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Article history:
Received 25 July 2013
Received in revised form 17 August 2014
Accepted 1 October 2014
Available online 22 October 2014
Keywords:
Decision support systems
Emergency ambulance
Ambulance scheduling
a b s t r a c t
This paper studies some decision rules for ambulance scheduling. The scheduling decision rules embedded in the decision support systems for emergency ambulance scheduling consider the criteria on the
average response time and the percentage of the ambulance requests that are responded within 15 min,
which is usually ignored in traditional scheduling policies. The challenge in designing the decision rules
lies in the stochastic and dynamic nature of request arrivals, fulllment processes, and complex trafc
conditions as well as the time-dependent spatial patterns of some parameters complicate the decisions
in the problem. To illustrate the proposed decision rules usage in practice, a simulator is developed for
performing some numerical experiments to validate the effectiveness and the efciency of the proposed
decision rules.
2014 Elsevier B.V. All rights reserved.
1. Introduction
Ambulance scheduling for emergency requests is important to
rescue people when their health is in risk of irreparable damage.
The cost of medical resources and request volume are growing.
Moreover, the trafc conditions in cities are extremely dynamic.
All of these issues make the decisions on ambulance scheduling
become more and more challenging. The control centers of ambulances are supposed to schedule ambulances from their bases
(waiting locations) so that ambulance requesters can be reached
in a time efcient manner. In reality, regulatory authorities usually
established some performance criteria for the emergency medical
resources transportation. In usual practice, the requests of the
emergency ambulances have several different levels of priorities.
As to each level of priority, the regulatory authorities require an
ambulance to arrive at the requester (patient)s place within a
particular response time. A widely used criterion for the ambulance
scheduling is that as to the high priority requests, ambulances need
arrive at the patients place in 15 min, which is a golden time and
during which the patients should be timely transported to a proper
healthcare center where appropriate medical team can give the
patients sophisticated medical treatments. The most straightforward but useful decision rule is to allocate an ambulance that is the
closest to the requesters place. However, this intuitive scheduling
policy cannot guarantee a high percentage of the requests that
can be responded within 15 min. The criterion on the percentage
of 15 min response is more important than the criterion on the
351
they are actually some sort of real-time DSS. The framework of the
decision support systems is shown in Fig. 1 as follows.
The framework of the DSS mainly contains ve core functions:
(1) Receiver of requests: It receives requests that are sent by
patients through call centers, and then transforms the requests
into a structured form, which is denoted by LO, TM, HP, AT, AN.
Here, LO is the location of the service requester; TM means an
ambulance should arrive at the LO within pre-dened response
time; HP denotes the set of hospitals that are suitable for treating the patient; AT denotes the type of the required ambulance,
for example, type-A means an advanced vital support vehicle
(SVA), and type-B means a basic vital support vehicle (SVB);
AN denotes the amount of ambulances required by the service
requester.
(2) Sender of instructions: It sends structured instructions AI, LA,
TA, LH, TH to ambulances. Here, AI is the ambulance (instruction receiver) index; LA is the location of the accident, where the
ambulance should arrive rst; TA denotes the estimated time
when the ambulance should arrive at LA; LH is the location of
the hospital, to which the patient is transported by the ambulance; TH denotes the estimated time when ambulance should
arrive at LH.
(3) Analyzer of traveling time: It can estimate the traveling time
of an ambulance going through a given route. The estimation is
based on the road information of the city map. The analyzer is
built on two databases. One is the city map database, which
stores the route length between two locations; the other is
the historical database of trips, which records the estimated
traveling speeds in some roads during some periods. When
calculating the ambulance travel time between two given locations, the simulator rst determines the areas (e.g., A1 , A2 , . . .,
An ) that the journey between the two locations will pass, and
nds the velocities (e.g., v1 , v2 , . . ., vn ) that relate with the above
obtained areas. Then the travel time between the two locations
(denoted by t) is calculated according to the lengths of the n
journey segments (e.g., d1 , d2 , . . ., dn ); the formula for calculating t is as follows: t = d1 /v1 + d2 /v2 + . . . + dn /vn . This formula
is used in the estimation of the travel times from the current
location of an ambulance to calls scenes, and then to hospitals;
it is also used in the decision process on choosing an ambulance
to fulll the task.
(4) Real-time data of ambulance: It includes the real-time
data on the status, location, and undertaking task of each
352
Table 1
The region coverage based decision rule.
Input: a request <LO, TM, HP, AT, AN>
Output: a ambulance u* is assigned to fulll the request
1
Dene a set U = all the ambulances whose status is idle at its base or
travelling to its base.
IF AT = A, THEN
2
U set {u G U; and u.type = A}.
3
END IF
4
For all the ambulances u G U, acquire their current locations, i.e.,
5
u.location.
6
Obtain Te (u.location, LO) by travel time analysis module.
7
//Te is the estimated travel time between u.location and LO.
8
Obtain T(u) on the basis on Te by Ambulance management module.
9
//T(u) is the estimated time for ambulance u traveling from
u.location to LO.
10
//T(u) = Te + Au , Au is estimated according to us past performances.
11
IF TM = 0, THEN
12
u* = argminuU T(u).
ELSE
13
U set {u G U; and T(u) < TM}.
14
15
IF U = THEN
u* = argminuU T(u)
16
ELSE
17
IF HP = NULL, THEN
18
HP the hospital that is nearest to LO
19
END IF
20
For u U, obtain T (u) and T (u).
21
22
//T (u) is the estimated time for ambulance u traveling from LO to
HP.
//T (u) is the estimated time for ambulance u traveling from HP to
23
its base.
For u U, calculate C1 (u) = T(u) + T (u) + T (u).
24
25
//C1 (u) is the rst criterion, which is the smaller, the better
For u U, obtain C2 u), i.e., the number of available ambulances in us
26
base now.
//C2 (u) is the second criterion, which is the larger, the better.
27
For u U, obtain C3 (u), i.e., the average rate for a request emerging in
28
the 29 neighborhood of us base.
//C3 (u) is the third criterion, which is the smaller, the better.
29
30
//The region is a circle area with its center at us base and radius
equal to a certain value.
31 u* = arg minuU {C1 (u) C2 (u) + C3 (u)}.
// and are parameters for the weighted sum of the three criteria.
32
END IF
33
34 END IF
353
354
Table 2
The centrality based decision rule.
Input: a request LO, TM, HP, AT, AN
Output: a ambulance u* is assigned to fulll the request
1 Dene a set U = all the ambulances whose status is idle at its base or
travelling to its base.
2 Dene a set RN = the number of requests that appear in each 1 km 1 km
subarea within 5 s
3 IF AT = A, THEN
U set {u U; and u.type = A}.
4
5 END IF
6
For a request r G R, obtain the current locations of the unresponsed
requests 5 s before it
in each l km 1 km subarea, i.e., r.LO.
7
Obtain RN
8
IF RN >= 3
9
10
Obtain W(r) by Request receiver module,
11
//W(r) is the weighted degree of a request, which is the smaller, the
better.
Obtain D(r) by Request receiver module,
12
//D(r) is the distance centrality of a request, which is the smaller, the
13
better.
Obtain B(r) by Request receiver module,
14
//B(r) is the betweenness of a request, which is the smaller, the better.
15
Calculate r* = arg minrR {W(r) + D(r) + B(r)}
16
// and are parameters for the weighted sum of the three criteria.
17
18 ELSE r* = r
For all the ambulances u G U, acquire their current locations, i.e.,
19
u.location.
Obtain Te (u.location, r*.LO) by travel time analysis module.
20
//Te is the estimated travel time between u.location and r*.LO.
21
Obtain T(u) on the basis on Te by Ambulance management module.
22
//T(u) is the estimated time for ambulance u traveling from u.location to
23
r*.LO.
//T(u) = Te u , u is estimated according to us past performances.
24
25 IF TM = 0, THEN
u* = arg minuU T(u)
26
27 ELSE
U set {u G U; and T(u) < TM}.
28
29 IF u U THEN
30
u* = arg minuU T(u)
31 ELSE
32 IF HP = NULL, THEN
HP the hospital that is nearest to r*.LO.
33
34 END IF
35 For u U, obtain T (u) and T (u).
//T (u) is the estimated time for ambulance u traveling from r*.LO to HP.
36
37
//T (u) is the estimated time for ambulance u traveling from HP to its
base.
For u U, calculate C1 (u) = T(u) + T (u) + T (u).
38
//C1 (u) is the rst criterion, which is the smaller, the better
39
40 For u U, obtain C2 (u), i.e., the number of available ambulances in us
base now.
//C2 (u) is the second criterion, which is the larger, the better.
41
42 For u U, obtain C3 (u), i.e., the average rate for a request emerging in the
neighborhood of us base.
43
//C3 (u) is the third criterion, which is the smaller, the better.
//The region is a circle area with its center at us base and radius equal
44
to a certain value.
45 u* = arg minuU {C1 (u) C2 (u) + C3 (u)}
// and , are parameters for the weighted sum of the three criteria.
46
END IF
47
48 END IF
The results in Table 6 show that the T decreases and the P15m
increases with the number of ambulance bases growing for all the
scheduling strategies. For the comparison between the region coverage based rule and the two other strategies, Table 6 indicates that
the region coverage based rules performance is better than the two
other strategies on the criteria of both the T and the P15m when the
number of ambulance bases is not sufcient. However, when the
number of ambulance bases increases to some certain level, the
region coverage based rules T becomes worse than the two other
strategies. For the criteria on P15m , the region coverage based rule
always performs better than the two other strategies. This phenomenon implies that the region coverage based rule can show
Table 3
Sensitivity analysis on the parameters and .
P15m
P15m
150
100
50
25
21
20
18
17
16
15
10
22
22
22
22
22
22
22
22
22
22
22
21.4
21.4
20.3
19.7
19.8
19.8
19.7
18.8
18.9
19.8
19.8
77.3%
77.3%
78.5%
78.5%
78.5%
78.5%
78.5%
80.7%
80.7%
78.5%
78.5%
17
17
17
17
17
17
17
17
17
17
17
0
10
15
20
21
22
23
24
25
50
100
18.9
18.9
18.9
18.9
18.9
18.8
19.0
19.2
19.5
19.7
19.8
80.7%
80.7%
80.7%
80.7%
80.7%
80.7%
80.7%
80.7%
80.7%
80.7%
78.5%
Notes: T denotes the average response time; P15m denotes the percentage of requests
that are responded in 15 min.
Table 4
Comparison between the region coverage based rule and other methods under different numbers of requests.
Number of
requests per day
700
800
900
1000
1100
1200
1300
1400
1500
1600
Strategy 1
Strategy 2
Region
coverage based
rule
P15m
P15m
P15m
10.9
11.8
11.8
12.6
13.2
14.6
15.6
15.9
17.4
16.1
84.7%
80.9%
79.9%
76.4%
72.8%
70.3%
65.2%
64.6%
56.3%
50.3%
13.7
14.3
15.0
15.4
16.8
17.3
18.7
19.5
20.2
21.8
88.7%
85.4%
85.3%
83.0%
80.4%
75.6%
72.6%
66.1%
57.5%
52.9%
14.5
15.2
16.5
17.2
18.5
18.8
19.0
20.2
20.6
22.4
91.1%
88.2%
88.0%
86.6%
84.5%
80.7%
75.6%
70.7%
62.3%
58.9%
Notes: T denotes the average response time; P15m denotes the percentage of requests
that are responded in 15 min.
more evident outperformance in the situations with less ambulance bases. The requests are not distributed evenly among a city
because the population densities of the residential areas in the city
are different from each other. The uneven degree of the request
distribution in the city may have inuences on the performance of
the ambulance scheduling strategies and the comparison between
them. A series of experiments are performed under different
uneven degrees of the request distribution. Here the uneven degree
is calibrated by the standard deviation of the requests that emerge
in all the subareas of the city, which is partitioned into 1 km 1 km
subareas. The results of the experiments are listed in Table 7.
Table 5
Comparison between the region coverage based rule and other methods under different numbers of ambulances.
Number of
ambulances
74
75
76
77
78
79
80
81
82
83
84
85
Strategy 1
Strategy 2
Region
coverage based
rule
P15m
P15m
P15m
16.4
15.6
15.2
15.1
14.8
14.6
14.6
14.3
13.7
13.7
13.5
13.4
63.4%
67.2%
66.9%
68.8%
69.6%
70.4%
70.3%
71.1%
71.5%
71.7%
72.5%
72.7%
17.7
17.6
17.5
17.6
17.4
17.4
17.3
17.3
17.3
17.3
17.3
17.3
74.0%
74.6%
77.1%
75.8%
76.0%
76.1%
75.6%
76.0%
76.0%
76.0%
76.0%
76.0%
22.4
22.0
21.4
21.1
20.8
20.5
18.8
19.0
18.7
18.9
17.8
17.8
70.4%
72.9%
76.0%
74.2%
76.9%
77.6%
80.7%
81.3%
82.1%
83.6%
85.8%
85.8%
Notes: T denotes the average response time; P15m denotes the percentage of requests
that are responded in 15 min.
8
9
10
11
12
13
14
15
16
Strategy 1
Strategy 2
Region
coverage based
rule
P15m
P15m
P15m
24.9
23.6
18.6
19.0
14.6
14.4
13.5
13.5
13.5
42.8%
45.9%
54.5%
54.3%
70.3%
69.9%
71.7%
73.0%
73.3%
21.6
21.6
20.0
18.9
17.3
17.2
17.1
17.0
16.9
51.1%
53.6%
58.6%
66.5%
75.6%
77.1%
78.8%
78.8%
79.5%
19.3
19.1
19.0
18.9
18.8
18.8
18.6
18.0
17.9
57.8%
58.3%
63.3%
72.8%
80.7%
82.9%
83.4%
86.5%
86.5%
355
Table 8
Comparison between the region coverage based rule and the centrality based rule
under different numbers of requests.
Number of
ambulances
400
600
800
1000
1200
1400
1600
1800
2000
Region
coverage based
rule
T
P15m
10.8
13.2
15.2
17.2
18.8
20.2
22.4
26.3
28.1
97.6%
96.3%
88.2%
86.6%
80.7%
70.7%
58.9%
54.8%
49.2%
Centrality
based rule
T
11.1
12.7
15.4
17.9
18.3
18.7
21.5
23.6
26.2
95.5%
92.5%
88.3%
87.2%
83.1%
75.2%
67.9%
62.3%
59.6%
Notes: T denotes the average response time; P15m denotes the percentage of requests
that are responded in 15 min.
Notes: T denotes the average response time; P15m denotes the percentage of requests
that are responded in 15 min.
Table 9
Comparison between the region coverage based rule and the centrality based rule
under different numbers of ambulances.
Table 7
Comparison between the region coverage based rule and other methods under different uneven degrees of request distribution in the city.
Uneven degree
of request
distribution
22.6
23.4
23.4
24.0
24.1
26.3
28.0
31.3
31.9
32.4
36.4
Strategy 1
Strategy 2
Region
coverage based
rule
P15m
P15m
P15m
16.8
13.8
14.4
14.1
12.3
13.4
13.8
14.6
14.8
16.0
16.2
61.4%
69.7%
66.3%
71.6%
76.1%
70.5%
69.5%
70.3%
65.0%
64.0%
62.3%
20.0
18.3
18.0
17.9
14.1
17.3
17.1
17.3
18.3
18.2
21.2
69.5%
74.2%
73.6%
75.4%
79.4%
78.0%
76.3%
75.6%
72.0%
70.9%
68.7%
20.7
19.3
20.1
19.2
14.9
18.8
18.9
18.8
20.2
20.6
23.1
70.9%
78.0%
75.0%
80.1%
82.4%
80.8%
79.9%
80.7%
76.6%
70.7%
69.4%
Notes: The uneven degree is calibrated by the standard variation of requests emerging in all the subareas (e.g., 1 km 1 km square) of the city; T denotes the average
response time; P15m denotes the percentage of requests that are responded in
15 min.
Number of
ambulances
Region
coverage based
rule
T
P15m
P15m
60
65
70
75
80
85
90
95
100
25.2
23.7
23.1
22.0
18.8
17.8
17.8
17.8
17.8
62.6%
65.4%
70.1%
72.9%
80.7%
85.8%
85.8%
85.8%
85.8%
26.5
23.9
23.0
20.7
18.3
16.3
15.9
15.8
15.8
65.2%
68.6%
72.4%
73.0%
83.1%
85.2%
83.5%
83.5%
83.5%
Centrality
based rule
Notes: T denotes the average response time; P15m denotes the percentage of requests
that are responded in 15 min.
Table 10
Comparison between the region coverage based rule and the centrality based rule
under different numbers of ambulance bases.
Number of
ambulance
bases
8
9
10
11
12
13
14
15
16
Region
coverage based
rule
Centrality
based rule
P15m
P15m
19.3
19.1
19.0
18.9
18.8
18.8
18.6
18.0
17.9
57.8%
58.3%
63.3%
72.8%
80.7%
82.9%
83.4%
86.5%
86.5%
20.5
19.6
19.5
18.1
18.3
17.3
16.9
15.3
15.3
63.8%
74.3%
73.9%
74.7%
83.1%
83.5%
85.1%
85.5%
85.5%
Notes: T denotes the average response time; P15m denotes the percentage of requests
that are responded in 15 min.
356
the effectiveness and efciency of the proposed rules. By comparing with the literature on the related topics, the contributions of
this paper are mainly listed as follows. Most related studies on
decision support systems for emergency medical scheduling only
concentrate on the average response time. However, this intuitive scheduling policy cannot guarantee a high percentage of the
requests that can be responded within 15 min. In reality, the criterion on the percentage of 15 min response is more important
than the criterion on the average response time. Moreover, the
proposed decision rules in this paper also consider a dynamic environment where the spatial distribution of potential requesters is
changing along the time, and the spatial patterns of trafc situations in the metropolises are also different in peak hours and
off-peak hours. The ambulance traveling and serving processes are
also in a stochastic environment where the travel time for a certain
journey may contain randomness; the service time at the request
calls scenes and hospitals is also uncertain. The above mentioned
dynamic and stochastic nature of the request arrivals and ambulance fulllment processes as well as the environments makes this
study different from the existing studies in the related areas. There
are also limitations in this study. Some parameters are contained
in the decision rules. How to optimize them is an interesting issue
for the further researches.
Acknowledgements
This research is supported by Program for Professor of Special
Appointment (Eastern Scholar) at Shanghai Institutions of Higher
Learning, National Natural Science Foundation of China (Grant No.
71422007), Excellent Young Faculty Research Program in Shanghai
University under the 085 Project Smart City and Metropolis Development.
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