Existing Emergency Medical Services System Research Articles

A multi-period capacitated facility location problem with maximum travel time and backup service for locating and sizing EMS stations

Emergency medical services (EMS) is a system that provides emergency medical care for incidents involving serious illness or injury. The location of EMS stations plays an essential role in delivering effective and efficient medical services. Numerous location models have been developed for locating and sizing EMS stations. However, it remains challenging to satisfy all EMS planning criteria within a single location model. In this study, a multi-period capacitated facility location problem with maximum travel time and backup service (EMSLSP) is proposed for locating and sizing EMS stations. The most important criteria for EMS planning are taken into account in EMSLSP: the demand changes due to population mobility, the maximum service capacity of an ambulance, the maximum number of ambulances at each EMS station, the maximum travel time from each EMS station to the locations it serves, the full coverage of dynamic demand, the minimum percent of population covered by EMS service in a specific travel time, and a backup station for each demand location in case of need. A case study in Zhengzhou, a large city in China, demonstrates that effective and efficient locations and sizes of EMS stations can be determined by solving the EMSLSP with various planning parameters. Compared with the existing EMS systems, the average ambulance travel time and the percentage of the population served are significantly improved. Simulations of ambulance scheduling confirm that the relocated and resized EMS stations perform better than those in the existing system. The evaluation-optimization-simulation method outlined in this paper provides a comprehensive and effective approach for EMS station planning.

Decision support framework for tactical emergency medical service location planning

A well-designed emergency medical services (EMS) system is essential to provide the best possible quality of care to patients in emergencies. Exogenous effects, such as demographic change or extreme weather conditions, lead to a continuous increase in emergency calls. On the other hand, emergency vehicles and qualified personnel are limited. Consequently, there is a continuous need to improve the existing EMS systems in order to optimize the use of the available resources. To assist decision makers in this complex task, we provide a decision support framework at the tactical site planning level. First, we analyze the given historical data to find suitable periods that have similar structures in terms of the number of calls and the time of day. We follow this approach to account for fluctuating demand and time-dependent travel times. A new stochastic, time-dependent, mixed-integer extension of the maximum expected coverage location problem (MEXCLP) is developed that accounts for ambulance site interdependencies. We conduct computational experiments for an existing EMS network structure to optimally locate sites and allocate ambulances. Furthermore, we analyze the benefit of additional ambulances and flexible waiting sites. A discrete-event simulation (DES) is used to evaluate the model solutions and to provide further insights into the trade-off between quality and cost of care for the given model solutions. Results based on anonymized real-world EMS data indicate that flexible waiting sites provide considerable potential savings in the use of ambulances while maintaining a high level of coverage.

Emergency medical services and palliative care: a scoping review

ObjectivesThe aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The...

Drone Network Design for Cardiac Arrest Response

Problem definition: Our objective is to design a defibrillator-enabled drone network that augments the existing emergency medical services (EMS) system to rapidly respond to out-of-hospital cardiac arrest (OHCA). Academic/practical relevance: OHCA claims more than 400,000 lives each year in North America and is one of the most time-sensitive medical emergencies. Drone-delivered automated external defibrillators (AEDs) have the potential to be a transformative innovation in the provision of emergency care for OHCA. Methodology: We develop an integrated location-queuing model that incorporates existing EMS response times and is based on the p-median architecture, where each base constitutes an explicit [Formula: see text] queue (i.e., Erlang loss). We then develop a reformulation technique that exploits the existing EMS response times, allowing us to solve real-world instances to optimality using an off-the-shelf solver. We evaluate our solutions using a tactical simulation model that accounts for the effects of congestion and dispatching, and we use a machine-learning model to translate our response-time reductions into survival estimates. Results: Using real data from an area covering 26,000 square kilometers around Toronto, Canada, we find that a modest number of drones are required to significantly reduce response times in all regions. An objective function that minimizes average response time results in drone resources concentrated in cities, with little impact on the tail of the distribution. In contrast, optimizing for the tail of the response-time distribution produces larger and more geographically dispersed drone networks that improve response-time equity across the regions. We estimate that the response-time reductions achieved by the drone network are associated with between a 42% and 76% higher survival rate and up to 144 additional lives saved each year across the geographical region we consider. Managerial implications: Overall, this paper provides a realistic framework that can be leveraged by system designers and/or EMS personnel seeking to investigate design questions associated with a drone network. An objective function focused on improving the tail of the response-time distribution is well-suited for use in practice because the model provides equitable solutions that reduce the entire response-time distribution and corresponds to the real-world metrics, on which EMS systems are most commonly evaluated.

Telemedicine-enabled ambulances and mobile stroke units for prehospital stroke management

The recognition and management of stroke in the prehospital setting has become increasingly important to improve patient outcomes. Several strategies to advance prehospital stroke care have been developed, including the mobile stroke unit and the telemedicine-enabled ambulance—or “mini-MSU.” These strategies both incorporate ambulance-based audio-visual telemedicine evaluation with a vascular neurologist to facilitate faster treatment but differ in several areas including upfront and recurring costs, scalability or growth potential, ability to integrate into existing emergency medical services systems, and interoperability across multiple specialties or conditions. While both the mobile stroke unit and mini-mobile stroke unit model are valid approaches to improve stroke care, the authors aim to compare these models based on costs, scalability, integration, and interoperability in order to guide our prehospital leaders to find the best solutions for their communities.

Weaknesses and Capacities Affecting the Prehospital Emergency Care for Victims of Road Traffic Incidents in the Greater Kampala Metropolitan Area: A Cross-Sectional Study

Introduction:Prehospital emergency care is a vital and integral component of health systems, particularly in resource-constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities, and trauma caused by road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the prehospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).Methods:A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions, respectively. Data were descriptively analyzed, and a principal component analysis was employed to identify the most influential weaknesses and capacities affecting the prehospital emergency care for the victims of RTI in the GKMA.Results:From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 20164. key weaknesses and 5 key capacities were identified to affect the prehospital emergency care for RTI victims in the GKMA. Although some strengths exist, (e.g., ambulance facilitation, EMS structuring, and coordination), the key weaknesses affecting the pre-hospital care for victims were noted to relate to the absence of predefined EMS systems, particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment, insufficient skills/training of the first responders, inadequate EMS resources, and avoidable delays to respond and transport RTI victims to medical facilities.Discussion:Though some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

Weaknesses and capacities affecting the Prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: a cross-sectional study

BackgroundPre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).MethodsA cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA.ResultsFrom 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities.ConclusionsThough some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

A Pilot Study Examining the Viability of a Prehospital Assessment with UltraSound for Emergencies (PAUSE) Protocol

BackgroundPrehospital ultrasound has been shown to aid in the diagnosis of multiple conditions that do not generally change prehospital management. On the other hand, the diagnoses of cardiac tamponade, tension pneumothorax, or cardiac standstill may directly impact patient resuscitation in the field. Study ObjectiveTo determine if prehospital care providers can learn to acquire and recognize ultrasound images for several life-threatening conditions using the Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol. MethodsThis is a prospective, educational intervention pilot study at an urban fire department with integrated emergency medical services (EMS). We enrolled 20 emergency medical technicians – paramedic with no prior ultrasonography training. Subjects underwent a 2-h training session on basic ultrasonography of the lungs and heart to evaluate for pneumothorax, pericardial effusion, and cardiac activity. Subjects were tested on image interpretation as well as image acquisition skills. Two bedside ultrasound-trained emergency physicians scored images for adequacy. Image interpretation testing was performed using pre-obtained ultrasound clips containing normal and abnormal images. ResultsAll subjects appropriately identified the pleural line, and 19 of 20 paramedics achieved a Cardiac Ultrasound Structural Assessment Scale score of ≥4. For the image interpretation phase, the mean PAUSE protocol video test score was 9.1 out of a possible 10 (95% confidence interval 8.6–9.6). ConclusionParamedics were able to perform the PAUSE protocol and recognize the presence of pneumothorax, pericardial effusion, and cardiac standstill. The PAUSE protocol may potentially be useful in rapidly detecting specific life-threatening pathology in the prehospital environment, and warrants further study in existing EMS systems.

(A285) Planning and Organization of Emergency Medical Services in Mumbai

In the past two decades, Mumbai has witnessed several mass-casualty incidents. Somehow, it seems that the city has missed some important lessons from these events. Mumbai has no formal structure for emergency medical services (EMS). Although EMS may seem to be a much-desired necessity, scholars have raised questions on the practicality and feasibility of having such a system in Mumbai. Factors such as population congestion, traffic volume, and lack of coordination among existing hospitals, the success of such a system in a city like Mumbai is jeopardized. In spite of having similar challenges in some other regions of the country, EMS systems (e.g., in Gujarat) have achieved substantial success. This paper deals with the planning and organization of EMS in Mumbai. It evaluates the performances of the existing EMS systems in other Indian cities. The paper also discusses the advantages of having such a system, particularly during the events such as disasters, accidents, acts of terrorism, etc. The paper also discusses the possible consequences of the absence of EMS, such as delayed ambulance dispatch, improper distribution of patients, overcrowding at certain hospitals thereby leading to poor triage, and several similar problems that can worsen a crisis. It studies the potential challenges for the establishment of such a system in Mumbai, and suggests a model for an effective EMS system for the city.

Modeling an emergency medical services system using computer simulation

Study objectives: In the emergency medical services (EMS) system, appropriate prehospital care can substantially decrease casualty mortality and morbidity. This study designed a simulation model, evaluated the existing EMS system, and suggested improvements. Methods: The study focused on 23 networked EMS hospitals affiliated with 36 emergency response units (subgroups) to perform two-tier rescues (advanced life support [ALS] in addition to basic life support [BLS] services) in Taipei, Taiwan. Using the existing EMS model as a base, this research constructed a computer simulation model and explored several model alternatives to achieve the study’s objectives. The virtual models varied with staffing level, number of assigned emergency network hospitals, and various two-tier rescue probabilities. Results: Increasing the staffing to two teams for Hospital 22 lessened the call waiting probability (delay between rescue call and ambulance dispatch) by 50%, even if the dispatch rate of the two-tier rescue increased from the empirical 2% to a simulated 10 and 20%. Changing the two-tier rescue pattern so each EMS subgroup cooperated with two specific, preassigned network hospitals lowered the probability of patients having to wait for rescue dispatch to under 1%. Conclusion: The following alternatives provided the greatest combination of effectiveness, quality patient care, and cost-efficiency: (1) because of its unique location, increase Hospital 22’s staffing level to two ALS teams. (2) Establish a specific rescue protocol for the two-tier system that preassigns two network hospitals to each of the 36 EMS subgroups along with a prearranged calling sequence. If implemented, this will improve EMS performance, streamline the system, reduce randomness, and enhance efficiency.

Prehospital emergency services and health maintenance organizations

Described are the cases of three acute cardiac patients and their referral to the emergency department by two health maintenance organization triage systems. The HMOs' methods did not use existing emergency medical services systems, and by policy virtually discouraged free use of the emergency medical services system. The patients required hospitalization and extensive ED treatment.