The first robot and networked tablets are making their way today to an Ebola treatment unit in Liberia, where they will give aid workers their first chance at sharing data about the deadly outbreak.
Debbie Theobald, co-founder and executive director of Cambridge, Massachusetts-based Vecna Cares left on a flight to Monrovia, Liberia Tuesday night, taking the company’s own CliniPaktablets, a robot and the technology needed to set up a local area wireless network.
For doctors and nurses accustomed to scribbling patient notes on pieces of paper in any of the Ebola Treatment Units (ETU) scattered across West Africa, this will be the first time they’ll have access to portable computers that can share information wirelessly. It also gives them an electronic medical record system to track patients and share treatment and disease information with clinicians in other units and researchers in various countries. This also marks the first time a robot will be working in one of the treatment centers.
“I think that this system is critical to fighting the outbreak,” Theobald told Computerworld. “This is the first time they’ll be using digital records at all in any of the ETUs. Everyone has been using paper. If they have had a tablet, all the information they’re capturing is stuck on that tablet because they haven’t been able to data share across tablets.”
Vecna Cares, a healthcare IT company, will also be bringing the medical records system, minus the robot, to ETUs in Lunsar and Makeni, both towns in Sierra Leone. Depending on how well the VGo robot functions and is accepted in Monrovia, others could be sent to Sierra Leone to aid outbreak efforts there.
Researchers are working on technology that could be shipped to West Africa to help fight the Ebola outbreak as soon as a few months from now, while also looking ahead to bigger plans to combat any disease outbreak.
“Absolutely. This is something we can do,” said Robin Murphy, a professor of computer science and engineering at Texas A&M University and director of the Center for Robot-Assisted Search and Rescue said Wednesday. “There are lots of things we found that can go right now … but this will continue to motivate research in human-robotic interactions and how to understand how you design a new technology, how you test a new technology, how you factor in cultural context, how to factor in the targeted environments and how you train people to use them, she said.”
Tech researchers from around the U.S. met with health care and aid workers nearly two weeks ago to discuss what kinds of technology, such as robotics, big data analysis or communications, could help fight the Ebola epidemic. Now plans are in the works to get the technological aid where it’s needed. The Nov. 7 workshop was livestreamed across locations at Worcester Polytechnic University, Texas A&M, the White House Office of Science and Technology Policy and the University of California at Berkeley. During the meetings, aid workers were able to explain to the researchers the obstacles they faced in using certain types of technology.
Nothing can be simply shipped to a treatment center in a foreign country however. All proposals from U.S. companies to send technology to areas hit by the Ebola outbreak must go through the U.S. Agency for International Development (USAID), which administers civilian foreign aid efforts. USAID has put out a call for proposals, and submissions are due by Dec. 1. Murphy said she’s expecting the agency to quickly act on some of the proposals so that some of the technologies can be shipped to West Africa early in the new year.
While researchers are looking at short-term answers for Ebola, they’re also focused on coming up with bigger, more complex systems that can be ready for outbreaks of other deadly diseases.
The Australian Rural Fire Service (RFS) is carrying out trials this fire season with “spy in the sky” unmanned aircraft and drones to evaluate their use to monitor fires for extended periods and to provide early data in the first minutes of arriving on the fire ground.
One test is to likely to take placed in the Wollemi National Park near Singleton, should a major fire operation arise. It will use the Scan Eagle Unmanned Aerial Vehicle (UAV), which can send back both thermal and visual image data and is capable of staying airborne for some 20 hours. Insitu Pacific, the Brisbane operator of the Scan Eagle, believes their use will become almost routine within a year, with a trial contract in place with the Queensland fire and emergency services.
The RFS NSW also has a contract to trial the Octocopter with multiple rotors with a view to it being launched by the first crew to arrive at the scene of a fire to provide information on the extent of the fire front to enable senior crew to determine how fire fighting assets are deployed. Anthony Ferguson, superintendent of aviation co-ordination and planning at RFS NSW, said several projects are looking at their potential usefulness for intelligence gathering around fires.
The malaria drone mission began in December 2013, when UK scientists decided to track a rare strain of the mosquito-borne disease that has surged near Southeast Asian cities. Understanding deforestation may be the key in seeing how this kind of malaria, known as Plasmodium knowlesi, is transmitted.
The mosquitoes that carry Plasmodium knowlesi are forest dwellers. The insects breed in cool pools of water under the forest canopy and sap blood from macaque monkeys that harbor the malaria parasite. Human cases of this kind of malaria didn’t surface in Malaysia until about 10 years ago, says infectious disease specialist Kimberly Fornace of the London School of Hygiene and Tropical Medicine. She is leading the drone study.
As part of a project called MONKEYBAR, the team tracks outbreaks by comparing the drone’s land surveillance with hospital records of malaria cases. Meanwhile, a local wildlife commission has fitted macaques with GPS collars, which let scientists monitor the locations of monkey troops. Together, this information paints a public health map that explains how land development has influenced monkey movements as well as transmission of malaria to humans.
The White House Office of Science and Technology Policy recently organized a symposium of top robotics experts at Worcester Polytechnic Institute to brainstorm how field robots could be used in future Ebola-like pandemics. While the researchers came up with a number of innovative short-term and long-term ideas for how robots could be used to fight Ebola – everything from cleaning and decontaminating rooms to actually administering IVs to humans under medical treatment — there are still a number of important issues to clarify before we hand over the task of fighting Ebola to the robots.
On the surface, of course, handing over the dirty work of cleaning up after an Ebola outbreak to the robots sounds like a no-brainer. Instead of putting humans into harm’s way, why not just send in a robot? Robots can’t develop symptoms from Ebola, they are relatively easy to disinfect (except for their wheels), they dutifully carry out tasks without talking back and they can dispose of hazardous waste efficiently.
Scratch the surface, though, and you can start to see the moral and philosophical questions that arise once robots start doing more than just grunt-level decontamination work. In short, everything changes once robots also become human-like caregivers of Ebola patients rather than just repurposed industrial robots. Even assuming that wise and highly moral technologists have created robots according to something approximating Isaac Asimov’s Three Laws of Robotics, there still exists all kinds of potential for things to go wrong as robots go about trying to observe these laws. Just read any of Asimov’s “Robot” stories (or, better yet, watch the Will Smith movie) to understand how things might go awry.
TEEX trainer in protective gear with a “MUTT” robot carrying a litter at the workhop demo.
CRASAR, with funding from the Center for Emergency Informatics, and the TEEX Product Development center held a two day series of workshops on robotics for medical disasters. The major takeaway was that robots do exist that could be immediately repurposed now to protect Ebola health workers but how robots fit into the medical response enterpriseis as important as what the robots can actually do. While most roboticists intuitively know that what will work in the US is not the same as what will work in West Africa, the differences go beyond physical constraints such as level floors, ample power, and reliable wireless communications infrastructure. Less intuitive is that the cultural appropriateness of the technology and the impact on the existing workflows and practices is equally important.
The workshops considered how robots could be used immediately and in future domestic medical responses. Hardened robots (and automation/CPS technologies) do exist that could be immediately repurposed to provide logistical services (e.g., packing and hauling contaminated waste) and reconnaissance (e.g. observing signs of mass graves near a village), less so for clinical applications (e.g., directly working with patients). The participants strongly concurred that a research roadmap is needed to prepare robots that the US can effectively use in future medical disasters.
The success of hardened robots in providing these services depends on ensuring that they are appropriate for the work domain in five ways:
Fit the cultural context. For example, a telepresence robot allowing a certified medical interpreter to talk with the family and talk the patient’s history may overwhelm a non-Western family who has never seen a computer. A less obtrusive telepresence solution may be more practical in that cultural context.
Fit the existing workflow and practices. For the short term, solutions aren’t solutions if they require health workers or medical responders to adopt radically new procedures. They simply can’t handle more things to do or change how they perform their current tasks (which impacts how everyone performs all the other tasks- “simple” changes can have system ramifications). However, small changes that produce at least a tenfold benefit can make a difference.
Can function in the target environment. For example robots in West Africa would have work reliably in field hospitals with canvas floors and narrow doors, muddy dirt roads in the rainy season, with power and wireless communications limitations, etc., while robots in the US would have more pristine conditions. Different groups use different decontamination procedures and chemicals- such as dousing everything with chlorine beach solution (easy and inexpensive) or using more chemically sophisticated decontamination foams used by urban hazardous materials teams.
Are maintainable and sustainable. Health workers and medical responders won’t have the time and skills to repair robots (especially if wearing PPE) and may not have access to consumables such as batteries to enable operations for weeks and months. A problem with the Fukushima response was that many robots were actually prototypes functioning at a Technical Readiness Level of 7 rather than a well-tested Level 9 system.
Are easy to use and be trained on. This is related to fitting into the existing workflow and practices, but deserves special emphasis. The health workers and responders will not have significant amounts of time to learn new tools, as their days are already overloaded and they have little personal time. Robots must be vetted for ease of use. Effective training for medical missions is important and the role of simulation or serious games should not under-estimated.
The sentiment shared by the TAMU participants was that the biggest barrier to near-term use was not the lack of capable robots but rather the lack of requirements that would allow industry to invest in repurposing robots and enable agencies to test and evaluate the robots and develop training.Currently there are no details on the operational envelopment for the robot or operator. There is no clearinghouse of social science data on cultural appropriateness or bioethics or specific missions.
OVERVIEW OF WORKSHOP ACTIVITIES
The first day of the workshop was hosted by CRASAR and held at the National Center for Therapeutic Manufacturing. The day was divided into two portions. One was a simulcast of shared presentations with the other three sites and brainstorming as part of the planning workshops on Safety Robotics for Ebola Workers for the White House OSTP/National Robotic Initiative. The other part, the Texas A&M Workshop on Robotic, Automation and Cyber Physical Systems for MedicalResponse to Disasters, provided additional talks and discussions on general domestic medical response. The Texas A&M talks covered the state of the practice in DoD robots (TARDEC) and casualty evacuation systems (TATRC) that can be repurposed, lessons learned so far in using robots at the Fukushima Daiichi decommissioning (University of Tokyo), and opportunities for community recovery (TAMU Hazards Reduction and Recovery Center). The day culminated with a reception and a thought provoking keynote talk by Andrew Natsios (TAMU Bush School of Government and Public Policy), who served as administrator of USAID from 2001-2006.
The second day, the Infectious Disease Response Workshop, was hosted by Caleb Holt and the TEEX Product Development Center and held at the TEEX Emergency Operations Training Center/Disaster City® complex. The focus was on the practice of medical response (one of TEEX many courses that they teach). A major portion of the day was spent in demonstrations of the current practices in medical response, walking participants through 3 modules of a field hospital (also called an Emergency Treatment Unit or ETU), showing how contaminated waste is stored and overpacked, and how domestic responders, equipment, and ambulances are decontaminated. One demonstration was not a current practice but showed how existing robots might be of use. That demonstration showed the General Dynamics Land Systems MUTT, a robot wagon that acts like a dog and can carry waste, supplies, or one or two litters. A responder guides the robot with a leash rather than a video game controller that is hard to carry and use while wearing personal protective equipment. If the responder stops, the robot stops. If the person backs up, the robot backs up. The second day also featured panels of practitioners, including from the Texas Ebola Task Force and the USMC Chemical Biological Incident Response Force, comparing military and domestic practices
TAMU FINDINGS ON WHAT ROBOTS CAN BE USED FOR
In terms of overall medical disasters, applications appear to fall into one of three broad categories below, regrouping the preliminary list of nine functions discussed in an earlier blog. Each category has a different set of stakeholders and a different operational envelope that the robots would operate in. Clinical applications are possibly what people think of first– how robots can replace what health workers do now—but logistical applications are perhaps the most feasible and practical.
Clinical: Clinical applications are where robots are used in the ETU as a “force multiplier” (another way of saying “reducing manpower”) by taking over some of the activities that health workers do or as adding reliability by coaching or supervising activities. Ignoring for a moment the cultural appropriateness and other adoption issues, robots could enable
Remote health workers to assist other health workers, such as telepresence robots (or just cameras/tablets) coaching or supervising taking off PPE– though the general consensus of our responder base was that having a second person physically helping with decon was more valuable than having someone saying “hey, you touched your face while trying to lift your hood.” Domestic hazmat responders and the USMC Chemical Biological Incident Response Forces use a two personal decontamination process.
Health workers could use robots to interact with patients, reducing the number of times workers have to risk exposure. Robots could provide non-invasive point-of-care such as changing IV bags, though the TAMU participants were more reserved about roboticizing invasive procedures such as starting IV lines.
Remote health workers to interact with family members, such as remote qualified medical interpreters working through telepresence to help with patient intake forms.
Logistical: Logistical applications can take place within the ETU, but the construction, layout, and clutter of ETUs make it hard for mobile robots to move around. Some ETUs have canvas floors over dirt or mostly level manufactured floors, and almost all have raised areas to step over between modules that seem intended to foul wheels. The general thought is that flexible automation and materials handling are more likely to be of benefit within an ETU and that robots would be more useful for outside the ETU. Logistical robots are also interesting in terms of stakeholders. Since they are not performing clinical functions, in theory the robots could be operated by locals (assuming favorable cultural considerations).
Logistical robots could provide
Materials handling. Robots could reduce the number of times humans handle contaminated waste or the number of people needed to carry a litter. The robots could pack and carry materials from the warm zone to the cold zone (e.g., taking out the trash) or carry supplies into the warm zone, saving another cycle of a person having to don and doff PPE.
Decontamination. Robots could spray biocide foam on equipment, though there was several ideas for using gases to rapidly decontaminate ambulances so as to keep them in service.
Delivery and resupply. Unmanned aerial vehicles or boats could drop off small amounts of supplies to villages cut off by the rainy season.
Reconnaissance: Reconnaissance activities take place outside of the ETU. Aerostats or UAVs can provide awareness of long lines or gathering refugees. A more somber recon activity is to fly over villages and look for signs of freshly turned earth indicating graves.
Other: The workshops also touched on preparation for medical response, such as redesigning field hospitals to make it easy to use robots and to add cameras, internet repeaters, etc. The workshops raised the value of automated construction in reducing the non-medical members of the team needed to set up and maintain the ETU.
The Netherlands has unveiled a prototype of an “ambulance drone” which could potentially save lives by offering a rapid response after heart attack incidents. The yellow-painted drone can gain speeds up to 100 km per hour and is equipped with a defibrillator. The unmanned aerial vehicle (UAV) is flown with the aid of six propellers and can carry up to four kilograms, according to the creator of the project, Alec Momont, who revealed the first test model at the Netherlands’ Delft University of Technology.
A new robotic tool could help rescue workers locate victims of disasters and other emergencies before venturing into collapsed buildings or other potentially dangerous places.
Developed by researchers at the University of Guadalajara in Mexico, the new robotic system enables small, rugged bots — designed for search-and-rescue missions — to distinguish between human bodies and other objects, such as piles and rubble.
As the robot roams around a disaster site, it snaps pictures of its surroundings with the 3D camera and then sends those images to the computer. The computer then scans the images for patterns that might indicate the presence of a human body, using a specially created algorithm. The algorithm must first break down visual information into mathematical data by using what’s known as a descriptor system, which assigns numerical values to different parts of the 3D images. The numbers represent the different shapes, colors and densities of the objects in the picture.
All of this mathematical data is then merged together to create a second, much simpler, image. This image is passed through another algorithm, which detects whether the object that appears in the new image is a person or something else.
The difference between life and death for a troubled soul who jumps over the Sunshine Skyway Bridge, which is ranked fourth for suicide jumps in the United States, can rest in the hands of a group of students on the Eckerd College Search and Rescue Team. There are about 50 students and three paid staff members on the team.
While the 24-7 team is the only volunteer, college-based marine search and rescue group in the country, there are other unique teams around the nation. Texas A&M has a Center for Robot Assisted Search and Rescue in College Station and a handful of schools perform backcountry searches.
Texas A&M is one of the four sites co-hosting a OSTP/NRI Workshop on Safety Robotics for Ebola Workers. Our workshop will be November 7-8, with November 7 coordinated with the other three sites and November 8 as a follow-on at Disaster City specifically on technology transfer. We are still working on the agenda, but attendance is limited and by invitation. Participants need to be physically at College Station in order to help generate and rank the list of opportunities for robotics to give to the White House and to work with the medical and humanitarian responders to elicit operational details critical for successful technology transfer. Attached are some photos of a 2004 robotics exercise we hosted with the USMC Chemical Biological Incident Response Force- as you can see we learned a lot about working with PPE. Likewise our involvement in the Fukushima Daiichi nuclear accident reinforced and amplified how little things can trip up responses.
Our site’s workshop will address how robots can be used beyond protecting Ebola workers and that it will focus not only on helping identify what robots can do but on how robots must do it in order to be successful. Here at A&M we are striving to create a set of detailed use cases and projected robot requirements that can be used by industry and the TEEX Product Development Center. The robotics community cannot provide robots without understanding the needs otherwise engineering mistakes or mismatches that will be both financially costly and delay the delivery of effective solutions.
Robot carrying a victim at CRASAR/USMC CBIRF exercise (2004)
To meet these objectives, our workshop is focused on working with medical and humanitarian relief experts (they talk, we listen) to answer two questions:
what are the most pressing problems, barriers, or bottlenecks? e.g. minimizing contact while burying bodies or disposing of waste, health worker protection from infection,decontamination and disinfection of facilities, detection of presence of Ebola in facilities,tele-consulting by remote experts, health work physical safety, delivery of supplies, etc.
What is the value proposition of using a robot? e.g., benefits versus manpower, logistics support, training requirements, economic costs, etc.Is a robot the best choice? For example, Dr. Mark Lawley here in Industrial and Systems Engineering is working on adapting low-cost flexible manufacturing methods for waste and materials handling within the field hospitals where a mobile robot would be a technological overkill.
In my previous blog, I described 9 categories of applications that we’ve identified so far for robots for Ebola. It’s fairly easy to come up with ideas and there is a wealth of ground, aerial, and marine robots that can be repurposed. But it’s much harder to determine what’s the real value to the medical and humanitarian responders and to ferret out those hidden requirements that support a successful technology transfer. Our research and hands-on experiences at CRASAR has shown that military robots have not been a perfect match for fire rescue and law enforcement and many attempts by vendors to deploy their robots to disasters or to sell their robots to the homeland security community have failed. I see these failures stemming from three types of constraints: the operational envelope, work domain,and culture.
The operational envelope focuses on workspace attributes such as environmental conditions, size of doors in field hospitals, communication and power infrastructure, etc. As detailed in Disaster Robotics, several types of rescue robots were not used at the 9/11 World Trade Center because they could not fit in the luggage bays on buses hired to carry FEMA search and rescue teams. Some concerns about robots such as how can robots be decontaminated become moot if the robot can be recharged and maintained by workers inside the Hot Zone so that it never needs decon– but this of course means that functions can be performed by workers wearing personal protection equipment.
The work domain is critical as anyone who works in system design knows. Who are the stakeholders? Will these robotic solution employ locals so as to help support their economy? If so, what does that mean in terms of making robots that are easy to use and reliable? We use a formal method called cognitive work analysis to determine the work domain.
Culture is technically part of the work domain, but I personally think it merits special attention. We robot designers need to have cultural sensitivity to customsfor caring for the ill and conducting burials if we create robots to tend to the sick and transport the deceased. The rhythms of village life also impact humanitarian relief, for example it is better for a medium sized UAV to drop off a large payload of supplies and let the village equivalent of the American Red Cross representative go fetch it and deliver it to different households as part of their daily routine or should a smaller UAV do a precision drop to individuals?
Robot operator’s view from the controller
Robot eye view of victim being transported so medical person can make sure they aren’t having a seizure, etc.
