Drones have delivered medications and other medical supplies to people in underdeveloped areas, but what of their use in times of disaster or even a pandemic to patients with chronic conditions such as diabetes? A multidisciplinary team has taken the first step to achieving insulin delivery via drone.
The Aran Islands, located about 12 miles off the west coast of Ireland, are a popular tourist destination, especially in the summer. Visitors come to temporarily inhabit this untouched and pristine part of the world, to stand among rolling green hills and along its rocky coastlines that inspired painters and poets alike.
About 1,200 people live on these islands that stretch out along the mouth of the Galway Bay, staying behind even when all the tourists have made the 45-minute ferry ride back to the mainland. It’s how they like it — the slow island life is attractive to many.
But in 2017, Hurricane Ophelia, a category three storm, hit Ireland, flooding streets and stranding people in their homes for days. Fifty-four people died; it was Ireland’s deadliest storm in 50 years. Then, a year later, Winter Storm Emma hit Ireland, with snowfall up to 22 inches, again leaving people stranded in their homes for a week. During both events, it was impossible for people to visit their doctors or refill their medications, a problem even worse for those living in places like the Aran Islands, and especially acute for those patients living with a chronic and potentially deadly disease like diabetes.
A year before Ophelia arrived on Ireland’s shores, unmanned aerial vehicles (UAVs) — also known as drones — operated by a company called Zipline had begun successfully delivering blood products in Rwanda. However, in the Western World, drones are typically only used as recreational tools, for racing or photography, but their use transporting medical supplies has only been documented here and there, in remote or underdeveloped areas like the East African jungles or South Pacific islands.
An international medical team figured that this same technology could be deployed in Western, heavily regulated airspace, initially to rural places like the Aran Islands, a remote region that had suffered a devastating one-two punch. The team, led by Derek O’Keeffe, MD, PhD, a consultant endocrinologist at National University of Ireland, Galway, and Spyridoula Maraka, MD, MS, an endocrinologist with the University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, wanted to find a solution for future disasters when people with diabetes in remote regions may be stranded for days without their lifesaving diabetes medicines. “An example of how detrimental this could be is that patients with type 1 diabetes who do not use their insulin for more than a day can slip into diabetic ketoacidosis, a life-threatening condition,” Maraka says. “We now have the drone technology and protocols in place to deliver diabetes medications and supplies in regulated airspace in an actual disaster if needed,” O’Keeffe says. “This is a milestone in improving patient care.”
“The Seagull Has Landed!”
But this wasn’t something that could just be done with the same ease as a teenager taking his or her drone to the park to fly around for an afternoon. This was a complex project that required a team of experts representing various fields — physicians, pharmacists, aviators, telecoms specialists — working together to make sure the 32-minute roundtrip test flight was a successful mission.
Maraka’s main role was to identify and address the medical and regulatory issues related to healthcare delivery. The team couldn’t simply load insulin in the drone for delivery. A physician prescribed the medication and a pharmacist dispensed the insulin, ensuring compliance with the Medication Dispensing Legislation.
“Then due to the Medication Transportation Cold Chain Legislation, we needed to ensure that the medications were appropriately packaged and transported in the right temperature and provide data that vibration during the flight would not negatively impact the quality of the medications,” Maraka says. “These are necessary ‘hurdles’ that enable us to maintain the quality of healthcare delivery no matter which mode we choose. The advantage for future projects is that we now know all the steps we need to take, and we can streamline the process.”
“There are multiple opportunities for medical drone delivery, which could be life-saving during sentinel events such as pandemics like the one we all experience today. Medications and blood samples are an ideal payload cargo for drones due to their low weight and high value.” — Spyridoula Maraka, MD, MS, endocrinologist, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System
It took one year from conceiving this mission to the maiden flight on Sept. 13, 2019. The drone — provided by a German company called Wingcopter and nicknamed “The Seagull” because it had a large white wingspan and was doing a lot of coastal flying — flew beyond the visual line of sight during commercial flight operations in regulated airspace. “After a year of planning, it launched from the Irish mainland and flew across the Atlantic Ocean and when it landed on the Aran Islands, we all smiled and said over the comms, ‘The Seagull has landed!’” O’Keeffe says.
The international team had completed the world’s first documented drone delivery of insulin to a patient living in a remote community. The drone also returned with a blood sample collected from the patient for monitoring blood glucose control (HbA1c). “We wanted to find a way to monitor glycemic control remotely,” Maraka says. “It was the full circle of care, which has not been done by drone before.
“Each person had a specific expertise which contributed to the success of the Diabetes Drone Mission,” she continues. “We had to ensure safety and redundancy in all flight operations in order to obtain airspace regulatory approval. Excellence in knowledge, skills, and communication across the team were essential to navigate this process.”
Mission accomplished. But what now?
An Invisible Storm
The beginning of 2020 has been four months of turmoil, with a global pandemic forcing people to remain indoors, cut off from the outside world by the invisible storm of a viral infection. Physicians are resorting to telemedicine more as state and local governments issue stay-at-home orders. This whole new world could be the perfect setting for emerging technology like drone delivery of medication.
“There are multiple opportunities for medical drone delivery, which could be lifesaving during sentinel events such as pandemics like the one we all experience today,” Maraka says. “Medications and blood samples are an ideal payload cargo for drones due to their low weight and high value. We showed that drones could, for example, deliver medications to remote communities and bring blood samples back to a clinic for patient monitoring. However, the key point here is that this was a proof-of-concept research mission, and we have used the findings to continue the collaboration with our partners to contribute to the future of medical drone deliveries.”
Indeed, there is still much to be done before the skies are abuzz with drones. In order to have regular drone flight operations, there exists a lot of challenges and opportunities for innovators across the technology, regulatory, and business domains, O’Keeffe says.
“At a minimum, there needs to be increased drone flight testing, to ensure that drones used in commercial operations have the correct flight certification (like normal airplanes) from the statutory agencies whose airspace they fly in (e.g., FAA),” he says. “This comprehensive flight testing of specific drone models will enable protocols and countermeasures to be developed (e.g., parachutes) for safe operations. In addition, a lot of research and development work is underway to establish an unmanned aircraft traffic management ecosystem to allow beyond visual line-of-sight drone operations (as we have for the traditional airplane Air Traffic Management systems in place around the world). Finally, we need to have societal acceptance of ‘drone corridors,’ which will have to become part of our environment where drone traffic will regularly use, like major road networks.”
“We need to think about our patients’ current and future needs, to continue to innovate, and to be open to interdisciplinary collaboration to achieve success.” — Derek O’Keeffe, MD, PhD, consultant endocrinologist at National University of Ireland, Galway
For now, O’Keeffe, Maraka, and everyone who worked on the project see a bright future for this technology. The maiden flight of The Seagull in regulated airspace was a towering achievement by itself. O’Keeffe says that next he sees drones first being used in emergencies, then in rural areas, then in light urban areas, and, ultimately, in dense urban areas. Wingcopter has teamed up with UPS to “extend the speed and reach of package delivery” and help move the industry forward. “We need to think about our patients’ current and future needs, to continue to innovate, and to be open to interdisciplinary collaboration to achieve success,” O’Keeffe says.
“Drone delivery can help us connect with our patient communities, especially when usual channels of healthcare delivery are disrupted,” Maraka says.
— Bagley is the senior editor of Endocrine News. He wrote the profile of Endocrine Society president Gary D. Hammer, MD, PhD, in the April issue.