An Evaluation of the Drone Delivery of Adrenaline Auto-Injectors for Anaphylaxis: Pharmacists’ Perceptions, Acceptance, and Concerns

Abstract

Anaphylaxis is a life-threatening condition where delays in medical treatment can be fatal. Such situations would benefit from the drone delivery of an adrenaline auto-injector such as EpiPen®. This study evaluates the potential risk, reward, and impact of drone transportation on the stability of adrenaline during episodes of anaphylaxis. Further, this study examines pharmacists’ perceptions on drone delivery—pharmacists approved the use of drones to deliver EpiPen® during emergencies but had concerns with drone safety and supply chain security. Laboratory simulated onboard drone conditions reflected typical missions. In these experiments, in vitro model and pharmaceutical equivalent formulations were subjected independently to 30 min vibrations at 5, 8.43, and 13.33 Hz, and temperature storage at 4, 25, 40, and 65 °C for 0, 0.5, 3, and 24 h. The chiral composition (an indicator of chemical purity that relates to molecular structure) and concentration of these adrenaline formulations were determined using ultraviolet (UV) and circular dichroism spectroscopy (CD). Adrenaline intrinsic stability was also explored by edge-of-failure experimentation to signpost the uppermost limits for safe transportation. During drone flight with EpiPen®, the temperature and vibration g-force were 10.7 °C and 1.8 g, respectively. No adverse impact on adrenaline was observed during drone flight and laboratory-simulated conditions shown by conformation to the British Pharmacopeia standards (p > 0.05 for CD and UV). This study showed that drone delivery of EpiPen® is feasible. There are more than 15,000 community pharmacies and ≈9000 GP surgeries spanning the UK, which are likely to provide achievable ranges and distances for the direct drone delivery of EpiPen®. The authors recommend that when designing future missions, in addition to medicine stability testing that models the stresses imposed by drone flight, one must conduct a perceptions survey on the relevant group of medical professionals, because their insights, acceptance, and concerns are extremely valuable for the design and evaluation of the mission.

How Do Dangerous Goods Regulations Apply to Uncrewed Aerial Vehicles Transporting Medical Cargos?

“…As an example, UAV in-flight conditions (~10 km flown in 18 min at~60 m above ground by a Clogworks Dark Matter HX multi-rotor UAV in the UK) were found to be 1.8 g and 11 • C for vibration force and temperature, respectively [39]. These measurements are well within the ranges considered normal for air transport, but this does not account for the impact of other UAV-specific conditions that could adversely affect package integrity such as airflow or precipitation ingress (e.g., water damage).…”

“…Recent examples of research into the effects of UAVs on medical cargos include Amukele et al [49], who investigated the stability of biological samples (packed in accordance with the DGR) transported on long-range UAV flights in the USA (258 km flown in 174 min), concluding that long-range UAV transport was feasible, but only with stringent environmental controls to mitigate the effects of vibration, acceleration and temperature. Beck et al [39] investigated the feasibility of delivering adrenaline auto-injectors (e.g., EpiPen) by UAV, and found that in-flight conditions (~10 km flown in 18 min) did not have an adverse impact on adrenaline stability.…”

Impact of Using Drones in Emergency Medicine: What Does the Future Hold?

“…Early administration of epinephrine is the only first-line medication for anaphylaxis treatment and is routinely delivered by patients themselves or lay bystanders using an EpiPen ® or similar delivery system. 53 Beck et al demonstrated that EpiPens ® can be feasibly transported by drone without pharmacological changes. 53 Mateen et al found that antiepileptic drugs could be feasibly and reliably delivered by a drone for both emergency/status epilepticus and non-urgent distribution in the capital of the Republic of Guinea to preidentified delivery stations.…”

“…53 Beck et al demonstrated that EpiPens ® can be feasibly transported by drone without pharmacological changes. 53 Mateen et al found that antiepileptic drugs could be feasibly and reliably delivered by a drone for both emergency/status epilepticus and non-urgent distribution in the capital of the Republic of Guinea to preidentified delivery stations. 54 Further, they found that a drone reduced the average delivery time by 78.8%.…”

Quantifying the Effects of Vibration on Medicines in Transit Caused by Fixed-Wing and Multi-Copter Drones

“…In terms of carriage and packaging regulations related to medicines, several classifications exist (Table 2). All products under these categories have to be packed according to their specific packing instruction (PI) which usually dictate multi-layer containment (primary receptacle and secondary bagged containment layers) before being placed in a sealed box with a coolant system (if temperature controlled) [30,40]. Temperature monitoring equipment should be placed within the secondary containment layer and may or may not provide live updates during transit.…”