Nurse-managed health clinics provide care to some of the most vulnerable and disadvantaged populations in the United States. The Health Wagon is one such clinic that serves southwest Virginia in the impoverished rural Appalachian region with the innovative use of mobile healthcare delivery. Ninety-eight percent of the Health Wagon’s patients are uninsured, and 78% have an income of less than $20,000 annually, despite working multiple jobs. Most make too much money to qualify for Medicaid but not enough to afford private insurance. The mobility of our clinic allows us to fill in the gaps and bring health care to the people living in Appalachia.

Innovation in healthcare delivery has been a mainstay of the Health Wagon not only where mobile health services are concerned, but most recently with the delivery of medications via drone at a Remote Area Medical (RAM) Wise County, Virginia, outreach, which is spearheaded annually by the Health Wagon. The event is the largest medical outreach in the country and was started by Sister Bernie Kenny, a nurse practitioner, and myself more than 17 years ago. This outreach program provides free eye, dental, and medical care during a summer weekend every year with the help of more than 1,400 volunteers. The clinic provides care at the local fairgrounds, and people camp out days in advance to receive desperately needed health care. The field clinic serves more than 6,000 patients during the 3-day weekend. Patients present with a variety of disorders, including hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, and mental health issues such as depression and anxiety.

Stan Brock, founder of RAM, and I had discussed the potential use of drones in health care. I believed that medication delivery would be a very highly innovative concept that would meet the crucial needs of patients in rural areas. The idea was soon embraced by other partners, including Flirty, an Australian-based drone delivery service; NASA Langley Research Center; Virginia Tech’s Institute for Critical Technology and Applied Science; the Business and Economic Development Office of Wise County; Mid-Atlantic Aviation Partnership; and the Appalachian College of Pharmacy, among others.

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The use of drones for medication delivery provides a great opportunity to address the medical needs of underserved communities. Living in a rural, mountainous area with frequent heavy snowfalls in the winter presents certain hardships, and patients often run out of much-needed medications. Last winter, southwest Virginia had a record-breaking 42 inches of snow, and the National Guard had to travel into rural areas and deliver life-saving medications such as insulin. The use of a drone to deliver medications to patients in need or to take supplies from our stationary clinics out to our mobile unit would be highly beneficial and meet crucial needs. Embracing this technology would give rural communities such as ours distinct advantages in the delivery of health care.

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Medication delivered by drone

The six-rotor drone delivered medication to the rural outreach clinic on July 17, 2015, after the medication was flown to the Lonesome Pine Airport in Wise, Virginia, by a remotely operated NASA fixed winged aircraft. From that point, the drone delivered 20 smaller packaged medications from the airport to the clinic located at the neighboring fairgrounds, making multiple trips throughout the day. The drone made the delivery by lowering the packages of medications, in a controlled manner, while it hovered above the ground. The packages were received by a pharmacist and given to patients in need of critical medications that were identified during the event by a healthcare provider. Safety was maintained with built-in features that included return-to-safe-location in the event of a low battery or communication loss. The demonstration proved that drones have a future in the healthcare arena, as the fully autonomous machines use their preprogrammed delivery schedule and post to delivery. The drone has now been accepted by the Smithsonian Institution’s National Air and Space Museum.

The endeavor allowed the group of partners to show how an unmanned aircraft can assist healthcare professionals in providing care more efficiently and how the gap of healthcare access can be closed between those who can offer medical care and those who are most in need. The event also highlighted the trials of delivering health care in rural areas and how this evolving technology can be married to overcome challenges that healthcare providers face in delivering care in these areas. According to Dr. Paula Meade, DNP, MSN, FNP-BC, PNP-BC, Clinical Director with the Health Wagon who also worked on the project, “This is a great accomplishment for our nurse-managed clinic and carries on our concepts of innovation.”