This month, residents of Caledon, Ontario, will continue to see multiple EMS vehicles zip by their streets, responding to 911 calls.
If they happen to look up, they will see something new. Drones equipped with Automated External Defibrillators (AEDs) – racing to the same locations.
Dr. Sheldon Cheskes will be examining the response time and the impact these drones will have in saving the lives of cardiac arrest victims.
“Drones may be able to beat firefighters and paramedics to the scene of a cardiac arrest, and those extra minutes could be life-savers,” says Cheskes, a CANet Investigator, medical director at Sunnybrook Centre for Prehospital Medicine, and Associate professor of Emergency Medicine at The University of Toronto. “Survival chances decrease by 7 to 10 per cent for every minute of cardiac arrest.”
Cheskes’ CANet-funded project, “AED On The Fly” is pioneering how Canada manages cardiac arrest situations, by assessing the potential of dispatching AED-equipped drones – when a 911 call comes in for a cardiac arrest victim, along with the traditional fire and ambulance response. Bystanders will be guided in the use of the AED in the drone by real-time smartphone technology applied to the AED.
“When bystanders provide shocks through defibrillation, survival chances are significantly greater than if we wait for EMS to get there,” Cheskes says.
The challenge with AED deployment is 85% of cardiac arrests occur in private locations while 15% occur in public locations classically accessible for AEDs. Yet historically only 2% of all cardiac arrests have a bystander apply an AED although the number jumps to 15-20% in public locations. Despite this fact, a vast majority of public cardiac arrests have an AED in close proximity that are not being used.
“We lag behind in the area of private access to, and efficient use of AEDs,” he says. “I want to rethink the way we approach this problem and bring a new mindset to cardiac arrest and AED deployment. “
CANet is helping Cheskes demonstrate his new approach in Caledon.
He will initially simulate mock cardiac arrests at six different locations around town, while simultaneously dispatching a drone equipped with an AED and an EMS vehicle. The response time to these mock cardiac arrests when applied in a “real world” scenario will be studied.
“By optimising where we place drones, based on the area’s historical call volume, we can cut down six minutes of response time in urban areas, and almost 10 minutes in rural areas,” Cheskes says.
In fact, cardiac arrest survival rates are worse in rural communities compared to urban areas. Ambulance and fire services have slower response times, and AED’s are not found in close proximity to the majority of cardiac arrests.
Cheskes anticipates that AED-equipped drones will be a great success in rural areas. Remote-controlled drones can safely land in these communities, which mostly consist of large, open spaces, and low-rise buildings.
The current system will likely not work in urban areas like downtown Toronto at this point in time.
“The technology to land drones on a condominium balcony in downtown Toronto, for example, is very difficult – we have to take into account multiple factors such as navigating high-rises, and wind shear,” Cheskes cautions. “It needs to be more specific and safe.” With the advent of rapidly evolving drone technology, this may change.
The U.S. and Europe have tested similar systems, but none has launched a drone as part of a 911 dispatched EMS response. Cheskes’ CANet project hopes to be the first of its kind to implement AED-equipped drones as part of a 911 dispatched EMS response.
To this end, CANet’s Commercialization Grant will play a crucial role in helping Cheskes improve the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada and the world.
CANet and Cheskes are working with Drone Delivery Canada (Ontario) and InDro Robotics and Remote Sensing (B.C.) – ‘both leaders in this space’ according to Cheskes. CANet’s industry partnerships help foster economic growth across Canada and fulfill the Network’s strategic and capacity development targets of commercializing new technologies.
“We are extremely grateful to CANet for being such willing collaborators, and funding our work. Without their support, it would be very unlikely that we would be able to continue,” Cheskes says.
His project aligns with an important CANet strategic clinical target – a 10 per cent drop in sudden cardiac death.
Cheskes is already thinking beyond cardiac arrests.
“CANet saw incredible potential in our technology, and have given us an opportunity to revolutionize health care not only for cardiac arrest but potentially, for other emergencies,” he says. “What if we use drones to deliver epinephrine for anaphylaxis, or medical kits for trauma victims?”
But even with such high-flying, fast-moving technology, Cheskes is firmly focused on the person on the ground.
“Much of cardiac arrest research is moving away from figuring out ways to merely surviving cardiac arrest but also understanding the patient’s own views and priorities,” he says.
Cheskes and his team will hold town-hall meetings with citizens of Caledon (and other Canadian towns and cities where the project is being conducted) to better understand their thoughts and concerns regarding drones.
“Anything that can improve health outcomes should be viewed favourably, but I don’t live in those communities and don’t know how they feel, their misgivings, or their suggestions to make the system better,” he says. “I am definitely interested in listening to them, help improve access to better care, and increase their confidence in operating AEDs, and saving lives.”