Ambulance Emergency Response Optimization in Developing Countries

The lack of emergency medical transportation is viewed as the main barrier to the access of emergency medical care in low and middle-income countries (LMICs). In this paper, we present a robust optimization approach to optimize both the location and routing of emergency response vehicles, accounting for uncertainty in travel times and spatial demand characteristic of LMICs. We traveled to Dhaka, Bangladesh, the sixth largest and third most densely populated city in the world, to conduct field research resulting in the collection of two unique datasets that inform our approach. This data is leveraged to develop machine learning methodologies to estimate demand for emergency medical services in a LMIC setting and to predict the travel time between any two locations in the road network for different times of day and days of the week. We combine our robust optimization and machine learning frameworks with real data to provide an in-depth investigation into three policy-related questions. First, we demonstrate that outpost locations optimized for weekday rush hour lead to good performance for all times of day and days of the week. Second, we find that significant improvements in emergency response times can be achieved by re-locating a small number of outposts and that the performance of the current system could be replicated using only 30% of the resources. Lastly, we show that a fleet of small motorcycle-based ambulances has the potential to significantly outperform traditional ambulance vans. In particular, they are able to capture three times more demand while reducing the median response time by 42% due to increased routing flexibility offered by nimble vehicles on a larger road network. Our results provide practical insights for emergency response optimization that can be leveraged by hospital-based and private ambulance providers in Dhaka and other urban centers in LMICs

Approximate Dynamic Programming: Health Care Applications

This dissertation considers different approximate solutions to Markov decision problems formulated within the dynamic programming framework in two health care applications. Dynamic formulations are appropriate for problems which require optimization over time and a variety of settings for different scenarios and policies. This is similar to the situation in a lot of health care applications for which because of the curses of dimensionality, exact solutions do not always exist. Thus, approximate analysis to find near optimal solutions are motivated. To check the quality of approximation, additional evidence such as boundaries, consistency analysis, or asymptotic behavior evaluation are required. Emergency vehicle management and dose-finding clinical trials are the two heath care applications considered here in order to investigate dynamic formulations, approximate solutions, and solution quality assessments. The dynamic programming formulation for real-time ambulance dispatching and relocation policies, response-adaptive dose-finding clinical trial, and optimal stopping of adaptive clinical trials is presented. Approximate solutions are derived by multiple methods such as basis function regression, one-step look-ahead policy, simulation-based gridding algorithm, and diffusion approximation. Finally, some boundaries to assess the optimality gap and a proof of consistency for approximate solutions are presented to ensure the quality of approximation

Integrated Management of Emergency Vehicle Fleet

The growing public concerns for safety and the advances in traffic management systems, that have made the availability of real-time traffic information a reality, have created an opportunity to build integrated decision support systems that can improve the coordination and sharing of information between agencies that are responsible for public safety and security and transportation agencies to provide more efficient Emergency Response Service. In an Emergency Response System, reduction of the duration of response time can yield substantial benefits. The response time plays a crucial role in minimizing the adverse impacts: fatalities and loss of property can be greatly reduced by reducing the response time for emergencies. In this dissertation, we have developed an integrated model that can assist emergency response fleet dispatchers in managing the fleet. This model can help reduce the response time and improve service level by specifically accounting for the following: Vehicle Deployment: given real-time information about the status of the emergency response fleet, traffic information and the status of emergency calls, select proper fleet assignment schemes that satisfy various operation requirements. Vehicle Routing: given real-time traffic information, provide real-time route guidance for drivers of dispatched vehicles. This goal is achieved by applying various shortest path algorithms into the solution procedure. Planning and Evaluation: given the status of the fleet and the frequency of emergency calls in various areas of a region, the model can help evaluate the performance of the current system and help plan for potential sites for the relocation of vehicles and allocate an appropriate fleet of vehicles to these sites. The vehicle deployment problem is formulated as an integer optimization problem. Since this problem has been shown to be NP-hard and because of the nature of emergency response, we developed heuristics which can provide quality solutions with short computational times. Several test algorithms are proposed to solve the emergency response vehicle deployment problem. Different methods for obtaining lower bounds for the value of objective function are analyzed in this dissertation. To evaluate the performance of the system under various scenarios, a simulation model is developed. The simulation system is calibrated based on real-world data. The results of simulation and analysis show the proposed system can effectively improve the emergency response service level. Application of this model in facility allocation illustrates its usage in other relevant operational scenarios

A generic method to develop simulation models for ambulance systems

In this paper, we address the question of generic simulation models and their role in improving emergency care around the world. After reviewing the development of ambulance models and the contexts in which they have been applied, we report the construction of a reusable model for ambulance systems. Further, we describe the associated parameters, data sources, and performance measures, and report on the collection of information, as well as the use of optimisation to configure the service to best effect. Having developed the model, we have validated it using real data from the emergency medical system in a Brazilian city, Belo Horizonte. To illustrate the benefits of standardisation and reusability we apply the model to a UK context by exploring how different rules of engagement would change the performance of the system. Finally, we consider the impact that one might observe if such rules were adopted by the Brazilian system

Strategic Planning for Setting up Base Stations In Emergency Medical Systems

Emergency Medical Systems (EMSs) are an important component of public health-care services. Improving infrastructure for EMS and specifically the construction of base stations at the ”right” locations to reduce response times is the main focus of this paper. This is a computationally challenging task because of the: (a) exponentially large action space arising from having to consider combinations of potential base locations, which themselves can be significant; and (b) direct impact on the performance of the ambulance allocation problem, where we decide allocation of ambulances to bases. We present an incremental greedy approach to discover the placement of bases that maximises the service level of EMS. Using the properties of submodular optimisation we show that our greedy algorithm provides quality guaranteed solutions for one of the objectives employed in real EMSs. Furthermore, we validate our derived policy by employing a real-life event driven simulator that incorporates the real dynamics of EMS. Finally, we show the utility of our approaches on a real-world dataset from a large asian city and demonstrate significant improvement over the best known approaches from literature

Integrating artificial neural networks, simulation and optimisation techniques in improving public emergency ambulance preparedness for heterogeneous regions under stochastic environments.

Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.The Bulawayo Emergency Medical Services (BEMS) department continues to rely on judgemental methods with limited use of historical data for future predictions, strategic, tactical and operational level decision making. The rural to urban migration trend has seen the sprouting of new residential areas, and this has put pressure to the limited health, housing and education resources. It is expected that as population increases, there is subsequent increase in demand for public emergency services. However, public emergency ambulance demand trends has been decreasing in Bulawayo over the years. This trend is a sign of limited capacity of the service rather than demand itself. The situation demanded for consolidated efforts across all sectors including research, to restore confidence among residents, reduce health risk and loss of lives. The key objective was to develop a framework that would assist in integrating forecasting, simulation and optimisation techniques for ambulance deployment to predefined locations with heterogeneous demand patterns under stochastic environments, using multiple performance indicators. Secondary data from the Bulawayo Municipality archives from 2010 to 2018 was used for model building and validation. A combination of methods based on mathematics, statistics, operations research and computer science were used for data analysis, model building, sensitivity analysis and numerical experiments. Results indicate that feed forward neural network (FFNN) models are superior to traditional SARIMA models in predicting ambulance demand, over a short-term forecasting horizon. The FFNN model is more inclined to value estimation as compared to SARIMA model, which is directional as depicted by the linear pattern over time. An ANN model with a 7-(4)-1 architecture was selected to forecast 2019 public emergency ambulance demand (PEAD). Peak PEAD is expected in January, March, September and December whilst lower demand is expected for April, June and July 2019. Simulation models developed mimicked the prevailing levels of service for BEMS with six(6) operational ambulances. However. the average response times were well above 15 minutes, with significantly high average queuing times and number of ambulances queuing for service. These performance outcomes were highly undesirable as they pose a great threat to human based outcomes of safety and satisfaction with regards to service delivery. Optimisation for simulation was conducted by simultaneously minimising the average response time and average queuing time, while maximising throughput ratios. Increasing the number of ambulances influenced the average response time below a certain threshold, beyond this threshold, the average response time remained constant rather than decreasing gradually. Ambulance utilisation inversely varied to increase in the feet size. Numerical experiments revealed that reducing the response time results in the reduction in number of ambulances required for optimal ambulance deployment. It is imperative to simultaneously consider multiple performance indicators in ambulance deployment as it balances resource allocation and capacity utilisation, while avoiding idleness of essential equipment and human resources. Management should lobby for de-congestion and resurfacing of old and dilapidated roads to increase access and speed when responding to emergency calls. Future research should investigate the influence of varying service time on optimum deployment plans and consider operational costs, wages and other budgetary constraints that influence the allocation of critical but scarce resources such as personnel, equipment and emergency ambulance response vehicles