Centrality-based ambulance dispatching for demanding emergency situations

One category of dispatching decisions in emergency medical service involves the selection of an ambulance among idle units when a call is received (call-initiated), and another involves the selection of a call among those waiting when a unit gets freed (ambulance-initiated). This research focuses on the ambulance-initiated dispatching and aims at developing a rule that can be flexibly used in various contexts characterized by the probability of transferring the patient to hospital. The idea behind this rule is to give a higher priority to the call that is more centrally located with respect to other calls. When the centrality along with the closeness is used to prioritize calls, the units would smoothly proceed towards dense regions while efficiently exploiting calls, thereby keeping the completion rate at maximum. This centrality-based dispatching rule is tested in various scenarios and demonstrates considerable reductions in both average and variation of response time.     

Priority dispatching strategies for EMS systems

Emergency medical service (EMS) systems provide urgent medical care and transport. In this study we implement dispatching policies for EMS systems that incorporate the severity of the call in order to increase the survival probability of patients. A simulation model is developed to evaluate the performance of EMS systems. Performance is measured in terms of patients’ survival probability, since survival probability more directly mirrors patient outcomes. Different response strategies are evaluated utilizing several examples to study the nature of the optimal dispatching policy. The results show that dispatching the closest vehicle is not always optimal and dispatching vehicles considering priority of the call leads to an increase in the average survival probability of patients. A heuristic algorithm, that is easy to implement, is developed to dispatch ambulances for large-scale EMS systems. Computational examples show that the dispatching algorithm is valuable in increasing the patients’ survival probability.     

Decision support tools for ambulance dispatch and relocation

In this paper, the development of decision support tools for dynamic ambulance relocation and automatic ambulance dispatching is described. The ambulance dispatch problem is to choose which ambulance to send to a patient. The dynamic ambulance relocation problem occurs in the operational control of ambulances. The objective is to find new locations for some of the ambulances, to increase the preparedness in the area of responsibility. Preparedness is a way of evaluating the ability to serve potential patients with ambulances now and in the future. Computational tests using a simulation model show that the tools are beneficial in reducing the waiting periods for the patients.     

城市医疗急救绩效分析研究

为了准确评估城市医疗急救(120急救)系统的救援绩效,面向救护车救援调度过程,通过将救护车状态定义为空闲或繁忙建立救护车队的救援状态空间,基于条件概率的乘法规则以及生灭过程平衡方程,构造求解各救护车工作强度(救护车处在繁忙状态的时间占比)的近似线性方程组及其迭代求解算法,由此提出了救护车工作强度近似模型。基于救护车工作强度,给出了救护车跨区救援比例、响应时间等救援绩效计算方法。为了验证上述模型,评价了苏州市区120急救系统的绩效指标,据此改善了救护车救援系统配置方案。研究表明,救护车工作强度近似模型克服了以往救护车数量较多时(大于20辆)难以求解的困难;根据救援距离设置救护车指派优先级能够实现救护车共享、平衡各救护车工作强度以及跨区救援比例;在不增加救护车总数的情况下,基于救援绩效能够改善救护车分布以及急救辖区划分从而有效缩短医疗急救响应时间。     

A Predictive Model for the Police Response Function

The expected response time to a call for service (CFS) for a given configuration of police beats is developed. The effect of downtime calls on the response time to a CFS is determined. Consideration is given to both travel time and waiting time. Travel time and service time distributions are isolated. The model is valid for Poisson arrivals and arbitrary service time distributions. A probabilistic assignment policy is determined for each beat. The fraction of incoming calls arriving in beat k answered by unit l is obtained. Pre-emptive priorities are allowed. Application to the Aurora, Illinois, Police Department is shown.     

Fifty years of operational research and emergency response

Over the past 50 years, a wealth of applications has resulted from researchers turning their attention to operations such as fire suppression, law enforcement and ambulance services. The 1970s might even be argued as the ‘golden age’ of this particular effort, producing many of the seminal works in fire station location planning, unit assignment and ambulance queuing models. Such efforts naturally continue through to the present, but with a focus shifting away from earlier contexts of established urban emergency service systems. Simultaneously, current evidence from the field suggests that far more work remains. In this paper, we review the operational research (OR) foundation in emergency response so far, highlighting the fact that most of what has been accomplished addresses the well-structured problems of emergency services. This, in turn, offers an explanation for some paradoxical challenges from the field: most of emergency response itself is semi-structured, at best. While OR has traditionally focused on the management of an organization, emergency response ultimately requires the management of disorganization, suggesting an important OR growth area for the next 50 years.     

Analysing emergency medical service ambulance deployment on a Brazilian highway using the hypercube model

In this study we analyse the ambulance deployment of an emergency medical system on a Brazilian highway connecting the cities of São Paulo and Rio de Janeiro. Our focus is on the mean response time of the system to an emergency call, viewed as an important component of the user service. To evaluate the system performance we applied the hypercube model, a well-known tool for planning server-to-customer systems, which is based on spatially distributed queuing theory. The results showed that the model can be effective in supporting design and operational decisions, in particular to reduce the workload unbalancing among the ambulances.     

一种解决集装箱港口拖车调度的混合策略

集装箱码头作为集装箱船舶与其它运输节点之间的枢纽,在不断增长的全球贸易中起着极其重要的作用.由于多种因素影响着集装箱码头的服务效率,从而使其成为了商界和学术界研究的热点.本文针对集装箱码头中的拖车调度问题,对于当某辆拖车完成一项作业任务后,如何去寻找下一个装卸任务的问题,提出了一个多因素的在线调度策略,该策略在针对我国大多数港口的现有布局和信息现状的基础上,综合考虑了拖车空驶和距离平衡多种因素,建立了综合评价函数,并应用评价搜索和离散事件仿真方法对评价函数进行了优化计算.在相关理论分析基础上,通过比较本文的调度策略和港口传统调度策略,我们认为本文的调度策略在缩短船舶停留时间和减少拖车空驶上具有十分明显的效果.     

Optimal access control for broadband services: Stochastic knapsack with advance information

Suppose that call reservation requests of K different types arrive randomly at a single capacitated link where each in turn must be accepted or rejected. Each request requires an amount of bandwidth and a random duration, both depending on its type. An accepted call generates an immediate fixed revenue followed by a variable revenue per unit time. We assume that each call's requested duration is known when it arrives and that the state of the link is constantly monitored. The problem is to find a call acceptance policy that maximizes the long-run average revenue per unit time generated by the accepted calls. We propose and investigate threshold-type control policies that use the known duration of arriving calls as well as the current link status. Two main contributions result. First are interpretable analytical results for the case of K = 1 that can also be applied to the case of K > 1 using complete partitioning scheme. Second, we illustrate how to apply stochastic optimization techniques to compute optimal thresholds in the general case. We also include the results of initial simulation experiments.     

Performance analysis of a call center with interactive voice response units

A Call center may be defined as a service unit where a group of agents handle a large volume of incoming telephone calls for the purpose of sales, service, or other specialized transactions. Typically a call center consists of telephone trunk lines, a switching machine known as the automatic call distributor (ACD) together with a voice response unit (VRU), and telephone sales agents. Customers usually dial a special number provided by the call center; if a trunk line is free, the customer seizes it, otherwise the call is lost. Once the trunk line is seized, the caller is instructed to choose among several options provided by the call center via VRU. After completing the instructions at the VRU, the call is routed to an available agent. If all agents are busy, the call is queued at the ACD until one is free. One of the challenging issues in the design of a call center is the determination of the number of trunk lines and agents required for a given call load and a given service level. Call center industries use the Erlang-C and the Erlang-B formulae in isolation to determine the number of agents and the number of trunk lines needed respectively. In this paper we propose and analyze a flow controlled network model to capture the role of the VRU as well as the agents. Initially, we assume Poisson arrivals, exponential processing time at the VRU and exponential talk time. This model provides a way to determine the number of trunk lines and agents required simultaneously. An alternative simplified model (that ignores the role of the VRU) will be to use anM|M|S|N queueing model (whereS is the number of agents andN is the number of trunk lines) to determine the optimalS andN subject to service level constraints. We will compare the effectiveness of this simplified model and other approximate methods with our model. We will also point out the drawbacks of using Erlang-C and Erlang-B formulae in isolation. Contributed paper for the First Madrid Conference on Queueing Theory, held in Complutense University, Madrid, Spain, July 2–5, 2002     

Location-allocation on congested networks

This paper deals with location-allocation decisions in networks under conditions of congestion, i.e. taking into consideration the possible arrival of calls for service while no server is available. The problem is to find simultaneously the optimal districting policy which determines how a region should be partitioned into separate service areas, and the optimal locations of facilities to house the service units. An alternate location and allocation solution improvement procedure is developed to combine an existing location algorithm of a single mobile service unit [3] with an existing districting heuristic for two servers [5]. The 2-server districting heuristic is further extended to treat the general case of m servers, and combined with the location algorithm for a single server it forms a general location-allocation heuristic for n nodes and m servers.     

Designing a call center with an IVR (Interactive Voice Response)

A call center is a service operation that caters to customer needs via the telephone. Call centers typically consist of agents that serve customers, telephone lines, an Interactive Voice Response (IVR) unit, and a switch that routes calls to agents. In this paper we study a Markovian model for a call center with an IVR. We calculate operational performance measures, such as the probability for a busy signal and the average wait time for an agent. Exact calculations of these measures are cumbersome and they lack insight. We thus approximate the measures in an asymptotic regime known as QED (Quality and Efficiency Driven) or the Halfin–Whitt regime, which accommodates moderate to large call centers. The approximations are both insightful and easy to apply (for up to 1000’s of agents). They yield, as special cases, known and novel approximations for the M/M/N/N (Erlang-B), M/M/S (Erlang-C) and M/M/S/N queue.     

时间窗变动的车辆调度干扰管理模型与算法

针对客户时间窗变动对原物流配送车辆调度方案造成干扰的问题,运用干扰管理思想,分析干扰事件对路径、成本和服务时间三个方面的影响,对其干扰程度加以度量;以该干扰事件对原方案造成的广义费用偏离最小为目标,建立客户时间窗变动的干扰管理模型,通过判断客户时间窗变动对原方案是否产生影响进行干扰辨识,并基于该干扰辨识结果,设计基于禁忌搜索新的调度算法;算例不仅验证了模型和算法的有效性,而且,敏感性分析也验证了其对各种不同价值货物的适用性。实验结果表明,本文提出的干扰管理模型可以全面地刻画干扰对原方案的影响,干扰处理方法优于全局重调度方法,且能够在更短时间内生成满意的物流配送车辆调度调整方案。     

The capacitated maximal covering location problem with backup service

The maximal covering location problem has been shown to be a useful tool in siting emergency services. In this paper we expand the model along two dimensions — workload capacities on facilities and the allocation of multiple levels of backup or prioritized service for all demand points. In emergency service facility location decisions such as ambulance sitting, when all of a facility's resources are needed to meet each call for service and the demand cannot be queued, the need for a backup unit may be required. This need is especially significant in areas of high demand. These areas also will often result in excessive workload for some facilities. Effective siting decisions, therefore, must address both the need for a backup response facility for each demand point and a reasonable limit on each facility's workload. In this paper, we develop a model which captures these concerns as well as present an efficient solution procedure using Lagrangian relaxation. Results of extensive computational experiments are presented to demonstrate the viability of the approach.     

基于成本效益分析的救护车多时段布局优化研究

院前急救服务水平和救护资源之间存在悖反效益,本文综合考虑急救服务效果与急救网络成本,应用延误成本刻画急救效果,运营成本刻画急救资源使用,同时考虑需求规模、需求空间分布、救护车行驶速度以及救护车不可获得率随时间变化的影响,建立以最小化社会总成本为目标的救护车多时段布局优化模型,应用上海市松江区的实际数据,系统研究多时段救护车布局优化问题。计算结果表明优化后的系统在保证80%的高标准覆盖水平下,社会总成本比原系统下降32.23%。相比静态的情况,考虑时变因素可以使社会总成本下降15.8%,双覆盖率提高12.84%,各时段车辆繁忙率方差下降91.67%。     

Retrial queues with balanced call blending: analysis of single-server and multiserver model

In call centers, call blending consists in the mixing of incoming and outgoing call activity, according to some call blending balance. Recently, Artalejo and Phung-Duc have developed an apt model for such a setting, with a two way communication retrial queue. However, by assuming a classical (proportional) retrial rate for the incoming calls, the short-term blending balance is heavily impacted by the number of incoming calls, which may be undesired, especially when the balance between incoming and outgoing calls is vital to the service offered. In this contribution, we consider an alternative to classical call blending, through a retrial queue with constant retrial rate for incoming calls. For the single-server case (one operator), a generating functions approach enables to derive explicit formulas for the joint stationary distribution of the number of incoming calls and the system state, and also for the factorial moments. This is complemented with a stability analysis, expressions for performance measures, and also recursive formulas, allowing reliable numerical calculation. A correlation study enables to study the system’s short-term blending balance, allowing to compare it to that of the system with classical retrial rate. For the multiserver case (multiple operators), we provide a quasi-birth-and-death process formulation, enabling to derive a sufficient and necessary condition for stability in this case (in a simple form), a numerical recipe to obtain the stationary distribution, and a cost model.     

Generalized model with repeated calls in case of extreme load

Recurrence formulas for finding any desired number of terms in the asymptotic expansion of basic stationary performance measures of a generalized full-available system with repeated calls into a power series of the intensity of primary calls as it tends to infinity are derived. The first 3–4 terms of the expansion are found in explicit form. Other coefficients can be found numerically. It is shown that a number of interesting particular cases can be obtained from the model by proper choice of the values of input parameters. Among them it is worth mentioning models with possibility of call repetitions because of unsuccessful finishing of waiting time, inner blocking or unsuccessful finishing of service time. This revised version was published online in June 2006 with corrections to the Cover Date.     

Optimal Positioning of Service Stations

An effective new algorithm is presented for positioning service stations for calls which come from a subset of the line. The coordinate of a call is a random quantity which has a distribution density with compact support. The asymptotic second order optimality of this algorithm is found. A necessary optimality condition of positioning stations for a family of optimality criteria is also found.     

Non‐parametric modelling of time‐varying customer service times at a bank call centre

Call centres are becoming increasingly important in our modern commerce. We are interested in modelling the time‐varying pattern of average customer service times at a bank call centre. Understanding such a pattern is essential for efficient operation of a call centre. The call service times are shown to be lognormally distributed. Motivated by this observation and the important application, we propose a new method for inference about non‐parametric regression curves when the errors are lognormally distributed. Estimates and pointwise confidence bands are developed. The method builds upon the special relationship between the lognormal distribution and the normal distribution, and improves upon a naive estimation procedure that ignores this distributional structure. Our approach includes local non‐parametric estimation for both the mean function and the heteroscedastic variance function of the logged data, and uses local polynomial regression as a fitting tool. A simulation study is performed to illustrate the method. We then apply the method to model the time‐varying patterns of mean service times for different types of customer calls. Several operationally interesting findings are obtained and discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Structural properties and stochastic bounds for a buffer problem in packetized voice transmission

We consider a communication channel which carries packetized voice. A fixed number (K) of calls are being transmitted. Each of these calls generates one packet at everyC timeslots and the channel can transmit at most one packet every timeslot. We consider the nontrivial caseK ≤C. We study the effectsK, C and the arrival process have on the number of packets in the buffer. When the call origination epochs in the firstC timeslots of theK calls are uniformly distributed (i.e. when the arrivals during the firstC timeslots have a multinomial distribution) it is shown that the stationary number of calls waiting in the buffer is stochastically increasing and convex in the number of calls. For a fixed average number of calls per slot, it is shown that increasing the number of slots per frame increases the stationary number of packets in the buffer in the sense of increasing convex ordering. Using this, it is shown that the stationary number of packets in the buffer is bounded from above by the number of packets in a stationary discreteM/D/1 queue with arrival rateK/C and unit service time. This bound is in the sense of the increasing convex order.