Shortly after five o’clock on a Sunday evening in February 2013, a severe EF4 tornado ripped through Hattiesburg, Mississippi. Winds whirling up to 170 mph tore through town, warping what seemed solid and upending the community. A church’s steeple was ripped off, along with roof after roof on main street. A vehicle parked near the baseball stadium was taken up by the twister and spit out near the pitching mound in the middle of the field, according to the storm report.
As soon as he saw the wreckage on TV—homes reduced to rubble, power lines snapped, mangled trees and traffic lights—Dr. Italo Subbarao panicked.
“I remember thinking, 'I can see my grandma’s house,'” he recalled. “'But an ambulance can’t get out there!'”
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That his grandmother was remote and isolated from emergency help ignited worry within Subbarao, an osteopathic physician specializing in emergency care.
So he began tinkering with a solution: an aerial ambulance that could fly above the chaos on the ground, with live-saving medical supplies in tow.
With the help of a team led by Dennis Lott, director of the unmanned aerial vehicle program at Hinds Community College in Mississippi, and Guy Paul Cooper Jr., D.O., then a fourth-year medical student at the William Carey University College of Osteopathic Medicine (where Subbarao is a senior associate dean), a new drone was born. They gave the modified DJI S1000+ drone a name worthy of a comic book cover: HiRO (Health Integrated Rescue Operations).
HiRO was “unveiled” in October. In the field, the drone acts as a 911 link to a remote, on-call doctor, who uses an augmented reality interface to give bystanders instructions to provide simple, Good Samaritan medical care until emergency personnel arrive.
Next February, the team will participate in a large disaster exercise with the Mississippi Emergency Management Agency (MEMA).
The drone carries a bright orange, hard-cased medical package that can treat up to 100 people in a disaster, such as a mass shooting, a terrorist incident, a wilderness emergency, or a hurricane. The medical kits range between two to 20 pounds depending on emergency, with supplies contained in an automated medication bin.
“They’re designed to be modular so that we can make adjustments as necessary,” Cooper said, who has designed several prototypes.
The system includes a camera mounted to the medical kit and a pair of smart glasses.
“We ask the bystander to put the glasses on,” Subbarao explained. “We can see what they see.” The remote, on-call doctor uses a Microsoft HoloLens headset and a holographic health record display to communicate with the bystander on the ground.
The drone can also potentially help bystanders stabilize injured people in more common emergencies, such as a heart attack, a bad fall, or a severe allergic reaction.
The tech targets a part of the healthcare system that’s often overlooked: the precious minutes before a patient arrives at the hospital. If rolled out fully, a fleet of HiRO drones could fundamentally streamline triage on the ground, increase access to care, and reduce the formidable pressure hospital emergency rooms face when disaster strikes.
“The drone operator will be distinct from the medical tech,” said Elizabeth Smith-Trigg, a William Carey University College of Osteopathic Medicine administrator who’s supporting the project. “The system will be integrated with local 911 services or through the State Emergency Management Alert System,” she added.
A recent study published in JAMA Surgery of over 1.8 million 911 calls found that, on average, bystanders in rural areas must wait twice as long for an ambulance than city-dwellers and suburbanites—about 13 minutes for a rural resident, compared to 6 minutes for the urban one. Around 10 percent of folks in rural areas had to wait 30 minutes for an ambulance, researchers found. The study’s authors offer one solution: the “You Are the Help Until Help Arrives” campaign, which is a series of videos and resources supported by the Federal Emergency Management Agency (FEMA). The idea is to turn bystanders — lay people with little medical knowledge—into immediate responders with simple instructions, such as how to administer CPR and control bleeding with a make-shift tourniquet (“Stop the Bleed”).
Medical drones like HiRO—such as those that deliver blood, carry defibrillators, and transport lab samples in rural and underserved areas—are currently only able to operate internationally. That’s because a GPS-enabled drone can’t legally fly beyond the operator’s visual line of sight” (BVLoS), which is restricted by the Federal Aviation Administration (FAA). Subbarao said that he felt optimistic that an “exemption” for disaster or “other regulatory allowance” for BVLoS “will come to fruition in the next year.”
Currently, in a disaster scenario, the HiRO team must first request a Public Agency Certificate of Authorization (COA). The approval process for an emergency, fast-tracked COA can take at the very fastest two hours, but can go up to 24 hours—a potentially dangerous timeline in a crisis. Subbarao said that the FAA target for approval is two hours, but declined to comment on the “intricacies of approval.” Subbarao’s team first requested a special “exemption” from the FAA last year, and securing regulatory approval has been a major challenge. “Ours is a need,” he said.
In October, President Donald Trump launched a program to expand drone use, with a goal of approving at least five pilot projects. The testing process has involved working locally with MEMA, but Subbarao said that he looks at HiRO as a “global solution.”
“It can be used in city and suburban environments as well as rural environments,” he said. “We envision the technology to be integrated with 911 and the emergency response system.” Subbarao said that to get FAA approval and show that HiRO is capable of working in an emergency situation, he’s looking to fly and test with federal agencies that work with emergency response, like the National Guard. But Subbarao said that it might be too soon for us to scan the skies for HiRO in the 2018 hurricane season.
“The truth is, the FAA is well aware of the tech we’re working on. They’re guiding us,” Subbarao said. “But we’ll get there. We’ll convince them.”
