, and he encouraged the student, if he really wanted to look into the possibility, to begin with a validation study. Unsure how to go about that process, the student asked Amukele to join in.

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The first study (doi: 10.1371/journal.pone.0134020) looked at commonly-used healthcare testing to see if drone flights would impact results. Half of the 336 total samples were driven to a flight field and held stationary, while the other half were flown for times ranging from 6 to 38 minutes. Following the flight, 33 chemistry, hematology, and coagulation tests were performed, and the results from flown and stationary sample pairs were similar across the board. Although the flight resulted in slightly reduced precision for some analytes, the researchers concluded that drone transport did not impact test accuracy.

They repeated the same type of study while looking at microbiological specimens to gain a sense of the impact on tests important to people who have infections. Blood and sputum culture specimens were seeded with pathogens and flown for roughly 30 minutes. The findings (doi: 10.1128/JCM.01204-16) indicated that factors such as the times to recovery, colony counts, and morphologies were all comparable between the flown and stationary specimens for all of the microbes examined.

A look at biologics made from human blood came back with similar outcomes. Six leukoreduced red blood cell (RBC) and six apheresis platelet (PLT) units were split, and the larger parent RBC and PLT units, as well as six unthawed plasma units frozen within 24 hours of collection (FP24), were put in a cooler, attached to a drone, and flown for stretches lasting up to 26.5 minutes. The results (doi: 10.1111/trf.13900) revealed that there was no adverse impact on the RBC, PLT, or FP24 units.

The most recently published study (doi: 10.1093/ajcp/aqx090), Amukele said, upped the ante. After their initial work began to attract some publicity, calls rolled in from people interested in the possibility of using drones. But in most cases, there was interest in flying them greater distances. “So we realized we had to test and see if the samples would be stable under much longer flights,” he said.

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Using 84 samples from 21 adult volunteers, the researchers held half of those samples stationary, while the others were flown for 3 hours in a cooling box attached to the drone. Following the flight, 19 chemistry and hematology tests were performed. This time around, it did affect the some of the results, Amukele explained. “What we’ve learned so far is that drones can work for the transport of medical samples,” he said, “as long as the flights are not too long and the environment is well-controlled.”

Coast to Coast Collaboration

The next step, Amukele said, is to move beyond the experiments and move samples from actual clinics to real-life laboratories. Some of this ongoing research is taking place in southern Africa, but he’s also moving forward with an early-stage collaborative project in the U.S.

Before he landed on the east coast at Johns Hopkins, Amukele’s residency took place at the University of Washington Medical Center, and since that time he has remained in contact with Geoff Baird, interim chair and associate professor of laboratory medicine at the University of Washington in Seattle.

“I am a drone hobbyist,” Baird said, “with multiple remote control flying toys and one quadricopter that I enjoy.” While he acknowledges that he is no expert in drone technology, Baird did point out that he is a potential end user.

“People want three things in a laboratory test,” he explained. They want it to be fast, they want it to be cheap, and they want it to be accurate. “And it’s really difficult with our current technology to get you any more than two of those things.”

It is more economical to handle laboratory testing in a centralized environment, Baird explained. It is less expensive, more accurate, and easier to control quality than at the point of care. But using a central lab typically means compromising on speed because of the transportation and related wait time.

Drone transport provides an opportunity to take advantage of a central lab’s accuracy and economy of scale without waiting for courier routes. “That’s why I’m so interested in this type of technology,” he said, “because it allows us to take the type of quality that we get from a central location and spread it out into the community.”

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“The other reason why I am so enthusiastic about it is it just seems to me that the technology matches perfectly with the need,” he added. In the lab, there are a variety of items that are small and don’t weigh much—tubes of blood, specimens, tissue biopsies, urine, and fluids—that are “incredibly high value.”

From his vantage point, the combination of unmanned aircraft and these types of medical materials is a match that makes sense from an economic, clinical, and technological standpoint. One of the big remaining roadblocks in the United States relates to the existing regulatory environment.

Zipline’s progress in other parts of the world is due, at least in part, to the flexibility of other governments in this regard. While some raise concerns ranging from safety and security risks to privacy and public nuisance issues, others are envisioning the use of drones to better serve Native American reservations, other rural portions of the US, and even urban settings hampered by heavy traffic.

Amid the ongoing debate between drone critics and enthusiasts, the Federal Aviation Administration (FAA)—the agency charged with keeping the US national airspace safe—has taken a step in the direction of accelerating the integration of drones into the national airspace by encouraging experimentation with business models and approaches through its new Unmanned Aircraft System (UAS) Integration Pilot Program (IPP).

Zipline has found itself among the entities involved in a North Carolina Department of Transportation (NCDOT) project selected as one of the 10 winning proposals. NCDOT’s proposal is geared toward working with drone delivery companies currently operating overseas, like Zipline and Matternet, to create a network of medical distribution centers that could use unmanned aircraft to make medical deliveries.

Reno, Nevada-based Flirtey is another drone company that has been accepted into the IPP. Its focus has centered on battling cardiac arrest, the leading cause of natural death in America. For every minute that passes as a victim waits to receive a jolt of electricity from an automated external defibrillator (AED), the odds of survival dip by about 10%. While emergency response times for ambulances can vary, Flirtey’s hope is that the drone-based delivery of AEDs would enable bystanders to begin initiating care while waiting for paramedics to arrive on site.

Although a proposal submitted by Amukele and Baird was not selected as one of the approved IPP projects, they indicated plans to pursue it anyway. If successful, it could allow the University of Washington to better serve some of the islands in the Puget Sound area. Laboratory testing for the clinics on these islands is possible, but the turnaround time is lengthy because of reliance on ground transport and fixed-wing planes.

Future efforts will likely progress with a crawl, walk, run mentality. The crawl will be simply flying a drone off an island in the Puget Sound, Baird said, in order to replace a fixed-wing aircraft flight. Next, a slightly longer flight further down the Sound could be attempted. The eventual goal would be to create a drone network between Seattle and the clinic sites located in the San Juan Islands.

Diagnostic Possibilities

As the head of the clinical laboratory at Johns Hopkins Bayview Medical Center, Amukele’s focus is on diagnostics, and he believes this is the area where drones will ultimately make the biggest splash as opposed to the delivery of pharmaceuticals or the transport of medical supplies.

While any small, high-value item is a potential fit for drone delivery, medical samples taken from people for the sake of diagnoses are inherently unstable. Natural materials degrade, he explained, and because of this dynamic a lab is always caught up in a race against the clock. The ability to speed up the delivery of samples, then, could be a game-changer.

Baird, too, envisions a number of diagnostic applications. The diagnostic tools available at a small community hospital, for example, are often different from those offered at a large academic medical center. But when drone technology is considered, Baird said, a diagnostic that isn’t practical or economical to install everywhere could conceivably be made available to all those places in a meaningful way.

There are situations where an infectious disease could be ruled in or out more quickly, he said, and therapy could be started or stopped more quickly as a result. Newborns are screened for levels of the jaundice-causing chemical bilirubin, which can imply that a baby is at a higher risk for injury and calls for a specific therapy. Drones could allow for faster test results and a faster initiation of therapy.

There are toxicology implications, too. Oftentimes, it isn’t economical to keep a full-service toxicology lab at every hospital because of the expense and expertise that goes into it, he explained, which means that there are outlying hospitals in a city that send items to a major toxicology center.

Baird runs the county hospital toxicology lab in Seattle, which receives testing from all over the county, and knows firsthand that it can take several hours to find out if an individual has been poisoned or determine what exactly a person has been poisoned with. In some cases, treatment is initiated based on reasoned guesswork because of the need to act fast. Improving the turnaround time on toxicology testing would enable physicians to make therapeutic decisions based on actual test results.

Paul Nicolaus is a freelance writer specializing in science, nature, and health. Learn more at www.nicolauswriting.com.