Drone-delivered health care in rural Appalachia
Nurse practitioners make history with the first FAA-approved drone delivery of medications in the United States.
History of the Health Wagon
The Health Wagon, a free and charitable clinic, began with Sister Bernie, who came to the Appalachian region more than 30 years ago at the request of the Catholic Richmond Diocese to treat the poor and marginalized. Sister Bernie was one of the earliest nurse practitioners in the region. She previously had been a midwife in Tanzania before returning to the states. She began giving care from the back of a Volkswagen Beetle, which became known as the “Health Wagon.” The Health Wagon quickly evolved into a 501c3 non-profit clinic. Today, it serves patients at 11 different locations via mobile health clinics and 2 stationary clinics that are located in some of Virginia's poorest areas. The 6 counties that the Health Wagon serves are designated as federal Health Professional Shortage Area and Medically Underserved Areas. In the region, 43% of the population is below 200% of the federal poverty level.
“The Affordable Care Act has done little to help our patient population,” said Dr. Meade. “Our patients are still too poor to afford the monthly premiums, and even if a perfect payer was implemented today, there are still not enough providers in the region to see the patients. The needs and healthcare disparities here are alarming, and we have to look at different delivery formats to optimize care and bring additional resources to the patients in need.”
The future of drones in health care
The sky is the limit with drone technology. We may be able to not only deliver medications via drones, but also crucial supplies. Most of the Health Wagon's service revolves around mobile health, and being able to deliver supplies such as sutures, dressings, and others out to the field where our mobile clinic is set up would be highly beneficial. Some of the mobile sites that the Health Wagon visits are more than 2.5 hours away, and it is impossible to anticipate all needed items for each trip.
In the future, I would like to have a drone pilot on our staff who would coordinate air-to-ground deliveries of medications and supplies to mobile field clinics and patients. This is where the future will take us. The technology is here, and this will be just one more part of the arsenal that can be used to reduce healthcare disparities. I have also seen concepts in which drones deliver automatic external defibrillators to provide stat defibrillation for ventricular fibrillation. It may be difficult to find an automatic external defibrillator in a prompt manner. In the future, one may be able to summon the defibrillator by an app on a smart phone.
The biggest obstacle for drone usage is currently the regulatory environment. The FAA has banned all drone commercial uses in the United States. This test flight allowed the only freight exemption that permitted a real delivery. The FAA continues to work on guidelines that will address safety issues related to drone usage. However, other countries are embracing the technology in rapid fashion, and the United States lags behind in policing the safety of drone activity. To the FAA's credit, airspace in the United States is the safest in the world, and progress toward the goal of full use of drones continues to be monitored and evaluated.
Merging humanitarian relief with technology
As demonstrated by the Health Wagon and its partners, humanitarian relief can be addressed with this emerging technology, which can be used to improve health outcomes. The locus of care is moved closer to the patient where health care can be optimized. In rural areas such as Appalachia where mountainous terrain and transportation are certain barriers for patients, using drones will be a transforming idea that will improve healthcare access. On another positive note, southwest Virginia is holding to the promise that this may be an answer to the coal counties' economic struggle to recover from mining job losses, which have been catastrophic for the region.
This unprecedented drone delivery has been the impetus for leaders to strategize on how the drone technology can be used to promote economic development. The type of testing that occurred was ideal, given the rural, unpopulated geography. This could translate into job creation with health insurance and go a long way to alleviate the mounting burden that the Health Wagon faces on a daily basis in seeing patients without insurance. The lack of healthcare access is multifaceted, and changing the dynamic at this level would be great for all involved. To know that it all started with a nurse-managed clinic would be another testament to the creative nature of nurses.
Teresa Gardner, DNP, MSN, FNP-BC, FANNP, is a family nurse practitioner who maintains a nurse-managed clinical practice caring for the uninsured in the rural Appalachian Mountains of Virginia. If you would like more information on volunteering or on the Health Wagon, please visit: thehealthwagon.org.