Drones may be used to save lives in out of hospital cardiac arrest due to drowning

Drones can be used to provide dispatch centres with on-site photos before arrival of EMS in time critical incidents

BACKGROUND

Drones are able to deliver automated external defibrillators in cases of out-of-hospital cardiac arrest (OHCA) but can be deployed for other purposes. Our aim was to evaluate the feasibility of sending live photos to dispatch centres before arrival of other units during time-critical incidents.

METHODS

In this retrospective observational study, the regional dispatch centre implemented a new service using five existing AED-drone systems covering an estimated 200000 inhabitants in Sweden. Drones were deployed automatically over a 4-month study period (December 2022-April 2023) in emergency calls involving suspected OHCAs, traffic accidents and fires in buildings. Upon arrival at the scene, an overhead photo was taken and transmitted to the dispatch centre. Feasibility of providing photos in real time, and time delays intervals were examined.

RESULTS

Overall, drones were deployed in 59/440 (13%) of all emergency calls: 26/59 (44%) of suspected OHCAs, 20/59 (34%) of traffic accidents, and 13/59 (22%) of fires in buildings. The main reasons for non-deployment were closed airspace and unfavourable weather conditions (68%). Drones arrived safely at the exact location in 58/59 cases (98%). Their overall median response time was 3:49 min, (IQR 3:18-4:26) vs. emergency medical services (EMS), 05:51 (IQR: 04:29-08:04) p-value for time difference between drone and EMS = 0,05. Drones arrived first on scene in 47/52 cases (90%) and the largest median time difference was found in suspected OHCAs 4:10 min, (IQR: 02:57-05:28). The time difference in the 5/52 (10%) cases when EMS arrived first the time difference was 5:18 min (IQR 2:19-7:38), p = NA. Photos were transmitted correctly in all 59 alerts. No adverse events occurred.

CONCLUSION

In a newly implemented drone dispatch service, drones were dispatched to 13% of relevant EMS calls. When drones were dispatched, they arrived at scene earlier than EMS services in 90% of cases. Drones were able to relay photos to the dispatch centre in all cases. Although severely affected by closed airspace and weather conditions, this novel method may facilitate additional decision-making information during time-critical incidents.

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.

Drones reduce the treatment-free interval in search and rescue operations with telemedical support - A randomized controlled trial

INTRODUCTION

Response to medical incidents in mountainous areas is delayed due to the remote and challenging terrain. Drones could assist in a quicker search for patients and can facilitate earlier treatment through delivery of medical equipment. We aim to assess the effects of using drones in search and rescue (SAR) operations in challenging terrain. We hypothesize that drones can reduce the search time and treatment-free interval of patients by delivering an emergency kit and telemedical support.

METHODS

In this randomized controlled trial with a cross-over design two methods of searching for and initiating treatment of a patient were compared. The primary outcome was a comparison of the times for locating a patient through visual contact and starting treatment on-site between the drone-assisted intervention arm and the conventional ground-rescue control arm. A linear mixed model (LMM) was used to evaluate the effect of using a drone on search and start of treatment times.

RESULTS

Twenty-four SAR missions, performed by six SAR teams each with four team members, were analyzed. The mean time to locate the patient was 14.6 min (95% CI 11.3-17.9) in the drone-assisted intervention arm and 20.6 min (95% CI 17.3-23.9) in the control arm. The mean time to start treatment was 15.7 min (95% CI 12.4-19.0) in the drone-assisted arm and 22.4 min (95% CI 19.1-25.7) in the control arm (p < 0.01 for both comparisons).

CONCLUSION

The successful use of drones in SAR operations leads to a reduction in search time and treatment-free interval of patients in challenging terrain, which could improve outcomes in patients suffering from traumatic injuries, the most commonly occurring incident requiring mountain rescue operations.

Drone Applications for Emergency and Urgent Care: A Systematic Review

Introduction:

In recent years, the use of drones in health emergencies has increased. Among their main benefits are avoiding endangering rescuers, travelling long distances in a short time, or contacting victims in risky situations; but despite their multiple advantages, their use has not been fully demonstrated.

Study Objective:

This study aims to identify the available evidence on the use of drones in emergency health care compared to traditional health care.

Methods:

Systematic review of the literature was conducted. Search protocols were developed to locate studies that met the established selection criteria. Six experimental or quasi-experimental studies with high methodological quality published from the beginning of indexing until 2020 were included.

Results:

Drones covered a significantly larger area than other traditional tracking methods and were very useful for performing preliminary triage, determining needs, and knowing the scene prior to the arrival of rescuers. In addition, drones reduced the time required to locate the victim.

Conclusions:

Drones are an element to be taken into account when attending health emergencies as they significantly improve the distance travelled to locate accident victims, have the possibility of performing triage prior to the arrival of the health care units, and improve the time and quality of the care provided.

Micro aerial vehicle with basic risk of operation

We draw current efforts towards proposing a wing-type micro UAV with characteristics of being a basic operation risk self handled (Micro-Brosh) platform. Its micro-sized wingspan and weight, which are less than 0.30 m and 0.150 kg, respectively, guarantee the low risk to the operator and installations in case of crashing. It can be launched manually without using an appropriate runway, besides using a soft grass field for landing is recommended. Its associated costs for construction and maintenance are very low (below US$ 500) if compared to traditional aircraft. The main contribution here is the architectural design, besides we provide detailed documentation including techniques for determining lift, thrust, drag, minimum flight velocity, maximum time of flight and distance (autonomy), and other issues that we have solved related to the aircraft development. We validate our prototype with experiments including several tests done with the UAV with results that have proven its flight ability. To the end, we understand that this work provides a nice starting document to researchers that intend to develop a UAV or enter this field.

Simulation-Based Drone Assisted Search Operations in a River

INTRODUCTION

Drones can transmit live video and geographic coordinates during the planning stages for search and rescue operations and the operations themselves. There are few simulation studies in which drones provided rescue support. However, the literature does not contain any simulation studies involving the use of drones to locate lost "victims" represented by dummies in rivers. We developed a simulation model to compare the first visual contact times for drone-assisted search techniques (DAST) and classic search techniques (CST).

METHODS

In this prospective experimental simulation study, we used both DAST and CST to perform a series of river searches for unconscious victims (represented by dummies). We calculated the first visual contact times, total scanned area, scanned area per minute, flight-walking distances, and flight-walking speeds and compared the results between both groups. The data are presented as mean±SD.

RESULTS

We performed 20 search and rescue operations, 10 with the CST and 10 with the DAST. The time to reach the victim was 823±177 s using CST and 80±14 s using DAST. The area scanned by unit time was 3091±54 m²·min^-1 using CST and 22,640±1622 m²·min^-1 using DAST.

CONCLUSIONS

The drone-assisted search technique located a simulated victim drifting in a river faster than the classic search technique. The use of drones in search and rescue operations could improve the time to find victims.

Impact of Using Drones in Emergency Medicine: What Does the Future Hold?

The use of unmanned aerial vehicles or "drones" has expanded in the last decade, as their technology has become more sophisticated, and costs have decreased. They are now used routinely in farming, environmental surveillance, public safety, commercial product delivery, recreation, and other applications. Health-related applications are only recently becoming more widely explored and accepted. The use of drone technology in emergency medicine is especially promising given the need for a rapid response to enhance patient outcomes. The purpose of this paper is to describe some of the main current and expanding applications of drone technology in emergency medicine and to describe challenges and future opportunities. Current applications being studied include delivery of defibrillators in response to out-of-hospital cardiac arrest, blood and blood products in response to trauma, and rescue medications. Drones are also being studied and actively used in emergency response to search and rescue operations as well as disaster and mass casualty events. Current challenges to expanding their use in emergency medicine and emergency medical system (EMS) include regulation, safety, flying conditions, concerns about privacy, consent, and confidentiality, and details surrounding the development, operation, and maintenance of a medical drone network. Future research is needed to better understand end user perceptions and acceptance. Continued technical advances are needed to increase payload capacities, increase flying distances, and integrate drone networks into existing 9-1-1 and EMS systems. Drones are a promising technology for improving patient survival, outcomes, and quality of life, particularly for those in areas that are remote or that lack funds or infrastructure. Their cost savings compared with ground transportation alone, speed, and convenience make them particularly applicable in the field of emergency medicine. Research to date suggests that use of drones in emergency medicine is feasible, will be accepted by the public, is cost-effective, and has broad application.

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.

COVID-19 Pandemic in Mountainous Areas: Impact, Mitigation Strategies, and New Technologies in Search and Rescue Operations

van Veelen, Michiel J., Anna Voegele, Simon Rauch, Marc Kaufmann, Hermann Brugger, and Giacomo Strapazzon. COVID-19 pandemic in mountainous areas: impact, mitigation strategies, and new technologies in search and rescue operations. High Alt Med Biol. 22:335-341, 2021.-Mitigating the spread of COVID-19, an airborne infection, can lead to delays in the prehospital response and impair the performance of search and rescue (SAR) services in mountainous and remote areas. We provide an overview of the developing epidemiological situation related to the COVID-19 pandemic in mountainous areas and review current protocols to determine their suitability for mountain rescue teams. We also discuss using novel technologies to reduce the adverse effects caused by COVID-19 mitigation strategies such as delays caused by donning personal protective equipment (PPE) and reduced rescuer performance due to impaired movement and ventilation. COVID-19 has spread even in mountainous and remote locations. Dedicated protocols for the use of PPE appropriate for SAR rescuers exerting physical effort in remote areas and using technologies such as drones, telemedicine, and localization and contact tracing applications could contribute to an effective and timely emergency response in mountainous and remote settings.

Descriptive Epidemiology of Rescue-Related Fatal Drowning in Turkey

Drowning is a public-health threat and a leading cause of injury-related death. In Turkey, drowning results in 900 fatalities annually, and the rate is rising. As data on rescue-related drowning are scarce, this retrospective study explores the epidemiology of fatal drowning among rescuers in Turkey. As there are no routinely collected death registry data on drowning in Turkey, data were sourced from media reports of incidents between 2015 and 2019. Rescuer fatalities were analysed by age, sex, activity prior to rescue, location, incident day of week and season, and place of death. Statistical analyses comprised X² tests of significance (p < 0.05) and calculation of relative risk (95% confidence interval) using fatality rates. In total, 237 bystander rescuers drowned (90% male; 35% 15–24 years). In 33% of cases, the primary drowning victim (PDV) was successfully rescued, while in 46% of cases the rescue resulted in multiple drowning fatalities (mean = 2.29; range 1–5 rescuers). Rescues were more likely to be successful in saving the PDV if undertaken at the beach/sea (X² = 29.147; p < 0.001), while swimming (X² = 12.504; p = 0.001), or during summer (X² = 8.223; p = 0.029). Risk of bystander rescue-related fatal drowning was twice as high on weekdays compared to on weekends (RR = 2.04; 95%CI: 1.56–2.67). While bystanders play an important role in reducing drowning, undertaking a rescue is not without risk and can lead to multiple drowning incidents. Training in rescue and resuscitation skills (especially the prioritization of non-contact rescues) coupled with increasing awareness of drowning risk, are risk-reduction strategies which should be explored in Turkey.

[Cardiac arrest under special circumstances]

These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy).

European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances

These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).

Effect of supercapacitors on the operation of an air-cooled hydrogen fuel cell

One of the greatest challenges associated with efficient energy use in unmanned aerial vehicles (drones) is that of the energy storage systems – more specifically it's weight and capacity. Current hydrogen fuel cell drones have very promising flight durations, but have a low power density thus performing poorly at peak power demands. Supercapacitors are known to have high power densities and respond significantly well to peak power demands. For this research it is desired to evaluate how supercapacitors can affect the operation of an existing hydrogen fuel cell system, when combined. This study will include the evaluation of the viability of a DC-DC converter used to reduce the size (and subsequently, weight) of a supercapacitor bank. It also evaluates whether specified switching of the sources has an effect. Using data generated from the experiment it was determined that the DC-DC converter (with efficiency >94%) reduced the efficiency (by 0.5%) and duration (by 3.8%) of the supercapacitor bank whilst increasing the weight (by 16.7%). It was also seen that the method of selective switching offered no benefit over that of a self-selecting system, where the former obtained 223 s of usability and the latter 365 s. However, comparing all the results it was observed that the addition of a supercapacitor bank allowed for an improvement in energy- and power density, of the hydrogen fuel cell system, from 0.65 Wh/kg to 1.19 Wh/kg and from 69.7 W/kg to 125.7 W/kg, respectively.

Drone versus ground delivery of simulated blood products to an urban trauma center: The Montreal Medi-Drone pilot study

BACKGROUND

Timely and safe distribution of quality blood products is a major challenge faced by blood banks around the world. Our primary objective was to determine if simulated blood product delivery to an urban trauma center would be more rapidly achieved by unmanned aerial vehicle (UAV) than by ground transportation. A secondary objective was to determine the feasibility of maintaining simulated blood product temperatures within a targeted range.

METHODS

In this prospective pilot study, we used two distinct methods to compare UAV flight duration and ground transport times. Simulated blood products included packed red blood cells, platelet concentrate, and fresh frozen plasma. For each blood product type, three UAV flights were conducted. Temperature was monitored during transport using a probe coupled to a data logger inside each simulated blood product unit.

RESULTS

All flights were conducted successfully without any adverse events or safety concerns reported. The heaviest payload transported was 6.4 kg, and the drone speed throughout all nine flights was 10 m/s. The mean UAV transportation time was significantly faster than ground delivery (17:06 ± 00:04 minutes vs. 28:54 ± 01:12 minutes, p < 0.0001). The mean ± SD initial temperature for packed red blood cells was 4.4°C ± 0.1°C with a maximum 5% mean temperature variability from departure to landing. For platelet concentrates, the mean ± SD initial temperature was 21.6°C ± 0.5°C, and the maximum variability observed was 0.3%. The mean ± SD initial fresh frozen plasma temperature was -19°C ± 2°C, and the greatest temperature variability was from -17°C ± 2°C to -16°C ± 2°C.

CONCLUSIONS

Unmanned aerial vehicle transportation of simulated blood products was significantly faster than ground delivery. Simulated blood product temperatures remained within their respective acceptable ranges throughout transport. Further studies assessing UAV transport of real blood products in populated areas are warranted.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.

Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

OBJECTIVES

This study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.

PARTICIPANTS

3296 emergency medical stations in Germany.

SETTING

Rural areas in Germany.

PRIMARY AND SECONDARY OUTCOME MEASURES

Three UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.

RESULTS

Current EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).

CONCLUSION

These results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

Drones in Emergency Medical Services: A Systematic Literature Review with Bibliometric Analysis

This paper conducts a systematic literature review with bibliometric analysis for drone-related research in Emergency Medical Services (EMS). Forty publications were extracted from the SCOPUS database during 2015–2019 for further analysis. The results show the current research landscape and guide future research directions. Interestingly, the occurrence of the COVID-19 pandemic made the use of drones necessary to assist EMSs lifesaving tasks to reduce fatality, which has also attracted more attention from the academic community. It was found that the co-evolution of drone technologies and entrepreneurial activities in the EMS ecosystem offers drone uses beyond medical applications.

A comprehensive review of energy sources for unmanned aerial vehicles, their shortfalls and opportunities for improvements

Unmanned Aerial Vehicles were first introduced almost 40 years ago and their applications have increased and diversified substantially since then, in both commercial and private use. One of the UAVs main issues when it comes to mobility is that the power sources available are inadequate, this highlights an area for improvement as the interest in drones is on the increase. There exist many different types of power supplies applied to UAVs, however each has their own limitations and strengths that pertain to weight contributions, charging and discharging times, size, payload capabilities, energy density and power density. The aim of this paper is to review the main power sources available for UAVs, determine their shortfalls, compare the power sources with each other and offer suggestions as to how they can be improved – hence identifying where the gap lies for developing better alternative power sources.

UAV Framework for Autonomous Onboard Navigation and People/Object Detection in Cluttered Indoor Environments

Response efforts in emergency applications such as border protection, humanitarian relief and disaster monitoring have improved with the use of Unmanned Aerial Vehicles (UAVs), which provide a flexibly deployed eye in the sky. These efforts have been further improved with advances in autonomous behaviours such as obstacle avoidance, take-off, landing, hovering and waypoint flight modes. However, most UAVs lack autonomous decision making for navigating in complex environments. This limitation creates a reliance on ground control stations to UAVs and, therefore, on their communication systems. The challenge is even more complex in indoor flight operations, where the strength of the Global Navigation Satellite System (GNSS) signals is absent or weak and compromises aircraft behaviour. This paper proposes a UAV framework for autonomous navigation to address uncertainty and partial observability from imperfect sensor readings in cluttered indoor scenarios. The framework design allocates the computing processes onboard the flight controller and companion computer of the UAV, allowing it to explore dangerous indoor areas without the supervision and physical presence of the human operator. The system is illustrated under a Search and Rescue (SAR) scenario to detect and locate victims inside a simulated office building. The navigation problem is modelled as a Partially Observable Markov Decision Process (POMDP) and solved in real time through the Augmented Belief Trees (ABT) algorithm. Data is collected using Hardware in the Loop (HIL) simulations and real flight tests. Experimental results show the robustness of the proposed framework to detect victims at various levels of location uncertainty. The proposed system ensures personal safety by letting the UAV to explore dangerous environments without the intervention of the human operator.

The use of drones and a machine-learning model for recognition of simulated drowning victims-A feasibility study

BACKGROUND

Submersion time is a strong predictor for death in drowning, already 10 min after submersion, survival is poor. Traditional search efforts are time-consuming and demand a large number of rescuers and resources. We aim to investigate the feasibility and effectiveness of using drones combined with an online machine learning (ML) model for automated recognition of simulated drowning victims.

METHODS

This feasibility study used photos taken by a drone hovering at 40 m altitude over an estimated 3000 m² surf area with individuals simulating drowning. Photos from 2 ocean beaches in the south of Sweden were used to (a) train an online ML model (b) test the model for recognition of a drowning victim.

RESULTS

The model was tested for recognition on n = 100 photos with one victim and n = 100 photos with no victims. In drone photos containing one victim (n = 100) the ML model sensitivity for drowning victim recognition was 91% (95%CI 84.9%-96.2%) with a median probability score that the finding was human of 66% (IQR 52-71). In photos with no victim (n = 100) the ML model specificity was 90% (95%CI: 83.9%-95.6%). False positives were present in 17.5% of all n = 200 photos but could all be ruled out manually as false objects.

CONCLUSIONS

The use of a drone and a ML model was feasible and showed satisfying effectiveness in identifying a submerged static human simulating drowning in open water and favorable environmental conditions. The ML algorithm and methodology should be further optimized, again tested and validated in a real-life clinical study.

An internet of things assisted drone based approach to reduce rapid spread of COVID-19

With the quick spread of pandemic disease, many individuals have lost their lives across different parts of the world. So, the need for a novel approach or model to overcome the problem becomes a necessity. In this paper, a mechanism is proposed called DBCMS (Drone Based Covid-19 Medical Service) for the safety of medical employees who are prone to Covid-19 infection. The proposed mechanism can effectively improve the treatment process of Covid-19 patients. Drones are nowadays commonly used in the field of medical emergency situations. The proposed model in this paper uses drone service to reduce the risk of infection to the doctors or other medical staff, thereby preventing the disease spread. This paper further assumes that the primary step is to isolate people at their home instead of admitting them to the hospitals, also called a situation of lockdown or curfew. Thus, in this way, the spread can be significantly reduced across the globe if DBCMS approach is implemented at cluster level.

The Use of Drones in Emergency Medicine: Practical and Legal Aspects

Unmanned aerial vehicles, also known as drones, can play a significant role in military and civil emergency medicine. The aim of the study was to present the real possibilities of using them in rescue operations and to provide examples from all over the world. Unmanned aerial vehicles can be applied to transport goods on demand, provide blood in urban areas, save sinking people, analyse the scale of damages, monitor large human gatherings, perform exploration activities, deliver blood samples and other analysis material, provide automated external defibrillators, support rescue operations and air transport, and perform agricultural activities. One must, however, be aware of the existing regulations regarding drone flights as an appearance of an unreported unmanned aircraft in the controlled space is identified worldwide as affecting aviation safety.

Identification of Swimmers in Distress Using Unmanned Aerial Vehicles: Experience at the Mont-Tremblant IRONMAN Triathlon

Background: This preliminary report describes our experience using unmanned aerial vehicles (UAVs) to identify swimmers in distress at the 2018 Mont-Tremblant IRONMAN triathlon (Quebec, Canada). Methods: In a prospective pilot study, we sought to determine whether UAV surveillance could identify swimmers showing signs of distress quicker than conventional methods (i.e., lifeguards on the ground and on watercraft). In addition, we investigated the feasibility of using UAVs for medical surveillance at a triathlon event in terms of operations, costs, safety, legal parameters, and added value. Prior to the race, we screened participants for medical conditions that could elevate their risk of injury during the swim portion of the triathlon. Athletes deemed to be at increased risk were given a yellow swimming cap to enhance their surveillance by trained observers watching a live video feed from the UAVs. Results: On race day, a total of 3 UAVs (2 mobile, 1 tethered) were launched over Lake Tremblant and provided 3 observers with live video of the swimmers. Of the 2,473 race participants, there were 25 athletes with pre-identified medical conditions who wore a yellow cap during the swim. We did not detect any signs of distress among swimmers wearing yellow caps. Among the remaining 2,448 athletes, there were 5 swimmers who demonstrated signs of distress and required mobilization of water rescue boats; UAV surveillance identified 1 of these 5 distress events before it was seen by lifeguards on rescue boats. None of the athletes in the IRONMAN suffered an adverse event while swimming. Several technical and safety issues related to UAV surveillance arose including poor visibility, equipment loss, and flight autonomy. Conclusion: While our preliminary findings suggest that using UAVs to identify distressed swimmers during an IRONMAN race is feasible and safe, more research is necessary to determine how to optimize UAV surveillance at mass sporting events and integrate this technology within the existing emergency response teams.

The promising future of drones in prehospital medical care and its application to battlefield medicine

Unmanned aerial vehicles, commonly referred to as drones, have been made widely available in recent years leading to an exponential growth in their roles and applications. The rapidly developing field of medical drones is on the verge of revolutionizing prehospital medicine enabling advanced health care delivery to once-inaccessible patients. The aim of this review is to clarify the basic technical properties of currently available medical drones and review recent advances and their usefulness in military and civilian health care missions. A thorough search was conducted using conventional medical literature databases and nonmedical popular search engines. The results indicate increasingly rapid incorporation of unmanned aerial vehicles into search and rescue missions, telemedicine assignments, medical supply routes, public health surveillance, and disaster management. Medical drones appear to be of great benefit for improving survivability of deployed forces on and off the battlefield. The emerging aerial medical delivery systems appear to provide particularly promising solutions for bridging some of the many serious gaps between third world health care systems and their western counterparts and between major metropolitan centers and distant rural communities. The global nature of drone-based health care delivery needs points to a need for an international effort between collaborating civilian and military medical forces to harness the currently available resources and novel emerging technologies for broader lifesaving capabilities. LEVEL OF EVIDENCE: Level V.

Recursive Rewarding Modified Adaptive Cell Decomposition (RR-MACD): A Dynamic Path Planning Algorithm for UAVs

A relevant task in unmanned aerial vehicles (UAV) flight is path planning in 3 D environments. This task must be completed using the least possible computing time. The aim of this article is to combine methodologies to optimise the task in time and offer a complete 3 D trajectory. The flight environment will be considered as a 3 D adaptive discrete mesh, where grids are created with minimal refinement in the search for collision-free spaces. The proposed path planning algorithm for UAV saves computational time and memory resources compared with classical techniques. With the construction of the discrete meshing, a cost response methodology is applied as a discrete deterministic finite automaton (DDFA). A set of optimal partial responses, calculated recursively, indicates the collision-free spaces in the final path for the UAV flight.

Unmanned aerial vehicle (drones) in public health: A SWOT analysis

In developing countries, lack of access to roads is critical for medical supplies like vaccines and drugs. Air transport like a helicopter is expensive and not affordable. The success of drones in the fields of ecology and environment makes us believe that they can also be used in the field of Public Health as medical couriers. The important strength of using drones is its potential to decrease the travel time for diagnosis and treatment. They are a cost-effective alternative to road transport in difficult terrains. Drones can be used in the transport of blood from the blood bank to the place of surgery and that of specimens from hard-to-reach areas to the labs in nearby towns. They can deliver essential medicines like anti-venom for snake bite and dog bite and prevent deaths. Drones can be employed in disaster relief operations for rescuing victims and in the delivery of food, water, and medicines. Organs can be transported in a short time bypassing the busy traffic. However, operating drones require trained staff and the lack of infrastructure like runway is a potential problem. Drones cannot carry heavier payloads or deliver goods long distances. Drones in the hands of terrorist groups may be weaponized and used for terror attacks. Medical drones may be mistaken for military Drone and attacked by armed forces.

Unmanned aerial vehicles (drones) to prevent drowning

BACKGROUND

Drowning literature have highlighted the submersion time as the most powerful predictor in assessing the prognosis. Reducing the time taken to provide a flotation device and prevent submersion appears of paramount importance. Unmanned aerial vehicles (UAVs) can provide the location of the swimmer and a flotation device.

OBJECTIVE

The objective of this simulation study was to evaluate the efficiency of a UAV in providing a flotation device in different sea conditions, and to compare the times taken by rescue operations with and without a UAV (standard vs UAV intervention). Several comparisons were made using professional lifeguards acting as simulated victims. A specifically-shaped UAV was used to allow us to drop an inflatable life buoy into the water.

RESULTS

During the summer of 2017, 28 tests were performed. UAV use was associated with a reduction of time it took to provide a flotation device to the simulated victim compared with standard rescue operations (p < 0.001 for all measurements) and the time was reduced even further in moderate (81 ± 39 vs 179 ± 78 s; p < 0.001) and rough sea conditions (99 ± 34 vs 198 ± 130 s; p < 0.001). The times taken for UAV to locate the simulated victim, identify them and drop the life buoy were not altered by the weather conditions.

CONCLUSION

UAV can deliver a flotation device to a swimmer safely and quickly. The addition of a UAV in rescue operations could improve the quality and speed of first aid while keeping lifeguards away from dangerous sea conditions.

Drones for Provision of Flotation Support in Simulated Drowning

OBJECTIVE

The feasibility and potential of using drones for providing flotation devices in cases of drowning have not yet been assessed. We hypothesize that a drone carrying an inflatable life buoy is a faster way to provide flotation compared with traditional methods. The purpose of this study is to explore the feasibility and efficiency of using a drone for delivering and providing flotation support to conscious simulated drowning victims.

METHODS

A simulation study was performed with a simulated drowning victim 100 m from the shore. A drone (DJI Phantom 4; dji, Shenzhen, China) equipped with an inflatable life buoy of 60 N was compared with traditional surf rescue swimming for providing flotation. The primary outcome was delay (minutes:seconds).

RESULTS

A total number of 30 rescues were performed with a median time to delivery of the floating device of 30 seconds (interquartile range [IQR] = 24-32 seconds) for the drone compared with 65 seconds (IQR = 60-77 seconds) with traditional rescue swimming (P < .001). The drone had an accuracy of 100% in dropping the inflatable life buoy < 5 m from the victim, with a median of 1 m (IQR = 1-2 m).

CONCLUSION

Using drones to deliver inflatable life buoys is safe and may be a faster method to provide early flotation devices to conscious drowning victims compared with rescue swimming.

Big Data's Role in Precision Public Health

Precision public health is an emerging practice to more granularly predict and understand public health risks and customize treatments for more specific and homogeneous subpopulations, often using new data, technologies, and methods. Big data is one element that has consistently helped to achieve these goals, through its ability to deliver to practitioners a volume and variety of structured or unstructured data not previously possible. Big data has enabled more widespread and specific research and trials of stratifying and segmenting populations at risk for a variety of health problems. Examples of success using big data are surveyed in surveillance and signal detection, predicting future risk, targeted interventions, and understanding disease. Using novel big data or big data approaches has risks that remain to be resolved. The continued growth in volume and variety of available data, decreased costs of data capture, and emerging computational methods mean big data success will likely be a required pillar of precision public health into the future. This review article aims to identify the precision public health use cases where big data has added value, identify classes of value that big data may bring, and outline the risks inherent in using big data in precision public health efforts.

The potential use of unmanned aircraft systems (drones) in mountain search and rescue operations

OBJECTIVE

This study explores the potential use of drones in searching for and locating victims and of motorized transportation of search and rescue providers in a mountain environment using a simulation model.

METHODS

This prospective randomized simulation study was performed in order to compare two different search and rescue techniques in searching for an unconscious victim on snow-covered ground. In the control arm, the Classical Line Search Technique (CLT) was used, in which the search is performed on foot and the victim is reached on foot. In the intervention arm, the Drone-snowmobile Technique (DST) was used, the search being performed by drone and the victim reached by snowmobile. The primary outcome of the study was the comparison of the two search and rescue techniques in terms of first human contact time.

RESULTS

Twenty search and rescue operations were conducted in this study. Median time to arrival at the mannequin was 57.3min for CLT, compared to 8.9min for DST. The median value of the total searched area was 88,322.0m² for CLT and 228,613.0m² for DST. The median area searched per minute was 1489.6m² for CLT and 32,979.9m² for DST (p<0.01 for all comparisons).

CONCLUSIONS

In conclusion, a wider area can be searched faster by drone using DST compared to the classical technique, and the victim can be located faster and reached earlier with rescuers transported by snowmobile.