Sweden’s need to react more quickly to sudden out-of-hospital cardiac arrests may have given rise to the world’s first drone killer app.
According to Andreas Claesson, chair of the Swedish Resuscitation Council, the country’s low cardiac arrest survival rate (10%) is a by-product of several factors – mainly response times and early access to onsite automated external defibrillators (AEDs).
“It takes too long for emergency crews to get to an incident site – and most often there are no accessible AEDs,” said Claesson. “In about 70% of the cases, the incident site is the patient’s home.
“We ran simulations and found that we can get a drone to most homes ahead of an ambulance – with a potential life-saving impact. Our hypothesis is that by getting AEDs to the site two minutes earlier, on average, we could make a big improvement to the survival rate.”
So Claesson contacted Everdrone, a Swedish company that already had a multi-purpose drone platform that could be adapted to different use cases. After discussions with Claesson, Everdrone developed a first responder application to deliver AEDs to incident sites.
Rather than make their own drones, Everdrone buys standard systems off the shelf and adds sensors, a navigation device, cameras, connectivity components, an on-board computer and a parachute safety system. These are just some of the extra components that make the drones intelligent, autonomous and safe.
Everdrone’s current generation of systems can reach a radius of 6km and operate in wind speeds of up to 14m per second, including gusts. For the time being, they do not operate in rain, but are expected to be able to in about 12 months’ time.
Going live
But Everdrone didn’t cross those barriers itself. A consortium of partners was formed to lobby Swedish regulators to relax some of the rules and accept the application, which had the potential to save Swedish lives. The partners included Everdrone, which provides the drone technology; Karolinska Institute, which runs the studies and is where Claesson is an associate professor; and SOS Alarm, the organisation that answers all emergency calls in Sweden and dispatches fire and medical resources.
With access to a large volume of historical cardiac arrest response time data from Sweden, the partners were able to run very precise simulations on where the Everdrone system would provide the best value. It turned out that the best areas to operate in are semi-urban, where drones can reach a relatively large number of people, and where the response time for the ambulance is still relatively long.
A typical area would have about 50,000 residents, and average ambulance response times between eight and 12 minutes. That is the scenario where Everdrone can provide the most value with a single drone system.
The first pilot project got off the ground in the summer of 2020. Based on data collected during the first run, the partners made changes to the technology and to the processes. A second pilot project began in April 2021 – and has been running ever since.
“We have five systems running today in the western part of Sweden, within reach of about 200,000 residents,” said Mats Sällström, CEO of Everdrone. “The system is operational about 100 hours a week and is tightly linked to the procedures and systems used by SOS Alarm.”
Mattias Regnell, head of innovation at SOS Alarm, said the system’s success rate is already remarkable. “In most cases, the drone is dispatched faster than the ambulance,” he said. “So far, the median time gain is around two minutes, which may save lives. Assuming optimal dispatcher interaction, two minutes faster could mean a 20% increase in the chances that a patient will survive.”
The technology itself is one part of the solution – teamwork is another major ingredient. Working in close coordination, Everdrone and SOS Alarm integrated the drone systems with emergency information systems. They worked with the Västra Götaland regional emergency medical dispatch centre on the process of triaging emergency calls, and also developed new processes for handling calls and trained dispatchers to work with those changes.
After receiving an emergency call, dispatchers assess the patient’s medical condition. If the person is unconscious or not breathing normally, the dispatcher highlights a medical index in the dispatch software. This automatically sets in motion a set of actions – the drone boots up and the hangar gates open. Simultaneously, the dispatch system alerts ambulances and fire and rescue, who head for the site as quickly as possible.
Although the drone is autonomous, Swedish regulators require a pilot to be present in a remote-control centre to monitor it. As soon as an alarm is activated, the pilot requests a flight permit from the local air traffic control and usually gets it within 20-30 seconds. The drone system is usually airborne about 60-70 seconds after the dispatcher has highlighted the medical index.
Drone in action
The drone navigates autonomously to the incident site and transmits a video feed from an on-board camera back to the control room, where the pilot checks that the delivery location is safe. In some instances, the coordinates communicated by the alarm centre point to the right address, but the drop-off needs to be at a more precise location – for example, on a rooftop, in front of a car or next to a swimming pool. In such cases, the pilot adjusts the coordinates slightly.
When the drone reaches the exact spot, it hovers about 30m above the delivery location and, using a winching system, lowers the AED to the ground. As soon as the device is on the ground, Everdrone reports back to the alarm centre. The dispatcher then instructs the caller to pick up the device and explains how to attach it to the patient and how to activate it.
This tight set of procedures was designed to get a shock to the patient’s heart a few minutes before the ambulance arrives. Getting an AED to the site just a little earlier may have a huge impact on the outcome because without treatment, the person’s chance of survival drops by about 7-10% per minute
“How much time we save completely depends on the location,” said Sällström. “The general response time of the ambulance service in the areas we are looking at might be anywhere between seven and 12 minutes, and the drone typically arrives in between three and six minutes. These are rough figures – more precise figures will be published in the coming months.”
Sällström added: “It’s one thing to put an AED on a drone and do some demonstration flights, but it’s something completely different to actually integrate this in live emergency situations and dispatch it with the level of safety and reliability that we are now doing in Sweden.
“We are the first to deploy this kind of system in real-world operations and to evaluate it from a scientific perspective. We do this with help from our research partner, Karolinska Institute, the sixth largest medical university in the world.”
Claesson adds: “There are a number of instances around the world where different research groups have been looking at this possibility – in Canada, the US and Holland – but none of these has gone into live operation. Sweden is the first to do this.”
More than just technology
Sällström attributes the project’s success to three things: “First, there is the drone technology and the regulatory perspective. Everdrone are experts in safe, reliable and smart technology. And we can also provide evidence that it is safe. It’s one thing to provide technology and say it’s safe; it’s a different thing to provide evidence of safety and a way that you can convince the authorities to give permit for this type of operation.
“The second ingredient for our success is that we are in very close collaboration with emergency dispatch and the emergency call centre. They know when an incident occurs and where it is. They have the dispatch centre and can communicate with bystanders.
“The third thing that makes this all possible is the partnership with medical experts. Because we are operating in an emergency care context, we must be very careful to not introduce something that is unsafe. You might need to ask someone to stop doing CPR for one minute, for example, and go out into the garden and pick up the AED. That situation raises several ethical questions: in what circumstances is that the right thing to do? Our research partners at Karolinska Institute oversee all medical and ethical matters.”
Even when all the technology works exactly as planned, there is still a very crucial human factor that makes all the difference in the world. “Transporting something is quite easy,” said Claesson at the Karolinska Institute. “Having people to use it in a distressing situation is another thing. The challenge now is to have the dispatchers explain to bystanders how to retrieve the AED as it is being delivered.”
Killer app ready for take-off
Much has been written in the press about drone delivery of consumer products, but most analysts, whose job it is to look beneath the surface at what is really happening, don’t think consumer deliveries is the application that will make drones commonplace.
“Certainly, there are some use cases around pizza delivery and retail delivery,” said Hendrik Bödecker, founder of Drone Industry Insights, which studies and reports on the drone industry worldwide. “Google Wing has run several proofs of concept in different parts of the world. But this use case does not scale well.
“Drones are too noisy for the neighbours, and the delivery process costs too much money to justify what is being delivered. Customers buying things like pizzas and shoes, for example, are unlikely to agree to pay several times more than the items being delivered. For these reasons, I doubt drone delivery will be a scalable urban use case within the next 10 to 15 years.”
Another use case often reported in the media is planned logistics, in which, unlike emergency logistics, people know ahead of time what they need, so delivery can be planned. Usually, planned logistics applications deploy bigger drones.
Sällström said: “I think that over larger distances, it might make sense and in some geographical regions – for example, you might have a short distance but with a lake between two facilities. But I think in many of these cases where people are developing drones for logistics, they will be less attractive in the future than ground-based autonomous vehicles that are easier to operate safely.
“These ground-based vehicles will probably be manufactured in much larger volumes and will therefore be much cheaper. Overall, I think many people are overly optimistic about some of the use cases for planned logistics.”
From his bird’s eye view of the market, Drone Industry Insights’ Bödecker agreed that emergency delivery may be the world’s first killer app for small drone technology. “With emergency medical, you can push through the regulations more easily,” he said. “And when you’re saving lives, people will accept high costs and noisy drones.”
And so the future looks bright for Everdrone. “About 72% of the people in Europe live in what is defined as urban areas,” said Sällström. “So potentially we could reach 72% of all European people with this type of service. We see a huge market opportunity in front of us.”
Indeed, Finland, Denmark, France and the UK have all noticed what is happening in Sweden and are eager to follow suit. Stakeholders in those countries have already begun discussions with Everdrone to try to bring a similar system to their countries.
