Next 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.
Who will be faster? Who will have shorter response times?
Dr. Sheldon Cheskes is rooting for the drones.
“Drones can beat fire trucks and ambulances 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 Professor of 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 providing ambulance stations with AED-equipped drones – when a 911 call comes in for a cardiac arrest victim, an AED-equipped drone is dispatched, along with ambulance and fire crews. Bystanders follow pre-recorded instructions to use the AED to help save lives.
“When bystanders provide shocks through defibrillation, survival chances are almost four times more than if we wait for EMS to get there,” Cheskes says.
Barely 15 per cent of AEDs in Canada are located in public places such as airports, health clubs, and casinos (the rest are in private locations). When someone goes into cardiac arrest, Cheskes notes, 80 per cent fail to find and apply AEDs successfully.
“We lag behind in the area of public 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 survival. “
CANet is helping Cheskes demonstrate his new approach in Caledon.
He will simulate mock cardiac arrests at six different locations around town, issuing 911 calls to the town’s emergency services.
“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 the public remains largely unaware of AEDs.
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 not work in urban areas like downtown Toronto, however.
“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.”
The U.S. and Europe have unsuccessfully tried similar systems; Cheskes’ CANet project is the first of its kind to implement AED-equipped drones as part of an EMS response.
He did have to seek approval for using drones, eventually obtaining clearances from Nav Canada, which operates Canada’s civil air navigation service, and Transport Canada.
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.
“The grant saw incredible potential in our technology, and gave us a chance 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 the ordeal to 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.”