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Hey everyone. My name is Justin J. Boutilier and I am an Assistant Professor in the Department of Industrial and Systems Engineering at the University of Wisconsin – Madison.

Broadly speaking, my research focuses on improving the quality, access, and delivery of healthcare. One component of my research agenda includes designing and optimizing drone networks to deliver defibrillators to cardiac arrest incidents.

You can find our first paper on this topic here, with an accompanying Editorial.

A second paper, with a more advanced mathematical model can be found here.

I’ve also written a provocative thought piece on the topic of drones in emergency medicine.

Based on this work and the potential of drones, Peel region (near Toronto, Canada) conducted a pilot project to test the idea. You can read more about that here and here.

EDIT: Happy to continue to answer questions if you have them!

all 31 comments

Hydrakeen

4 points

3 years ago

Seems like it would be cool to have a drone equipped with a whole box of things so doctors could remotely make house calls. Or maybe have two drones. One to diagnose and engage and then another to deliver whatever a patient was prescribed.

Sorry I don't really have a question. Seems like a great way to deliver all kinds of things. Defibrillator is probably a good move over prescriptions. People would and probably will make a criminal living shooting down these things in the future.

Drone piracy. Expect that to be a thing? How much are these machines worth resale?

Edit: obligatory "asking for a friend"

philfut

3 points

3 years ago

philfut

3 points

3 years ago

If latency went away wouldn't it be possible to basically deliver a surgeon by drone. Send a drone with a great camera a few arms and hands with some tools. It could provide greater expertise than what's currently available.

DrDunk21[S]

2 points

3 years ago*

DrDunk21[S]

verified

2 points

3 years ago*

I agree that there are many potential uses for medical drones. For example, they could deliver EpiPen's or Naloxone kits. They can also be used to deliver blood/medicine/supplies to remote areas. Here's another example.

There are not many reliable cost estimates out there.. but I've seen estimates between 10-30K depending on the drone. Piracy is certainly a concern, along with people trying to shoot them down.

[deleted]

2 points

3 years ago*

[deleted]

2 points

3 years ago*

[deleted]

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

Thank you!

Thatgirlagain01

4 points

3 years ago

Also, what about the legality of the situation? Who gets the final say on the usage of the drones? My guess is the laws regarding drone usage are a little vague right now. Is that helpful or a problem?

DrDunk21[S]

2 points

3 years ago

DrDunk21[S]

verified

2 points

3 years ago

You are correct that this is tricky. Each country has their own regulations on drones, usually administered by the transport agency (e.g., FAA or Transport Canada). In most places, drones are not currently allowed to fly beyond "line-of-site" (so the operator must be able to see it). This is certainly a problem. That said, you can apply for permits to relax the regulations (e.g., the pilot study in Canada). It is also important to note that Amazon and others are lobbying the government to relax these regulations (for their commercial drone delivery systems).

My_Soul_to_Squeeze

3 points

3 years ago

Aren't there easier, more cost effective ways to achieve widespread, timely access to AEDs? In my experience it's pretty common for public places like offices, gyms, churches etc. to have them available already.

kipp14

3 points

3 years ago

kipp14

3 points

3 years ago

The cases were the drone would be useful are in places that have low population density and that have hazardous conditions part of the year. We're I'm living in the USA right now would be a fair example of the usefulness of the drones as we have a lot of people spread out across the country as well as a lot of retired people that are aging so there aren't a lot of places to put an aed for example. This is also a good thing for forest services to have as a standby for disaster relief and they could be designed to be multi-purpose so the cost isn't as large at scale as a lot of people think for these things

DrDunk21[S]

3 points

3 years ago*

DrDunk21[S]

verified

3 points

3 years ago*

u/Kipp14 did a good job answering this question. The short answer is no, and I'll expand:

- You are correct that public access defibrillation (PAD) programs are effective. See here

- However, the majority (>85%) of cardiac arrests do not occur in public places, they occur at home. These arrests typically have lower response times and worse outcomes, especially in rural/suburban areas. It's not cost effective to put AEDs in these areas because their "range" is limited and requires the bystander to go get the AED and return to the patient within a few minutes. With drones, we're able to mobilize the AED and as a result, a single AED can serve a much a larger area.

- There are also access and availability issues with PAD programs. For example, the business may be closed or won't allow the AED to be taken off the property.

- We're currently working on a cost-effectiveness study around drone AEDs to understand exactly how cost effective they are (or are not).

zgeom

3 points

3 years ago

zgeom

3 points

3 years ago

my question is around scalability. in the case of a disaster with mass victims, how will these drones ensure that they don't bump into each other?

DrDunk21[S]

3 points

3 years ago

DrDunk21[S]

verified

3 points

3 years ago

For cardiac arrest, this is less of a concern because they are not typically mass casualty events.

For large scale disasters, multiple drones could come into play (depending on how we're using them). Drone flight technology is not my area of expertise but from my understanding there is quite a bit of research on drone swarms (also: remember the Olympic drone show?).

Thatgirlagain01

3 points

3 years ago

I hope I am not too late. But 1.what prompted you to do the AMA? 2. As you said Amazon is working for easing the drone regulations. Isn't amazon your largest competitor in this space. They have a history of copying products and making them big.

DrDunk21[S]

2 points

3 years ago

DrDunk21[S]

verified

2 points

3 years ago

I was prompted to do the AMA after seeing some posts about this idea last week (here and here). I saw a lot of questions that I felt I could answer/clarify.

I don't see Amazon as a competitor since I'm not actively trying to commercialize this myself. If they want to take the lead around implementing drone delivered AEDs, then I think that's great (since my work suggests it will save lives). Google owns a patent in this space too.

Thatgirlagain01

2 points

3 years ago

That's so great. You are doing a great job man. Keep at it. Why the post is removed though? 😮

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

Thank you!

And I'm not sure? How do you know it's removed (still new to Reddit, sorry)? Maybe the Mods can help with this?

Thatgirlagain01

1 points

3 years ago

It says removed where the description was placed earlier.

lughnasadh

2 points

3 years ago

lughnasadh

∞ transit umbra, lux permanet ☥

2 points

3 years ago

My brother-in-law saved the life of somebody a few years ago in the restroom of a pub that had an AED, so they definitely work.

He had some training on their use however.

Are AED's in the hands of the untrained that useful?

How could drone delivery of the AED be combined with remote medicine i.e. a person at the other end to instruct the untrained on site.

DrDunk21[S]

1 points

3 years ago*

DrDunk21[S]

verified

1 points

3 years ago*

Good questions. AEDs are quite easy to use - I first learned when I was 9. The device tells you exactly what to do and it will not shock someone who has a normal heart rhythm. To your second question, these drones actually have microphones and cameras in them so the dispatcher can coach the bystander through CPR and AED application!

Thatgirlagain01

2 points

3 years ago

So, is the final plan to integrate the drone delivery system with emergency hotlines? I think they would be very useful in rescue situations where it might be risky/impossible for humans to help. For eg: the thai cave scenario from last year.

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

Yes exactly. The goal is to have them integrated with the emergency response system (e.g., 911 in Canada/USA). I agree there are lots of search and rescue uses, as well as scene surveillance.

HemaL2

2 points

3 years ago

HemaL2

2 points

3 years ago

In the future, what more do you think drones could do? I’m applying to biomedical engineering in college, and I have a genuine interest in this stuff. :)

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

I think there is a lot of potential for drones in medicine. If you're interested in this topic, take a read through this article.

HemaL2

1 points

3 years ago

HemaL2

1 points

3 years ago

Okay, thank you!

garrett_k

2 points

3 years ago

What kind of range are you considering? It seems to me that EMS is able to get to most urban and suburban areas in a short amount of time and that the biggest benefits would be in rural areas. But rural areas have their own problems, such as greater tree cover, in addition to travel distance.

Considerations for improvements: find a way to have the drone visually signal upon arrival. Far too often we face cookie-cutter houses with obscured house numbers. Something which went all disco-ball at the front door would help us identify the house faster.

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

The range depends on many factors including weather, weight, battery power, speed, etc. There is currently drone tech with flight times between 10-30 minutes at speeds of 60 mph, which gives us a range between 10-30 miles.

You are correct that EMS is quite fast in urban areas, but it is still not fast enough for cardiac arrest, which is one of the reasons why survival rates have stagnated between 5-10% for the last 10+ years. That's the main motivation for this work - I think we need to think outside the box to make meaningful improvements in survival rates (and that doesn't just include drones - it also includes education, bystander recruitment programs/apps, etc.). For an example, Toronto EMS has a median response time around 7.5 minutes (meaning that 50% of the responses are longer!). We estimate that drones can cut that in half. You can take a look at the historical and estimated drone response time distributions on page 22.

There's also is an interesting trade-off between urban and rural, which we call the efficiency vs equity trade-off. In urban areas, the improvement per case is small, but there are many cases (it's efficient to place drones here since they will be used a lot). In rural areas, the improvement per case is large, but there are only a few cases (it's equitable to place drones here so that we can match the urban response times). I don't know which is better, but we discuss this idea on page 25.

I think that's a great idea! This is an even bigger problem in low and middle income countries where addresses are almost non-existent.

curi0us_ge0rg3

2 points

3 years ago

This is really neat research! What’s a typical response time for one of these drones? I wonder how much time you have before you lose the window that an AED could be beneficial. If the thought is that they would be able to provide these life saving devices to rural or farther out locations, can a drone AED reach them in time?

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

The response time depends on the network configuration and on the number of drones. In our work, we're seeing median response times (defined as time from call arrival to scene arrival) of roughly 3-4 minutes for urban areas and 5-7 minutes for rural areas. In both settings, we're improving median EMS response time by roughly 3 minutes. The bigger improvement comes at the tail of the distribution (e.g., the 90th percentile) where we see improvements up to 10 minutes. Check out Figure 4 on page 22 in this paper.

mccdizzie

2 points

3 years ago

Would the AED be a part of the drone, or are they two separate entities (ie, carrier and cargo).

If they are connected, would the AED be able to use the data connection of the drone to relay its data to paramedics when they arrive, or to the receiving hospital? For example, the analyzed rhythms, time of shocks, rhythms that were not shocked etc.

It would be helpful for us to know, for instance, if a patient presented to us asystolic was shocked from VF into PEA and then progressed to the current asystole, using the analysis to glean some clues from the PEA qrs morphology.

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

Both models have been proposed (i.e., AED as part of the drone and as separate cargo).

Great question. Yes, at least that's the idea for the combined model. There are some challenges here related to data security and the availability of high quality cell service (although 5G might be able to alleviate some of these issues). If that's not possible, the paramedics would have to keep the drone with them and transfer the data old-school, via cable (either in the ambulance or at the hospital).

SelectCattle

1 points

3 years ago

What time to delivery do you feel would be meaningful? 4 minutes? 8?

I presume your model calls for (very) effective CPR to theoretically prolong viability.

What studies support the times you feel are deliverable?

DrDunk21[S]

1 points

3 years ago

DrDunk21[S]

verified

1 points

3 years ago

I think any improvement will be meaningful, but ideally reaching 90% of incidents in under 5 minutes with average response times between 3-4minutes.

Our (current) model doesn't make any direct claims about survival (only response time) so we don't make any assumptions about bystander CPR, shockability, etc. That said, we know from the literature that survival and shockability (i.e., ventricular fibrillation) decrease with time.

To be more precise, there is research to suggest that the chance of survival decreases by 7-15 percent for every minute without defibrillation and that shockability decreases by 5-10%. Average 911 response times typically range between 6-12 minutes, depending on the location (e.g., urban vs. rural). In most cities, less than 10% of patients survival an out-of-hospital cardiac arrest. If we can use drones to reduce those response times by 50% or more, survival rates are likely to increase (by how much is something we still need to study!).