Drone Risks

Trespasses Unforgiven

As the nuisance potential of drones becomes increasingly apparent, a whole new market in anti-drone technology is springing up.
By: | March 14, 2016 • 4 min read

Technological advance has provided both consumers and businesses with a variety of shiny new gadgets and services. However, as the rise of cyberattacks has underlined, it has also provided society’s undesirable elements new means of creating nuisance or committing crime.

The growing popularity of unmanned aerial vehicles (UAVs) — aka drones — is a case in point. Their powerful video cameras open up a whole new world of photographic opportunities. Insurers and loss adjusters are finding them a valuable aid in claims investigation. Unfortunately, drones are also increasingly intruding on people’s privacy, crashing into buildings and intruding on aircraft flight paths.

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The problem of rogue drones is on the rise on both sides of the Atlantic. In the UK, the British Airline Pilots Association (BALPA) this month called for research by the government and safety regulator the Civil Aviation Authority (CAA) into the impact of a drone hitting a plane or helicopter, following a spate of near-misses at Heathrow and other UK airports.

BALPA believes that the impact of a drone colliding with an aircraft could smash the windscreen or, worse, that their lithium batteries could trigger an engine fire.

Even more alarming was the January report “Hostile Drones: The Hostile Use of Drones by Non-State Actors Against British Targets” published by security think-tank Oxford Research Group, which warned that “drones are a game changer in the wrong hands.”

The report assessed the design and capabilities of more than 200 unmanned aerial, ground and marine systems and also how drones had been used by activists, terrorists and organised crime groups.

“Drones are a game changer in the wrong hands.”

“Drones are being used by individuals beyond authorized and accepted use,” the report’s authors concluded. “There is particular concern [they] will be used as affordable and effective airborne improvised explosive devices (IEDs), as well as concern regarding the decentralisation and democratisation of intelligence, surveillance and reconnaissance (ISR) capabilities.”

The list of potential targets for flying bomb attacks included foreign embassies, nuclear power stations, a G7 summit or the prime minister’s car. “The UK government, police, military and security services will need to introduce countermeasures to reduce or mitigate the risk of commercially available drones being used for attack,” the report concluded.

Those recommended included the licensing of drones and defenses such as laser systems to protect targets, radio frequency jammers and authorization for the police and army to shoot down any suspect drone.

From Eagles to Bazookas

Meanwhile, initiatives to defend against rogue drones are a mixture of the surreal and James Bond movie. Police in the Netherlands have joined forces with Guard From Above, which describes itself as “the first company in the world to use birds of prey to intercept hostile drones”.

GFA held an international press day earlier this month to demonstrate how trained eagles can be used to snatch a rogue drone in mid-air. This company assures doubters that this “lo-tech solution to a hi-tech problem” is perfectly feasible as the birds’ “incredible visual acuity” enables them to hit the drone without being injured by the rotors.

A more hi-tech solution has been developed by the European aerospace conglomerate Airbus, which last September unveiled its counter-UAV system. Based on a combination of radars, infrared cameras and direction finders, the system can identify possible rogue drones from a distance of up to 10 kilometres (6 miles), determine their threat potential and bring them down if needed.

“Furthermore, the direction finder tracks the position of the pilot who subsequently can be arrested,” Toulouse, France-based Airbus stated. “Since the jamming technology contains versatile receiving and transmitting capabilities, more sophisticated measures like remote control classification and global positioning system [GPS] spoofing can be utilized as well. This allows effective and specific jamming and also a controlled takeover of the UAV.”

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More 007-type technology has come from this month’s UK launch of the SkyWall 100 anti-drone net bazooka. Developed by the Northumberland-based start-up OpenWorks Engineering, the concept behind the system is to capture a rogue drone in a net and deliver it intact with a parachute, via a combination of compressed gas-powered smart launcher and an intelligent programmable projectile.

SkyWall 100 is the first release in a planned series of systems; described as a “man-portable handheld launcher that is highly mobile and a cost effective way of dealing with the drone threat.” In the pipeline are SkyWall 200, a semi-permanent device that can be carried by two people and the SkyWall 300, a permanent installation with a fixed mechanical turret.

Each of these initiatives could be contenders for the S100,000 prize offered last November by MITRE Corp for novel ways to detect and identify suspicious small drones and “interdict those that present a safety or security threat”. Participants had until early February to submit a white paper outlining their approach and the most promising entries will be demonstrated early in the fall.

Graham Buck is editor of gtnews.com. He can be reached at riskletters.com.

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Claims Trends

Treating Pain Without Drugs

Other pain relief therapies hold substantial promise in defeating drug dependency.
By: | February 20, 2018 • 9 min read

From high praise to a spiraling crash, opioid-based pain medications are out of favor. Once thought to be the solution to chronic pain, opioids opened the door to an even bigger and scarier addiction epidemic — one that menaces the workers’ comp industry and the population in general.

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According to the Centers for Disease Control and Prevention, since 1999, more than 183,000 people have died from narcotic painkiller addiction. An estimated 91 people die each day from opioid abuse.

“Opioids are dangerous drugs. The side effects are dangerous and severe. Their efficacy is not always what people expect,” said Marcos Iglesias, senior vice president, chief medical officer, Broadspire.

“If opioids aren’t the answer, what do we turn to?”

The time to answer that question is now. Workers’ comp professionals, physicians, insurers and employers alike are looking for that next solution to pain, one that will help curb addiction and more quickly get workers on their feet.

Medical cannabis is one candidate.

Marcos Iglesias, senior vice president, chief medical officer, Broadspire

“Marijuana is unique in that everyone comes into the conversation with a bias,” said Mark Pew, senior vice president, PRIUM, a division of Genex Services.

With opioids, he said, no one knew of the dangers at first. Marijuana, on the other hand, always provoked two very polarized views: It does a great deal of good or it’s a strong drug with bad consequences.

A 2014 study published by the Journal of the American Medical Association (JAMA) found a link between legalized medical marijuana and a decrease in opioid-related deaths. States that legalized medical marijuana saw a 25 percent decrease in deaths from opioid overdoses.

Yet, “when people make the claim that medical marijuana is the solution to the opioid epidemic, it resonates with some people because of that bias,” said Pew.

Because of ongoing controversy, not to mention its classification as a Schedule 1 narcotic by the federal government, medical marijuana isn’t lined up to be the pain-relief answer anytime soon.

Non-Drug Therapies

So how about this: Let’s treat pain with no drugs. Radical as it may sound, non-drug pain therapies hold merit.

Meta-analyses collected for a U.S. National Library of Medicine study found that cognitive behavior therapy (CBT) had a positive effect on chronic pain and fatigue. Specifically, CBT was found to be a superior method to other treatments for decreasing pain intensity in fibromyalgia patients.

Iglesias, who has worked as a physician for more than 25 years, said CBT, a psycho-social therapy used to teach patients about the emotional and psychological factors influencing their pain, leaves a lasting impression on the injured.

“The methods I’ve seen work well are behavioral approaches — giving people tools and methods so they can manage their own life.”

“Marijuana is unique in that everyone comes into the conversation with a bias.” — Mark Pew, senior vice president, PRIUM

In workers’ comp, physicians using a CBT approach look at an injured worker’s life outside the office walls. Their home life, their health, their financial responsibilities and their mental ability to cope with an injury all factor into the healing process and could potentially lead to a lengthened claim if untreated.

Assessing these additional forces enables a physician to recommend therapies beyond the typical pill prescription.

Sometimes that means sending a patient to physical or occupational therapy. Sometimes yoga or acupuncture will do the trick, with both philosophies tapping into the mind-body connection  and encouraging relief. Exercise, diet and overall wellness are factored into an injured worker’s chronic pain management.

“Drug-related therapies tend to mask the pain symptoms,” said Michelle Despres, vice president, national product leader physical therapy, One Call Care Management. “Opioids are like the ‘quick fix.’ In physical therapy, we investigate pain patterns, seek to correct musculoskeletal problems and teach people about their anatomy.”

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A non-drug pain therapy, PT looks at the physical components of an injury, educating injured workers about the muscles that hurt and how to effectively use them in daily activities. The big question physical therapists ask: What triggers the pain?

“We look at outside activities that could be affecting the injured worker,” she said. “We look at strength, range and flexibility. We want to change the behavior instead of masking the pain.”

Iglesias pointed to another example of non-drug pain therapy called acceptance and commitment therapy (ACT), in which health care professionals work with an injured worker to accept their chronic pain but then commit to living their values in spite of that pain.

ACT, in essence, focuses on mindfulness and function in a person’s life.

Iglesias added he’s seen disability duration lessen because more professionals are starting to address function instead of pain.

Cost and Well-being

But pain is still a big factor in an injury, and CBT primarily focuses on pain management. It’s being used increasingly as an alternative to opioids, too. So much so, in fact, that some states are starting to draft legislation aimed at adopting  its methods.

In Ohio, for example, residents with work-related back injuries are now required by law to try remedies such as rest, physical therapy or chiropractic care before surgery or opioids are even brought into the discussion.

And Ohio isn’t alone; at least 17 states have added restrictions on opioid prescriptions, including limiting the length of time such pills can be prescribed. But not all states are turning to CBT and like methods to combat the growing epidemic.

Michelle Despres, vice president, national product leader physical therapy, One Call Care Management

“In workers’ comp, anytime we talk about change, it’s about cost containment,” said Pew. “But this has nothing to do with cost containment, premiums, closing claims, scale of benefits. It’s about personal well-being.”

Iglesias added he has seen much more acceptance of CBT and other non-drug therapies on the payers’ side, though not everyone is on board.

“Payers see opioids have not helped patients. They’re cognizant of needing to move beyond just drug medications. However, psych and behavioral factors can be a significant issue in workers’ comp. Some individual payers are afraid that a behavior approach might induce a psych claim,” he said.

“Nobody wants to pay for everything that happened to you in your life but, in essence, we do when psychosocial concerns aren’t addressed early and it delays recovery,” added Pew.

“There are payers who have started to see the value in the biopsychosocial model [looking at every aspect of a person’s life], but there’s still an obstacle with psych.”

Still, cost-wise, moving beyond opioids yields reduced pharmacy expenses — not just for opioid prescriptions but also for other prescriptions written for opioid-related side effects like nausea, vomiting, headaches, lack of sleep and so on.

“Opioids have addictive qualities,” said Despres. “It’s easy for us as a society to want to see something diagnostic tied to a drug-based solution. But with alternatives, we lose nothing and chances are we can mitigate chronic pain. We know there are no long-term bad effects to physical therapy.

“The cost to get people off of opioids is huge. Just getting them back to their daily routine, the back-end cost of detox from opioids is enough to at least consider other non-drug pain relief methods as the first treatment option.”

Changing Mindsets

Effective change comes once the employers and their workers understand the benefits of non-drug pain therapies.

Untill now, “in between the payer and the treatment is the patient who has often created this passive mindset that someone else will take care of them,” said Pew.

This mindset isn’t going to help in the long run. Education is key for both employees and employers to work toward pain management.

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“One appointment isn’t going to solve the problem,” said Despres. “We have to break the cycle. Time is the biggest downfall; we have to get people moving versus letting someone sit at home. For chronic pain, we provide the education [to the injured worker] on what’s happening inside when they do activities and how to not only manage their symptoms but also correct musculoskeletal imbalances.

“Workers’ comp, as a practice, needs to embrace the idea of being seen quickly and early and getting the injured worker in the mindset of having a role to play,” she added.

For employers, Pew said those who are engaged in their workers’ well-being see more positive outcomes when injuries occur. Investing in wellness programs enables workers to address those outside factors — like psych and diet and exercise routines — before any injury.

“[Wellness programs are] a way of trying to show there is more than a drug or a procedure; employers and physicians can work to teach that concept before an injury even occurs,” said Iglesias.

“There’s a fear that we’re taking something away. There’s a belief that opioids are the best pain modality. Could we develop more programs to teach about opioids to an employer’s population before an injury?”

His answer is a resounding yes.

Public perception plays a big role in the move away from opioids. Workers’ comp professionals, health care workers and legislators see and understand the negative effects of opioids; however, the public isn’t as convinced.

Mark Pew, senior vice president, PRIUM

The New England Journal of Medicine released a study in January entitled, “The Public and the Opioid-Abuse Epidemic.” In it, researchers examined several national polls conducted in 2016 and 2017 regarding how the public believes opioid addiction should be addressed. They found that a significant number (28 percent) don’t actually see it as a national emergency.

Fifty-three percent did say it was a major problem, though only 38 percent of respondents said it affected their home communities.

“An important finding from our review is that at a time when [we] are seeking a substantial increase in government funding for opioid-addiction treatment programs … polls show a large share of the public uncertain about the long-term effectiveness of treatment,” the authors wrote.

They speculate this uncertainty might lead to less funding for alternative treatments to opioids and less funding for people recovering from addiction.

“Sometimes we don’t know everything,” said Despres, “but we should still open up and embrace what could be. If [non-drug therapies] don’t work, you haven’t lost anything. If it does help, you’re better off.”

That’s why engaging employers and their employees is imperative.

“If we see an employer with a pattern of the same injuries, we can offer many possible solutions from ergonomic improvements to classes for body mechanics training.”

A Balancing Act

But one size doesn’t fit all when it comes to pain relief, and while non-drug pain therapies do help, Pew said that doing away with drugs altogether would be unwise.

“Every person is an individual and needs customized — individualized — treatment plans. Every individual is different. How they deal with pain is different, what their support system is like is different — that’s why treating pain is so difficult.

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“Exercise, a better diet, yoga and other non-pharmaceutical treatments are effective, but often underutilized components to a successful pain management protocol. But trying to come up with a one-size-fits-all is counter to common sense,” he added.

In a 2017 study released by JAMA, researchers examined patients admitted to the emergency room for pain-related causes. They monitored the cause of their pain and what medicine brought them relief.

Acetaminophen and ibuprofen were found to be more effective than opioids. Combined, they had as much of an effect on pain as opioids.

Iglesias added, “We do need to move beyond opioids. Other pharmaceuticals do have a role to play, but we need to embrace other modalities of treating pain.” &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]