Delivery of Automated External Defibrillators (AED) by Drones: Implications for Emergency Cardiac Care
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Purpose of Review
Out-of-hospital cardiac arrest (OHCA) remains a significant health problem in the USA and only 8.6% of victims survive with good neurological function, despite advances in emergency cardiac care. The likelihood of OHCA survival decreases by 10% for every minute without resuscitation.
Automatic external defibrillators (AEDs) have the potential to save lives yet public access defibrillators are underutilized (< 2% of the time) because they are difficult to locate and rarely available in homes or residential areas, where the majority (70%) of OHCA occur. Even when AEDs are within close proximity (within 100 m), they are not used 40% of the time.
Unmanned aerial vehicles, or drones, have the potential to deliver AEDs to a bystander and augment emergency medical service (EMS) care. We review the use of drones in medicine, what is currently known, and clinical implications for advancing emergency cardiac care.
KeywordsSudden cardiac arrest Automatic external defibrillation Public access defibrillation Unmanned aerial vehicles Drones
Compliance with Ethical Standards
Conflict of Interest
The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through grant award numbers KL2TR002490 and UL1TR002489. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This is TraCS Pilot award grant no. UNCSUR31707.
Human and Animal Rights and Informed Consent
This article does not contain any studies with animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 4.Daya MR, Schmicker RH, Zive DM, Rea TD, Nichol G, Buick JE, et al. Out-of-hospital cardiac arrest survival improving over time: results from the resuscitation outcomes consortium (ROC). Resuscitation. 2015;91:108–15. https://doi.org/10.1016/j.resuscitation.2015.02.003.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S315–67. https://doi.org/10.1161/cir.0000000000000252.CrossRefPubMedGoogle Scholar
- 13.Smith CM, Lim Choi Keung SN, Khan MO, Arvanitis TN, Fothergill R, Hartley-Sharpe C, et al. Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review. Eur Heart J Qual Care Clin Outcomes. 2017;3(4):264–73. https://doi.org/10.1093/ehjqcco/qcx023.CrossRefPubMedGoogle Scholar
- 14.Malta Hansen C, Kragholm K, Pearson DA, Tyson C, Monk L, Myers B, et al. Association of bystander and first-responder Intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA. 2015;314(3):255–64. https://doi.org/10.1001/jama.2015.7938.CrossRefPubMedGoogle Scholar
- 15.Van de Voorde P, Gautama S, Momont A, Ionescu CM, De Paepe P, Fraeyman N. The drone ambulance [A-UAS]: golden bullet or just a blank? Resuscitation. 2017;116:46–8. https://doi.org/10.1016/j.resuscitation.2017.04.037.CrossRefPubMedGoogle Scholar
- 16.• Claesson A, Bäckman A, Ringh M, et al. Time to delivery of an automated external defibrillator using a drone for simulated out-of-hospital cardiac arrests vs emergency medical services. JAMA. 2017;317(22):2332–4. https://doi.org/10.1001/jama.2017.3957. The purpose of this pilot study was to compare delivery times of autonomous flying drones equipped with AEDs versus EMS in simulated OHCA. Investigators conducted eighteen flights to test the feasibility of autonomous drones equipped with AEDs and concluded it was feasible to fly drones equipped with AEDs in out-of-sight flights. CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Hart A, Chai PR, Griswold MK, Lai JT, Boyer EW, Broach J. Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management. Am J Disaster Med. 2017;12(4):261–5. https://doi.org/10.5055/ajdm.2017.0279.CrossRefPubMedGoogle Scholar
- 20.• Bhatt K, Pourmand A, Sikka N. Targeted applications of unmanned aerial vehicles (drones) in telemedicine. Telemed J E Health. 2018; https://doi.org/10.1089/tmj.2017.0289. This comprehensive review identified UAV application in medicine in three categories: prehospital emergency care, expediting laboratory diagnostic testing, and surveillance. Authors concluded that UAVs have the potential to both access and quality of healthcare for patients otherwise restricted due to cost, distance, or infrastructure.
- 21.• Boutilier JJ, Brooks SC, Janmohamed A, Byers A, Buick JE, Zhan C, et al. Optimizing a drone network to deliver automated external defibrillators. Circulation. 2017; https://doi.org/10.1161/circulationaha.116.026318. Investigators describe a hypothestical drone network based on mathematical modeling designed to reduce time to AED arrival. Their primary analysis quantified the drone network size required to deliver an AED in one, two, or three minute faster than historical median 911 times across Toronto regions. CrossRefPubMedPubMedCentralGoogle Scholar
- 23.• Pulver A, Wei R, Mann C. Locating AED enabled medical drones to enhance cardiac arrest response times. Prehosp Emerg Care. 2016;20(3):378–89. https://doi.org/10.3109/10903127.2015.1115932. Investigators developed a geographical approach using drones equipped with AEDs. Their goal was to have one drone on scene within one minute for at least 90% of the demand while minimizing implementation costs. Maximum Coverage Location Problem model was used to determine the best configuration of drones to increase service. Using a combination of current EMS sites and new locations to launch drones equipped with AEDs would result in 90.3% of demand being reached within a minute. CrossRefPubMedGoogle Scholar
- 25.Fukushima H, Panczyk M, Spaite DW, Chikani V, Dameff C, Hu C, et al. Barriers to telephone cardiopulmonary resuscitation in public and residential locations. Resuscitation. 2016;109:116–20. https://doi.org/10.1016/j.resuscitation.2016.07.241.CrossRefPubMedGoogle Scholar
- 26.Transportation USDo. Federal Aviation Administration. Getting started. 2018. https://www.faa.gov/uas/getting_started/. Accessed 7 Aug 2018.