EMS Usage - Development and Test Analysis

Author: Dr. Michael Zimmer

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The development of emergency medical services (EMS) is rooted from military combat medicine. As events occur that require rapid medical response, the EMS sector have evaluated the successes and failures from the military to form its own standard operating procedures. As the Command, Control, and Communicate (C3) in an organization may differ, EMS response is upheld by healthcare accrediting body (i.e. TJC) practices. Personnel, equipment, and supplies are rapidly deployable and are expected to respond within 20 minutes of an incident. A 20-minute response is essential to meet an EMS 60-minute timeframe (also known as the Golden Hour). The Golden Hour requires EMS to respond, triage, and move a patient to the nearest treatment facility. The Golden Hour is an industry standard as 99% survival rate is reflected in this practice. Unmanned Aerial Systems (UAS) is a valuable resource that can deploy and arrive to a Point of Injury (POI) quicker than an EMS response team. Regardless of the injury, UAS can aid in the Golden Hour response time as a supportive resource. This paper will explore the use case for EMS UAS by analyzing development requirements, testing requirements, configuration, test strategy, and design rationale. In addition, the researcher will share his thoughts in the application of EMS UAS. 

Basic EMS Requirements

According to Clifford (2021), the cost to operate personnel, equipment, and supplies in an ambulance is $182,731, while an additional $122,929 is applied to ambulance’ maintenance, gas, insurance, and other related expenses per year. As regulations currently restricts patient transport using an UAS, at this time EMS UAS can only be used for ambulatory (non-litter) medical equipment and supply purposes. Based on litter exclusion, initial EMS UAS will range between $80,000-$100,000. This is an assume figure that eliminates a $200,000 physical ambulance costs (Clifford, 2021). Furthermore, a $80,000-$100,000 EMS UAS cost factors in a cross trained remote pilot paramedic and prepackaged medical kits. For an EMS UAS to be capable in aiding ambulatory patients within the Golden Hour, the EMS UAS will need to hold similar designs as to an air (rotor) and road ambulance. Such a design will allow for difficult terrain landings that is medically equipped and suppled with compact life saving aids. Lastly, an EMS UAS will need to hold federal, state, and local UAS (Part 107 and 135) and emergency medical treatment (Federal Statute 42 USCS) operational requirements (Cordi & Goldstein, 2020). 

Another practice that EMS has adapted from the military is the 9-Line medical format when requesting EMS. A 9-Line is only as effective as the C3 that support the 9-1-1 caller and EMS team. 9-Line has been tested and proven to be the most efficient method to support to a patient in EMS needs. According to Jenkins, Robbins, and Lunday (2018), 9-line requests reflect improved patient outcomes when C3 is able to allocate additional resources. Based on the fundamental structure of a UAS, technology exists that allows for a cost effective and speeder EMS UAS response compared to a traditional road ambulance.

Proposed Design Configuration


A prefer EMS UAS would be configured on a multi-rotor chassis that is electric powered using Li-Po batteries. A prime commercial off the shelf UAS candidate is the DJI AGRAS MG-1P. The EMS UAS will be manually controlled with waypoint features, FPV, and infrared camera gimbal capabilities. The EMS UAS sensors will feature a compass, GPS, and IMU components. The EMS UAS communication system will have dual-antennas bridging triband (5, 2.4, and 28ghz) frequency to an antenna dish housed on top of a building that is used as the EMS UAS Ground Control Station (GCS). The EMS UAS will be regulated under FAA Part 107 and Part 135 requirements, while upholding to EMS Federal Statute 42 USCS. Medical equipment and supply payload will be interchangeable based on 9-Line request. In addition, medical equipment and supply payload will be prepacked into specialize kits for first responder simplicity. 

Aerial EMS UAS element will fly under a 400-foot Above Ground Level (AGL) altitude with 49mph speed capabilities. Furthermore, an EMS UAS will have a response coverage of 7.84 miles from GCS to POI. A 7.84-mile response coverage will allow an EMS UAS to be launched and arrive within 10 minutes (under DJI AGRAS MG-1P specifications). Lastly, under a DJI AGRAS MG-1P platform an EMS UAS will be able to provide freedom of movement telemetry with such features that allow for autonomous pattern movement around object of interest (Kesteloo, 2017).

Testing Strategy


Golden Hour response using an EMS UAS is dependent on C3 flow. As first responders arrive to a site, a 9-Line will be called into an emergency coordination cell. The 9-Line is a formal method that provides EMS with the situation. In the military, an on-site responder will prompt the 9-Line to a Patient Emergency Coordination Cell (PECC). The PECC will then request movement of medical assets. Dependent on the requesting need and medical resources available, the PECC will prompt the movement of personnel, equipment, supplies, while coordinating treatment facility support. Regardless of the equipment and supplies aided to support a 9-Line request, an EMS UAS can easily be worked into an EMS dispatching process. In the military, a Humvee, Blackhawk, or C-130 are used to respond to a POI. In the private sector, a 9-1-1 operator communicates with the caller and department dispatcher. An EMS UAS is not intended to be used as a primary EMS response, yet as an equipment and supply delivery resource.

Design Decisions 

Time is essential when responding to an EMS request. Within EMS delivery of care, the industry is always seeking methods to improve. Golden Hour standards for an ambulance to arrive to a POI is 20 minutes, while 5 minutes is allotted to receive the request, gather equipment and supplies, and deploy. The next 20 minutes is devoted to arrival, triage, and securely preparing a patient for transport (if needed). Lastly, the remaining 20 minutes is intended for patient transport and patient transfer to treatment facility staff. The initial costs to operate an ambulance in its first year is $500,000. Ambulance calls are billable at a rate of $2,000 while ambulance transport can cost $21,000 (Phelps, 2020).

EMS UAS is a speedy and cost-effective method that provide first responders with medical equipment and supplies to begin triage. Many UAS can deploy and arrive to a site faster than an EMS team. At this time an EMS UAS can only act as an ambulatory support resource, yet as federal, state, and local patient transport regulations are established EMS UAS will be able to assist with litter patients.

There are three primary features that make the DJI Agras MG-1P suitable for EMS UAS uses; payload lift, speed, and adjustable configuration components. The DJI Agras MG-1P have a payload lift of 10kg (22Ibs), which will allow for ambulatory equipment and supplies to be transported to a destination. In addition, the DJI Agras MG-1P can travel at the speed of 49mph. Between the DJI Agras MG-1P speed and a 10-minute time to deploy and arrive to the POI, the DJI Agras MG-1P can cover a response radius of 7.84 miles. Lastly, the DJI Agras MG-1P is designed to allow for component changes that equips the EMS UAS with specialize servicing needs. 

Conclusion

Injuries can occur at anytime and anywhere. When aid is most needed, conventional EMS modes of dispatch can be expensive and slow. Cost and timeliness are primary variables that EMS UAS can affect emergency management for the better. Although EMS UAS cannot physically triage a patient, an EMS UAS is able to deliver essential items to first responders with life-saving medical equipment and supplies. According to CB Information Services (2020), roads, rail, and water can be transient as the air is always accessible. In addition, this paper has reflected EMS UAS benefits by solving an emergency response cost and timeliness need. In 2020, experimentation using UAS to move medical supplies was demonstrated by Soarizon (a Scotland company) to rapidly deliver PPE, medical triage kits, and COVID test kits (Kerr, 2020). For Soarizon, utilizing UAS have shown to reduce traditional road and ferry medical supply movement time from 6-hours to 15-minutes. Lastly, this paper has reflected a use case for EMS UAS by analyzing development requirements, testing requirements, configuration, test strategy, and design rationale as the researcher shared his thoughts in the benefits for EMS UAS.    

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References

CB Information Services. (2020). 38 Ways Drones Will Impact Society: From Fighting War To Forecasting Weather, UAVs Change Everything. Drone Impact Society UAV. https://www.cbinsights.com/research/drone-impact-society-uav/

Clifford, D. (2021). What’s in a Sunstar ambulance and how much does it cost? Tampa Bay Times. EMS Technology Solutions, LLC. https://operativeiq.com/ambulance-equipment-and-supply-costs/

Cordi, H., Goldstein, S. (2020). EMS Federal Regulations. StatPearls. Treasure Island, FL. https://www.ncbi.nlm.nih.gov/books/NBK551651/

Jenkins, P. R., Robbins, M. J., & Lunday, B. J. (2018). Examining military medical evacuation dispatching policies utilizing a markov decision process model of a controlled queueing system. Annals of Operations Research, 271(2), 641-678. https://doi.org/10.1007/s10479-018-2760-z

Kerr, K. (2020). Delivering critical medical supplies in the Scottish Highlands. News. Soarizon by Thales. https://www.soarizon.io/news/delivering-critical-medical-supplies-in-the-scottish-highlands

Kesteloo, H. (2017). More details on the MG-1S Advanced and MG-1P RTK agricultural drones by DJI. The DJI MG-1P and MG-1P RTK Edition. DroneDJ, LLC. https://dronedj.com/2017/12/25/more-details-on-agricultural-drones-by-dji/

Phelps, S. (2020). If you call 911 for ambulance services, but don't get transported to a hospital, are you still charged for the ambulance arrival/patient care? Ambulance. Quora Inc. https://www.quora.com/If-you-call-911-for-ambulance-services-but-dont-get-transported-to-a-hospital-are-you-still-charged-for-the-ambulance-arrival-patient-care


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