Over the years, several ambulance location models have been discussed in the literature. Most of these models have been further developed to take more complicated situations into account. However, the existing standard models that are often used in case studies have never been compared computationally according to the criteria used in practice. In this paper, we compare several ambulance location models on coverage and response time criteria. In addition to four standard ambulance location models from the literature, we also present two models that focus on average and expected response times. The computational results show that the maximum expected covering location problem (MEXCLP) and the expected response time model (ERTM) perform the best over all considered criteria. However, as the computation times for ERTM are long, the average response time model (ARTM) could be a good alternative. Based on these results, we also propose four alternative models that combine the good coverage provided by MEXCLP and the quick response times provided by ARTM. All four considered models provide balanced solutions in terms of coverage and response times. However, the multiple response times target model (MRTTM) outperforms the other models based on computation time.

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Many ambulance providers operate both advanced life support (ALS) and basic life support (BLS) ambulances. Typically, only an ALS ambulance can respond to an emergency call, whereas non-urgent patient transportation requests can be served by either an ALS or a BLS ambulance. The total capacity of BLS ambulances is usually not enough to fulfill all non-urgent transportation requests. The remaining transportation requests then have to be performed by ALS ambulances, which reduces the coverage for emergency calls. We present a model that determines the routes for BLS ambulances while maximizing the remaining coverage by ALS ambulances. Different from the classical dial-a-ride problem, only one patient can be transported at a time, and not all requests are known in advance. Throughout the day, new requests arrive, and we present an online model to deal with these requests.

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Background Ambulance services play a crucial role in providing pre-hospital emergency care. In order to ensure quick responses, the location of the bases, and the distribution of available ambulances among these bases, should be optimized. In mixed urban-rural areas, this optimization typically involves a trade-off between backup coverage in high-demand urban areas and single coverage in rural low-demand areas. The aim of this study was to find the optimal distribution of bases and ambulances in the Vestfold region of Norway in order to optimize ambulance coverage. Method The optimal location of bases and distribution of ambulances was estimated using the Maximum Expected Covering Location Model. A wide range of parameter settings were fitted, with the number of ambulances ranging from 1 to 15, and an average ambulance utilization of 0, 15, 35 and 50%, corresponding to the empirical numbers for night, afternoon and day, respectively. We performed the analysis both conditioned on the current base structure, and in a fully greenfield scenario. Results Four of the five current bases are located close to the mathematical optimum, with the exception of the northernmost base, in the rural part of the region. Moving this base, along with minor changes to the location of the four other bases, coverage can be increased from 93.46% to 97.51%. While the location of the bases is insensitive to the workload of the system, the distribution of the ambulances is not. The northernmost base should only be used if enough ambulances are available, and this required minimum number increases significantly with increasing system workload. Conclusion As the load of the system increases, focus of the model shifts from providing single coverage in low-demand areas to backup coverage in high-demand areas. The classification rule for urban and rural areas significantly affects results and must be evaluated accordingly.

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In the next decades, many public infrastructure assets will reach the end of their life that they were originally designed for. Replacement costs are high, and therefore increasing effort is put into lifetime-extending maintenance, including major overhauls and renovations. A key question is whether the investments in lifetime-extending maintenance justify the postponement of a full replacement. This question becomes more complicated when future life cycle cash flows are non-repeatable. Differential inflation and technological change, including multiple intervention strategies to maintain a desired functionality, cause such non-repeatability. In this case, classic replacement analysis techniques will not suffice in answering this question. Literature demonstrates that case-specific modelling with dynamic or linear programming techniques is required to find economic optimisation. However, such literature primarily addresses replacement interval optimisation of new investments within relative short time horizons, whereas the current research develops a nested dynamic programming (DP) approach for typical ageing infrastructure assets over long service life periods. The model can deal with multiple and various successive intervention strategies and addresses differential inflation and age-related cost increases. Finally, it is shown in an infrastructure case study that this DP approach leads to a better decision in comparison to the application of classical replacement techniques.@en

Providers of Emergency Medical Services (EMS) face the online ambulance dispatch problem, in which they decide which ambulance to send to an incoming incident. Their objective is to minimize the fraction of arrivals later than a target time. Today, the gap between existing solutions and the optimum is unknown, and we provide a bound for this gap. Motivated by this, we propose a benchmark model (referred to as the offline model) to calculate the optimal dispatch decisions assuming that all incidents are known in advance. For this model, we introduce and implement three different methods to compute the optimal offline dispatch policy for problems with a finite number of incidents. The performance of the offline optimal solution serves as a bound for the performance of an – unknown – optimal online dispatching policy. We show that the competitive ratio (i.e., the worst case performance ratio between the optimal online and the optimal offline solution) of the dispatch problem is infinitely large; that is, even an optimal online dispatch algorithm can perform arbitrarily bad compared to the offline solution. Then, we performed benchmark experiments for a large ambulance provider in the Netherlands. The results show that for this realistic EMS system, when dispatching the closest idle vehicle to every incident, one obtains a fraction of late arrivals that is approximately 2.7 times that of the optimal offline policy. We also analyze another online dispatch heuristic, that manages to reduce this gap to approximately 1.9. This constitutes the first quantification of the gap between online and offline dispatch policies.

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Since ambulance providers are responsible for life-saving medical care at the scene in emergency situations and since response times are important in these situations, it is crucial that ambulances are located in such a way that good coverage is provided throughout the region. Most models that are developed to determine good base locations assume strict 0-1 coverage given a fixed base location and demand point. However, multiple applications require fractional coverage. Examples include stochastic, instead of fixed, response times and survival probabilities. Straightforward adaption of the well-studied MEXCLP to allow for coverage probabilities results in a non-linear formulation in integer variables, limiting the size of instances that can be solved by the model. In this paper, we present a linear integer programming formulation for the problem. We show that the computation time of the linear formulation is significantly shorter than that for the non-linear formulation. As a consequence, we are able to solve larger instances. Finally, we will apply the model, in the setting of stochastic response times, to the region of Amsterdam, the Netherlands.

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This thesis discusses different aspects of the logistics of emergency response vehicles. In most parts, we consider providers of ambulance care in the Netherlands. However, also firefighters and air ambulance providers in both Canada and Norway are considered. Even though significant differences exist between the considered systems, they share the task of providing adequate service in emergency situations. In these situations, a prompt response is important and this importance is typically expressed by a response time target set by law. For most emergency services, providing the appropriate care within this target in an efficient way is the main objective. This thesis uses optimization techniques to handle three aspects of the logistical process: facility location, routing, and shift scheduling. All three can have a significant impact on the performance of the system.@en

Background Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations. Methods We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5–95 percentile) of 13 (1–391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data. Results For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information. Conclusions The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis. @en

Over the years, several ambulance location models have been discussed in the literature. Most of these models have been further developed to take more complicated situations into account. However, the existing standard models have never been compared computationally according to the criteria used in practice. In this paper, we compare several ambulance location models on coverage and response time criteria. In addition to four standard ambulance location models from the literature, we also present two models that focus on average and expected response times. The computational results show that the Maximum Expected Covering Location Problem (MEXCLP) and the Expected Response Time Model (ERTM) perform the best over all considered criteria. However, as the computation times for ERTM are long, we advice to use the
MEXCLP except when response times are more important than coverage.@en

We study the capacitated k-facility location problem, in which we are given a set of clients with demands, a set of facilities with capacities and a positive integer k. It costs fi to open facility i, and cij for facility i to serve one unit of demand from client j. The objective is to open at most k facilities serving all the demands and satisfying the capacity constraints while minimizing the sum of service and opening costs. In this paper, we give the first fully polynomial time approximation scheme (FPTAS) for the single-sink (single-client) capacitated k-facility location problem. Then, we show that the capacitated k-facility location problem with uniform capacities is solvable in polynomial time if the number of clients is fixed by reducing it to a collection of transportation problems. Third, we analyze the structure of extreme point solutions, and examine the efficiency of this structure in designing approximation algorithms for capacitated k-facility location problems. Finally, we extend our results to obtain an improved approximation algorithm for the capacitated facility location problem with uniform opening costs.@en

In this paper we introduce a time-dependent probabilistic location model for Emergency Medical Service (EMS) vehicles. The goal is to maximize the expected coverage throughout the day and at the same time minimize the number of opened facilities and the number of relocations. We apply our model to both a randomly generated test instance and to data from the city of Amsterdam, the Netherlands. We see that time-dependent models can result in better solutions than time-independent models. Furthermore, we see that the current set of base locations in Amsterdam is not optimal. We can obtain higher coverage with even less base locations.@en