The Application of Drones in Healthcare and Health-Related Services in North America: A Scoping Review

Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach

BACKGROUND

The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones.

OBJECTIVE

This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones).

METHODS

A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations.

RESULTS

The study found a positive correlation between the usability of a pharmacy drone app and participants' willingness to use it (r=0.833). Participants' perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=-0.542; System Usability Scale and r=-0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration.

CONCLUSIONS

With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable.

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.

Risks of Drone Use in Light of Literature Studies

This article aims to present the results of a bibliometric analysis of relevant literature and discuss the main research streams related to the topic of risks in drone applications. The methodology of the conducted research consisted of five procedural steps, including the planning of the research, conducting a systematic review of the literature, proposing a classification framework corresponding to contemporary research trends related to the risk of drone applications, and compiling the characteristics of the publications assigned to each of the highlighted thematic groups. This systematic literature review used the PRISMA method. A total of 257 documents comprising articles and conference proceedings were analysed. On this basis, eight thematic categories related to the use of drones and the risks associated with their operation were distinguished. Due to the high content within two of these categories, a further division into subcategories was proposed to illustrate the research topics better. The conducted investigation made it possible to identify the current research trends related to the risk of drone use and pointed out the existing research gaps, both in the area of risk assessment methodology and in its application areas. The results obtained from the analysis can provide interesting material for both industry and academia.

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.

Drone Detection and Tracking Using RF Identification Signals

The market for unmanned aerial systems (UASs) has grown considerably worldwide, but their ability to transmit sensitive information poses a threat to public safety. To counter these threats, authorities, and anti-drone organizations are ensuring that UASs comply with regulations, focusing on strategies to mitigate the risks associated with malicious drones. This study presents a technique for detecting drone models using identification (ID) tags in radio frequency (RF) signals, enabling the extraction of real-time telemetry data through the decoding of Drone ID packets. The system, implemented with a development board, facilitates efficient drone tracking. The results of a measurement campaign performance evaluation include maximum detection distances of 1.3 km for the Mavic Air, 1.5 km for the Mavic 3, and 3.7 km for the Mavic 2 Pro. The system accurately estimates a drone's 2D position, altitude, and speed in real time. Thanks to the decoding of telemetry packets, the system demonstrates promising accuracy, with worst-case distances between estimated and actual drone positions of 35 m for the Mavic 2 Pro, 17 m for the Mavic Air, and 15 m for the Mavic 3. In addition, there is a relative error of 14% for altitude measurements and 7% for speed measurements. The reaction times calculated to secure a vulnerable site within a 200 m radius are 1.83 min (Mavic Air), 1.03 min (Mavic 3), and 2.92 min (Mavic 2 Pro). This system is proving effective in addressing emerging concerns about drone-related threats, helping to improve public safety and security.

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.

Elevating Healthcare: Rapid Literature Review on Drone Applications for Streamlining Disaster Management and Prehospital Care in Saudi Arabia

Saudi Arabia's health sector faces pressing challenges in disaster and prehospital care delivery, such as prolonged response times, limited access to remote areas, and strained medical resources. Integrating drone technology has emerged as an innovative approach to address these challenges and revolutionize healthcare delivery. Drones can significantly enhance response times, increase access to underserved areas, and reduce the burden on existing medical infrastructure. A detailed analysis of global case studies demonstrates the successful use of drones in healthcare delivery, emphasizing the importance of regulatory frameworks and public-private partnerships. These examples provide valuable insights into Saudi Arabia's health sector transformation. The potential benefits of integrating drone technology include improved patient outcomes, increased efficiency, and cost savings. To ensure the successful implementation of this transformative approach, it is crucial to establish clear regulatory guidelines, invest in research and development, and foster collaboration between the government, private sector, and healthcare stakeholders. The aim of this study is to explore the potential of drone technology in transforming healthcare delivery in Saudi Arabia, particularly within disaster response and prehospital care services.

The Use of Drones to Deliver Rift Valley Fever Vaccines in Rwanda: Perceptions and Recommendations

Given the recent emergence of Rift Valley Fever (RVF) in Rwanda and its profound impact on livelihoods and health, improving RVF prevention and control strategies is crucial. Vaccinating livestock is one of the most sustainable strategies to mitigate the impact of RVF on health and livelihoods. However, vaccine supply chain constraints severely limit the effectiveness of vaccination programs. In the human health sector, unmanned aerial vehicles, i.e., drones, are increasingly used to improve supply chains and last-mile vaccine delivery. We investigated perceptions of whether delivering RVF vaccines by drone in Rwanda might help to overcome logistical constraints in the vaccine supply chain. We conducted semi-structured interviews with stakeholders in the animal health sector and Zipline employees in Nyagatare District in the Eastern Province of Rwanda. We used content analysis to identify key themes. We found that stakeholders in the animal health sector and Zipline employees believe that drones could improve RVF vaccination in Nyagatare. The primary benefits study participants identified included decreased transportation time, improved cold chain maintenance, and cost savings.

"Of course, drones delivering urgent medicines are necessary. But I would not use them until…" Insights from a qualitative study on users' needs and requirements regarding the use of medical drones

BACKGROUND

The current COVID-19 pandemic, demographic trends, and the increasing shortage of skilled workers pose major challenges for the care of people with and without care needs. The potential of drones as unmanned aerial vehicles in health care is being discussed as an effective innovative way of delivering much-needed medicines, especially in rural areas. Although the advantages are well known, the needs of the users have not yet been taken into account.

METHODS

Online-based focus groups (via WebEx) were conducted with participants from different disciplines: nursing, pharmacy, physicians. Focus groups with COVID-19 patients were conducted face-to-face. The focus was primarily on potential problems and requirements of the users regarding the use of drones. Structured and contrastive snowball sampling has been deployed. The focus groups were audio recorded, transcribed by a transcription-company, and coded with the help of the program "f4analyse 2" for content (Elo et al. 2008).

RESULTS

Especially during the pandemic situation, delays, and restrictions in the delivery of medicines have been noticed. All interview partners (patients, pharmacists, physicians, and nurses; n = 36 participants) see drones as useful in cases of limited mobility, time-critical medicines (rapid availability), emergencies, and disasters (e.g., floods), but also for the delivery of regular medicines in rural areas (e.g., for the treatment of chronic diseases). Moreover, only 16.7% of the participants have experiences with drones.

DISCUSSION

Drone deliveries do not play a role in the health system yet despite their great importance, which is perceived as particularly evident in the pandemic situation. The results lead to the conclusion that this is mainly due to knowledge and application deficits, so that educational and advisory work is absolutely necessary. There is also a need for further studies that go beyond the scope of acceptance research to describing and evaluating concrete scenarios of drone delivery on the basis of a user-centered approach.

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.

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.

Novel Drone Design Using an Optimization Software with 3D Model, Simulation, and Fabrication in Drone Systems Research

This paper presents the design of a small size Unmanned Aerial Vehicle (UAV) using the 3DEXPERIENCE software. The process of designing the frame parts involves many methods to ensure the parts can meet the requirements while conforming to safety and industry standards. The design steps start with the selection of materials that can be used for the drone, which are polylactic acid (PLA), acrylonitrile styrene acrylate (ASA), and acrylonitrile butadiene styrene (ABS). The drone frame consists of four main parts, which are the center top cover (50 g), the side top cover (10 g), the middle cover (30 g), and the drone’s arm (80 g). A simulation was carried out to determine the stress, displacement, and weight of the drone’s parts. Additionally, a trade-off study was conducted to finalize the shapes of the parts and the various inputs based on their priorities. The outcome of this new design can be represented in design concepts, which involve the use of the snap hook function to assemble two body parts together, namely the middle cover and the center top cover, without the need of an additional fastener.

Design of a Service for Hospital Internal Transport of Urgent Pharmaceuticals via Drones

The internal transport of medical goods in a hospital heavily relies on human resources that carry the materials on foot. Such mode of transport may be affected by inefficiencies, e.g., due to bottlenecks, and other logistic challenges. Thus, it may benefit from the use of unmanned aircraft systems in several aspects. Such a scenario introduces specific criticalities for healthcare organizations in densely populated areas and below congested airspace, such as the Milan metropolitan area. The authors applied a co-creation methodology to design a highly automated drone service for the delivery of pharmaceuticals at San Raffaele Hospital, Milan, Italy. The needs of the main users were identified by means of semi-structured interviews and visualization material. Based on those outcomes, a drone service was designed and validated with the main users. It emerged that the main gain point of such a service would be increasing hospital logistics efficiency. The risks tied to the operations (e.g., tampering of the delivery container) were evaluated and appropriate mitigations were identified (e.g., use of tamper-evident seals or mechatronic locks). The information required by the digital system offering the needed logistics functions was analyzed for future development. Recent conceptual and regulatory advancements in the field of Urban Air Mobility (UAM) in Europe were elaborated to outline the digital ecosystem in which aviation and non-aviation actors would exchange information to ensure operations’ efficiency, safety and regulatory compliance.

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.

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.

Quantifying the Effects of Vibration on Medicines in Transit Caused by Fixed-Wing and Multi-Copter Drones

The concept of transporting medical products by drone is gaining a lot of interest amongst the medical and logistics communities. Such innovation has generated several questions, a key one being the potential effects of flight on the stability of medical products. The aims of this study were to quantify the vibration present within drone flight, study its effect on the quality of the medical insulin through live flight trials, and compare the effects of vibration from drone flight with traditional road transport. Three trials took place in which insulin ampoules and mock blood stocks were transported to site and flown using industry standard packaging by a fixed-wing or a multi-copter drone. Triaxial vibration measurements were acquired, both in-flight and during road transit, from which overall levels and frequency spectra were derived. British Pharmacopeia quality tests were undertaken in which the UV spectra of the flown insulin samples were compared to controls of known turbidity. In-flight vibration levels in both the drone types exceeded road induced levels by up to a factor of three, and predominant vibration occurred at significantly higher frequencies. Flown samples gave clear insulin solutions that met the British Pharmacopoeia specification, and no aggregation of insulin was detected.

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.

A Quickly Deployed and UAS-Based Logistics Network for Delivery of Critical Medical Goods during Healthcare System Stress Periods: A Real Use Case in Valencia (Spain)

On the one hand, Unmanned Aircraft Systems (UASs) have experienced great applicability surge in the recent years, arising as a promising technology with a wide field of use. On the other hand, healthcare, a critical system in modern society, is subject to a heavy and unexpected pressure in the case of situations such as the COVID-19 pandemic. This article aims to leverage the flexibility of UASs as complementary support for healthcare logistic systems when under high-stress conditions, via quick deployment of an air delivery network. We have defined a logistics network model and created three scenarios based on the model and current needs in Valencia (Spain). Flight tests have been performed in these scenarios, which include urban areas and controlled airspace. Operations complied with requirements derived from the application of Specific Operations Risk Assessment (SORA) methodology, recently adopted by the European Aviation Safety Agency (EASA). Flights were successful, being able to swiftly deliver medical goods without requiring any dedicated infrastructure. However, a moderate number of contingencies took place during the tests, mainly related to control link quality and Air Traffic Management (ATM) integration, forcing the use of dedicated procedures to cope with them. Although additional development is required to ensure the safety of large-scale automated operations, the use of UASs as part of logistic networks is a feasible means to support existing structures, especially in situations in dire need.