ABC Baltimore

Drones could soon deliver medical supplies and blood samples, changing health care

by Catherine Hawley

For the last four years, researchers at Johns Hopkins have been field testing drones to move medical samples. 

"We knew that these samples are sensitive and we wanted to figure out what things do we need to bring to the drone to help make medical transport viable," said Assistant Professor at Johns Hopkins School of Medicine, Dr. Timothy Amukele.

The experiments focus on if those bumpy flights and temperature changes in the air hurt cells and impact biological samples. A difference of just two degrees, or a few hours can make specimens unsuitable for lab tests and blood bad for transfusions.

The team had to modify and customize the drone before the studies even started, transforming it from a high-flying camera rig to a medical ferry.

"We developed a refrigerated compartment,” Jeff Street, drone engineer and pilot said. “That is a compartment that is lightly insulated to save weight, but it attaches to the aircraft power supply and uses that power to use a very small refrigerator that keeps the specimens in a control temperature that is set and monitored by a computer onboard."

In the most recent tests, the samples were flown around for up to 40 minutes, covering a distance of about 12 miles. Then packed up and taken back to the lab to be examined.

"And in those studies we found no impact, which is great,” said Amukele. “So basically the samples arrived fine, which is what we would need if we're going to use drones to move these samples."

Using unmanned aerial vehicles instead of cars for medical transportation could revolutionize health care.  The drones could get critical blood supplies to rural, hard to reach places quicker, deliver life-saving pints of blood to the scenes of accidents and natural disasters, as well as speed up diagnosis and save lives in poor countries.

But Amukele thinks the technology could really take off by providing a faster and cheaper option to move specimens between medical facilities.

"If we had two hospitals here in Baltimore City that were separated by five miles, for example, we know that that distance can be covered by a drone in say ten minutes, in a car it would probably take a half an hour," Amukele said.

Saving time and money getting across town in heavy traffic. Eventually, Amukele envisions a drone network, connecting area hospitals and labs.

Questions still remain about the logistics and capabilities of using drones this way, as well as navigating FAA regulations. The team at Johns Hopkins says they plan to continue running tests to bring medical drones closer to reality. 

Drones are already being used to move medical supplies across the globe, but it's not widespread. A handful of groups  are also exploring this area.

San Francisco based company Zipline is working with the government in Rwanda to parachute blood products to remote areas from drones. Trials are also underway in Switzerland testing autonomous flights transporting lab samples between two hospitals.

Association of American Medical Colleges News

Those Magnificent Medical Flying Machines

by Tom Marcinko

Nearly 8 million YouTube viewers have had a highly speculative glimpse into the future. In the video, a man suffers a heart attack during rush hour in a crowded city. His life is saved by the timely arrival of a futuristic “ambulance drone,” summoned when his companion calls an emergency number. Via streaming video and two-way audio, emergency responders miles away guide the stricken man’s companion on how to use the defibrillator carried by the drone. It all happens before an emergency vehicle can make its way through traffic.

The video was created by Alec Momont, a design graduate at Delft University of Technology in the Netherlands, who is now working in Milan. “Instead of centralizing everything into one area, where ambulances are, [the drone] creates a network across the country to decrease these response times,” Momont said in a 2015 TED (Technology, Entertainment, Design) talk.

Proof of concept

Drones already have delivered packages successfully from online retailers to customers in the United States and other countries. So it's not far-fetched that they could also be used to deliver medical devices, medications, and other forms of medical assistance, especially to remote or underserved areas in the United States.

Of course, medical material often requires more delicate handling than consumer goods. But test drones launched by U.S. companies, international groups such as Doctors Without Borders, and other organizations have delivered aid packages in Rwanda, flown contraceptives and oxytocin in Ghana, and carried blood and biological samples to labs from remote locations in Papua New Guinea and Madagascar. 

“These small vehicles have the same name as some military weapons, [but] they’re not the same thing at all,” said Timothy K. Amukele, MD, PhD, assistant professor of pathology at Johns Hopkins University School of Medicine.

In 2015, when a student came to Amukele with the idea of using drones to fly blood samples from clinic to lab, the physician was skeptical until he learned that drones were shrinking in size and price. Since then—“a million years in technology,” he said—the demand for drones led his student to found a drone-making company, one of several in the country.

Still, when Amukele applied for institutional review board (IRB) permission, “they thought it was a joke,” he said. Amukele initially had his doubts about drones’ capabilities, too. For example, he thought that in-flight vibrations might rupture blood cells, which happens to samples on bad roads.

But Amukele and his team have shown that drones can transport blood samples and products, and blood and sputum culture specimens undamaged. Now the group is working to see if samples in secure packaging can survive a crash intact.

The off-the-shelf drones cost $2,000 to $3,000 after the team modifies them—a camera may be removed to make room for a snug cargo bay, for example. The team uses both airplane-like fixed-wing drones and helicopter-like multirotor vehicles.

The future of specimen transport

An American of Nigerian descent, Amukele wants to improve the delivery of medical care in remote locales in the United States and sub-Saharan Africa. Drones might someday be part of the health care delivery system in that part of the world, he said.

“One of the factors that worsened the West African Ebola outbreak were the poor roads that hindered the transport of biological samples. [Drones are] now a relatively inexpensive solution with a relatively low barrier to implementation,” Amukele and team wrote in the Journal of Clinical Microbiology last year.

“Drones are now a relatively inexpensive solution with a relatively low barrier to implementation.”
- Timothy K. Amukele, MD, PhD, Johns Hopkins School of Medicine

“There’s a large potential for a reworking of how we do specimen transport employing that technology,” agreed Geoffrey S. Baird, MD, PhD, medical director at Seattle’s Northwest Hospital Clinical Laboratory. Lab specimens—small packages with a high value—are ideal candidates for drone transport, he said.

He is working on flying blood products by drone between sites that are a few miles apart in the University of Washington (UW) medical system. He has longer flights in mind, but for now must obey regulations that require drones to stay in the pilot’s line of sight.

Drone-traffic rules are works in progress, said Baird, also an associate professor at the department of laboratory medicine at the UW School of Medicine. “There’s a big regulatory hump to get over.”

Beyond liftoff

Cornelius A. Thiels, DO, surgery resident at the Mayo Clinic in Rochester, Minn., is looking even further ahead. “Drones could also be used to deliver tourniquets and combat gauze to the scene of a trauma or mass casualty event,” he said. They could enhance telemedicine as well: “It is not unrealistic to think that drones may one day provide home visits for patients, thus maximizing the care physicians can provide.” When speed, payload capacity, and cooling systems improve, it’s even possible that drones could rush organs for transplant to remote locations.

“It is important to distinguish the ‘wow’ factor of such innovations from the ultimate value they add to patient care,” said Scott Shipman, MD, MPH, director of primary care initiatives and workforce analysis at AAMC. The benefits of drones to patient outcomes and cost savings still need to be demonstrated, he said. “Time will tell if drones in medicine will meet these criteria.”

If so, drones could even become a topic for medical educators.

“I don’t think medical students are going to have to take Drones 101 [but] we have to bring different people to the table,” Baird said, forecasting a need for physicians who appreciate software, and industrial and mechanical engineering.

Such doctors might out-invent the engineers, suggested Thiels. “My mom always taught me that it takes three bad ideas to come up with one good one,” he said. “If every trainee would be encouraged to come up with three innovations, I think we could revolutionize the delivery of health care in the United States.”

Baltimore Sun

 Amy Davis / Baltimore Sun

Amy Davis / Baltimore Sun

Drones could soon get crucial medical supplies to patients in need

By Meredith Cohn

Aerial drones could one day ferry life-or-death medical supplies between hospitals now that Johns Hopkins Medicine researchers have figured out how to keep blood, medications and vaccines consistently cool during the flights.

Interest in the use of drones has surged in recent years as companies, including retail giant Amazon, explore the use of the unmanned aircraft to efficiently and cheaply transport goods above traffic, through bad weather or to otherwise inaccessible or remote areas.

"If the blood somehow was changed or destroyed in transport, then none of it matters," said Dr. Timothy Amukele, a pathologist and director of the Hopkins Bayview Medical Center's clinical laboratories, who has spent the last 18 months on a team perfecting refrigeration on drones.

Amukele published findings in the journal Transfusion in November that showed no biological change to blood packed in specially refrigerated coolers during test flights, which lasted about 26 minutes and covered 12 miles at 328 feet above ground. He said he knows of no other advanced effort to solve the temperature problem.

He now hopes to begin sending lab samples and other materials between the Bayview campus and Johns Hopkins Hospital less than three miles away. He still needs buy-in from neighbors who might hear buzzing overhead, and approval from the Federal Aviation Administration, which recently issued regulations about where and when drones can fly in controlled airspace.

Other Baltimore-area hospitals and eventually farther-flung medical facilities could be looped in, enabling them to share limited medications and blood products, as as well making advanced lab testing more accessible. Eventually, Amukele envisions first responders requesting pints of blood to be delivered to the scene of accidents and natural disasters.

"Drones may become a realistic option," said Ian Weston, executive director of the American Trauma Society, a membership organization for trauma care providers.

Rapid delivery of needed supplies by drone would save lives when patients can't be transported quickly to a hospital by ambulance or helicopter, Weston said.

He said patients in 90 percent of the country can get to a trauma hospital by medevac within 60 minutes, a crucial "golden hour" first described by Dr. R Adams Cowley, for whom the Maryland Shock Trauma Center is named.

Local communities likely would support use of drones for life-saving medical supplies, just as they have embraced helicopters, Weston said. Drones equipped with cameras already are used to assess large fires and accident scenes, he noted, though more widespread use could prompt privacy and security concerns, as they have in some other countries where drones have been used for surveillance and fighting wars.

Practical questions remain about drone capabilities and what the FAA would allow. The agency now bans drones over 55 pounds, flying faster than 100 miles per hour or higher than 400 feet, and the pilots operating them remotely must be certified. Waivers are needed to fly over certain places and distances.

Solving the refrigeration problem, however, at least makes drone use possible, Weston said. But he and others warned that more trials will be needed to show if drones are better than other delivery options.

Dr. Thomas M. Scalea, Shock Trauma's physician-in-chief, said the Hopkins researchers answered a big question about "if we could do it, but now we have to ask if we should do it."

Drones might not be worth pursuing just yet if they often crash or miss their mark, don't improve patient outcomes, or cost a lot to operate. Scalea said he'd particularly like to see whether drones could help hospitals share resources, but he cautioned officials to resist the temptation to just run with the new technology.

"It's an issue of risk, benefits and costs," Scalea said. "If you could devise an incredibly reliable way to deliver what you want to deliver and be quicker than going on the roads, and you could make it as cheap as driving, then you've got something. We're a little ways away from that, though now that they've demonstrated proof of concept, it's possible to ask the questions."

There might not be widespread need for blood at accident scenes because it's still most important to get patients to the hospital, said Scalea and Dr. Peter P. Taillac, professor of emergency medicine at the University of Utah School of Medicine and a former official with the National Association of State EMS Officials.

First responders are more likely to turn to blood-clotting advances such as freeze-dried plasma developed by the U.S. military that can be rehydrated with saline. Blood might be needed if patients are stuck in the field or when natural disasters result in many victims, Taillac said.

He sees other uses for drones, however, such as on-demand access to expensive and rarely used drugs, such as an antidote to rattlesnake bites. He also noted some Canadian university students are developing a system to deliver automatic external defibrillators, or AEDs, directly to bystanders to use on heart attack patients.

"What are all the niches we can fill?" he said. "There are probably more than 100."

Other groups, including Doctors Without Borders, the emergency medical aid group, already are exploring drone use in the field. The group worked with the Menlo Park, Calif.-based company Matternet in 2014 to send samples via drone from patients with suspected tuberculosis from remote health centers in the Pacific island nation of Papua New Guinea to a hospital in Kerema, a regional capital. Officials are exploring ways to send back results and treatments.

Matternet also has said it would develop drone systems in the Dominican Republic and Malawi to transport medical tests and blood samples from remote villages to labs, bypassing muddy roads and treacherous waters.

A San Francisco-based company called Zipline is working with the government of Rwanda in central Africa to parachute blood products to remote areas from drones. The firm plans eventually to expand to other products and countries.

Back in Maryland, the University of Maryland Shore Regional Health tested drone delivery of medications in August. Officials used vials of saline to stand in for epinephrine, used to treat severe allergic reactions.

A Talon 120LE drone flew 12 miles from Southern Maryland across the Chesapeake Bay to an airport near Shore Regional's Cambridge hospital. With an Eastern Shore service area of 2,700 square miles surrounded by water, officials said they want backup transportation for medical supplies during weather emergencies or natural disasters. Eventually supplies could be delivered directly to patients.

The test was conducted with the University of Maryland Unmanned Aircraft Systems Test Site, a project housed in the School of Engineering.

"Imagine being able to deploy insulin or another critical medication to someone in need by landing or dropping it right in their backyard," Matthew Scassero, the test site director, said in a statement.

For Amukele's project at Hopkins, he and Jeff Street, a Hopkins drone engineer, began work when a medical student they knew asked for help delivering medications in remote areas of India.

They got funding from Hopkins and the Blum-Kovler Foundation and bought an off-the-shelf DJI S900 drone made for commercial cinematography that costs about $10,000 and comes with extra motors and batteries should the main ones fail. They removed the cameras and added a cooler, which they are replacing with a specially designed refrigerated box engineered to withstand a hard landing.

"Ultimately we think drones will serve different purposes in different places," Amukele said. "There will be a lot of collaboration to figure that out."

Popular Science

Good News: It's Safe To Use Drones To Fly Blood Around

By Kelsey D. Atherton

Delivering objects via drone is a tempting notion bound by hard constraints: drones are small, so the cargo has to be small. Drones need power to fly, and any additional weight requires more power to cover the same distance, which further limits the size of the cargo. For a drone delivery to make sense, then, the small cargo has to justify both its weight and the urgency of a drone flight. Pound for pound and ounce for ounce, few cargoes match that limitation better than blood.

In a study published in the journal Transfusion, Johns Hopkins researcher Timothy Amukele demonstrated that drones are a safe and efficient way to get blood pouches to remote locations. This isn't Amukele's first blood drone rodeo. In 2015, he demonstrated that small vials of blood could catch a ride with a drone and arrive in good condition, no worse for wear than vials transported by car.
In the summer of 2016, Amukele partnered with drone delivery company Flirtey to demonstrate that a drone could fly to shore, pick up blood samples, and then deliver them back to a hospital ship. In places where the land is rough but waterways are clear (like coastal Haiti after an earthquake) testing drone-flown blood could help scientists identify illnesses in a timelier fashion than more traditional delivery methods.

Those previous tests focused on small vials of blood samples. That’s good for research and tracking disease, but what about the person who needs blood and can’t be easily reached by normal means? That’s the focus of Amukele’s latest study. From Johns Hopkins:

For the study, the team purchased six units of red blood cells, six units of platelets and six units of unthawed plasma from the American Red Cross, and then packed the units into a 5-quart cooler two to three units at a time, in keeping with weight restrictions for the transport drone. The cooler was then attached to a commercial S900-model drone. This particular drone model comes equipped with a camera mount, which the team removed and replaced with the cooler.

The team then flew the drone between 8 and 12 miles, at around 330 feet above the ground, for a total flight time of just under half an hour. After the flight, the team tested the blood temperature and found it within acceptable levels. When back in the lab, they tested the blood to see if drone transport damaged it. The test so far appears to be a success, which is good news for anyone who made need robot-flown blood in the future (and good news for other companies already trying to transport transfusable amounts of blood).

"My vision is that in the future, when a first responder arrives to the scene of an accident, he or she can test the victim's blood type right on the spot and send for a drone to bring the correct blood product," Amukele told Johns Hopkins.

Release - Study Shows Blood Products Unaffected By Drone Trips


By Chanapa Tantibanchachai

In what is believed to be the first proof-of-concept study of its kind, Johns Hopkins researchers have determined that large bags of blood products, such as those transfused into patients every day, can maintain temperature and cellular integrity while transported by drones.

In a report about the findings, published ahead of print in the journal Transfusion in November, the investigators say the findings add to evidence that remotely piloted drones are an effective, safe and timely way to quickly get blood products to remote accident or natural catastrophe sites, or other time-sensitive destinations.

“For rural areas that lack access to nearby clinics, or that may lack the infrastructure for collecting blood products or transporting them on their own, drones can provide that access,” says Timothy Amukele, M.D., Ph.D., assistant professor of pathology at the Johns Hopkins University School of Medicine and the paper’s first author.

Drones also can help in urban centers like Baltimore City to improve distribution of blood products and the quality of care, he says.

The Johns Hopkins team previously studied the impact of drone transportation on the chemical, hematological and microbial makeup of drone-flown blood samples and found that none were negatively affected. The new study examines the effects of drone transportation on larger amounts of blood products used for transfusion, which have significantly more complex handling, transport and storage requirements compared to blood samples for laboratory testing.

For the study, the team purchased six units of red blood cells, six units of platelets and six units of unthawed plasma from the American Red Cross, and then packed the units into a 5-quart cooler two to three units at a time, in keeping with weight restrictions for the transport drone. The cooler was then attached to a commercial S900-model drone. This particular drone model comes equipped with a camera mount, which the team removed and replaced with the cooler.

For each test, the drone was flown by remote control a distance of approximately 13 to 20 kilometers (8 to 12 miles) while 100 meters (328 feet) above ground. This flight took up to 26.5 minutes. The team designed the test to maintain temperature for the red blood cells, platelets and plasma units. They used wet ice, pre-calibrated thermal packs and dry ice for each type of blood product, respectively. Temperature monitoring was constant, keeping with transport and storage requirements for blood components. The team conducted the tests in an unpopulated area, and a certified, ground-based pilot flew the drone.

Following flight, all samples were transported to The Johns Hopkins Hospital, where Amukele’s team used the institution’s laboratories to centrifuge the units of red blood cells and check them for red blood cell damage. They checked the platelets for changes in pH as well as the number of platelets and the plasma units for evidence of air bubbles, which would indicate thawing.

The team plans further and larger studies in the U.S. and overseas, and hopes to test methods of active cooling, such as programming a cooler to maintain a specific temperature.

“My vision is that in the future, when a first responder arrives to the scene of an accident, he or she can test the victim’s blood type right on the spot and send for a drone to bring the correct blood product,” says Amukele.

Other authors on this study include Paul M. Ness, Aaron A.R. Tobian, Joan Boyd and Jeff Street of The Johns Hopkins Hospital.

Funding for this study was provided by Peter Kovler of the Blum-Kovler Foundation.


Doctors Test Drones To Speed Up Delivery Of Lab Tests

By Esther Landhuis

Three years ago, Geoff Baird bought a drone. The Seattle dad and hobby plane enthusiast used the 2.5-pound quadcopter to photograph the Hawaiian coastline and film his son's soccer and baseball games.

But his big hope is that drones will soon fly tubes of blood and other specimens to Harborview Medical Center, where he works as a clinical pathologist running the hospital's chemistry and toxicology labs. In the near future, Baird and others say, drones could transform health care — not only in rural areas by bringing critical supplies into hard-to-reach places, but also in crowded cities where hospitals pay hefty fees to get medical samples across town during rush hour. By providing a faster, cheaper way to move test specimens, drones could speed diagnoses and save lives. "It's super exciting to me," Baird says.

The technology seems to be there. Drones are delivering pizza in New Zealand and taking condoms to parts of Ghana that lack reliable roads or access to birth control. Tech giants and big retailers, including Amazon and Wal-Mart, are testing drones for deliveries and pickups.

However, "blood specimens are not like a book or a shoe," Timothy Amukele, an assistant professor of pathology at Johns Hopkins School of Medicine, said in a TED talk earlier this year. No one knew whether bumpy flights would hurt cells or otherwise make biological samples unsuitable for lab tests.

So Amukele and co-workers conducted several experiments to find out. In their first study, published in PLOS ONE last July, the team collected several hundred blood samples from healthy volunteers. They drove the samples to a flight field an hour northwest of Baltimore, packed half of them into foam containers and flew them around in a drone for up to 40 minutes. The other samples sat. All specimens went back to the lab for 33 routine tests. The results were the same for each group, suggesting samples stay intact during drone flights.

In follow-up analyses, drone transport also seemed safe for samples containing microbes and for donated blood. The microbial study was published in August in the Journal of Clinical Microbiology; a manuscript on the blood products study is under review. (Videos of each experiment can be found here.)

"The results don't surprise me," says Bill Remillard, chief technical officer at TriCore Reference Laboratories in Albuquerque, N.M. "But until you do the science, you just don't know."

TriCore handles nearly three-quarters of New Mexico's clinical lab testing. And in a sparsely populated state, moving samples over large distances is expensive. TriCore spends $3.5 million per year. So after Remillard heard the results of Amukele's first drone experiment at a meeting last summer, the two started discussing a possible pilot study using drones to transport lab samples in New Mexico.

Condoms By Drone: A New Way To Get Birth Control To Remote Areas
Condoms By Drone: A New Way To Get Birth Control To Remote Areas
While Amukele's experiments show it's feasible to move lab specimens with drones, pilot studies in real clinical settings are still needed to work out logistics. Questions include how to request a drone, where it would land, who would pick up the samples and how often a drone would need new batteries.

Safety is another concern. Some drones drop cargo with parachutes or other release mechanisms, making it harder for people to tamper with the vehicles. But as far as how safe drones are, "those data don't yet exist," Amukele says. Though millions of drones have been sold worldwide, "we don't know how many crashes happen and how many are due to operator error," he says. The Federal Aviation Administration is starting to collect this data.

It's a promising development for an industry where legislation has lagged behind the fast-advancing technology. For years, the FAA had imposed a near-ban on commercial drones, only allowing them to fly if businesses applied for an exemption. But in June the agency announced a set of rules for companies to operate drones in the United States, and on Aug. 29 those regulations took effect. The FAA expects the number of registered commercial drones to jump 30-fold, from 20,000 to 600,000, within months.

"The rules had not been well defined. This is an attempt to define them," says Lawrence Williams, who heads business development at Zipline, a Silicon Valley startup making drones for medical applications. Zipline is focusing much of its effort in Rwanda, where less crowded skies, relative to the U.S., make it easier to negotiate drone delivery of blood samples.

Another drone startup, Vayu, whose CEO is a co-author on the PLOS ONE drone study, is also dipping into the international arena. In July, the Michigan-based company did a demo flight in Madagascar, carrying specimens from a remote village to a lab for testing. Vayu makes a quadricopter plane capable of vertical takeoff — an appealing feature for hospitals with limited landing space.

While it's easy to see how drones could improve health care in poor countries, Amukele thinks medical drone delivery could make a bigger splash in the U.S. Compared to Africa and developing countries, the U.S. does much more testing per person, he says, and many of the country's 200,000 medical labs are collection-only sites that rely on central labs for testing. So "there are likely to be more [medical drone users] in the U.S. than anywhere else," Amukele says.

As Zipline prepares to launch blood delivery drones in Rwanda, the company is also seeking regulatory approval for three projects using drones to bring medical supplies to underserved communities in the U.S.

One project would integrate drone delivery of medications with telemedicine appointments at a small clinic in rural Maryland. Another would use Zipline drones to link a large health care distribution center to hospitals and tribal clinics around Reno, Nev. And for the third project, the company would partner with a regional blood bank in Washington state, creating a plan to distribute blood to various hospitals and clinics in the event of earthquakes and other natural disasters.

Johns Hopkins was initially skeptical of Amukele's experiments — the review board thought his first proposal was a joke — but now the university is giving the pathologist space and funds to hire a drone engineer and continue researching medical delivery drones.

In Seattle, Baird is working with Amukele and aeronautical engineers at the University of Washington on their own drone proposal. Ideally their test flights would take samples from Seattle Children's to Harborview, a bustling facility that runs thousands of tests each day. However, that flight path would violate the FAA rule requiring drones to stay within the pilot's line of sight. So the initial plan is to run 2-mile line-of-sight flights between the children's hospital and UW Medical Center, Baird says.

Drones could be a huge help in poison emergencies, Baird says. In a typical scenario, a child gets rushed to the emergency room after accidentally swallowing some pills. Though routine tests can rule out some things, clinics often send samples to a centralized toxicology lab for confirmation and further testing. This can take hours. A drone could zip samples downtown in five to 10 minutes, Baird says, helping a child get diagnosed and receive medications more quickly.

He also envisions drones collecting samples from patients' homes and taking them to the hospital. You could prick your finger and rub the blood onto a card that a drone could fly back to the lab for testing, Baird says.

In the meantime, though, Zipline's U.S. projects remain on hold, awaiting the regulatory go-ahead, and the Seattle team continues studying maps and sketching flight routes for the small drone test it hopes to launch. The team has presented the plan to grant agencies and gotten positive responses — but no funding yet.

Like other technological advances, Baird suspects drones for medicine will "wait, wait, wait and then go very quickly."