The ubiquity of smartphones and ever-improving digital communications offers a unique opportunity for everyday citizens to save lives in mass casualty events. Terrorism (both domestic and international) and the odd crazed individual with a gun or blade continue to provide an ever-increasing flow of such events. We all know about the American College of Surgeons ‘Stop The Bleed’ initiative and how it aims to empower everyday citizens to provide life-saving emergency care and prevent early death from compressible haemorrhage. This was recently demonstrated at the Tree of Life Synagogue in Pittsburgh, where active shooter drills likely saved several lives. Public knowledge of the initiative is all well and good, but how do we ensure that the good citizens who step up to the plate at a time of need are properly equipped to carry out that task at hand?
Well let’s look first at the kind of things that already exist. As a medical professional in the UK I’m one of a growing number of people signed up to the GoodSAM app which alerts users to a cardiac arrest in their immediate vicinity and identifies the locations of defibrillators. The aim is to get any nearby person trained in CPR/defibrillation to the patient’s side as soon as possible, before the ambulance arrives. The app has been a success and is now integrated into the London Ambulance Service dispatch process such that when a cardiac arrest call comes through to the emergency call centre, they automatically send out a GoodSAM alert as well as sending an ambulance. Live on-scene video streaming from responders’ smartphones is now incorporated into the app and more recently drone technology has been used to deliver defibrillators to patients in remote locations.
From delivering blood products to maternity hospitals in rural Rwanda to delivering disaster relief packages to flood-hit parts of Queensland, Australia, the use of drones for dropping off emergency medical equipment has really taken off (see what I did there) in recent years. The Ambulance Drone from the University of Delft in The Netherlands was one of the first widely publicised devices and similar defibrillator delivery drones have proved promising in studies where they’ve been shown to dramatically cut time to defibrillation in out-of-hospital cardiac arrest. At the back end of 2017, the city of Reno, NV was chosen as one of 10 test sites selected by the Department of Transportation as part of the Unmanned Aircraft System Integration Pilot Program, which aims to facilitate the integration of drones from various industrial sectors into national airspace. Tech firm Flirtey has been given the go-ahead to begin delivering defibrillators to wherever they’re needed in the city and should the pilot scheme prove successful it will no doubt be rolled out across the country.
Trauma care has always been the ugly step-sister of sexier medical topics like cardiac care and cancer when it comes to public awareness, investment in research and new technologies. In the midst of a mass casualty event why can’t an army of drones equipped with tourniquets, haemostatic dressings, the necessary PPE and maybe even a shot of TXA be dispatched to the scene to be used by trained or un-trained first responders? Pre-loaded video illustrations or even real-time voice guidance could talk a novice through the basics of opening airways, putting pressure on bleeding points, applying tourniquets or even performing needle decompressions of suspected tension pneumothoraces, thus buying crucial minutes before back-up arrives.
The possibilities are only limited by our imagination and determination to think outside of the box. Victims of mass casualty incidents are best served by the rapid arrival of lifesaving kit and not simply well-meaning but poorly equipped civilians. Stop The Bleed is a great start and drone technology has the potential to multiply its impact.
Obi Nnajiuba is a British surgical resident and current PhD student with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.