Featured Heart health Innovation Sunnybrook Magazine Sunnybrook Magazine - Fall 2019 Sunnyview Video

How drones could help deliver life-saving treatment in rural areas

Text by David Israelson, video by Monica Matys

If you look up at the skies in Ontario’s Peel region, don’t be startled if you see a fast-moving object zipping over the tree line. It might be a drone on a life-saving mission.

This past spring, Sunnybrook launched an innovative pilot project in southern Ontario to see whether drones carrying an automated external defibrillator, or AED, can respond more quickly than emergency medical service (EMS) vehicles to cardiac arrest. An AED is an easy-to-use medical device that delivers an electric shock – or defibrillation – to re-establish a normal heart rhythm when someone is experiencing sudden cardiac arrest.

Drone delivery technology is already being deployed for everything from delivering pizzas to sending cameras down mine shafts. In reading about these applications, Dr. Sheldon Cheskes wondered: Could drones be used to improve response times for out-of-hospital cardiac arrest, particularly in rural and remote communities? 

Dr. Cheskes, medical director of the Sunnybrook Centre for Prehospital Medicine, is leading the tests in Caledon, Ont., with the help of voluntary community CPR Responders.

“Many strategies have been tried in the past to deliver help to victims of cardiac arrest faster. But in general, surviving cardiac arrest tends to be lower in rural areas, where it’s difficult to get responders with an ambulance or a fire truck to the scene rapidly,” says Dr. Cheskes, who provides medical oversight for emergency medical services in Ontario’s Peel and Halton regions.

“Every minute of delay in response time decreases the chance of survival by 7 to 10 per cent,” he says. 

Until now, the general strategy for giving people access to AEDs has been to put them in areas where people congregate, such as public buildings, stadiums, hockey rinks and restaurants. Peel Region started a program in 2014 to put defibrillators in high-traffic locations and has placed nearly 1,200 AEDs since that time.

The problem is that you can’t put defibrillators everywhere they might be needed. An area like Caledon is a mix of town, suburbs and rural areas, including the beautiful, rugged Niagara Escarpment and the Bruce and Trans Canada trails.

In addition, while it’s important to have defibrillators in public areas, “the difficulty with cardiac arrest is that 85 per cent of cardiac arrests occur in private locations where AEDs are not readily available,” Dr. Cheskes says. 

His team put together a feasibility study and received funding from the Cardiac Arrhythmia Network of Canada (CANet) for a research proposal, which led to the first test flights in May 2019. 

“We want to find out if we can use drones to save patients in cardiac arrest,” he says of the project. 

The drones being tested to deliver defibrillators are larger and more elaborate than the recreational rigs sold to consumers. 

“They are called Sparrow Emergency Response drones,” says Greg Colacitti, vice-president of business development for Drone Delivery Canada (DDC), a partner in the pilot project and supplier of the flying machines. “Each one is approximately four feet in diameter, and with its cargo – the AED – [in place], it weighs 24 kilograms.”

The Sparrow drones can reach speeds of 80 kilometres per hour. While this may not sound all that fast, they may be able to go quicker in a straight line than an EMS vehicle speeding to a scene along a twisted or congested road. 

Under the tests, when a simulated 911 call comes in, a drone is dispatched to the mock emergency by a volunteer using an app developed by the Region of Peel. The dispatcher first decides if the emergency is easier to reach by drone than by vehicle; if it is, the dispatcher taps in the location.

Dr. Cheskes says the test also sends EMS teams by vehicle, to compare their arrival time with the drone’s delivery. In the first test, the drone travelled about eight kilometres and arrived four minutes earlier than the land ambulance, he says. 

The DDC drone uses a proprietary system to take off automatically and get to the scene. Transport Canada officials are monitoring the project, and earlier this year the federal government tightened the rules for flying drones. Requirements now include mandatory licences for drone flyers, night-flight permissions and strict safety design standards for drones that fly near the public.

“Believe me, what we go through for a launch is a lot like taking off from Pearson Airport,” Dr. Cheskes says. 

During the testing, volunteers playing the role of bystanders unpack the defibrillator from the drone and simulate deploying the equipment on a patient suffering cardiac arrest.

“In our tests, our volunteer managed to administer two [defibrillator] shocks before the EMS arrived. That’s good,” Dr. Cheskes says. “Our mathematical model suggests that we could decrease response time in an urban area by six or seven minutes, and in a rural area by 11 minutes – crucial minutes in cardiac arrest.”

The project team plans to test-fly more drones to see if they can land the units more quickly. They are also exploring ways to make it easier for bystanders to use the AEDs even if they have not been trained – for example, by including a smartphone in the drop with an app that can give simple instructions.

Dr. Cheskes says he’s convinced it’s only a matter of time before it becomes commonplace to use drones for 911 responses. 

“Using it in real life, not just testing – that’s the ultimate goal of all this,” he says.