Challenges in Emergency Medical Services in India

LavanyaMarla SystemsScientist,CMU

CMU-Heinz and GVK-EMRI Collaboration

GVKEMRI(EmergencyMedicalResearchInstitute)
FirstEMS(911type)ProviderinIndia Startedin2005inonestate Nowpresentin10states

CMUTeam
Prof.Ramayya Krishnan Lavanya Marla Yisong Yue Aayush Kumar UnderstandingoperationsinHyderabad

Ground realities at EMRI

PriortoEMRI,nocentralambulanceprovider
Adhocemergencyprovidernetworks Hospitalambulances,taxis

Publicprivatepartnership
Funding:95%stategov,5%privatepartner Nofeeschargedforservice(paidbystate)

Highlyresourceconstrained
75Mpeople,75ambulancebases(AP)

Cellphonebasedcommunications

Challenges at EMRI
Publicacceptability
Cleartrafficforambulance

Competitionwithadhocnetworks
Decreasesutilizationofambulances

Norealtimepositionavailability Newcities
Newtrafficpatterns Highrisebuildingswithoutelevators Newmodesoftransport

Key Questions of Interest and First steps

Howcanperformancebeimprovedusing existingresources(e.g.,ambulances)? Howtocharacterizethestateofthesystem? Howtomodelhowthesystemisaffectedby currentallocationanddispatchingpolicy? Canadecisionsupporttoolbedevelopedto answerthesequestions?

Key Concepts
Networkconsistsofambulanceslocatedatbases Eachbaseservicescallsthatariseinasetofgridsaround it Thedefault(EMRI)modelistohaveoneambulancein eachbasetoservecallsintheassociatedgrids Acallthatisservicedconsistsoftheambulancearriving fromthebasetoasceneandthentakingthepatienttoa hospitalfromthesceneandthenreturningtobase

Design Principles
Consistencywithcurrentdispatchingmodel
Assignnearestfreeambulanceavailable Priorityorderforambulances

Donotaddextrabasesthanthose determinedbyEMRI
Logisticalchallenges

Donotaddextraambulances Derivecongestioninformationfromdatalogs

Modeling Concept: Chain Formation

25 min (20 min)

30 min

Dependency Graph

(15 min)

(25 min) 45 min

Modeling Concept: Chain Formation

Modeling Concept: Chain Formation

Modified Dependency Graphfornew allocation

25 min

18 min (12 minutes saved)

15 min (30 minutes saved)

25 min (no vehicle assigned previously)

Breaking dependencies improves service

Simulation framework
Basedoncalllogswecanmodel: Callcongestionpatterns Chainsandotherlongrangesystem effects Utilizationofvariousbaselocations

Simulationapproachtoevaluateambulancetobaseallocations SimulateDispatchOfficerassigningambulancestocalls Simulateresponsetimesandoutcomes Datadrivenapproach(basedonactualcalllogs)

Mathematical formulation
G =dependencygraph C(G) =totalcostofgraphG T(G,S) =modifieddependencygraphwithchangeS toallocation Changeinobjective(F): F(G,S)=C(G)- C(T(G,S) F(G,S):
Monotonicallyincreasing Orderinvariant Approximatelysubmodular

Simulation-optimization approach
Goal:AllocateNambulancesamongMbases
Number ambulances added<N? Addone ambulance periteration

Testaddinganambulanceatlocationm M

Simulate calls

Simulate calls

Simulate calls

Findlocationm*withmostimprovement Addambulanceatm*

Visualization tool (1)

Visualization tool(2)

n t h Metric e
#Callsw/BasetoScene< 15min

CurrentEMRI Optimized

Improvement

5459 2940 61 6569

6415 3279 20 7297

18% 12% 67% 11%

t #Callsw/TotalServiceTime< 60min w# VehicleBusy o #Callsserviced byprimarysegment a l l o

*Measuredusingsimulationbasedononemonthofdata

New/needed technology: Traffic models

Existingroutes
Currentlyusedatadrivenmodelsfortraffic congestioncapture Allowstoextrapolatedataforroutestakeninpast

Newroutes?
Crowdsource/obtaintrafficinformationfrom otherambulances Communicationbetweenambulancestoshare trafficdata(Prof.Ramayya Krishnan)

Needed technology: Human behavior models

Conflictbetweenexistingadhocnetworksand EMRInetwork Customercallsmultipleserviceproviders

Choosetheonewhicharrivesfirst

Modeledhigherabandonmentinselecturbanareas Howtoimproveambulanceutilization? Whatsystemcanleadtoimprovedsocialwelfare?

Ongoing research directions

Improvedambulancebase allocations:
Bettertrafficcongestion modeltoestimateservicetime Furtherbenefits loweraverageservicetime Servemorecallswithin survivalthreshold

Realtimeambulance deployment:
Predicthighdemandregions Systemstress Repositionambulancesin realtime Realtimepositiondata

Solution Approach Summary

Ambulance Location

Dynamic Reposition

TRAFFIC MODELING