Physiology-Aware Rural Ambulance Routing

In emergency patient transport from rural medical facility to center tertiary hospital, real-time monitoring of the patient in the ambulance by a physician expert at the tertiary center is crucial. While telemetry healthcare services using mobile networks may enable remote real-time monitoring of transported patients, physiologic measures and tracking are at least as important and requires the existence of high-fidelity communication coverage. However, the wireless networks along the roads especially in rural areas can range from 4G to low-speed 2G, some parts with communication breakage. From a patient care perspective, transport during critical illness can make route selection patient state dependent. Prompt decisions with the relative advantage of a longer more secure bandwidth route versus a shorter, more rapid transport route but with less secure bandwidth must be made. The trade-off between route selection and the quality of wireless communication is an important optimization problem which unfortunately has remained unaddressed by prior work. In this paper, we propose a novel physiology-aware route scheduling approach for emergency ambulance transport of rural patients with acute, high risk diseases in need of continuous remote monitoring. We mathematically model the problem into an NP-hard graph theory problem, and approximate a solution based on a trade-off between communication coverage and shortest path. We profile communication along two major routes in a large rural hospital settings in Illinois, and use the traces to manifest the concept. Further, we design our algorithms and run preliminary experiments for scalability analysis. We believe that our scheduling techniques can become a compelling aid that enables an always-connected remote monitoring system in emergency patient transfer scenarios aimed to prevent morbidity and mortality with early diagnosis treatment.Comment: 6 pages, The Fifth IEEE International Conference on Healthcare Informatics (ICHI 2017), Park City, Utah, 201

An emergency vehicles allocation model for major industrial disasters

One of the main issues in the event of a major industrial disaster (fire, explosion or toxic gas dispersion) is to efficacy manage emergencies by considering both medical and logistics issues. From a logistics point of view the purpose of this work is to correctly address critical patients from the emergency site to the most suitable hospitals. A Mixed Integer Programming (MIP) Model is proposed, able to determine the optimal number and allocation of emergency vehicles involved in relief operations, in order to maximize the number of successfully treated injured patients. Moreover, a vehicles reallocation strategy has been developed which takes into account the evolution of the patients health conditions. Alternative scenarios have been tested considering a dynamic version of the Emergency Vehicles Allocation Problem, in which patient health conditions evolves during the rescue process. A company located in Italy has been considered as case-study in order to evaluate the performance of the proposed methodology

Optimizing emergency preparedness and resource utilization in mass-casualty incidents

This paper presents a response model for the aftermath of a Mass-Casualty Incident (MCI) that can be used to provide operational guidance for regional emergency planning as well as to evaluate strategic preparedness plans. A mixed integer programming (MIP) formulation is proposed for the combined ambulance dispatching, patient-to-hospital assignment, and treatment ordering problem. T he goal is to allocate effectively the limited resources during the response so as to improve patient outcomes, while the objectives are to minimize the overall response time and the total flow time required to treat all patients, in a hierarchical fashion. The model is solved via exact and MIP-based heuristic solution methods. The applicability of the model and the performance of the new methods are challenged on realistic MCI scenarios. We consider the hypothetical case of a terror attack at the New York Stock Exchange in Lower Manhattan with up to 150 trauma patients. We quantify the impact of capacity-based bottlenecks for both ambulances and available hospital beds. We also explore the trade-off between accessing remote hospitals for demand smoothing versus reduced ambulance transportation times

From flooding to finance: NHS ambulance‐assisted evacuations of care home residents in Norfolk and Suffolk, UK

Focusing on the counties of Norfolk and Suffolk (UK), this investigation examines the effect of coastal and fluvial flooding on the use of ambulance service vehicles in the assisted evacuation of care home residents and quantifies the cost of this service to the NHS under flood conditions. This was completed using GIS Network Analyst functions to identify the impacts of flood probability (high: 1 in 30, medium: 1 in 30 to 1 in 100, and low: 1 in 100 to 1 in 1000) and target ambulance response-times (7, 18, 120, and 180 min) on ambulance service area, road network accessibility, the number of vulnerable care homes and their accessibility, the appropriateness of pre-identified evacuation routes, and the drive-time based evacuation cost to the National Health Service (NHS). The results indicate that approximately 68 care homes and 2,320 residents in Norfolk and Suffolk are at risk of inundation, and care home accessibility, in addition to ambulance service area, decreases with shorter ambulance response-times and lower flood probabilities. Additionally, the use of pre-identified evacuation routes, by the ambulance service, promotes efficient navigation between ambulance stations, care homes, and rest centres, but can unfavourably cause network clustering if unmanaged. In association with these routes, an estimated cost of evacuation based on ambulance drivetime was calculated at £34,000–£42,000 depending on flood probability. The importance of this research is highlighted by the current lack of identified flood evacuation and accessibility maps for emergency responder use, and the associated lack of evacuation cost estimations to be used by the government and NHS to budget for aid assistance during these natural disasters. Therefore, the application of this approach at a national level in the flood emergency planning process would be beneficial to promote strategic efficiency and financial preparedness of ambulance services for the purpose of ambulance-assisted flood evacuations

ОПТИМАЛЬНАЯ МАРШРУТИЗАЦИЯ ВОЗДУШНЫХ СУДОВ И МАШИН СКОРОЙ ПОМОЩИ В ЛОГИСТИКЕ ПРИ СТИХИЙНЫХ БЕДСТВИЯХ

One of the most vital aspects of emergency management studies is the development and examination of post-disaster search and rescue activities and treatment facilities. One of such issues to be considered while performing these operations is to reach the disaster victims within minimum time and to plan disaster logistics in the most efficient manner possible. In this study, the problem of planning debris scanning activities with Unmanned Aerial Vehicles after an earthquake and transporting the injured people to the hospitals by ambulances within minimum time was discussed, and mathematical models were developed to solve the problem. The ambulance routing problem and the mathematical model to be used in the solution to the problem are discussed for the first time in the literature. The developed model was tested on the problem sets created by taking into account the data of the province under investigation.Одним из наиболее важных аспектов исследований по управлению рисками и чрезвычайными ситуациями является разработка и изучение поисково-спасательных мероприятий и очистных сооружений после стихийных бедствий. Одним из вопросов, которые необходимо учитывать при выполнении этих операций, является обеспечение доступа к жертвам стихийных бедствий в минимальные сроки и планирование логистики в случае стихийных бедствий наиболее эффективным способом. В данном исследовании рассматривается проблема планирования работ по спасению с помощью беспилотных летательных аппаратов после землетрясения и транспортировки пострадавших людей в больницы на машинах скорой помощи за минимальное время. Для решения этой проблемы были разработаны и предложены математические модели. Впервые рассматривается задача маршрутизации скорой помощи и математическая модель, которая будет использоваться для решения этой задачи. Разработанная модель была протестирована на множествах задач, созданных с учетом реальных данных исследуемой провинции Турции

A mathematical programming approach for dispatching and relocating EMS vehicles.

We consider the problem of dispatching and relocating EMS vehicles during a pandemic outbreak. In such a situation, the demand for EMS vehicles increases and in order to better utilize their capacity, the idea of serving more than one patient by an ambulance is introduced. Vehicles transporting high priority patients cannot serve any other patient, but those transporting low priority patients are allowed to be rerouted to serve a second patient. We have considered three separate problems in this research. In the first problem, an integrated model is developed for dispatching and relocating EMS vehicles, where dispatchers determine hospitals for patients. The second problem considers just relocating EMS vehicles. In the third problem only dispatching decisions are made where hospitals are pre-specified by patients not by dispatchers. In the first problem, the objective is to minimize the total travel distance and the penalty of not meeting specific constraints. In order to better utilize the capacity of ambulances, we allow each ambulance to serve a maximum of two patients. Considerations are given to features such as meeting the required response time window for patients, batching non-critical and critical patients when necessary, ensuring balanced coverage for all census tracts. Three models are proposed- two of them are linear integer programing and the other is a non-linear programing model. Numerical examples show that the linear models can be solved using general-purpose solvers efficiently for large sized problems, and thus it is suitable for use in a real time decision support system. In the second problem, the goal is to maximize the coverage for serving future calls in a required time window. A linear programming model is developed for this problem. The objective is to maximize the number of census tracts with single and double coverage, (each with their own weights) and to minimize the travel time for relocating. In order to tune the parameters in this objective function, an event based simulation model is developed to study the movement of vehicles and incidents (911 calls) through a city. The results show that the proposed model can effectively increase the system-wide coverage by EMS vehicles even if we assume that vehicles cannot respond to any incidents while traveling between stations. In addition, the results suggest that the proposed model outperforms one of the well-known real time repositioning models (Gendreau et al. (2001)). In the third problem, the objective is to minimize the total travel distance experienced by all EMS vehicles, while satisfying two types of time window constraints. One requires the EMS vehicle to arrive at the patients\u27 scene within a pre-specified time, the other requires the EMS vehicle to transport patients to their hospitals within a given time window. Similar to the first problem, each vehicle can transport maximum two patients. A mixed integer program (MIP) model is developed for the EMS dispatching problem. The problem is proved to be NP-hard, and a simulated annealing (SA) method is developed for its efficient solution. Additionally, to obtain lower bound, a column generation method is developed. Our numerical results show that the proposed SA provides high quality solutions whose objective is close to the obtained lower bound with much less CPU time. Thus, the SA method is suitable for implementation in a real-time decision support system