Drones in the service of health! – e-health innovation

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Since the 1935 De Havilland DH Queen Bee, which was actually a drone sound (drone in English!), These unmanned remote-controlled aircraft have evolved. Their use is in France under the authority of the Civil Aviation Code, the Transport Code and the General Directorate of Civil Aviation, in the United States of the Federal Aviation Administration and NASA, in Europe. 'AESA. In Europe, national authorities are competent within 150 kilograms.This is to tell you from the outset the brake on their use in the aforementioned regions given these regulations of the use of airspace, even if closer to the ground (well above our heads) it is little frequented.

For those who want to get lost in the regulation read: (https://www.ecologique-solidaire.gouv.com/drones-usages-professionnels). This may be part of the reason why the first routine uses of UAVs in the field of health are outside these geographical areas.

For the moment in the hexagon apart from agricultural and industrial uses, the drone is more often at the foot of the Christmas tree intended for fun activities, but even in this context please be in possession of all permissions …. And to read the regulations well.

A bit of history by limiting itself to medical uses.While some experiences may have been significant during natural disasters such as in Haiti in 2012 for the distribution of relief kits, or in 2014 in Papua New Guinea (MSF) to transport samples and fight against tuberculosis.

If in India a drone-organ transporter project has been under consideration in Bangalore since 2016, it is on the African continent, in Rwanda that the serious things begin.

The Zipline start-up has been implementing since October 2016, in partnership with the local government, a long-term solution for the transport of blood bags and medicines to the most isolated hospitals; thanks to drones 7,000 blood bags were delivered for 4,000 flights. The company estimates that a third of these flights were set up urgently, in situations where life was at stake.

Outside Kigali (capital of Rwanda), 20% of blood deliveries would be provided by drones.From 2016 near Lake Kivu, the project to build a droneport (airport for drones) was considered.This is to my knowledge the first time such an infrastructure is programmed. This station offers drones facilities equivalent to what the airport is to civil aviation. This shows a real commitment of the Rwandan government to make the drone solution a national public health issue.This first droneport must be operational in 2020. It will streamline and industrialize the transport of health products faster and more cost-effectively than any other solution, terrestrial for example.

Alongside the creation of this new infrastructure, a project to build two new generation drones is underway. The Redline drone will be three meters wide and will be able to carry 10 kilograms of equipment over a distance of 50 kilometers to 100 kilometers per hour. And the Blueline drone of six meters wingspan can bring a load of 100 kg per 100 km much faster than the very bad and dangerous roads.

The stakes in terms of public health are considerable in Rwanda and even more so in the vast African countries where a large number of patients suffer (and die) from the absence of health products that are often needed urgently (blood, vaccine, etc.). , or the possibility of sending blood samples (endemic diseases, epidemic crisis of viral disease for example …) to laboratories in large cities. The goal is therefore to save time for the transport of a large number of products in a continent where road conditions and terrain characteristics make long, expensive and sometimes dangerous land transport!

In the same spirit and still in Africa DHL, the GIZ (the German international development cooperation agency) and the drone manufacturer Wingcopter launched the project "Deliver Future". The idea being tested is to open up an isolated island in Lake Victoria.The drone travels the 60 km that separate the continent from the island in 40 minutes on average. He carries sensitive products on the island; for example, he can collect blood samples to send them to the continent. For designers, beyond this experiment, the use of the drone could improve the logistics chain in the field of public health, contribute to the prevention of crises (Ebola-type viral outbreaks, etc.) by reacting more quickly, thus enabling to limit a propagation for example.Due to the specific needs in these countries where public health problems are dramatically different from ours, but also perhaps because of less draconian regulations and a more favorable geographical environment, Africa is an excellent field of development of these new solutions. The use of drones in the medical field is organizing faster than anywhere else.

But in a more commercial context the benefits are rather expected in the richer countries or drone could integrate into the local economy.The usual leaders in the use of ICTs are very active in this area.In Australia, Google initiated in 2012 and finally launched in 2014, the project wing (Google X) transport by cargo drones. Google had communicated on the role that these drones could play in the assistance to populations. Following a natural disaster, they could indeed support the public authorities by bringing drugs, food or essential equipment. But in the Australian regulatory context, we are far from the installation of droneport as in Rwanda. Over the past 18 months, Google has completed the first real-world tests in the suburbs of Canberra, with the Guzman Y Gomez chain and the pharmaceutical retailer Chemist Warehouse. 3,000 parcels have been delivered. Google has obtained in this early 2019 authorizations in a very limited and binding. No economically significant result is really in sight …

For its part Amazon announced in 2013 with the usual precautions that we know from the GAFA (ie marketing to make the buzz, it's good for the immediate business …). So Jeff Bezos announced in December 2013 that parcel deliveries would be "soon" to be done by drones in the US. Nearly 6 years later but predictably for regulatory problems (Federal Aviation Administration …) but also technical, nothing concrete on the horizon. For some experts, it will still take at least 10 years before the evolution of the regulations can allow the realization in the US of the fantasy of 2013 by Jeff Bezos. In the meantime, the delivery tests remain very limited and over very short distances, so without practical interest in the short term. But moreover I do not find on the part of Amazon communication on any impact in the field of health but rather in the grocery store! ( Infographic Les Echos; In the Amazon Jungle )

To return to projects more relevant to our concerns, a study in Sweden indicates that drones equipped with a defibrillator can arrive four times faster than an ambulance to a person suffering a cardiac arrest. According to French Federation of Cardiology, 50,000 people die prematurely of cardiac arrest every year in France, for lack of a sufficiently fast care. The Swedish study has shown very good results in an experiment from a fire station in a rural area near Stockholm; the drone was four times faster than the ambulance. This saving of time could save hundreds of lives each year in Sweden, say the researchers. There are similar experiments in the Netherlands.

I can only think of our French friends who developed APP to assist people with cardiac arrest outside health care facilities. The APPSAUV Life " of Dr. Lionel Lamhaut intended especially for EMS and theStaying Alive APP mostly used by firefighters. These two APP could not it in addition to their specificities already remarkable, to experiment jointly the defibrillator / drone. This would be a good topic of collaboration SAMU / Firefighter … Notice to startuppers! First aid training, the use of APPs and the addition of the defibrillator / drone system could explode the survival chances of victims of cardiac arrest, which is less than 5% with conventional non-APP relief ( neither drones).

Let's stay in France with the consortium "Drones for life (DFL) "Grouping the Bordeaux University Hospital, Abbott, BeTomorrow, Sysveo, theRegional Health Agency Aquitaine, DSAC-SO Aquitaine, and AETOS who works on the solution of drone in urban environment experimenting the transport of blood and organs.The Bordeaux University Hospital has received authorization from the Directorate General of Civil Aviation (DGAC) to test this project. The interest is to connect three CHU sites and route 2,000 tubes each day over a maximum distance of 10 km, in the context of sometimes difficult traffic in Bordeaux. Again the solution drone seems faster cheaper, and I would like to emphasize it, with probably a much lower carbon impact. The experimentation therefore begins at the beginning of the year 2019. In the end, if all goes well, a "tolerance" of the use of a well defined and very restricted airspace could be obtained … A project in addition which will have to be accepted by the elected officials, the population … we are far from the Rwandan enthusiasm!Let's go back to the US with UPS, who with his experience in Africa (Zipline in Rwanda) wants to deliver medical samples by drone to the United States. With a limited time trial in a small area of ​​North Carolina, the company reports that health care and life sciences logistics was a priority segment. The program will be supervised by the FAA (Federal Aviation Administration) and by the North Carolina Department of Transportation. So once again the evolution of the project will depend on the possibility of obtaining the authorizations; US airspace is harder to conquer than the African skies and there is no real development here yet!Back in Europe for a similar project, which shows that there is an interest, at least theoretically for the moment, to integrate the drone in our cities as well as in the plains and mountains of Africa. This is for example a Belgian project to streamline the lab-hospital link and to carry blood and urine samples as well as pharmaceutical preparations. First flights are planned in 2020, a very sophisticated control center was created: the first European droneport after the African pioneer? Five companies are partners: Belgocontrol (newly SKeyes), the SABCA, Unifly, NSX and Helicus. Each company will focus on a specific part of the overall solution.The baptized project MEDRONA obtain funding from the government. Inter-hospital test flights will take place during the second half of 2019 in Antwerp's urban airspace. The goal is always the same: to demonstrate the interest of drones that use the underutilized capacity of the Very Low Level (VLL) airspace for the transport of medical products in a reliable, environmentally friendly and efficient way. The clear will eventually shown is the organization of a sustainable inter-hospital transport solution in compliance with air traffic management and health care regulations with an improvement of existing services and the possibility of avoiding congestion on land.Let's go back to a less favored region with a project that gives full meaning to these new technologies that should favor humanitarian projects: In Madagascar drones are about to be used in the fight against tuberculosis. It involves the transport of clinical specimens and anti-tuberculosis drugs between landlocked areas and diagnostic and treatment centers as part of the national tuberculosis control program in Ifanadiana district. Applications may be extended to epidemiological surveillance, delivery of essential materials and the management of epidemic emergencies such as plague. This is a collaboration between the Pasteur Institute of Madagascar (IPM) the Ministry of Public Health, UNICEF, WHO and other organizations working in the field of health and Stony Brook University in the USA.

The South American continent is not left with a project to use drones between the city and rural areas. The problem is the poor condition of the roads and terrain and therefore very long transport times. The goal is to connect Cali hospitals to some health centers located for example in the mountains west of the city 7 km. With a vehicle, it takes two hours to complete this journey. A drone takes 13 or 14 minutes to cover this distance, saving time is enormous. Using drones to send samples to hospitals in Cali, to send the results to rural areas or to transport drugs should save time and money.And I would end this panorama by Asia and China or BAT (Baidu, Tencent and Alibaba), the equivalent of US GAFA invest heavily in new technologies in general and drones in particular with in this area a desire to 'a soon industrial use. I did not notice in the media the impression of regulatory brakes as in the US and Europe. The idea of ​​BAT is to invest colossally (in a Chinese way!). In new technologies to reduce the gap between China's cities and China's countryside, the drone could be a symbol of this otherwise ecological industrial evolution … (article)

In the medical field, to be noted in the US and India, particularly organ transport in the experimental state or even in fact pre-experimentall.

In conclusion, drones are already widely used in the defense, film service, agriculture, surveillance and security, rescue at sea … In the field of health, they are well and truly newcomers to consider, remains to be seen if the regulations in modern countries will follow and will quickly accept these new uses. Already in Africa where the needs are crying, more adaptable legislation and less restrictive geography, the uses are organized and may industrialize for a return to Europe and US futures. For Asia (India, China …) that shudders a lot too.

References :

Rémy Teston

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