The Case for Drone-assisted Emergency Response to Cardiac Arrest

Abstract

BACKGROUND Despite evidence linking rapid defibrillation to out-of-hospital cardiac arrest (OHCA) survival, bystander use of automatic external defibrillators (AEDs) remains low, due in part to AED placement and accessibility. AED-equipped drones may improve time-to-defibrillation, yet the benefits and costs are unknown. METHODS We designed drone deployment networks for the state of North Carolina using mathematical optimization models to select drone stations from existing infrastructure by specifying the number of stations and the targeted AED arrival time. Expected outcomes were evaluated over the drone’s lifespan (4 years). We estimated the following parameters: proportion of OHCAs within a targeted AED delivery time, bystander utilization of AEDs, survival/neurological status, and incremental cost per quality-adjusted life year (QALY). RESULTS Statewide, 16,503 adults aged 18 or older were expected to experience OHCA with an attempted resuscitation over 4 years. Compared to no drone network, all proposed drone networks were expected to improve survival outcomes. For example, assuming 46% of OHCAs have bystanders willing to use an AED, a 500-drone network decreased the median time of defibrillator arrival from 7.7 to 2.7 minutes compared to no drone network. Expected survival rates doubled (24.5% versus 12.3%), resulting in an additional 30,267 QALYs ($858/incremental QALY). If just 4.5% of OHCAs had willing bystanders, 13.8% of victims would have survived. Sensitivity analysis demonstrated that an AED drone network remained cost-effective over a wide range of assumptions. CONCLUSI0NS With proper integration into existing systems, large-scale networks for drone AED delivery have the potential to substantially improve OHCA survival rates while remaining cost-effective. Public health researchers should consider advocating for feasibility studies and policy development surrounding drones.

A Systematic Review of Effectiveness of Automated External Defibrillators Delivered by Drones

“…Bogle et al looked at the health economics aspect by cost-effectiveness perspective approach and demonstrated QALYs and ICERs with UAV technology for AED delivery. The authors employed a sensitivity analysis with a variety of assumptions, such as number of docking stations, willingness to apply AED to OHCA, survival rate, and so on, and it was still demonstrated that an AED drone network remained cost-effective over a wide range of assumptions (Bogle et al, 2019). This kind of sensitivity analysis around the cost-effectiveness of this new technology should be performed with different assumptions, especially in the other regions and countries to show the cost-effectiveness in the other situations as well.…”

“…For example, a 500-drone network decreased the median time of defibrillator arrival from 7.7 to 2.7 minutes. Expected survival rates doubled (24.5% versus 12.3%), resulting in an additional 30,267 Quality-adjusted life years (QALYs) (Bogle, Rosamond, Snyder, & Zègre-Hemsey, 2019).…”

A Data-Driven Simulator for the Strategic Positioning of Aerial Ambulance Drones Reaching Out-of-Hospital Cardiac Arrests: A Genetic Algorithmic Approach

“…With the lifespan of a drone being four years and each drone costing £15,000, the total cost to implement the drone network including 20% of the purchase price for annual maintenance, is approximately £2.11million [12], [34]. In a cost-effective analysis of utilizing AED drones in North Carolina, US, Bogle et al [34] concluded that in a large scale network, AED drones have the potential to improve OHCA survival rate while being cost-effective. However, due to the wide range of assumptions taken in that study, it is important to undertake a detailed cost-effective analysis for AED drone networks considering personnel training and maintenance.…”

The Use of Drones in Emergency Medicine: Practical and Legal Aspects

“…A study published by Bogle et al described drone-based AED deployment networks. The authors revealed that all analysed drone networks improved AED delivery time and suggested that they can improve out-of-hospital cardiac arrest survival outcomes [11].…”