Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest

Out-of-Hospital Cardiac Arrest in the Eye of the Beholder and Emergency Medical Service

Purpose

Out-of-hospital cardiac arrest (OHCA) remains a global healthcare problem, with low survival and bystander cardiopulmonary resuscitation (CPR) rates. This study aimed to identify event-related factors in OHCA and their impact on return of spontaneous circulation (ROSC) achievement and maintenance until hospital admission.

Patients and Methods

All data were collected from Utstein Resuscitation Registry Template for OHCA from The Institute of Emergency Medicine of Zagreb from January 2012 to August 2022. This cross-sectional research analyzed 2839 Utstein reports, including 2001 male, 836 female, and 8 subjects of unknown gender. The average age was 65.4 ± 16.2 years.

Results

The most frequent place of collapse was private residence, and 27% of collapses were unwitnessed. Dispatcher-provided CPR instructions were provided in 39.7% of cases until the arrival of the emergency service team, which showed a very strong effect on bystander-provided CPR, and were followed in 68.4% of cases, while non-instructed bystander CPR was provided in only 7.9% of cases. Bystander CPR is more likely to be provided in public places than in private residences, often with both compression and ventilation. Bystander CPR was also more likely to be provided to men. Cases with bystander CPR, and compressions with ventilation compared to compression only CPR, showed a significantly greater success in maintaining ROSC later in CPR, both with moderate effects.

Conclusion

Bystander CPR has been shown to have a significant role in achieving and maintaining ROSC until hospital admission. However, our results showed a location-dependent nature of bystanders' willingness to perform CPR as well as sex disparities in patients receiving CPR. With deficient education in basic life support in Croatia, dispatchers need to insist on and instruct bystander CPR performance.

Challenges & barriers for real-time integration of drones in emergency cardiac care: Lessons from the United States, Sweden, & Canada

Importance

Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality in the US and Europe (∼600,000 incident events annually) and around the world (∼3.8 million). With every minute that passes without cardiopulmonary resuscitation or defibrillation, the probability of survival decreases by 10%. Preliminary studies suggest that uncrewed aircraft systems, also known as drones, can deliver automated external defibrillators (AEDs) to OHCA victims faster than ground transport and potentially save lives.

Objective

To date, the United States (US), Sweden, and Canada have made significant contributions to the knowledge base regarding AED-equipped drones. The purpose of this Special Communication is to explore the challenges and facilitators impacting the progress of AED-equipped drone integration into emergency medicine research and applications in the US, Sweden, and Canada. We also explore opportunities to propel this innovative and important research forward.

Evidence review

In this narrative review, we summarize the AED-drone research to date from the US, Sweden, and Canada, including the first drone-assisted delivery of an AED to an OHCA. Further, we compare the research environment, emergency medical systems, and aviation regulatory environment in each country as they apply to OHCA, AEDs, and drones. Finally, we provide recommendations for advancing research and implementation of AED-drone technology into emergency care.

Findings

The rates that drone technologies have been integrated into both research and real-life emergency care in each country varies considerably. Based on current research, there is significant potential in incorporating AED-equipped drones into the chain of survival for OHCA emergency response. Comparing the different environments and systems in each country revealed ways that each can serve as a facilitator or barrier to future AED-drone research.

Conclusions and relevance

The US, Sweden, and Canada each offers different challenges and opportunities in this field of research. Together, the international community can learn from one another to optimize integration of AED-equipped drones into emergency systems of care.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

Unmanned aerial vehicles and pre-hospital emergency medicine

Unmanned aerial vehicles (UAVs) are used in many industrial and commercial roles and have an increasing number of medical applications. This article reviews the characteristics of UAVs and their current applications in pre-hospital emergency medicine. The key roles are transport of equipment and medications and potentially passengers to or from a scene and the use of cameras to observe or communicate with remote scenes. The potential hazards of UAVs both deliberate or accidental are also discussed.

Drone a technological leap in health care delivery in distant and remote inaccessible areas: A narrative review

In developing countries, last-mile delivery of medical products is a challenge, especially in hilly and rural areas where there is no road connectivity. As helicopters or other air services are not affordable all the time, drones can be used for the supply of medical products. They are cost-effective as compared to other air or road transport. However, the carrying capacity of drone is less, it is not able to carry heavier payloads. Also, operating drones requires trained operators, and it is a new venture in a developing country so possibilities of confusion and lack of clarity on operating procedures are there. Drones are becoming increasingly reliable for the health care delivery. This narrative review explores the use of drones in healthcare delivery globally.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

The Latest in Resuscitation Research: Highlights From the 2022 American Heart Association's Resuscitation Science Symposium

BACKGROUND

Every year the American Heart Association's Resuscitation Science Symposium (ReSS) brings together a community of international resuscitation science researchers focused on advancing cardiac arrest care.

METHODS AND RESULTS

The American Heart Association's ReSS was held in Chicago, Illinois from November 4th to 6th, 2022. This annual narrative review summarizes ReSS programming, including awards, special sessions and scientific content organized by theme and plenary session.

CONCLUSIONS

By exploring both the science of resuscitation and important related topics including survivorship, disparities, and community-focused programs, this meeting provided important resuscitation updates.

Improving EMS response times for out-of-hospital cardiac arrest in urban areas using drone-like vertical take-off and landing air ambulances: An international, simulation-based cohort study

BACKGROUND

Advances in vertical take-off and landing (VTOL) technologies may enable drone-like crewed air ambulances to rapidly respond to out-of-hospital cardiac arrest (OHCA) in urban areas. We estimated the impact of incorporating VTOL air ambulances on OHCA response intervals in two large urban centres in France and Canada.

METHODS

We included adult OHCAs occurring between Jan. 2017-Dec. 2018 within Greater Paris in France and Metro Vancouver in Canada. Both regions utilize tiered OHCA response with basic (BLS)- and advanced life support (ALS)-capable units. We simulated incorporating 1-2 ALS-capable VTOL air ambulances dedicated to OHCA response in each study region, and computed time intervals from call reception by emergency medical services (EMS) to arrival of the: (1) first ALS unit ("call-to-ALS arrival interval"); and (2) first EMS unit ("call-to-first EMS arrival interval").

RESULTS

There were 6,217 OHCAs included during the study period (3,760 in Greater Paris and 2,457 in Metro Vancouver). Historical median call-to-ALS arrival intervals were 21 min [IQR 16-29] in Greater Paris and 12 min [IQR 9-17] in Metro Vancouver, while median call-to-first EMS arrival intervals were 11 min [IQR 8-14] and 7 min [IQR 5-8] respectively. Incorporating 1-2 VTOL air ambulances improved median call-to-ALS arrival intervals to 7-9 min and call-to-first EMS arrival intervals to 6-8 min in both study regions (all P < 0.001).

CONCLUSION

VTOL air ambulances dedicated to OHCA response may improve EMS response intervals, with substantial improvements in ALS response metrics.

Optimizing a Drone Network to Respond to Opioid Overdoses

Introduction:Effective out-of-hospital administration of naloxone in opioid overdoses is dependent on timely arrival of naloxone. Delays in emergency medical services (EMS) response time could potentially be overcome with drones to deliver naloxone efficiently to the scene for bystander use. Our objective was to evaluate a mathematical optimization simulation for geographical placement of drone bases in reducing response time to opioid overdose. Methods: Using retrospective data from a single EMS system from January 2016-February 2019, we created a geospatial drone-network model based on current technological specifications and potential base locations. Genetic optimization was then used to maximize county coverage by drones and the number of overdoses covered per drone base. From this model, we identified base locations that minimize response time and the number of drone bases required. Results: In a drone network model with 2,327 opioid overdoses, as the number of modeled drone bases increased the calculated response time decreased. In a geospatially optimized drone network with four drone bases, response time compared to ambulance arrival was reduced by 4 minutes 38 seconds and covered 64.2% of the county. Conclusion: In our analysis we found that in a mathematical model for geospatial optimization, implementing four drone bases could reduce response time of 9-1-1 calls for opioid overdoses. Therefore, drones could theoretically improve time to naloxone delivery.

Survey on Path Planning for UAVs in Healthcare Missions

This article presents a comprehensive review of the state-of-the-art applications and methodologies related to the use of unmanned aerial vehicles (UAVs) in the healthcare sector, with a particular focus on path planning. UAVs have gained remarkable attention in healthcare during the outbreak of COVID-19, and this study explores their potential as a viable option for medical transportation. The survey categorizes existing studies by mission type, challenges addressed, and performance metrics to provide a clearer picture of the path planning problems and potential directions for future research. It highlights the importance of addressing the path planning problem and the challenges that UAVs may face during their missions, including the UAV delivery range limitation, and discusses recent solutions in this field. The study concludes by encouraging researchers to conduct their studies in a realistic environment to reveal UAVs' real potential, usability, and feasibility in the healthcare domain.

Community Interventions for Out-of-Hospital Cardiac Arrest in Resource-Limited Settings: A Scoping Review Across Low, Middle, and High-Income Countries

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) is a major global health challenge, characterized by poor survival outcomes worldwide. Resource-limited settings are burdened with suboptimal emergency response and worse outcomes than high-resource areas. Engaging the community in the response to OHCA has the potential to improve outcomes, although an overview of community interventions in resource-limited settings has not been provided.

OBJECTIVE

This review evaluated the scope of community-based OHCA interventions in resource-limited settings.

METHODS

Literature searches in electronic databases (MEDLINE, EMBASE, Global Health, CINAHL, Cochrane Central Register of Controlled Clinical Trials) and grey literature sources were performed. Abstract screening, full-text review, and data extraction of eligible studies were conducted independently by two reviewers. The PCC (Population, Concept, and Context) framework was used to assess study eligibility. Studies that evaluated community-based interventions for laypeople (Population), targeting emergency response activation, cardiopulmonary resuscitation (CPR), or automated external defibrillator (AED) use (Concept) in resource-limited settings (Context) were included. Resource-limited settings were identified by financial pressures (low-income or lower-middle-income country, according to World Bank data on year of publication) or geographical factors (setting described using keywords indicative of geographical remoteness in upper-middle-income or high-income country).

RESULTS

Among 14,810 records identified from literature searches, 60 studies from 28 unique countries were included in this review. Studies were conducted in high-income (n = 35), upper-middle-income (n = 2), lower-middle-income (n = 22), and low-income countries (n = 1). Community interventions included bystander CPR and/or AED training (n = 34), community responder programs (n = 8), drone-delivered AED networks (n = 6), dispatcher-assisted CPR programs (n = 4), regional resuscitation campaigns (n = 3), public access defibrillation programs (n = 3), and crowdsourcing technologies (n = 2). CPR and/or AED training were the only interventions evaluated in low-income, lower-middle-income, and upper-middle-income countries.

CONCLUSIONS

Interventions aimed at improving the community response to OHCA in resource-limited settings differ globally. There is a lack of reported studies from low-income countries and certain continental regions, including South America, Africa, and Oceania. Evaluation of interventions other than CPR and/or AED training in low- and middle-income countries is needed to guide community emergency planning and health policies.

An unmanned emergency blood dispatch system based on an early prediction and fast delivery strategy: Design and development study

BACKGROUND AND OBJECTIVE

For severe trauma patients, hemorrhage is the most common cause of medically preventable deaths. Early transfusion is beneficial to major hemorrhagic patients. However, the early supply of emergency blood products for major hemorrhagic patients is still a major problem in many areas. The aim of this study was to design and develop an unmanned emergency blood dispatch system for the fast delivery of blood resources and rapid emergency response to trauma events, especially those with mass hemorrhagic trauma patients and those occurred in remote areas.

METHODS

Based on the process of emergency medical services for trauma patients, we introduced unmanned aerial vehicle (UAV) and designed the main flowchart of the dispatch system, which combines an emergency transfusion prediction model and UAV-related dispatch algorithms to improve first aid efficiency and quality. The system identifies patients in need of emergency transfusion through a multidimensional prediction model. Then, by analyzing the blood center, hospitals and UAV stations nearby, the system recommends the patient's transfer destination for emergency transfusion and dispatch schemes of UAVs and trucks for a fast supply of blood products. Simulation experiments of urban and rural scenarios were conducted to evaluate the proposed system.

RESULTS

The developed emergency transfusion prediction model of the proposed system achieves a higher AUROC value of 0.8453 than a classical transfusion prediction score. In the urban experiment, by adopting the proposed system, the average wait time per patient decreased from 32 to 18 min, and the total time decreased from 42 to 29 min. Owing to the combination of the prediction and the fast delivery function, the proposed system took 4 and 11 min less wait time than the strategy with only the prediction function and the strategy with only the fast delivery function, respectively. In the rural experiment, for trauma patients requiring an emergency transfusion at 4 locations, the wait time for transfusion under the proposed system was 16.54, 17.08, 38.70 and 46.00 min less than that under the conventional strategy. The health status-related score increased by 6.9%, 0.9%, 19.1% and 36.7%, respectively.

CONCLUSIONS

Experimental results demonstrate that the proposed system works well with a faster blood supply speed for severe hemorrhagic patients and better health status. With the assistance of the system, emergency doctors at the scene of an injury are able to comprehensively analyze patients' status and the surrounding rescue conditions and then make decisions, especially when encountering mass casualties or casualties in remote areas.

Characteristics of out-of-hospital cardiac arrest patients in Riyadh province, Saudi Arabia: a cross-sectional study

Introduction

Little work has been done on out-of-hospital cardiac arrest (OHCA) in Saudi Arabia. Our goal is to report the characteristics of OHCA patients and predictors of bystander cardiopulmonary resuscitation (CPR).

Materials and methods

This cross-sectional study utilized data from the Saudi Red Crescent Authority (SRCA), a governmental emergency medical service (EMS). A standardized data collection form based on the "Utstein-style" guidelines was developed. Data were retrieved from the electronic patient care reports that SRCA providers fill out for every case. OHCA cases that were attended by SRCA in Riyadh province between June 1st, 2020 and May 31st, 2021 were included. Multivariate regression analysis was performed to assess independent predictors of bystander CPR.

Results

A total of 1,023 OHCA cases were included. The mean age was 57.2 (±22.6). 95.7% (979/1,023) of cases were adults and 65.2% (667/1,023) were males. Home was the most common location of OHCA [784/1,011 (77.5%)]. The initial recorded rhythm was shockable in 131/742 (17.7%). The EMS mean response time was 15.9 min (±11.1). Bystander CPR was performed in 130/1,023 (12.7%) and was more commonly performed in children as compared to adults [12/44 (27.3%) vs. 118/979 (12.1%), p = 0.003]. Independent predictors of bystander CPR were being a child (OR = 3.26, 95% CI [1.21-8.82], p = 0.02) and having OHCA in a healthcare institution (OR = 6.35, 95% CI [2.15-18.72], p = 0.001).

Conclusion

Our study reported the characteristics of OHCA cases in Saudi Arabia using EMS data. We observed young age at presentation, low rates of bystander CPR, and long response time. These characteristics are distinctly different from other countries and call for urgent attention to OHCA care in Saudi Arabia. Lastly, being a child and having OHCA in a healthcare institution were found to be independent predictors of bystander CPR.

Current summary of the evidence in drone-based emergency medical services care

Interventions for many medical emergencies including cardiac arrests, strokes, drug overdoses, seizures, and trauma, are critically time-dependent, with faster intervention leading to improved patient outcomes. Consequently, a major focus of emergency medical services (EMS) systems and prehospital medicine has been improving the time until medical intervention in these time-sensitive emergencies, often by reducing the time required to deliver critical medical supplies to the scene of the emergency. Medical indications for using unmanned aerial vehicles, or drones, are rapidly expanding, including the delivery of time-sensitive medical supplies. To date, the drone-based delivery of a variety of time-critical medical supplies has been evaluated, generating promising data suggesting that drones can improve the time interval to intervention through the rapid delivery of automatic external defibrillators (AEDs), naloxone, antiepileptics, and blood products. Furthermore, the improvement in the time until intervention offered by drones in out-of-hospital emergencies is likely to improve patient outcomes in time-dependent medical emergencies. However, barriers and knowledge gaps remain that must be addressed. Further research demonstrating functionality in real-world scenarios, as well as research that integrates drones into the existing EMS structure will be necessary before drones can reach their full potential. The primary aim of this review is to summarize the current evidence in drone-based Emergency Medical Services Care to help identify future research directions.

Drones delivering automated external defibrillators: A new strategy to improve the prognosis of out-of-hospital cardiac arrest

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) is a serious threat to human life and health, characterized by high morbidity and mortality. However, given the limitations of the current emergency medical system (EMS), it is difficult to immediately treat patients who experience OHCA. It is well known that rapid defibrillation after cardiac arrest is essential for improving the survival rate of OHCA, yet automated external defibrillators (AED) are difficult to obtain in a timely manner.

OBJECTIVE

This review illustrates the feasibility and advantages of AED delivery by drones by surveying current studies on drones, explains that drones are a new strategy in OHCA, and finally proposes novel strategies to address existing problems with drone systems.

RESULTS

The continuous development of drone technology has been beneficial for patients who experience OHCA, as drones have demonstrated powerful capabilities to provide rapid delivery of AED. Drones have great advantages over traditional EMS, and the delivery of AED by drones for patients with OHCA is a new strategy. However, the application of this new strategy in real life still has many challenges.

CONCLUSION

Drones are promising and innovative tools. Many studies have demonstrated that AED delivery by drones is feasible and cost-effective; however, as a new strategy to improve the survival rate of OHCA patients, there remain problems to be solved. In the future, more in-depth investigations need to be conducted.

Cortical theta-gamma coupling tracks the mental workload as an indicator of mental schema development during simulated quadrotor UAV operation

Objective. In the emerging field of neuroergonomics, mental workload assessment is one of the most important problems. Previous studies have made some progress on the relationship between task difficulties and mental workload, but how the mental schema, a reflection of the understanding and mastery degree of a task, affects mental workload has not been clearly discussed.Approach. There is emerging appreciation for the role of theta-gamma coupling (TGC) in high-level cognitive functions. Here, we attempt to further our understanding of how mental schema development and task difficulty had an impact on mental workload from the perspective of TGC. Specifically, the variation of TGC coupling strength and coupling pattern was estimated with different test orders and task difficulties performed by 51 students in a ten-day simulated quadrotor unmanned aerial vehicle flight training and test tasks.Main results. During the training, TGC increased with mental schema development. For the test tasks, TGC did not change with increasing task difficulty before the operator formed a mental schema but decreased with the increasing mental workload after the formation of the mental schema.Significance. Our results suggest that TGC was a robust indicator of mental schema development and could be biased by task difficulty. In conclusion, TGC can be a promising measure of mental workload, but only for experienced operators.

[AED drones on the rise? : Use of drones to improve public access defibrillation]

BACKGROUND

The poor availability of automatic external defibrillators (AED) and the modest knowledge of lay persons in handling these devices has led to an insufficient spread of public access defibrillation in Germany.

OBJECTIVE

This article examines whether the automated deployment of AED drones to out-of-hospital cardiac arrest can help to remedy this situation.

METHODS

Narrative literature review, evaluation of statistics, analysis of relevant media reports, and discussion of key research.

RESULTS

The present investigations are mainly located in the experimental field and demonstrate the feasibility and safety of drone use, as well as shorter times to first defibrillation, which is confirmed by initial clinical studies. Mathematical models also indicate cost-effectiveness of airborne AED delivery compared to ground dispatch. Integration into the chain of survival appears to be possible but adaptations to existing emergency medical service structures and close cooperation with regional first responder and AED schemes as well as local authorities is required to optimise patient benefit and efficiency.

CONCLUSION

The use of AED drones could probably contribute to improving public access defibrillation in Germany. This applies to both rural and urban regions. The technological requirements are met but flight regulations still have to be amended. In order to explore the full potential of this novel technology, further field trials are required to achieve smooth integration into existing emergency medical services.

Possibilities of Using UAVs in Pre-Hospital Security for Medical Emergencies

The term unmanned aerial vehicle (UAV) was post-applied in the 1980s to describe remotely piloted multi-purpose, unmanned, autonomous aircraft. The terms unmanned aircraft systems with data terminal connectivity (UAS) and remotely piloted aircraft systems (RPV, RPAS-military systems) are also used. This review aims to analyze the feasibility of using UAVs to support emergency medical systems in the supply and urgent care ranges. The implementation of drones in the medical security system requires proper planning of service cooperation, division of the area into sectors, assessment of potential risks and opportunities, and legal framework for the application. A systematic literature search was conducted to assess the applicability based on published scientific papers on possible medical drone applications in the field of urgent mode. The widespread applications of UAVs in healthcare are concerned with logistics, scope, and transportability, with framework legal constraints to effectively exploit opportunities for improving population health, particularly for costly critical situations.

Quality Analysis of Tuberculosis Specimens Transported by Drones versus Ground Transportation

There are many challenges that impact the current referral network for Tuberculosis (TB) sputum specimens in Mozambique. In some cases, health facilities are remote and the road infrastructure is poor and at times impassable, leading to delays in laboratory specimen transportation and long turn-around times for results. Drone transportation is a promising solution to reduce transportation time and improve access to laboratory diagnostics if the sample quality is not compromised during transport. This study evaluated the impact of drone transportation on the quality of TB sputum specimens with suspected Mycobacterium tuberculosis. 156 specimens were collected at five (5) health centers and sent to the Instituto Nacional de Saúde (INS) National TB Reference Laboratory. Specimens were then equally divided into two aliquots; one to be transported on land and the other by air using a drone. Control and study group specimens were processed using the NALC-NaOH method. Agreement between sample and control specimens was acceptable, indicating that drone transportation did not affect the quality of TB specimens. The authors recommend additional studies to validate drone transportation of TB specimens over a longer period of time to give further confidence in the adoption of drone delivery in Mozambique.

Strategic placement of automated external defibrillators (AEDs) for cardiac arrests in public locations and private residences

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We ranked businesses for their ability to fill gaps in the AED landscape.

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23% of OHCAs in public, and 4% in homes, were within 100 m of an existing AED.

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Many businesses can simultaneously improve coverage of arrests in public and homes.

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Rankings were largely robust to the coverage radius used (100 m, 200 m, and 500 m).

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Even if all 5006 business locations hosted AEDs, large gaps in OHCA coverage remain.

Aim

Methods

Results

Conclusion

Human drone interaction in delivery of medical supplies: A scoping review of experimental studies

Background

The COVID-19 pandemic, ageing populations and the increasing shortage of skilled workers pose great challenges for the delivery of supplies for people with and without care needs. The potential of drones, as unmanned air vehicles, in healthcare are huge and are discussed as an effective new way to delivery urgent medicines and medical devices, especially in rural areas. Although the advantages are obvious, perspectives of users are important particularly in the development process. Investigating human drone interaction could potentially increase usefulness and usability. The present study aims to perform a systematic scoping review on experimental studies examining the human drone interaction in deliveries of drugs and defibrillators.

Methods

Two databases (MEDLINE and CINAHL) and references of identified publications were searched without narrowing the year of publication or language. Studies that investigated the human drone interaction or medical delivery with drones in an experimental manner were included (research articles). All studies that only simulated the delivery process were excluded.

Results

The search revealed 83 publications with four studies being included. These studies investigated the user experience of drone delivered defibrillators, but no study was identified that investigated the human drone interaction in the delivery of drugs. Three categories of human drone interaction were identified: landing, handover, and communications. Regarding landing and handover, the most important issue was the direct physical contact with the drone while regarding communications users need clearer instructions about drone´s direction, sound and look like.

Discussion

The identified studies used technology-driven approaches by investigating human drone interaction in already existing technologies. Users must become integral part of the whole development process of medical drone services to reduce concerns, and to improve security, usability and usefulness of the system. Human drone interaction should be developed according to the identified categories of human drone interaction by using demand- and technology-driven approaches.

A Conceptual Approach to Time Savings and Cost Competitiveness Assessments for Drone Transport of Biologic Samples with Unmanned Aerial Systems (Drones)

Unmanned aerial vehicles (UAVs, drones) are expected to save transport time and improve service reliability for transport of biologic samples, but few studies have evaluated the potential time savings of such services. The total transport time defined as time from sample ready for transport until arrival at the laboratory was used to assess the absolute and relative time savings of drones compared with ground transport, using ground distances from 4–7 km (urban model) to 179–262 km (rural district routes) with one to eight daily scheduled trips. Costs of existing ground transport were allocated to drone flight times as a proxy for drone cost competitiveness. Time savings were less than 20–30% in the urban model but 65–74% in the rural routes using drone speeds of 100 km/h, but the time between trips (route frequencies) and drone speeds influenced the relative time savings substantially. Cost of time gains per number of samples was less favorable using drones in the rural models due to lower transport volumes. This research concludes that drone solutions provide marginal gains for short-distance transports, whereas time savings are more promising in long transport models with appropriate scheduling and sufficiently high drone speeds.

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

A Socio-Analytical Approach to the Integration of Drones into Health Care Systems

The integration of drones into health care as a supplement to existing logistics methods may generate a need for cooperation and involvement across multiple resource areas. It is currently not well understood whether such integrations would merely represent a technical implementation or if they would cause more significant changes to laboratory services. By choosing socio-technical theory as the theoretical lens, this paper intends to harvest knowledge from the literature on various organizational concepts and examine possible synergies between such theories to determine optimal strategies for introducing the use of drones in a health care context. Our particular interest is to examine whether the insights generated from the multi-level perspective (MLP) may have the potential to create dynamic spin-offs related to the organizational transitions associated with the implementation of drones in health services. We built our study on a scoping literature review of topics associated with the MLP and socio-technical studies from differing arenas, supplemented with studies harvested on a broader basis. The scoping review is based on 25 articles that were selected for analysis. As a way of organizing the literature, the niche, regime, and landscape levels of the MLP are translated to the corresponding health care-related terms, i.e., clinic, institution, and health care system. Furthermore, subcategories emerged inductively during the process of analysis. The MLP provides essential knowledge regarding the context for innovation and how the interaction between the different levels can accelerate the diffusion of innovations. Several authors have put both ethical topics and public acceptance into a socio-technological perspective. Although a socio-technical approach is not needed to operate drones, it may help in the long run to invest in a culture that is open to innovation and change.

Examining New Zealand Unmanned Aircraft Users’ Measures for Mitigating Operational Risks

While the potential risks of unmanned aircraft have received significant attention, there is little in the academic literature that examines how operational risks are mitigated by users. This study examines the prevalence of key operational risk mitigations amongst a sample of 812 unmanned aircraft users in New Zealand, their confidence levels in identifying and complying with airspace requirements, and their ability to read visual navigation charts (VNCs) and use AirShare (a local tool that shows airspace requirements). Significant differences exist between the number and type of mitigations applied, users’ confidence levels in identifying and complying with airspace requirements, and users’ ability to read VNCs and use AirShare based upon user characteristics. Education, practical assessment, membership of a professional body, professional/semi-professional use, and operating for a certificated organisation all improve risk mitigation (greater number and variety of risk mitigations applied). The only risk mitigation employed by almost all users was conducting a pre-flight check of their aircraft, identifying the need for users to view risk mitigation more holistically. The findings support policy directions related to educational requirements, the ability for member-based organisations and professional bodies to self-regulate, and the fitness of the current regulatory system in New Zealand.

Applications of drone in disaster management: A scoping review

The use of drones has rapidly evolved over the past decade involving a variety of fields ranging from agriculture, commercial and becoming increasingly used in disaster management or humanitarian aid. Unfortunately, the evidence of its use in mass disasters is still unclear and scarce. This article aims to evaluate the current drone feasibility projects and to discuss a number of challenges related to the deployment of drones in mass disasters in the hopes of empowering and inspiring possible future work. This research follows Arksey and O'Malley framework and updated by Joanna Briggs Institute Framework for Scoping Reviews methodology to summarise the results of 52 research papers over the past ten years, from 2009 to 2020, outlining the research trend of drone application in disaster. A literature search was performed in Medline, CINAHL, Scopus, individual journals, grey literature and google search with assessment based on their content and significance. Potential application of drones in disaster are broad. Based on articles identified, drone application in disasters are classified into four categories; (1) mapping or disaster management which has shown the highest contribution, (2) search and rescue, (3) transportation and (4) training. Although there is a significant increase in the number of publications on use of drone in disaster within the last five years, there is however limited discussion to address post-disaster healthcare situation especially with regards to disaster victim identification. It is evident that drone applications need to be further explored; to focus more on drone assistance to humans especially in victim identification. It is envisaged that with sufficient development, the application of drones appears to be promising and will improve their effectiveness especially in disaster management.

Drones Delivering Automated External Defibrillators-Integrating Unmanned Aerial Systems into the Chain of Survival: A Simulation Study in Rural Germany

BACKGROUND

Community first responders (CFR) improve survival in out-of-hospital cardiac arrest (OHCA) but are often hampered by limited availability of public access defibrillation. Unmanned aerial systems (UAS) delivering automated external defibrillators (AED) directly to an OHCA site could help overcome this. We evaluated the feasibility of integrating UAS into the chain of survival in rural Northeast Germany.

METHODS

This simulation study explored UAS-AED delivery combined with a smartphone-based CFR dispatch. Five OHCA locations (A-E) were randomly selected. We routed a flight corridor to each of these sites from a corresponding UAS base; 50 OHCA scenarios with 10 flights per corridor were scheduled. All steps were accurately simulated, from a bystander finding the patient, making an emergency call, conducting dispatcher-assisted cardiopulmonary resuscitation, and simultaneous CFR plus UAS deployment, to the bystander and CFR interacting with UAS and AED. This process was time-tracked and video-recorded until defibrillation.

RESULTS

We performed 46 OHCA simulations. Missions were flown autonomously but needed pilot assistance during landing. Distances (km) and average time intervals from alert to defibrillation (t_d in min:sec±SD) were 0.4 (6:02±0:56), 2.29 (6:53±0:19), 4.0 (8:54±0:25), 7.43 (14:51±1:055), and 9.79 (15:51±1:16) for routes A to E, respectively. All participants were able to retrieve the AED within seconds after UAS landing and interacted safely with the UAS and AED.

CONCLUSIONS

Integrating airborne AED delivery into the chain of survival appeared feasible and safe but remains an experimental technology. Linking this with CFR potentially improves the availability of early public-access defibrillation, particularly in rural regions.

Effect of topography and weather on delivery of automatic electrical defibrillator by drone for out-of-hospital cardiac arrest

Delivery of automatic electrical defibrillator (AED) by unmanned aerial vehicle (UAV) was suggested for out-of-hospital cardiac arrest (OHCA). The goal of this study is to assess the effect of topographic and weather conditions on call to AED attach time by UAV-AED. We included OHCA patients from 2013 to 2016 in Seoul, South Korea. We developed a UAV-AED flight simulator using topographic information of Seoul for Euclidean and topographic flight pathway including vertical flight to overcome high-rise structures. We used 4 kinds of UAV flight scenarios according to weather conditions or visibility. Primary outcome was emergency medical service (EMS) call to AED attach time. Secondary outcome was pre-arrival rate of UAV-AED before current EMS based AED delivery. Call to AED attach time in topographic pathway was 7.0 min in flight and control advanced UAV and 8.0 min in basic UAV model. Pre-arrival rate in Euclidean pathway was 38.0% and 16.3% for flight and control advanced UAV and basic UAV. Pre-arrival rate in the topographic pathway was 27.0% and 11.7%, respectively. UAV-AED topographic flight took longer call to AED attach time than Euclidean pathway. Pre-arrival rate of flight and control advanced UAV was decreased in topographic flight pathway compared to Euclidean pathway.

Drone versus ambulance for blood products transportation: an economic evaluation study

BACKGROUND

Medical transportation is an essential step in health care services, and includes ground, air and water transportation. Among the important uses of medical transportation is the delivery of blood products in the event of a clinical emergency. Drone technology is the latest technological advancement that may revolutionize medical transportation globally. Nonetheless, its economic evaluation is scant and insufficient, whilst its cost-effectiveness remains controversial. The aim of this study was to compare the cost-effectiveness of drone transportation versus the ambulance.

METHODS

The setting of the study was within a developing nation. An economic evaluation study of drone versus ambulance for emergency blood products transportation between the Sabah Women and Children Hospital (SWACH) and the Queen Elizabeth II Hospital (QEH2) on Borneo Island was conducted using the Cost-Effectiveness Analysis (CEA) technique. The total cost of each mode of transportation was calculated using the Activity Based Costing (ABC) method. Travel time was used as a denominator to estimate the Incremental Cost Effectiveness Ratio (ICER).

RESULTS

For one clinical emergency in SWACH, a round trip of blood products transportation from SWACH to QEH2 costs RM1,266.02 (USD307.09) when using the ambulance, while the drone costs RM1,313.28 (USD319.36). The travel time for the drone was much shorter (18 min) compared to the ambulance (34 min). The Cost-Effectiveness Ratio (CER) of ambulance transportation was RM37.23 (USD9.05) per minute whilst the CER of drone transportation was RM72.96 (USD17.74) per minute. The ICER of drone versus ambulance was - 2.95, implying an increase of RM2.95 in cost for every minute saved using a drone instead of an ambulance.

CONCLUSION

Although drone transportation of blood products costs more per minute compared to the ambulance, the significantly shorter transport time of the drone offset its cost. Thus, we believe there is good economic potential for drone usage for blood products transportation in developing nations particularly if the drone price decreases and its operational lifespan increases. Our limitation of a non-clinical denominator used in this study leads to the recommendation for use of clinical outcomes in future studies.

A simulation study of drone delivery of Automated External Defibrillator (AED) in Out of Hospital Cardiac Arrest (OHCA) in the UK

Background

Drones are increasingly used in healthcare, and feasibility studies of deployment of Automated External Defibrillators (AED) in Out-of-hospital cardiac arrest (OHCA) have been conducted. Despite the potential contribution of drones to healthcare, regulatory barriers exist, including limits on flights beyond visual line-of-sight (BVLOS). The aim of this project was to deliver an AED BVLOS in Wales.

Methods

We developed of a Concept of Operations (CONOPS) to identify requirements, constraints, organisation and roles and responsibilities associated with deploying a drone to deliver an AED BVLOS. We equipped a Penguin B drone with satellite-enabled technology to enhance situational awareness and safety for the remote pilot. A BVLOS Operating Safety Case and three-week flight test programme was conducted with an AED attached directly to parachute for deployment to simulated OHCA.

Results

We completed six flights totalling 92km, 1:02.5 hours of flight time and four successful parachute payload drops. We conducted a successful end-to-end flight demonstration of an AED delivered via BVLOS by drone to a simulated OHCA and resuscitation by lay responder’s in a remote location; the final delivery of 4.5km was completed in 2:50 minutes.

Conclusion

We have delivered an AED by parachute, from fixed wing drone BVLOS in the UK in simulated OHCA. This project adds to the body of knowledge required for regulatory assurance on drone use BVLOS. Further research is needed before routine use of this technology.

Smart delivery and retrieval of swab collection kit for COVID-19 test using autonomous Unmanned Aerial Vehicles

Drones, also known as Unmanned Aerial Vehicles (UAVs), are one of the highly emerging technologies of the modern day. Due to their small size, flying capabilities, and complex machinery, drones can be deployed in diverse fields, including agriculture, sports, entertainment, parcel delivery, disaster management, search and rescue, emergency medicine, and healthcare. In case of medical emergency, timely delivery of the required emergency kit is very important. This is often not possible in many underdeveloped countries due to lack of resources, traffic jams, congestion or challenging routes. Also, in times like today’s when the world is hit with COVID-19 pandemic, the movement is very limited due to lockdowns and emergency. In such case, drones can be deployed to deliver the emergency kits and collect samples for tests. This may save someones life as well as time and financial resources. In third world countries, the COVID-19 has spread chaos because of very limited hospitals, resources and staff. Therefore, it is difficult for the government and health officials to accommodate every patient or give him/her the care that he/she needs. Amidst the fear of pandemic, everyone is trying to undergo tests for COVID-19 which is difficult to handle In our research, we have proposed a solution that comprises smartphone application with the help of a patient sending a call to a healthcare centre for delivering emergency kit. The kit contains equipment with the help of which a person can collect swab. The drone takes the swab samples back to the healthcare centre for tests. We have introduced an optimization factor as a baseline for future studies of this kind. We have further conducted field experiments to test our proposed scheme. The results have shown that drones can be quite efficient in collecting samples and delivering emergency kits.

A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services

Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.

A Smart Capsule Equipped with Artificial Intelligence for Autonomous Delivery of Medical Material through Drones

In the last few years, many examples of blood and medicine delivery drones have been demonstrated worldwide, which mainly rely on aeronautical experience that is not common in the medical world. Speaking about drone delivery, attention should focus on the most important thing: the transported lifesaving good. Traditional boxes that monitor temperature are not usually in real time, and are not suitable for drone transportation because they are heavy and bulky. This means that the biomedical characteristics of delivery are of primary importance. A Smart Capsule, equipped with artificial intelligence (AI), is the first system ever proposed to provide a fully autonomous drone delivery service for perishable and high-value medical products, integrating real-time quality monitoring and control. It consists in a smart casing that is able to guide any autonomous aerial vehicle attached to it, specifically designed for transporting blood, organs, tissues, test samples and drugs, among others. The system monitors the conditions of the product (e.g., temperature, agitation and humidity) and adjusts them when needed by exploiting, for instance, vibrations to maintain the required agitation, ensuring that goods are ready to be used as soon as they are delivered. The Smart Capsule also leverages external temperature to reduce energy uptake from the drone, thus improving the drone’s battery life and flight range. The system replaces the need for specialized drivers and traditional road-bound transportation means, while guaranteeing compliance with all applicable safety regulations. A series of 16 experimental tests was performed to demonstrate the possibility of using the smart capsule to manage the flight and internal good delivery. Eighty-one missions were carried out for a total of 364 min of flight. The Smart Capsule greatly improves emergency response and efficiency of healthcare systems by reducing delivery times by up to 80% and costs by at least 28%. The Smart Capsule and its enabling technology based on AI for drone deliveries are discussed in this paper. The aim of this work is to show the possibility of managing drone delivery with an AI-based device.

Automated external defibrillators delivered by drones to patients with suspected out-of-hospital cardiac arrest

AIMS 

Early defibrillation is critical for the chance of survival in out-of-hospital cardiac arrest (OHCA). Drones, used to deliver automated external defibrillators (AEDs), may shorten time to defibrillation, but this has never been evaluated in real-life emergencies. The aim of this study was to investigate the feasibility of AED delivery by drones in real-life cases of OHCA.

METHODS AND RESULTS 

In this prospective clinical trial, three AED-equipped drones were placed within controlled airspace in Sweden, covering approximately 80 000 inhabitants (125 km2). Drones were integrated in the emergency medical services for automated deployment in beyond-visual-line-of-sight flights: (i) test flights from 1 June to 30 September 2020 and (ii) consecutive real-life suspected OHCAs. Primary outcome was the proportion of successful AED deliveries when drones were dispatched in cases of suspected OHCA. Among secondary outcomes was the proportion of cases where AED drones arrived prior to ambulance and time benefit vs. ambulance. Totally, 14 cases were eligible for dispatch during the study period in which AED drones took off in 12 alerts to suspected OHCA, with a median distance to location of 3.1 km [interquartile range (IQR) 2.8-3.4). AED delivery was feasible within 9 m (IQR 7.5-10.5) from the location and successful in 11 alerts (92%). AED drones arrived prior to ambulances in 64%, with a median time benefit of 01:52 min (IQR 01:35-04:54) when drone arrived first. In an additional 61 test flights, the AED delivery success rate was 90% (55/61).

CONCLUSION 

In this pilot study, we have shown that AEDs can be carried by drones to real-life cases of OHCA with a successful AED delivery rate of 92%. There was a time benefit as compared to emergency medical services in cases where the drone arrived first. However, further improvements are needed to increase dispatch rate and time benefits.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT04415398.

Computer simulation of the effectiveness of novel cardiac arrest response systems

Aims

To use a computer simulation model to predict the response time and survival impact of a sample of novel cardiac arrest response systems, such as those that use cellphone apps to dispatch citizen mobile responders and those that use drones to deliver an AED to the cardiac arrest location.

Methods

We developed a model which applies a Monte Carlo approach to simulate the response time and predicted survival for cardiac arrest events within a specific region. We used the model to compare the performance of 4 different novel response systems, along with simulated EMS performance, in Bellevue, Washington. We estimated the 10 year cost for each system, which was utilized together with the system performance predictions in a cost-benefit analysis.

Results

The best performing systems in the simulation were a mobile responder system capable of providing both CPR and defibrillation, similar to the PulsePoint verified responder program, as well as a drone AED delivery system with bystander application. Both systems showed an incremental improvement in survival of 10% over the simulated EMS survival. The systems that provided the best cost-benefit ratio were the mobile responder system providing only CPR (PulsePoint Respond) and drone systems with bystander application.

Conclusions

Our simulation results suggest that these novel response systems have the potential to substantially improve survival at an efficient cost.

Comparing audio- and video-delivered instructions in dispatcher-assisted cardiopulmonary resuscitation with drone-delivered automatic external defibrillator: a mixed methods simulation study

This study compared first responders' cardiopulmonary resuscitation (CPR) performance when a dispatcher provides audio instructions only and when both audio and video instructions are given. In the simulation, an automatic external defibrillator (AED) was delivered via drone in response to a cardiac arrest occurring outside a hospital setting. Participants' qualitative experiences were also explored.An exploratory sequential mixed methods design was used. AEDs were delivered to college students via drone with one group receiving both audio and video instructions and the other receiving audio-only instruction, and differences in CPR performance and accuracy were compared. After completion, focus group interview data were collected and analyzed. Video-based instruction was found to be more effective in the number of chest compressions (p < 0.01), chest compression rate (p < 0.01), and chest compression interruptions (p < 0.01). The accuracy of the video group for the chest compression region was high (p = 0.05). Participants' experiences were divided into three categories: "unfamiliar but beneficial experience," "met helper during a desperate and embarrassing situation," and "diverse views on drone use." Our results lay the groundwork for a development plan for providing emergency medical services using drones, as well as the preparation of guidelines for dispatchers on the provision of video instructions.

Recreational Drone-Related Injuries in Children: A Review of National Electronic Injury Surveillance System (NEISS) Data

Introduction Drones are unmanned aerial vehicles controlled by a person on the ground, used for recreational purposes. The purpose of the study is to describe characteristics and patterns of injuries reported in children from recreational drones. Methods We extracted data from the National Electronic Injury Surveillance System involving (NEISS) over a period of 10 years from 2010 to 2019 regarding injuries to children for ages zero up to 18 years. We included the subjects with drone-related injuries. All other toy-related injuries were excluded. We applied descriptive statistics to calculate proportions and confidence intervals for categorical variables and median for continuous variables. Results We included a total of 26 subjects. In our sample, the number of male subjects (65%; n = 17) was higher than the number of females (35%; n = 9). Head and face were the commonly affected body parts (58%, n = 15). The most common diagnoses were lacerations (42%; n = 11) and contusions/abrasions (27%; n = 7). The majority of the subjects were treated and discharged from the emergency department (92%; n = 24). A significant number of injuries were caused by the direct impact of drones (65%; n = 17). Conclusion Drones have the potential to cause injuries. Precautions are warranted to decrease the incidence of these injuries in children.

A Drone Logistic Model for Transporting the Complete Analytic Volume of a Large-Scale University Laboratory

We present a model for drone transport of the complete annual analytic volume of 6.5 million analyses—(routine and emergency) between two inner-city university laboratories at Oslo University Hospital located 1.8 km apart and with a time restriction for the analyses of no more than 60 min. The total laboratory activity was analyzed per min for the complete year of 2018. The time from the clinical ordering of tests to the loading of the drone, drone transport time, and analysis time after the sample arrived at the analyzing laboratory were assessed using the lead time of emergency analyses of C-reactive protein, troponin, and the international normalized ratio. The activity had characteristic diurnal patterns, with the most intensive traffic between 8 and 12 a.m. on weekdays and there being considerably less traffic for the rest of the day, at night and on weekends. Drone schedules with departures 15–60 min apart were simulated. A maximum of 15 min between flights was required to meet the emergency demand for the analyses being completed within 60 min. The required drone weight capacity was below 3.5 kg at all times. In multiple simulations, the drone times were appropriate, whereas variations in the clinic- and laboratory-related time intervals caused violations of the allowed time 50% of the time. Drone transport with regular schedules may potentially improve the transport time compared with traditional ground transport and allow the merging of large laboratories, even when the demand for emergency analyses restricts the maximum transport time. Comprehensive economic evaluations and robust drone technology are needed before such solutions can be ready for implementation.

Advancing Prehospital Combat Casualty Evacuation: Patients Amenable to Aeromedical Evacuation via Unmanned Aerial Vehicles

INTRODUCTION

The U.S. military currently utilizes unmanned aerial vehicles (UAVs) for reconnaissance and attack missions; however, as combat environment technology advances, there is the increasing likelihood of UAV utilization in prehospital aeromedical evacuation. Although some combat casualties require life-saving interventions (LSIs) during medical evacuation, many do not. Our objective was to describe patients transported from the point of injury to the first level of care and characterize differences between patients who received LSIs en route and those who did not.

MATERIALS AND METHODS

We conducted a retrospective review of the records of traumatically injured patients evacuated between January 2011 and March 2014. We compared patient characteristics, complications, and outcomes based on whether they had an LSI performed en route (LSI vs. No LSI). We also constructed logistic regression models to determine which characteristics predict uneventful flights (no en route LSI or complications).

RESULTS

We examined 1,267 patient records; 47% received an LSI en route. Most patients (72%) sustained a blast injury and injuries to the extremities and head. Over 78% experienced complications en route; the LSI group had higher rates of complications compared to the No LSI group. Logistic regression showed that having a blunt injury or the highest abbreviated injury scale (AIS) severity score in the head/neck region are significant predictors of having an uneventful flight.

CONCLUSION

Approximately half of casualties evaluated in our study did not receive an LSI during transport and may have been transported safely by UAV. Having a blunt injury or the highest AIS severity score in the head/neck region significantly predicted an uneventful flight.

Bézier Curves-Based Optimal Trajectory Design for Multirotor UAVs with Any-Angle Pathfinding Algorithms

Multirotor Unmanned Aerial Vehicles (UAVs) play an imperative role in many real-world applications in a variety of scenarios characterized by a high density of obstacles with different heights. Due to the complicated operation areas of UAVs and complex constraints associated with the assigned mission, there should be a suitable path to fly. Therefore, the most relevant challenge is how to plan a flyable path for a UAV without collisions with obstacles. This paper demonstrates how a flyable and continuous trajectory was constructed by using any-angle pathfinding algorithms, which are Basic Theta*, Lazy Theta*, and Phi* algorithms for a multirotor UAV in a cluttered environment. The three algorithms were modified by adopting a modified cost function during their implementation that considers the elevation of nodes. First, suitable paths are generated by using a modified version of the three algorithms. After that, four Bézier curves-based approaches are proposed to smooth the generated paths to be converted to flyable paths (trajectories). To determine the most suitable approach, particularly when searching for an optimal and collision-free trajectory design, an innovative evaluation process is proposed and applied in a variety of different size environments. The evaluation process results show high success rates of the four approaches; however, the approach with the highest success rate is adopted. Finally, based on the results of the evaluation process, a novel algorithm is proposed to increase the efficiency of the selected approach to the optimality in the construction process of the trajectory.

European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe

In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.

Automatic external defibrillator provided by unmanned aerial vehicle (drone) in Greater Paris: A real world-based simulation

AIM

To reduce the delay in defibrillation of out-of-hospital cardiac arrest (OHCA) patients, recent publications have shown that drones equipped with an automatic external defibrillator (AED) appear to be effective in sparsely populated areas. To study the effectiveness of AED-drones in high-density urban areas, we developed an algorithm based on emergency dispatch parameters for the rate and detection speed of cardiac arrests and technical and meteorological parameters.

METHODS

We ran a numerical simulation to compare the actual time required by the Basic Life Support team (BLSt) for OHCA patients in Greater Paris in 2017 to the time required by an AED-drone. Endpoints were the proportion of patients with "AED-drone first" and the defibrillation time gained. We built an open-source website (https://airborne-aed.org/) to allow modelling by modifying one or more parameters and to help other teams model their own OHCA data.

RESULTS

Of 3014 OHCA patients, 72.2 ± 0.7% were in the "no drone flight" group, 25.8 ± 0.2% in the "AED-drone first" group, and 2.1 ± 0.2% in the "BLSt-drone first" group. When a drone flight was authorized, it arrived an average 190 s before BLSt in 93% of cases. The possibility of flying the drone during the aeronautical night improved the results of the "AED-drone first" group the most (+60%).

CONCLUSIONS

In our very high-density urban model, at most 26% of OHCA patients received an AED from an AED-drone before BLSt. The flexible parameters of our website model allows evaluation of the impact of each choice and concrete implementation of the AED-drone.

Use of Public Automated External Defibrillators in Out-of-Hospital Cardiac Arrest in Poland

Background and objectives: National medical records indicate that approximately 350,000–700,000 people die each year from sudden cardiac arrest. The guidelines of the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) indicate that in addition to resuscitation, it is important—in the case of so-called defibrillation rhythms—to perform defibrillation as quickly as possible. The aim of this study was to assess the use of public automated external defibrillators in out of hospital cardiac arrest in Poland between 2008 and 2018. Materials and Methods: One hundred and twenty cases of use of an automated external defibrillator placed in a public space between 2008 and 2018 were analyzed. The study material consisted of data on cases of use of an automated external defibrillator in adults (over 18 years of age). Only cases of automated external defibrillators (AED) use in a public place other than a medical facility were analysed, additionally excluding emergency services, i.e., the State Fire Service and the Volunteer Fire Service, which have an AED as part of their emergency equipment. The survey questionnaire was sent electronically to 1165 sites with AEDs and AED manufacturers. A total of 298 relevant feedback responses were received. Results: The analysis yielded data on 120 cases of AED use in a public place. Conclusions: Since 2016, there has been a noticeable increase in the frequency of use of AEDs located in public spaces. This is most likely related to the spread of public access to defibrillation and increased public awareness.

The Moderating Role of Pro-Innovative Leadership and Gender as an Enabler for Future Drone Transports in Healthcare Systems

Drones have been suggested as an emerging technology that has the potential to disrupt and improve healthcare. The attitude among healthcare workers towards the use of drones is important for its successful implementation. Our aim was to examine individual and institutional variables among employees that may be relevant for the successful implementation of drones. This study used a self-administered questionnaire to investigate the expectations and beliefs among 400 employees at three Norwegian healthcare organizations regarding the future role of drones in the provision of healthcare. The results showed that the use of drones in healthcare is positively perceived across professional groups, age, and location. Working in an innovative environment, having experienced previous technological change in one's working environment, and having leadership that supports new ideas were identified as drivers of individual beliefs regarding the use of drones as an innovative solution in future healthcare services. Men had significantly higher scores than women, and this was associated with reporting innovative leadership. This may indicate that a future implementation of drone usage should focus on local system environments and may depend on the presence of innovative leadership. Our results are harvested from a developed health care system and should be applicable for similar technologically advanced systems where the full potential of drone solutions may benefit from the integration of drones into the overall socio-technical system.

Real-time breath recognition by movies from a small drone landing on victim's bodies

In local and global disaster scenes, rapid recognition of victims' breathing is vital. It is unclear whether the footage transmitted from small drones can enable medical providers to detect breathing. This study investigated the ability of small drones to evaluate breathing correctly after landing on victims' bodies and hovering over them. We enrolled 46 medical workers in this prospective, randomized, crossover study. The participants were provided with envelopes, from which they were asked to pull four notes sequentially and follow the written instructions ("breathing" and "no breathing"). After they lied on the ground in the supine position, a drone was landed on their abdomen, subsequently hovering over them. Two evaluators were asked to determine whether the participant had followed the "breathing" or "no breathing" instruction based on the real-time footage transmitted from the drone camera. The same experiment was performed while the participant was in the prone position. If both evaluators were able to determine the participant's breathing status correctly, the results were tagged as "correct." All experiments were successfully performed. Breathing was correctly determined in all 46 participants (100%) when the drone was landed on the abdomen and in 19 participants when the drone hovered over them while they were in the supine position (p < 0.01). In the prone position, breathing was correctly determined in 44 participants when the drone was landed on the abdomen and in 10 participants when it was kept hovering over them (p < 0.01). Notably, breathing status was misinterpreted as "no breathing" in 8 out of 27 (29.6%) participants lying in the supine position and 13 out of 36 (36.1%) participants lying in the prone position when the drone was kept hovering over them. The landing points seemed wider laterally when the participants were in the supine position than when they were in the prone position. Breathing status was more reliably determined when a small drone was landed on an individual's body than when it hovered over them.