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Ambulance Deployment and Shift Scheduling: An Integrated Approach
Ambulance Deployment and Shift Scheduling: An Integrated Approach
Ambulance Deployment and Shift Scheduling: An Integrated Approach
Received October 14th, 2010; revised November 23rd, 2010; accepted November 27th, 2010.5
ABSTRACT
Emergency medical response providers primary responsibility is to deploy an adequate number of ambulances in a
manner that will yield the best service to a constituent population. In this paper we develop a two-stage integrated solution for complex ambulance deployment and crew shift scheduling. In the first stage we develop a dynamic expected
coverage model to determine the minimum number of ambulances and their locations for each time interval and solve
via a tabu search. For the second stage, we develop an integer programming model which uses the solution obtained
from the first stage to determine optimal crew schedules. We present computational statistics and demonstrate the efficacy of our two-stage solution approach using a case study.
Keywords: Ambulance Location, Dynamic Relocation, Shift Scheduling, Hypercube
1. Introduction
Emergency medical service (EMS) providers ultimate
goal is that at any given moment an ambulance can reach
a medical emergency within a predefined time standard.
Although there is no universally accepted response time
standard in the U.S. the most widely used EMS (ambulance) response time standard is based on National Fire
Protection Association (NFPA) 1720 [1] which is 8 minutes 59 seconds (inclusive of the 60 seconds of call handling time) for 90 percent of life threatening calls [2]. In
order to meet the response time standard EMS administrators must determine the minimum number of ambulances they need to deploy in order to provide the required coverage consistently over the entire service area.
However, demand often fluctuates both temporally and
spatially. The volume of demand at 2 am in the morning
is likely to be very different from the volume of demand
at 9 am or 5 pm. Also, where demand originates from
changes with time. During morning rush hours people
tend to travel towards city center, business and industrial
parks, and schools and universities. Generally this kind
of population flow reverses direction during afternoon
rush hours. Data analyses from various metropolitan areas show significant variability in both volume and location of demand for EMS services [2,3]. Therefore, given
Copyright 2011 SciRes.
2. Literature Review
Earlier models for ambulance coverage were deterministic, but, nevertheless they presented computational challenges for researchers. The advent of cheaper and faster
computing during the 1990s, availability of fast commercial solvers such as CPLEX [4] and the development of
meta-heuristics facilitated researchers in developing probabilistic, and therefore, more realistic models [5-11].
For earlier developments readers are referred to the reviews by Shilling, Jayaraman, and Barkhi [12] and Owen
and Daskin [13]. The latest developments in this field
can be found in Brotcorne, LaPorte and Semets comprehensive review [14].
Probabilistic models incorporate the probability that
the nearest ambulance(s) may not be available when
needed. This uncertainty can be modeled using a queuing
or simulation approach, or embedded into a math programming formulation. Daskins maximum expected coverage location problem (MEXCLP) model was among
the first to explicitly incorporate the probabilistic dimension of the ambulance location model [15]. In contrast to
deterministic models, Daskin assumed that all units operate independently and have the same busy probability
, estimated a priori. With these simplifying assumptions Daskin computed the probability of a demand node
being covered as 1 k where k is the number of servers (ambulances) located within the time threshold thus
capable of being covered. He was able to develop an expression for expected coverage as h j 1 k , where hj
is the demand at node j. Thus, given a fleet of ambulances MEXCLP maximizes the expected coverage subject to a response-time standard or, equivalently, a distance threshold. At about the same time, ReVelle and
Hogan proposed the maximum availability location
problem (MALP) [16] where they also utilized a priori
system wide busy probability to compute the number of
servers required to meet the availability requirement.
The first wave of probabilistic models based on a mathematical programming approach utilized simplifying
assumptions such as all ambulances 1) operate independently and 2) have the same busy probability. However, there have been notable efforts towards relaxing
some of these assumptions. For example, with their second MALP formulation (MALP II), ReVelle and Hogan
allow server busy probabilities to be different in various
neighborhoods, sectors of a given region but not location
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k 1
Q Z , t , k 1 h j ,t yk , j ,t 1 k ,t l ,t .
j 1 k 1
l 1
Minimize:
T
Z x j , k ,t
t 1 j 1 k 1
Subject to:
Copyright 2011 SciRes.
(1)
x j , k N , t y j , k , t
j
k 1
69
j , t
(2)
k 1
k 1
Q Z , t , k 1 h j ,t yk , j ,t 1 k ,t l ,t ct
j 1 k 1
l 1
(3)
n
x j ,k ,t m
(4)
j 1 k 1
x j , k ,t , yk , j ,t 0,1 k , j , t
(5)
70
12
Z xi , j , k
(6)
i 1 j 1 k 1
Subject to:
7
xi , j ,k Ri , j
i, j
(7)
i 1 jSi k 1
xi , j , k 0, 1, 2,
(8)
The objective (6) minimizes the number of ambulances in each shift starting at one of the 84 time intervals
in the week. Equation (7) ensures that in each of the 84
time intervals there are at least the required number of
ambulances which are generated by the DECL model. An
interesting observation is that when the objective function (6) simply minimizes the sum number of shifts
which implies that 10, 12 and 14 hour shifts are weighted
equally.
Consequently the model is likely to allocate as many
ambulances as possible to 14 hour shifts and utilize the
12 and 10 hour shifts as needed. A more versatile approach can be modeled by weighting the three shifts. For
example, one can reflect the shift lengths by using 1, 1.2,
and 1.4 as weights for the 10, 12 and 14 hour shifts, respectively. Let wk be the weight for shift k.
Minimize
7
12
Z wk xi , j , k
(9)
i 1 j 1 k 1
Subject to:
7
xi , j ,k Ri , j
i, j
(10)
i 1 jSi k 1
xi , j , k 0, 1, 2,
(11)
5. Computational Experiments
Since the first stage requires a heuristic solution approach, the DECL is tested on two important metrics: 1)
quality of solutions, and 2) CPU times. The quality of a
solution is determined by the minimum number of servCopyright 2011 SciRes.
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Table 1. Average coverage (%), CPU times (sc) and frequency of difference between RTS and RTSLAP fleet sizes.
ISA-RTS
Prob.
Size
ISA-RTSLAP
Cov.
CPU
Cov.
CPU
64
95.85%
14
95.47%
12
13
256
95.92%
110
95.56%
107
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
12 am 2 am
743
428
446
427
442
459
643
2 am 4 am
684
380
338
356
386
352
565
4 am 6 am
382
297
265
302
304
313
361
6 am 8 am
399
587
524
577
553
544
420
8 am 10 am
622
850
816
850
854
797
660
10 am 12 pm
780
1015
959
942
1033
951
822
12 pm 2 pm
863
994
941
1044
1041
1049
934
2 pm 4pm
870
1026
992
993
1014
1091
927
4 pm 6 pm
821
1029
1067
1033
1063
1108
949
6 pm 8 pm
866
883
916
884
911
888
970
8 pm 10 pm
847
728
757
760
764
876
875
10 pm 12 am
648
591
648
612
673
812
906
Total
8,525
8,808
8,669
8,780
9,038
9,240
9,032
73
74
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
12 am 2 am
17
11
14
13
14
15
19
2 am 4 am
16
13
14
13
13
14
15
4 am 6 am
13
12
13
12
13
14
13
6 am 8 am
13
15
16
15
15
15
13
8 am 10 am
15
17
18
17
17
18
16
10 am 12 pm
17
19
19
17
18
19
18
12 pm 2 pm
18
19
19
18
19
19
19
2 pm 4pm
18
19
19
19
18
19
18
4 pm 6 pm
16
18
19
18
18
19
18
6 pm 8 pm
16
17
19
16
16
17
18
8 pm 10 pm
16
16
16
15
16
17
18
10 pm 12 am
15
14
16
14
14
17
17
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
12 am 2 am
95.32
95.00
95.63
95.34
95.17
95.75
95.31
2 am 4 am
95.00
95.44
95.51
96.34
95.35
95.47
95.10
4 am 6 am
95.97
96.08
95.46
95.22
95.54
95.71
95.52
6 am 8 am
95.67
95.35
95.68
95.87
95.53
95.15
95.35
8 am 10 am
95.69
95.14
95.48
95.41
95.61
95.33
95.69
10 am 12 pm
95.13
95.71
95.31
95.14
95.23
95.49
95.94
12 pm 2 pm
95.01
95.74
95.68
95.04
95.74
95.04
95.81
2 pm 4pm
95.47
95.12
95.10
95.91
95.55
95.04
95.31
4 pm 6 pm
95.14
95.20
95.34
95.54
95.71
95.08
95.99
6 pm 8 pm
95.03
95.72
95.92
95.78
95.47
95.33
95.11
8 pm 10 pm
95.09
96.17
95.16
95.13
96.00
95.22
95.14
10 pm 12 am
95.42
95.76
95.74
95.52
95.62
95.80
95.15
75
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
12 am 2 am
1.51%
1.07%
1.81%
2.52%
0.42%
1.78%
1.16%
2 am 4 am
1.56%
2.38%
1.58%
1.90%
0.60%
2.34%
0.26%
4 am 6 am
0.70%
1.79%
1.15%
1.81%
1.07%
2.84%
1.29%
6 am 8 am
0.08%
1.87%
1.00%
0.47%
1.05%
1.29%
1.73%
8 am 10 am
0.87%
1.36%
0.41%
1.52%
1.05%
1.28%
1.58%
10 am 12 pm
0.56%
0.47%
0.77%
1.13%
0.31%
0.92%
1.12%
12 pm 2 pm
1.06%
0.65%
0.44%
0.84%
0.21%
0.57%
1.15%
2 pm 4pm
0.76%
0.92%
0.81%
0.82%
0.28%
1.29%
0.94%
4 pm 6 pm
0.66%
0.01%
0.55%
0.07%
1.30%
0.52%
0.74%
6 pm 8 pm
0.24%
0.39%
0.56%
1.29%
1.32%
0.19%
d0.13%
8 pm 10 pm
2.19%
1.43%
0.02%
0.37%
0.09%
0.23%
0.13%
10 pm 12 am
0.41%
1.79%
0.01%
0.61%
1.10%
1.88%
0.96%
Table 6. Ambulance schedule for shifts (10, 12 and 14 hours) with equal weights.
Sunday
Shift
10
12
Monday
14
10
12
Tuesday
14
3
2
12
14
10
14
Thursday
10
12
Friday
14
4
12
14
10
12
14
11
12
10
Saturday
10
12
4
5
10
Wednesday
administrators. Further, managers can determine the preferred shift lengths, by surveying their crews and using
this information determine the weights they would use
when solving the scheduling model. Also, the scheduling
model can easily accommodate simple upper or lower
bounds on the number of shifts, however, if these managerial choices are too tight there may not be a feasible
solution. Thus, it is best to solve the scheduling model
with weighted objective function which can be seen as a
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shift lengths (e.g., 6-, 8-, 10-, 12- and 14- hour) the more
likely it is that the final solution will have zero slack (no
unnecessary ambulances scheduled for any given 2-hour
period). On the other hand, having extra ambulances is
not necessarily undesirable as it gives EMS administrators flexibility to handle various additional services they
provide such as non-emergency transports etc. Therefore,
from a managerial stand point it is worthwhile for EMS
administrators to explore what if scenarios and modify
Table 7. Ambulance schedule for shifts (10, 12 and 14 hours) with weights (1, 1.2 and 1.4).
Sunday
Shift
10
1
2
12
Monday
14
10
12
Tuesday
14
10
12
Wednesday
14
10
12
Thursday
14
10
12
2
3
Friday
14
10
10
10
12
14
11
2
5
14
1
2
1
12
3
1
10
12
12
11
2
1
4
12
10
1
1
12
14
12
Saturday
1
1
Table 8. Extra ambulances during each time period based from run 1.
Time Period
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
12 am 2 am
2 am 4 am
4 am 6 am
6 am 8 am
8 am 10 am
10 am 12 pm
12 pm 2 pm
2 pm 4pm
4 pm 6 pm
6 pm 8 pm
8 pm 10 pm
10 pm 12 am
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ing the weights in the scheduling model to generate alternative schedules to handle different situations.
7. Conclusions
In this paper we developed a two-stage comprehensive
solution approach to solving the ambulance deployment
and personnel scheduling problem for EMS administrators. The first stage utilizes a realistic model for dynamic
environments with the objective of deploying the minimum number of ambulances required to meet mandated
coverage requirements. A search algorithm was developed and tested for efficiency and effectiveness. Computational findings showed that the model and the algorithm are consistent, fast and provide optimal or near
optimal solutions. To further test the realism of our model
we utilized EMS call data from Charlotte, North Carolina
and validated our findings using a discrete event simulation. Comparisons with the simulation model show that
our predicted coverage statistics are on average quite
accurate with less than 1% net average deviation. For the
second stage two variations of the scheduling model was
formulated and applied to the case study. The shift
scheduling model is shown to be both practical and
flexible giving managers the opportunity to reflect shift
length preference of their personnel.
This integrated approach is a viable alternative to
making deployment decisions and developing crew schedules independently, manually or aided by software. To
the best of our knowledge, while the existing EMS crew
scheduling software are very user friendly allowing
crews to sign up for their preferred shifts, they do not
optimize any objective. What is lacking from the commercially available software are the integrated (two-stage)
deployment and crew scheduling models. Solution from
the scheduling model should be the starting screen for the
commercially available EMS crew scheduling software.
As shown above, solutions with multiple shift lengths
weighted according to their shift lengths will generate
minimum slack solutions.
There are a number of directions for future studies. For
example, in our model the expected coverage requirement is a hard constraint. Future studies might treat the
coverage requirement as a goal constraint while penalizing negative deviations from the coverage requirement
with an exponential function. Given a deployment plan,
it would be interesting to compare the crew schedules
generated manually or via commercial software to those
from the scheduling models generated from this work.
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