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      Drone delivery of AED's and personal protective equipment in the era of SARS-CoV-2

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          Abstract

          To the editor, Scquizzato and colleagues have recently described the fear of contracting SARS-CoV-2 as an obstacle to perform bystander cardiopulmonary resuscitation (CPR). 1 A case similar to the one reported has also occurred in our country. 2 The authors describe the current ERC guidelines that advise continuous chest compressions (CCC)-CPR and early defibrillation, as well as an only-look technique to assess the absence of signs of life to dispel bystanders’ concern about CPR in the SARS-CoV-2 pandemic. It is currently not predictable what dynamics SARS-CoV-2 transmission will develop in the coming years, but prolonged or intermittent social distancing may be necessary until 2022. 3 A long-term strategy is required to maintain the current out-of-hospital-cardiac-arrest (OHCA) survival rate. We believe that the development and introduction of novel techniques may help to limit human contact and encourage bystanders to start CPR on site as soon as possible. Studies have demonstrated the capability of drones to carry medical equipment 4 and personal protective equipment (PPE) like gloves and facemasks to the site of an emergency. Experimental studies involving drone delivered AED's have also proven that drones can reach an accident faster than the emergency medical service (EMS). Drones can provide first responders with CPR advice and may convey a sense of security through telemedical support. Claesson and colleagues recorded the time interval from dispatch to arrival of an AED in cases of OHCA in a suburban area of Stockholm, which is characterised by restricted airspace and excessive Emergency Medical Services (EMS) response times. 4 Drones were sent on 18 flights to locations where OHCAs within a 10-km radius from the fire station had historically occurred, with a median flight distance of 3.2 km. The median time from dispatch to arrival was 5:21 minutes (IQR, 3:03-8:33; shortest time, 1:15 min) for drones compared to 22:00 minutes (IQR, 17:48-29:00; shortest time, 5:00 min) for EMS (P  < 0.001). Bystanders reported that availability and use of the AED was perceived safe and feasible and conversation with the dispatcher via the drone was positive and helpful. 5 Resuscitation councils stress the relevance of CCC-CPR without mouth-to-mouth ventilation and advise first responders to look for the absence of signs of life only, to reduce the fear of disease contraction. We further suggest the introduction of drones wherever may be indicated. Aside from providing AED and CPR advice to bystanders, drones can deliver PPE and communicate safety instructions. Although this seems a logistical challenge, it can be a crucial part of the strategy to encourage, instruct and reassure bystanders to perform CPR even in times of epidemic. Conflicts of interest None Credit Author Statement Michiel J van Veelen: Conceptualization, investigation, writing original draft Marc Kaufmann: Conceptualization, review & editing Hermann Brugger: Supervision, review & editing Giacomo Strapazzon: Conceptualization, supervision, review & editing

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          Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

          It is urgent to understand the future of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission. We used estimates of seasonality, immunity, and cross-immunity for betacoronaviruses OC43 and HKU1 from time series data from the USA to inform a model of SARS-CoV-2 transmission. We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022. Additional interventions, including expanded critical care capacity and an effective therapeutic, would improve the success of intermittent distancing and hasten the acquisition of herd immunity. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to SARS-CoV-2. Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.
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            Time to Delivery of an Automated External Defibrillator Using a Drone for Simulated Out-of-Hospital Cardiac Arrests vs Emergency Medical Services

            This study compares the time to delivery of an automated external defibrillator using fully autonomous drones for simulated out-of-hospital cardiac arrests vs emergency medical services real-time responses.
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              Drone delivery of an automated external defibrillator – a mixed method simulation study of bystander experience

              Background Out-of-hospital cardiac arrest (OHCA) affects some 275,000 individuals in Europe each year. Time from collapse to defibrillation is essential for survival. As emergency medical services (EMS) response times in Sweden have increased, novel methods are needed to facilitate early treatment. Unmanned aerial vehicles (i.e. drones) have potential to deliver automated external defibrillators (AED). The aim of this simulation study was to explore bystanders’ experience of a simulated OHCA-situation where a drone delivers an AED and how the situation is affected by having one or two bystanders onsite. Methods This explorative simulation study used a mixed methodology describing bystanders’ experiences of retrieving an AED delivered by a drone in simulated OHCA situations. Totally eight participants were divided in two groups of bystanders a) alone or b) in pairs and performed CPR on a manikin for 5 minutes after which an AED was delivered by a drone at 50 m from the location. Qualitative data from observations, interviews of participants and video recordings were analysed using content analysis alongside descriptive data on time delays during bystander interaction. Results Three categories of bystander experiences emerged: 1) technique and preparedness, 2) support through conversation with the dispatcher, and 3) aid and decision-making. The main finding was that retrieval of an AED as delivered by a drone was experienced as safe and feasible for bystanders. None of the participants hesitated to retrieve the AED; instead they experienced it positive, helpful and felt relief upon AED-drone arrival and were able to retrieve and attach the AED to a manikin. Interacting with the AED-drone was perceived as less difficult than performing CPR or handling their own mobile phone during T-CPR. Single bystander simulation introduced a significant hands-off interval when retrieving the AED, a period lasting 94 s (range 75 s–110 s) with one participant compared to 0 s with two participants. Conclusion The study shows that it made good sense for bystanders to interact with a drone in this simulated suspected OHCA. Bystanders experienced delivery of AED as safe and feasible. This has potential implications, and further studies on bystanders’ experiences in real cases of OHCA in which a drone delivers an AED are therefore necessary.
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                Author and article information

                Contributors
                Journal
                Resuscitation
                Resuscitation
                Resuscitation
                Elsevier B.V.
                0300-9572
                1873-1570
                5 May 2020
                5 May 2020
                Affiliations
                [a ]Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
                [b ]Emergency Medical Services 112, Health Care System Alto Adige, Bolzano, Italy
                Author notes
                [* ]Corresponding author. Eurac Research, Institute of Mountain Emergency Medicine, Via Ipazia 2, 39100, Bolzano, Italy. Tel.: +39 3489044136. michiel.vanveelen@ 123456eurac.edu michielvanveelen@ 123456hotmail.com
                [1]

                Emergency Medical Services 112, Health Care System Alto Adige, Via Druso 116, 39100, Bolzano, Italy.

                [2]

                Eurac Research, Institute of Mountain Emergency Medicine, Via Ipazia 2, 39100, Bolzano, Italy

                [3]

                Eurac Research, Institute of Mountain Emergency Medicine, Via Ipazia 2, 39100, Bolzano, Italy.

                Article
                S0300-9572(20)30176-3
                10.1016/j.resuscitation.2020.04.038
                7198402
                41c51c61-a1cd-41d0-aa66-a1bebf154b4d
                © 2020 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 23 April 2020
                : 27 April 2020
                Categories
                Article

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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