Optimization approaches to the ambulance dispatching and relocation problem

In the Emergency Medical Service (EMS) context, the decision-making process plays a very important role since some decisions highly impact patients’ health. This thesis focuses on the operational level by solving the dispatching and relocation ambulance problems. Dispatching decisions assign ambulances to emergencies, and the relocation problem decides to which base ambulances should be (re)assigned. Two optimization approaches are proposed to improve the effectiveness and efficiency in the EMS response: a mixed-integer linear programming (MILP) model and a pilot method heuristic. The aim is to maximize the system’s coverage using a time-preparedness measure allowing relocations to any base. Experiments are performed using EMS data from Lisbon, Portugal, where solving these problems is still a handmade task. Different ambulance types are considered, which should be used according to the severity of each emergency. The proposed approaches are tested under different scenarios: varying the period size, varying the number of emergencies, and simulating a whole day. Furthermore, they are adapted to compare the proposed strategy with the current Portuguese EMS strategy, which dispatches the closest available ambulance for each emergency and always relocates ambulances to their home bases. Results highlight the potential of the mathematical model and of the proposed strategy to be applied in realtime contexts since a reduction of 10% is obtained in the average response time to emergencies in the simulation scenario. The heuristic should be used when more emergencies occur in the same time period since a solution can be obtained almost immediately in contrast to the MILP usage. To help EMS managers in the decision-making process, we propose an ambulance management tool using Geographic Information Systems, which embeds the proposed approaches. It can be used in real-time or for simulation purposes. It incorporates a map visualization that analyzes ambulances’ movements on the map and the emergencies’ location

Models and algorithms for trauma network design.

Trauma continues to be the leading cause of death and disability in the US for people aged 44 and under, making it a major public health problem. The geographical maldistribution of Trauma Centers (TCs), and the resulting higher access time to the nearest TC, has been shown to impact trauma patient safety and increase disability or mortality. State governments often design a trauma network to provide prompt and definitive care to their citizens. However, this process is mainly manual and experience-based and often leads to a suboptimal network in terms of patient safety and resource utilization. This dissertation fills important voids in this domain and adds much-needed realism to develop insights that trauma decision-makers can use to design their trauma network. In this dissertation, we develop multiple optimization-based trauma network design approaches focusing minimizing mistriages and, in some cases, ensuring equity in care among regions. To mimic trauma care in practice, several realistic features are considered in our approach, which include the consideration of: (i) both severely and non-severely injured trauma patients and associated mistriages, (ii) intermediate trauma centers (ITCs) along with major trauma centers (MTCs), (iii) three dominant criteria for destination determination, and (iv) mistriages in on-scene clinical assessment of injuries. Our first contribution (Chapter 2) proposes the Trauma Center Location Problem (TCLP) that determines the optimal number and location of major trauma centers (MTCs) to improve patient safety. The bi-objective optimization model for TCLP explicitly considers both types of patients (severe and non-severe) and associated mistriages (specifically, system-related under- and over-triages) as a surrogate for patient safety. These mistriages are estimated using our proposed notional tasking algorithm that attempts to mimic the EMS on-scene decision of destination hospital and transportation mode. We develop a heuristic based on Particle Swarm Optimization framework to efficiently solve realistic problem sizes. We illustrate our approach using 2012 data from the state of OH and show that an optimized network for the state could achieve 31.5% improvement in patient safety compared to the 2012 network with the addition of just one MTC; redistribution of the 21 MTCs in the 2012 network led to a 30.4% improvement. Our second contribution (Chapter 3) introduces a Nested Trauma Network Design Problem (NTNDP), which is a nested multi-level, multi-customer, multi-transportation, multi-criteria, capacitated model. The NTNDP model has a bi-objective of maximizing the weighted sum of equity and effectiveness in patient safety. The proposed model includes intermediate trauma centers (TCs) that have been established in many US states to serve as feeder centers to major TCs. The model also incorporates three criteria used by EMS for destination determination; i.e., patient/family choice, closest facility, and protocol. Our proposed ‘3-phase’ approach efficiently solves the resulting MIP model by first solving a relaxed version of the model, then a Constraint Satisfaction Problem, and a modified version of the original optimization problem (if needed). A comprehensive experimental study is conducted to determine the sensitivity of the solutions to various system parameters. A case study is presented using 2019 data from the state of OH that shows more than 30% improvement in the patient safety objective. In our third contribution (Chapter 4), we introduce Trauma Network Design Problem considering Assessment-related Mistriages (TNDP-AM), where we explicitly consider mistriages in on-scene assessment of patient injuries by the EMS. The TNDP-AM model determines the number and location of major trauma centers to maximize patient safety. We model assessment-related mistriages using the Bernoulli random variable and propose a Simheuristic approach that integrates Monte Carlo Simulation with a genetic algorithm (GA) to solve the problem efficiently. Our findings indicate that the trauma network is susceptible to assessment-related mistriages; specifically, higher mistriages in assessing severe patients may lead to a 799% decrease in patient safety and potential clustering of MTCs near high trauma incidence rates. There are several implications of our findings to practice. State trauma decision-makers can use our approaches to not only better manage limited financial resources, but also understand the impact of changes in operational parameters on network performance. The design of training programs for EMS providers to build standardization in decision-making is another advantage

2017 Annual report of the officers of the town of Plymouth, N.H. year ending December 31, 2017, fiscal year ending June 30, 2017.

This is an annual report containing vital statistics for a town/city in the state of New Hampshire

Mamaroneck EMS and the Continuity of Operations: Homeland Security on a Local Level

The definition of homeland security and all that it encompasses has been an ongoing discussion since the events of 9/11. As a homeland security professional it has become clear to me that homeland security is not only a federal obligation, but a local priority as well. All events are local and the government cannot be solely responsible for the preparation, response, and resilience of each individual community. The Village of Mamaroneck is a small jurisdiction approximately 30 miles from New York City. The prime threat this Village has faced is inclement weather and severe flooding due to the multiple floodplains scattered around the 32 square miles that make up the community. However, due to the rising tensions and hardships around the world, it is imperative that the Village of Mamaroneck be prepared to deal with unique situations that may affect the safety and prosperity of our residents. The following research has been organized into a unified strategic plan for the continuity of operations for Mamaroneck Emergency Medical Services (MEMS). This plan is formatted to better prepare MEMS for unfamiliar situations and enhance our response and resiliency if ever faced with a catastrophic event. Although it is a starting point, this document produces optimism that MEMS will be able to build their operation into a prototype for other EMS agencies in surrounding jurisdictions

State of Arizona emergency response and recovery plan

tableOfContents: Introduction -- Basic plan -- Emergency support function annexes -- Support annexes -- Incident annexes -- General Informationabstract: The State Emergency Response and Recovery Plan (SERRP) is a guide to how the State of Arizona conducts all hazards response. It is built upon National Response Framework as a scalable, flexible, and adaptable coordinating structures to align key roles and responsibilities, linking all levels of government, nongovernmental organizations, and the private sector. It is intended to capture specific authorities and best practices for managing incidents that range from the serious but purely local, to large-scale terrorist attacks or catastrophic natural disaster

Tax Increment Financing in Missouri: Political Development of the Statute Contextualized with Use and Patterns of Adoption

Economic development is in the interests of all governments as a component of society that impacts its citizenry’s well-being, yet in a democratic, capitalistic society, many aspects of the economy rely on the activities of private enterprise. Governments are often motivated to develop policies that allow them to “partner” with private enterprise in order to persuade their behavior on behalf of its citizenry. Tax Increment Financing (TIF) is one of the tools that states have enacted to assist local governments partner with private investors. The statute that enabled TIF use in the state of Missouri is now 30 years old. This study looks at the development of this statute over 27 years of its existence, and documents changes in the statute over this time in the context of political actors and court decisions. In particular, this statute is commonly assumed to have been targeted for use in urban, distressed areas experiencing blight and in need of attracting redevelopment opportunities. In reconstructing the narrative of the development of the statute over this period, a particular aspect examined is whether the “erosion of targeting” occurred to widen the benefit to all users through political or court activity. Additionally, 2009 data collected by the state is analyzed using regression analysis and other summary statistics to look at which type of Missouri municipalities use TIF and when they began using it. The study confirmed that TIF was intended to assist urban areas experiencing economic decline compete for economic projects. It also observed that during the time period studied, political actors contended with each other, one side to contain TIF use to its original intended purpose and the other side to keep the “evolved” use of TIF. Additionally, the regression supported other studies that size of municipality was a highly significant variable of TIF usage. It also indicates that % person in poverty is a significant variable of municipalities in “urbanized clusters.

1995 BRAC Commission

Air Force/Navy - Base Visit Presentations, May 1995. Box 85, L-007