Page 94 - JSOM Winter 2019

amount of weight (including a single person), allowing means if there is a mistake with a poor outcome there is no
them to deliver large payloads to a variety of operational standard to use in defense of litigation. This is likely a large
environments. Tactical Operators gain the ability to have reason why there is relatively fewer studies and knowledge
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quick access to medical equipment, particularly equipment currently found in the literature today on drone applica-
to assist with casualty evacuation, that would otherwise be tion in prehospital, and even more so tactical/operational,
cumbersome or impractical to transport on scene. A study medicine today.
performed in Salt Lake City, Utah, demonstrated the ef- 2. Drone programs can be expensive, and inclusion into your
fectiveness and efficiency of including drones in a medical team requires training, as well as ongoing certification and
response to emergencies. Pulver et al. showed how properly recertification of pilots through the regulating government
stationed drones around the city can reach 96% of the pop- entities. Drones are becoming less expensive, but they
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ulations in less than 1 minute with an automated external still would not be considered cheap by most. The price of
defibrillator, whereas traditional ambulances could achieve purchasing the drone is also not solely the cost associated
this only 4.3% of the time. They can also repeat the pro- with purchasing them. Operators must be trained, certified,
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grammed trip with confidence as demonstrated by Mesar and continue to maintain certification in how to properly
et al. in the application and reliability of drones being able operate these drones. Drones also are machines in the end
to carry supplies on multiple flights without deviating from and will require maintenance from trained technicians who
the original input programming. Drones offer not only a understand how to properly sustain these machines. All of
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unique, but potentially superior method for medical Op- these aforementioned aspects require funds from the de-
erators to transport and access a larger variety of medical partment budget that may already be limited.
resources to bring to any situation. 3. Drones pose a risk of causing collateral damage by crash-
4. Drones offer a very important ability to survey a situation, ing or falling onto bystanders. Despite their increasing
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and give real time video feedback to any medical personnel sophistication and technology, one must remember that
who are assisting. The ability to monitor, not just a patient, drones are high speed flying solid objects with potential
but also potentially larger mass casualty incidents is vital to to cause bodily harm if mistakes occur. Campolettano et
more effectively manage and treat patients in a tactical en- al. demonstrated that the risk of suffering a severe injury
vironment. This immediate situational evaluation via video (concussion, severe laceration, major contusion, etc.) after
from drones gives the medical operator important feedback being hit by a falling drone in general is around 50%, and
on surrounding potential impacts that may affect their care 11.6% for direct collision from live flight with regard to
of patients on site. Surrounding conditions such as traffic, 1.2kg to 11kg drones. Drones larger than these demon-
obstructions, and route optimization are just a few of the strated that they are not safe to operate over bystanders. 12
variables that can acutely alter the most effective and effi- 4. Drones themselves also can pose threats to the team.
cient means of caring for and transporting a patient. Other Drones are being used around the world to carry explo-
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threats may also arise, such as bombs and biohazards that sives and other harmful material as offensive weapons. In
are not safe for non-hazmat teams to assess. Drones enable Israel as well as Iraq and Afghanistan, they are finding sev-
medical Operators to safely evaluate patients in scenarios eral instances of weaponized drones being used to carry out
where there is concern of explosives or hazardous material attacks. One the more recent attacks that became world
on scene. news occurred August 2018 in Venezuela, when an assassi-
5. Drones can be applied very broadly in their uses and allow nation attempt on President Maduro was unsuccessful af-
Operators to bridge the gap between third world and first ter two drones loaded with explosives were flown toward
world healthcare systems. This does not just refer to first him during a parade in Caracas. While unsuccessful, it
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and third world countries, but can also represent different did demonstrate the ability of civilian drones to be used as
communities within the same country that have different offensive weapons. These drones can pose threats to tacti-
levels healthcare infrastructure which Operators may have cal teams in the field and even in areas thought safe. For
to work with. Drones allow Operators to bring advanced instance, a drone equipped with a cone-shaped explosive
medical techniques and tools to environments that would charge can be landed on the top of an armored vehicle and
normally offer challenging physical and technological bar- have the potential to kill the entire crew. Many hardened
riers that limit standard medical teams/vehicles. government buildings today have also not been secured
from above and are particularly susceptible to harm from
aerial drones.
Limitations
5. One must remember the importance of public perception of
Although drones are clearly versatile with multiple appli- government use of drones. While many recognize the bene-
cations that can benefit the tactical medical Operator, there ficial capabilities that drones give Operators, some citizens
are several important limitations that should be addressed see drones as a violation of their privacy. They see it as
for those seeking to include drones into their tactical team’s expansion of the Orwellian Big Brother and an unnecessary
toolkit. The following are some of the risks/liabilities that one expansion of the government’s ability to monitor citizens.
must be prepared to address when including drones in their Some government officials, including Ted Poe (R-Texas)
operational medical team. and Zoe Lofgren (D-California), have already taken steps
to address these concerns by introducing legislation such
1. It is important to be aware there is no designated orga- as the Preserving American Privacy Act (H.R. 637) which
nization responsible for overseeing or recommending best requires law enforcement agencies to obtain warrants for
practice with utilization of drones in prehospital medicine UAV application. It is important to remember this when
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specifically, even though the DOT and FAA currently reg- using a drone, and it may not always be perceived by the
ulate civilian UAV operators. While some would see this public as a positive asset to their local agency tasked with
as advantageous because it allows more autonomy, it also protecting them and their freedom.

92 | JSOM Volume 19, Edition 4 / Winter 2019