Unmanned Aerial Vehicle Transport of Blood Products in Mass Casualty Incidents

Natural disasters (including earthquakes, tsunamis, pandemics, and drought) and manmade events (such as transportation or industrial accidents, acts of terrorism, and mass shootings) may result in mass casualties requiring healthcare practitioner expertise and response.

Mass Casualty Incidents

Over the past several decades, the nature of mass casualty incidents (MCIs) has evolved in the U.S., resulting in a higher number of non-nature-related events and a greater number of events attributed to intentional violence. These changes have led to a concomitant evolution in the epidemiology of injuries, resulting in a higher volume of patients with blast and penetrating wounds necessitating emergency trauma care, including resuscitation of hemorrhagic shock.

Damage Control Surgery and Resuscitation

Over this same period, the state-of-the-art treatment for such injuries has also evolved to encompass damage control surgery, damage control resuscitation, and remote damage control resuscitation (prehospital resuscitation). Strategies now prioritize early surgical stabilization, aggressive resuscitation, and delayed definitive surgical repair to prevent the development of the “deadly triad” of hypothermia, coagulopathy, and metabolic acidosis.

Surgery. Damage control surgery limits initial surgical interventions to only those required to control major bleeding and infection containment (e.g., bowel ruptures), thereby minimizing the time in the operating room to avoid further heat loss. Once the patient is adequately stabilized in the intensive care unit, the patient is returned to the operating room for definitive treatment of injuries and wound closure.

Resuscitation. Evidence has shown that the most effective resuscitation fluids to prevent the deadly triad are early administration of whole blood or blood products approximating whole blood. In conventional management of massive hemorrhage, patients were traditionally administered crystalloids and/or colloids followed by packed red blood cells (PRBCs), then plasma, platelets, and cryoprecipitate to correct coagulopathies. These practices have been replaced by a balanced approach to early administration of blood components replicating whole blood in ratios approximating 1:1:1 (plasma:platelets:PRBCs). This strategy requires higher volumes of blood components—especially greater numbers of plasma and platelets per individual patient.

Blood Supply. The key challenge to preserving life and limb in MCIs is to deliver lifesaving care rapidly to a large number of severely injured patients in a setting of overwhelmed resources. Because massive hemorrhage is the primary cause of death in many intentional MCIs, the ability to expeditiously provide adequate supplies of blood components in sufficient quantities is paramount to minimizing mortality.¹ Given this evolution in trauma care, the blood supply available at point-of-care hospitals may be insufficient to meet the ideal resuscitation demands during high-volume, high-acuity MCIs. This necessitates the delivery of blood products from regional blood centers to hospitals without delay.

Unmanned Aerial Vehicles

One proposed solution to quickly deliver blood components from blood centers to hospitals or even directly to the field during MCIs is with unmanned aerial vehicles (UAVs).

Using UAVs has become increasingly common in military and civilian settings. These versatile vehicles are agile, quick, and relatively low cost. Due to remote navigation, they also pose less risk to pilots and crew than traditional aircraft such as helicopters.

On the battlefield, UAVs are routinely used as weapons and for surveillance activities. They have also been used as couriers, capable of delivering supplies and equipment to remote settings over long distances. In civilian applications, UAVs have been traditionally used for aerial photography. More innovative uses have included delivering groceries and fast food.

Modern MCI preparedness and response warrant a more significant role in the delivery of expedient and effective trauma and resuscitative care. The use of UAVs may be a viable innovation to transport lifesaving therapy quickly to those in need. A 2021 study by Christina Álvarez-Garcia, et al., examined the use of UAVs in disaster situations in remote locations or where dangers to rescuers may exist.² The authors have outlined a triage system to categorize patients remotely for care priority. In addition, the UAV loudspeaker would be capable of delivering instructions to individuals on the ground. Lifesaving interventions, such as hemorrhage compression or recovery positioning, could be broadcast to bystanders at the scene using the UAV. Lifesaving equipment such as tourniquets, dressings, or emergency medications could also be delivered remotely.

Innovations such as these can only be expected to continue to grow in the next few years. In August 2022, the Federal Aviation Administration awarded $2.7 million in drone research to support disaster preparedness and emergency response. These awards went to five universities to “address coordination procedures among drone operators from federal agencies as well as state and local disaster preparedness and emergency response organizations.”³

Challenges

Federal, state, and local regulations represent challenges to using UAVs for blood transportation during MCIs. To prevent interference with airline flight paths and for other security reasons, UAVs are restricted from flying in certain airspaces, such as near airports, stadiums, prisons, and wildlife preserves. UAVs have also been traditionally restricted from flying over people and road traffic.

Additionally, to fly the distances required to transport blood from regional blood centers to hospitals, UAVs must fly “beyond visual line of sight,” meaning beyond the operator’s physical line of vision. For the transport of blood products, longer distance flights would be required.

Unlike UAV usage for commercial endeavors, healthcare usage requires attention to privacy and confidentiality issues. Any blood product linked to a specific patient that is carried within the UAV must not contain identifiable patient-specific information or must be secured in a manner to protect this information.

Another challenge to using UAVs for blood product delivery is integrating the process into the healthcare system. Integration of blood orders, dispatch of the UAVs, and receipt of blood products must all be coordinated and integrated into the current blood delivery system.

Conclusion

To minimize mortality rates in modern MCIs, it is incumbent upon healthcare professionals in the fields of emergency medicine, trauma surgery, anesthesiology, and critical care to work with technical engineers, policymakers, and business executives to further study and build the technical, regulatory, and business infrastructure required to make UAV blood delivery during MCIs the standard of care in the U.S.

The opinions expressed here do not necessarily reflect the views of The Doctors Company. We provide a platform for diverse perspectives and healthcare information, and the opinions expressed are solely those of the author.