Alternate risk measures for emergency medical service system design

The stochastic nature of emergency service requests and the unavailability of emergency vehicles when requested to serve demands are critical issues in constructing valid models representing real life emergency medical service (EMS) systems. We consider an EMS system design problem with stochastic demand and locate the emergency response facilities and vehicles in order to ensure target levels of coverage, which are quantified using risk measures on random unmet demand. The target service levels for each demand site and also for the entire service area are specified. In order to increase the possibility of representing a wider range of risk preferences we develop two types of stochastic optimization models involving alternate risk measures. The first type of the model includes integrated chance constraints (ICCs ), whereas the second type incorporates ICCs  and a stochastic dominance constraint. We develop solution methods for the proposed single-stage stochastic optimization problems and present extensive numerical results demonstrating their computational effectiveness.     

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.     

An analysis of p-median location problem: Effects of backup service level and demand assignment policy

Any solution to facility location problems will consider determining the best suitable locations with respect to certain criteria. Among different types of location problems, involving emergency service system (ESSs) are one of the most widely studied in the literature, and solutions to these problems will mostly aim to minimize the mean response time to demands. In practice, however, a demand may not be served from its nearest facility if that facility is engaged in serving other demands. This makes it a requirement to assign backup services so as to improve response time and service quality. The level of backup service is a key, strategic-level planning factor, and must be taken into consideration carefully. Moreover, in emergency service operations conducted in congested demand regions, demand assignment policy is another important factor that affects the system performance. Models failing to adopt sufficient levels of backup service and realistic demand assignment policies may significantly deteriorate the system performance.Considering the classic p-median problem (pMP) location model, this paper investigates the effects of backup service level, demand assignment policy, demand density, and number of facilities and their locations on the solution performance in terms of multiple metrics. For this purpose, we adopt a combined optimization and simulation approach. We will first modify the classic pMP to account for distances to backup services. Next, we employ a discrete event simulation to evaluate the performance of location schemes obtained from the deterministic mathematical model. Our results provide insights for decision-makers while planning ESS operations.     

Joint ground and air emergency medical services coverage models: A greedy heuristic solution approach

Aeromedical and ground ambulance services often team up in responding to trauma crashes, especially when the emergency helicopter is unable to land at the crash scene. We propose location-coverage models and a greedy heuristic for their solution to simultaneously locate ground and air ambulances, and landing zones (transfer points). We provide a coverage definition based on both response time and total service time, and consider three coverage options; only ground emergency medical services (EMS) coverage, only air EMS coverage, or joint coverage of ground and air EMS in which the patient is transferred from an ambulance into an emergency helicopter at a transfer point. To analyze this complex coverage situation we develop two sets of models, which are variations of the Location Set Covering Problem (LSCP) and the Maximal Covering Location Problem (MCLP). These models address uncertainty in spatial distribution of motor vehicle crash locations by providing coverage to a given set of both crash nodes and paths. The models also consider unavailability of ground ambulances by drawing upon concepts from backup coverage models. We illustrate our results on a case study that uses crash data from the state of New Mexico. The case study shows that crash node and path coverage percentage values decrease when ground ambulances are utilized only within their own jurisdiction.     

应急救援物资紧缺的配送车辆路径选择研究

针对应急救援物资总量紧缺不能全部满足各点需求量的实际情形,以单个需求点最大缺货量最小为目标,建立基于单个配送中心、车辆数目有限和带时间窗的应急救援物资配送车辆路径选择模型,并讨论了三种不同缺货情形下模型的求解。对于车辆按最短路径行驶也无法在救援时间内到达导致需求点缺货的情形,删除这些需求点的需求量后,如果剩余需求点的需求量不大于物资总量且车辆足够多,可转化为车辆最短路径问题求解;对于物资紧缺无法满足所有需求且车辆足够多的情形,设计时间复杂性为O(mn²)的精确算法A^*求解,其中m和n分别为车辆数和需求点数;对于物资紧缺且车辆数目不足无法把全部物资送达需求点的情形,设计时间复杂性为O(n²)的近似算法GA^*求解,并分析了算法GA^*的近似比。最后结合云南彝良县地震灾区局部路网进行实例分析,验证模型和算法的有效性。     

Improving emergency service in rural areas: a bi-objective covering location model for EMS systems

Emergency medical service (EMS) systems are public services that often provide the first line of response to urgent health care needs within a community. Unfortunately, it has been widely documented that large disparities in access to care exist between rural and urban communities. While rural EMS is provided through a variety of resources (e.g. air ambulances, volunteer corps, etc.), in this paper we focus on ground ambulatory care. In particular our goal is to balance the level of first-response ambulatory service provided to patients in urban and rural areas by locating ambulances at appropriate stations. In traditional covering location models the objective is to maximize demand that can be covered; consequently, these models favor locating ambulances in more densely populated areas, resulting in longer response times for patients in more rural areas. To address the issue of fairness in semi-rural/semi-urban communities, we propose three bi-objective covering location models that directly consider fairness via a secondary objective. Results are discussed and compared which provide a menu of alternatives to policy makers.     

An optimization based approach for deployment of roadway incident response vehicles with reliability constraints

In recent years transportation agencies have introduced patrol based response programs to remove roadway incidents rapidly. With the evolution of technology incident detection and notification from remote traffic operation centers is possible and patrols to detect incidents are not necessary. Instead, the response units can be placed at various depots in urban areas and dispatched to incident sites upon notification. In this paper, we propose a reliability based mixed integer programming model to find best locations of incidence response depots and assign response vehicles to these depots so that incidents can be cleared efficiently at a minimum cost. The approach is unique as it considers fixed and variable costs of vehicles and depots, occurrences of major and minor incidents, and reliability of response service in the same model. Numerical results are generated for an example problem and sensitivity analysis is conducted to explore the relationships between parameters of the problem.     

资源受限下森林火灾应急救援多目标调度优化

许多森林火灾由于救援资源受限而不能在第一时间扑灭,导致火灾扩大蔓延,进而造成更大的森林资源损失。因此,在救援资源受限情形下,如何对消防救援车辆进行合理的调度安排以快速和低成本地扑灭火灾已成为亟待解决的现实问题。本文研究了一类资源受限下森林火灾应急救援多目标调度优化问题,为该问题构建了多目标混合整数非线性规划模型,优化目标为同时最小化总灭火救援时间和救援车辆总行驶距离。为有效求解该问题,首先将上述非线性模型等价转化为线性模型。然后提出ε-约束法和模糊逻辑相结合的算法对问题进行求解。最后,以大兴安岭山发生的火灾案例和随机生成仿真算例对模型和算法有效性进行验证,结果表明所提出的模型和算法能够有效解决资源受限下森林火灾应急救援问题,并为决策者提供最优的消防调度方案。     

Queueing models for police-fire merger analysis

Cities with under 100,000 in population expend a significant portion of their budgets on emergency services. One option that a number of these cities have considered for improving service and cutting costs is training personnel to handle both police and fire roles. In this paper we describe a hierarchy of models that we have used to assess the performance viability of a merger as well as to design specific deployment plans. The modeling environment is more complex than a traditional police or fire system. We need to model the response pattern of four or more patrol units along with the simultaneous dispatch of fire equipment from one or more fire stations. The major contribution of the paper is the manner in which a series of models is linked together to forecast a wide range of performance measures under differing dispatch assumptions. We use a queueing model of police patrol to calculate steady state probabilities and expected delays without preemption. We then model two types of preemptive dispatch strategies utilized in responding initially to a major fire by superimposing a binomial distribution on the basic queueing model. There is also a travel time simulation model to calculate conditional expected response time statistics. The queueing models and the travel time simulation are then combined to estimate unconditional expected values. Lastly, we describe a simulation model used to address transient performance issues that are of concern during a major fire.     

A multi-period double coverage approach for locating the emergency medical service stations in Istanbul

We consider the multi-period location planning problem of emergency medical service (EMS) stations. Our objective is to maximize the total population serviced by two distinct stations within two different response time limits over a multi-period planning horizon. Our aim is to provide a backup station in case no ambulance is available in the closer station and to develop a strategic plan that spans multiple periods. In order to solve this problem, we propose a Tabu Search approach. We demonstrate the effectiveness of the proposed approach on randomly generated data. We also implement our approach to the case of Istanbul to determine the locations of EMS stations in the metropolitan area.     

突发事件情景下串联式需求系统应急物资协同调度研究

针对突发事件情景下串联式需求系统遭受破坏问题,分析了突发事件情景下串联式需求系统应急物资协同调度的特征。在对系统提供应急物资进行修复的基础上,以串联式需求系统修复的时间最短及成本最小为目标,分别构建了纵向配送的应急物资调度模型和纵向配送与横向转运相结合的应急物资协同调度模型,并设计一种遗传算法对两种模型进行求解。最后通过算例分析,求解得到两种模式下串联式需求系统应急物资调度的最优配送方案,比较解的结果,得出纵向配送与横向转运相结合的应急物资协同调度模式优于一般的应急物资纵向配送模式的结论,验证了该应急物资协同调度模式的有效性和可行性。     

Probabilistic programming models for traffic incident management operations planning

This paper proposes mathematical programming models with probabilistic constraints in order to address incident response and resource allocation problems for the planning of traffic incident management operations. For the incident response planning, we use the concept of quality of service during a potential incident to give the decision-maker the flexibility to determine the optimal policy in response to various possible situations. An integer programming model with probabilistic constraints is also proposed to address the incident response problem with stochastic resource requirements at the sites of incidents. For the resource allocation planning, we introduce a mathematical model to determine the number of service vehicles allocated to each depot to meet the resource requirements of the incidents by taking into account the stochastic nature of the resource requirement and incident occurrence probabilities. A detailed case study for the incident resource allocation problem is included to demonstrate the use of proposed model in a real-world context. The paper concludes with a summary of results and recommendations for future research.     

A robust counterpart approach to the bi-objective emergency medical service design problem

The paper presents a bi-objective robust program to design a cost-responsiveness efficient emergency medical services (EMS) system under uncertainty. The proposed model simultaneously determines the location of EMS stations, the assignment of demand areas to EMS stations, and the number of EMS vehicles at each station to balance cost and responsiveness. We develop a robust counterpart approach to cope with the uncertain parameters in the EMS system. Extensive numerical studies are performed to demonstrate the benefits of our robust optimization approach.     

Emergency Logistics Planning in Natural Disasters

Logistics planning in emergency situations involves dispatching commodities (e.g., medical materials and personnel, specialised rescue equipment and rescue teams, food, etc.) to distribution centres in affected areas as soon as possible so that relief operations are accelerated. In this study, a planning model that is to be integrated into a natural disaster logistics Decision Support System is developed. The model addresses the dynamic time-dependent transportation problem that needs to be solved repetitively at given time intervals during ongoing aid delivery. The model regenerates plans incorporating new requests for aid materials, new supplies and transportation means that become available during the current planning time horizon. The plan indicates the optimal mixed pick up and delivery schedules for vehicles within the considered planning time horizon as well as the optimal quantities and types of loads picked up and delivered on these routes. In emergency logistics context, supply is available in limited quantities at the current time period and on specified future dates. Commodity demand is known with certainty at the current date, but can be forecasted for future dates. Unlike commercial environments, vehicles do not have to return to depots, because the next time the plan is re-generated, a node receiving commodities may become a depot or a former depot may have no supplies at all. As a result, there are no closed loop tours, and vehicles wait at their last stop until they receive the next order from the logistics coordination centre. Hence, dispatch orders for vehicles consist of sets of “broken” routes that are generated in response to time-dependent supply/demand. The mathematical model describes a setting that is considerably different than the conventional vehicle routing problem. In fact, the problem is a hybrid that integrates the multi-commodity network flow problem and the vehicle routing problem. In this setting, vehicles are also treated as commodities. The model is readily decomposed into two multi-commodity network flow problems, the first one being linear (for conventional commodities) and the second integer (for vehicle flows). In the solution approach, these sub-models are coupled with relaxed arc capacity constraints using Lagrangean relaxation. The convergence of the proposed algorithm is tested on small test instances as well as on an earthquake scenario of realistic size.     

Supporting decision making to improve the performance of an Italian Emergency Medical Service

An Emergency Medical Service (EMS) plays a fundamental role in providing good quality health care services to citizens, as it provides the first answer in distressing situations. Early response, one of the key factors in a successful treatment of an injury, is strongly influenced by the performance of ambulances, which are sent to rescue the patient. Here we report the research carried on by the authors on the ambulance location and management in the Milano area (Italy), as a part of a wider research project in collaboration with the EMS of Milano and funded by Regione Lombardia. The question posed by the EMS managers was clear and, at the same time, tricky: could decision making tools be applied, based on the currently available data, to provide suggestions for decision makers? To answer such a question, three different studies have been carried on: first the evaluation of the current EMS system performance through statistical analysis; then the study of operational policies which can improve the system performance through a simulation model; and finally the definition of an alternative set of posts through an optimization model. This paper describes the methodologies underlying such studies and reports on how their main findings were crucial to help the EMS in changing its organization model.     

需求不确定下应急医疗服务站鲁棒配置模型与算法

大型突发事件发生后需要快速启动应急救灾网络,合理配置应急医疗服务站。本文考虑各应急医疗服务站选址节点需求的不确定性,引入三个不确定水平参数,构建四类不确定需求集合(box, ellipsoid, polyhedron和interval-polyhedron)对应的应急医疗服务站鲁棒配置模型,运用分支-切割算法求解,最后,进行需求扰动比例的灵敏度分析。算例结果表明,四类不确定需求集下的鲁棒配置模型中,ellipsoid不确定需求集合配置模型开放设施较少,总成本最小,鲁棒性较好。决策者还可以根据风险偏好选择不确定水平和需求扰动比例的组合,以使得总成本最小。     

Microscopic modeling and control logic for incident-responsive automatic vehicle movements in single-automated-lane highway systems

Automatic response to lane-blocking incidents is a critical issue in the field of automated highway systems (AHS). Accordingly, this paper presents a microscopic vehicular control methodology for automatic-control (AC) vehicular movements in response to lane-blocking incidents in the AHS environment. The embedded traffic control logic is based on the basic safety requirements for automatic-control lane traffic maneuvers responding to lane-blocking incidents in the single-automated-lane AHS environment. Accordingly, respective automated vehicular control models are proposed to deal with AC vehicles moving in three corresponding sequential phases, i.e., (1) AC platoon approaching the incident site from the blocked lane, (2) mandatory lane changing and mixed car following in the adjacent lane, and (3) AC platoon reforming downstream from the incident site in the blocked automated lane. Using a microscopic simulation model which embeds these proposed models, preliminary tests are conducted to investigate the relative performance of the proposed method in various traffic flow and control scenarios. The resulting numerical results, including simplified sensitivity analyses, indicate that the proposed microscopic traffic control logic permits regulating automatic-control vehicular movements in response to the effects of lane-blocking incidents on traffic flows either in control-free lanes or in the automatic-control lanes. Implications of the results and some findings are discussed for further research.     

Modeling the number of insureds’ cars using queuing theory

In this paper, we propose to model the number of insured cars per household. We use queuing theory to construct a new model that needs 4 different parameters: one that describes the rate of addition of new cars on the insurance contract, a second one that models the rate of removal of insured vehicles, a third parameter that models the cancellation rate of the insurance policy, and finally a parameter that describes the rate of renewal. Statistical inference techniques allow us to estimate each parameter of the model, even in the case where there is censorship of data. We also propose to generalize this new queuing process by adding some explanatory variables into each parameter of the model. This allows us to determine which policyholder’s profiles are more likely to add or remove vehicles from their insurance policy, to cancel their contract or to renew annually. The estimated parameters help us to analyze the insurance portfolio in detail because the queuing theory model allows us to compute various kinds of useful statistics for insurers, such as the expected number of cars insured or the customer lifetime value that calculates the discounted future profits of an insured. Using car insurance data, a numerical illustration based on a portfolio from a Canadian insurance company is included to support this discussion.     

城市消防站点布局的改进启发式算法

面对数量较多需要及时处理的突发事故,为了满足最短应急时间限制,最低应急资源数和最少的出救点等目标,在城市规划决策中,考虑在一个确定应急限制期下的安全消防站选址问题,给出一个反映决策者对时间和费用偏好的折衷选址方案十分必要.从实际应用出发,运用改进启发式算法方法研究时间与资源限制条件下的多出救点组合模型求解问题.给出了应急限制期和安全消防设施点建立的费用模型,从理论上证明了模型求解方法的正确性.在给定限制期条件下,通过分析得出应急服务设施点选择方法.通过算例说明该计算方法的具体应用,为交通安全消防站点选择提供参考,该方法还适用于诸如医院急救站等类似公共设施的规划建设.     

公交车调度问题的数学模型

对 2 0 0 1年全国大学生数学建模竞赛的 B题——公交车调度问题进行了分析 ,建立了调度的目标规划模型及 0— 1规划模型 .在假设各站上、下车人数服从均匀分布的条件下 ,通过对模型的求解 ,求出了公交公司的最小运行车辆数 5 2辆 ,并给出了发车时刻表 ,其中上行方向运行 2 2 5班次 ,下行方向运行 2 2 0班次 .该模型简单 ,求解容易 ,能较好地考虑各方利益