On July 17, 2015, a small drone traversed the mountainous terrain of Wise County, Va., and lowered a shipment of medications to a pop-up clinic offered by Remote Area Medical. This hexacopter, operated by Flirtey, an Australian company, was the first such medical flight sanctioned by the Federal Aviation Administration.

Since then, the U.S. Department of Transportation has selected 10 state and local governments to test drones as part of the FAA’s Unmanned Aircraft System Integration Pilot Program. Many of these programs focus on delivering packages of health care products. (A note on terminology: The unmanned aerial systems community generally dislikes the term “drone,” preferring “unmanned aerial vehicles” or “remotely piloted aircraft.” We use drone here because of its brevity and widespread use in the general community.)

While the United States is just beginning to integrate drones into its airspace, thousands of medical flights have occurred in Rwanda since that country started a nationwide drone system in late 2016. Fixed-wing drones, operated by California-based Zipline, carry medications, blood supplies, and other items to clinics across the Maryland-sized country. In 2017, Zipline and Rwanda’s neighbor, Tanzania, announced plans to establish a similar system across that bigger-than-Texas country. In late 2018, another Australian company, Swoop Aero, began delivering vaccines in the Pacific nation of Vanuatu.

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Zipline has documented lifesaving experiences from its Rwandan operation. For example, Alice Mutimiutugye began bleeding severely during childbirth. By road, the nearest supply of blood that matched her type was too many hours away to save her life. By drone, the blood reached her a half-hour after the clinic placed the order. Ms. Mutimiutugye survived to leave the hospital with her baby.

Dutch developers are testing drone-borne defibrillators for heart attack victims. Conceptual designs foresee remotely piloted ambulance copters carrying emergency medical technicians to stricken patients and transporting those patients to hospitals with no need for onboard pilots.

Why has the technology caught on so quickly in Rwanda, Tanzania, and Vanuatu, but not in the United States and other industrialized countries? Do we not need this technology as much as developing nations with poor transportation? Are our skyways too congested to add another layer of flying vehicles? Do threats of criminality, security breaches, and loss of privacy make drones too risky in wealthy countries?

Many believe that deploying drones for public safety and humanitarian aid will be key to public acceptance here in the United States. Drones could benefit Americans in multiple ways. Sizable portions of America are sparsely settled, with people living far from urban medical centers. Weather conditions often render existing delivery vehicles impractical or hazardous, such as icy roads for cars, trucks, and ambulances, or foggy skies for helicopters. Traffic conditions impose dangerous slowdowns in delivery — imagine trying to drive emergency blood supplies across Los Angeles at rush hour. Drones could offer effective alternatives in these situations.

Drones also have cost advantages. A 25-pound drone carries supplies less expensively than a 2-ton automobile or 3-ton helicopter. And there’s no need to pay an employee to travel the distance with a car or helicopter. Drones offer potential economies of scale: a single remote pilot, for example, can manage the occasional flights in multiple cities rather than having conventional pilots waiting in each individual city.

Drones could also mitigate safety issues that arise with traditional modes of transport. People are injured or die transporting supplies and patients surprisingly often. Where current modes of transport are hazardous, drones could eliminate the risk to human passengers, and a lost drone is far less expensive than a lost helicopter or airplane.

What, then, are the obstacles to adoption? Foremost is achieving what’s called beyond visual line of sight flight. Current regulations generally prohibit a drone from flying past its pilot’s visual horizon line. (A trial exception to the rule was just tested in North Dakota.) Another challenge is establishing a workable traffic management system in the national airspace. There are fears of midair collisions involving drones and manned aircraft. Other hazardous situations include flying over people or at night, with concerns of drones striking buildings or hillsides or falling onto people below.

There are privacy concerns, as drones make it possible for unidentifiable individuals to spy on us from a distance. There’s also the specter of a more cluttered sky. Visionaries imagine American skies filled with drones carrying Amazon packages, beer, and other items. (Australia’s Flirtey has experimented with defibrillator deliveries in Nevada and pizza deliveries in New Zealand.) Add in countless people with recreational drones and the skies could be filled with aircraft.

Drones — or fears of drones — recently shuttered Gatwick airport.

Most small drones are built in the People’s Republic of China, raising concerns that command-and-control software could be programmed into them to collect and transmit reconnaissance data without the knowledge of drone owners, operators, or clients.

Medical drones also raise technological and regulatory issues. John Coglianese, the former U.S. Special Operations Command director for unmanned aerial systems, suggested several to us: First, drones will eventually need the equivalent of transponders to integrate them into the national air control systems. Second, ground-to-drone communications must be protected to prevent hackers from hijacking drones or using their data for nefarious purposes. Third, allowing drones to travel beyond the operator’s line of sight significantly increases the complexity and cost of pilot-to-drone communications. Fourth, medical drones must be especially robust and capable of fulfilling missions far beyond what we in the United States currently expect of hobbyists’ drones.

That said, police and fire crews already routinely and successfully use drones, as does the U.S. Border Patrol, despite some concerns about civil liberty violations by law enforcement drones. We may sensibly wish to go slow on filling the skies with swarms of vehicles for myriad banal uses, and line-of-sight restrictions probably make good sense for recreational drones.

There are good arguments for advancing and supporting the goals set forth in the FAA’s Integration Pilot Program and for opening skies to emergency medical drones and other vital public services. Lives and scarce funds in the United States are likely being lost from the inability to use these technologies to their full capacity.

Robert Graboyes, Ph.D., is a senior research fellow with the Mercatus Center at George Mason University, where he focuses on technological innovation in health care. Darcy Nikol Bryan, M.D., is an associate clinical professor at University of California, Riverside, School of Medicine and has an active practice in obstetrics and gynecology at Riverside Medical Clinic. She is also a student pilot of small aircraft and a certified remote pilot. The authors thank John Coglianese and Jason McNally for helpful suggestions on this article.

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