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GIS based Placement and Route Planning of Emergency Response Vehicle (ERVs)
for Efficient Incident Management.

Conference Paper · July 2010

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 GIS Based Placement and Route Planning of Emergency Response Vehicles
(ERVs) for Efficient Incident Management

Rasheed Jooma
(DG Health, Government of Pakistan, Islamabad)

Junaid Razzak
(Associate Professor, Agha Khan University, Karachi)

Muhammad Ahmed
(GIS Developer, Department of Urban and Infrastructure Engineering, NED University, Karachi)

Madiha
(Lecturer, Department of Urban and Infrastructure Engineering, NED University, Karachi)

Abstract

Emergency response refers to the minimum time to reach at within place or a response action to situation
that may cause immediate and serious harm to people or environment. In Karachi, accident is one of the
major issues according to Road Traffic Injury Research & Prevention Centre (RTI&PC), around 100
people died at urban roads of Karachi in favor of acquiring minimum response time for road accident
victims; several NGO‘s deputed their Ambulances near traffic black spot. Some of these Ambulance
locations made possible to reach at victim places in minimum time. The purpose of this paper is to
correlate the existing ERV location and frequency of accident in their catchment buffer using geo
database of RTI. The theme of paper also belongs with identifying the best possible location using GIS
and then the route planning to reach trauma center in minimum time. The methodology adopted for this
paper initiate with background knowledge of incident management. For this, it required collection of data
including GPS location, existing ERVs location and major trauma centers. Furthermore ERV location is
then correlate with patient arrivals along with, accident location will cater for accident timing and arrival
timings including expiry rate factor and then incorporate with GIS map that will have layers of roads
towns,streets,colonies and RTA locations of the year 2008.By using spatial intersection command in Geo
media Professional, frequency of injuries in buffer of ERV location will be calculated and the zone where
deputation of ERV is considered necessary will be identified and finally their route to connect with
trauma center will be drawn.

Keywords

Emergency Response Vehicle (ERVs), Road Traffic Injury (RTI), spatial analysis, Buffer, Geographic
Information System (GIS).

1. Introduction

Traffic Accident are an unfortunate legacy of the 21st century can be call as Transport revolution, new
techniques and ways are constructing for reducing travel time but unfortunately it behave as well as
reducing life time of road user, according to Road Traffic Injury Research & Prevention Centre
(RTI&PC) up to 33% fatal accident rise after the freeways development in Karachi (Road Traffic Injury
research and Prevention Centre ,2008). Today‘s we are replacing roundabout with signalized intersection
and intersection with flyover/underpass or interchanges that‘s collectively result in the rise of vehicle
speed and high speed of bikes ultimate the result of high risk of Rider‘s life or pedestrian. Although
various accident countermeasures are being taken, some have proven significant .Road Traffic injuries are

Proceedings of IEDC 2010, 1-3 July, 2010 411 IEDC-522-088

a major public Health challenge and an estimated 1.2 million persons world-wide are killed in Road
crashes each year and as many as 50 million are injured. Low and middle income countries account 85%
of the Road-Use related death and Disabilities. It is clear that in High income countries, despite increased,
Road Safety deaths have been declining while converse is true in the newly motorized nations. (JAMA.
2004).

Karachi is one of the seventh largest city of developing countries having an area of 3,365 sq Km. while
Urban area around 1800sq km tolerate around 17 million of Population which is increasing with growth
rate of 4.0% over a 1.5 million registered vehicle contain almost 47% Cars & 40% Motor Bike inclusive
of those that are moving in Karachi but registered in other district Trucks and others HTV‘s are the
common example of it (Zaheer-ul-Islam.M ,2006) .Karachi have more 10,000 km of metal road network
which includes 3,438.5 km of major Road while around 7041.91 km of streets or Low roads (calculated
using GIS).

Incorporation of Geographical Information System (GIS) not only plays a bridge role between one Road
Geometry and Traffic Data (that may be of Traffic Volume, Accident, rush hours etc) but also we can
correlate these data with road users facilities available spatially; for example location of pedestrian
accident with pedestrian facility, correlation of traffic black spot with Ambulance location & trauma
centre etc. We can make a multiple kind of query/analysis quickly change the parameter and get the
response from it. it provides an efficient system of linking a large number of disparate data bases, it
provides a spatial referencing system for reporting output at different levels of aggregation, it allows input
of both historical and statistical accident experience in estimating accident risk at different locations and
times, and it allows controls on a myriad of risk factors explaining variations in accident involvement and
injury severity.

Emergency response refers to the minimum time to reach at victim place and ensure the public safety.
People need emergency response mainly from three departments
i. Police (headed by provisional government)
ii. Fire Brigade(headed by CDGK)
iii. Ambulance (organized by NGO‘s )

The above mentioned departments are almost universally acknowledged and as being core to the
provision of emergency care to the populace; they would generally be summoned on a dedicated
emergency telephone number, reserved for critical emergency calls. In this paper we are exclusively focus
on Non-Government Organization i.e. Ambulance service available and placement location in Karachi
and then find the efficiency of these services. The availability of Ambulance service depends very
heavily on its spatial value.

The term Ambulance comes from the Latin word ambulare, which means to-walk or move about. The
word originally means a moving hospital but unfortunately Karachi commonly doesn‘t have such
ambulance services, we are just using such vehicle for patient transport from a victim place to Hospital.
These ambulances are not usually equipped with life-support equipment and staff has fewer
qualifications. There are numerous NGO‘s organized there services in Karachi majors are Edhi &Chippa
while others remarkable are Aman foundation, KKF, Al-Khidmat, Al-Mustafa etc.

2. Literature Review

Most of the research papers in application of Geographical Information System (GIS) in ambulance
response for road crashes have been written in multi discipline, as the theme of paper is to enhance
effectiveness of ERV‘s such kind of study was conducted by Brodsky H.Geograpkic in 1990‘s as
―Delay in Ambulance Dispatch to Road Accidents‖. In this Harold Brodsky resulted that about 20% of

Proceedings of IEDC 2010, 1-3 July, 2010 412 IEDC-522-088

fatal road accidents in Missouri, waiting for confirmation of need resulted in a delay of 5 minutes or more
in the dispatch of Ambulance. (Brodsky H.Geograpkic, 1990).

Another study which is carried out in 2008 ―Transport time to trauma facilities in Karachi; an exploratory
study‖ they identified RTIs in Karachi via medico logical records of five major trauma centres of city,
then measured the time from identified black spot and nearly trauma centre or emergency care facility.
According to their findings crucial time is lost in reaching government designated trauma care centres
emergency care facilities might be a substitute option, but are not fully outfitted and funded to provide
sufficient trauma care to all (Channa, et al.,2008).

Trauma statistics in developing countries are notoriously difficult to accurately assess. In 1998 developing
countries accounted for more than 85% of all deaths due to road traffic crashes globally and for 96% of
all children killed (Nantulya N and Reich M. BMJ ,2002).

Similarly, a study on spatial analysis of ambulances services have been carried out in Ireland. The aim of
this paper is to show the importance of GIS in emergency health care provision within the Ambulance
service in Ireland. Spatial analysis techniques were used that examined the distribution of all Ambulance
stations in the country and assessed the demand and capacity of complimentary alternative community
based emergency care provision. The studies examined ‗Response Times‘ [the time taken for an
ambulance to reach an emergency scene required for individual stations to service their areas within target
timescales. . The benefits of rapid response and treatment of road traffic accident victims is increasingly
being recognized in research in road safety strategies. The study and the methodology behind it provide
an evidence-based analysis of emergency service provision. The model utilized reflects average drive-
time and despite taking a conservative estimation of activation times and traffic delays the results are
standardized and allow comparison between different regions. The results of the initial studies have
already been used to identify a priority location for a new ambulance station. (Moore, David, Spatial
Planning Solutions).

3. Methodology

This paper correlates the spatial distribution of Road Traffic Injuries with ERV‘s placement variable
buffers. In the first stage of paper vector map has been developed in GIS that include Town boundary, and
Major Road layers. In the next stage GeoDatabse of RTI of the year 2008 developed and then incorporate
with GIS vector map. In the third stage the GPS (Global positioning System) based survey to identified
the placement location of major Ambulance services (Edhi &Chippa) conducted and incorporate with GIS
map, in this stage four layer in GIS namely; Road, Town, RTI2008, ERV‘s locations have been worked
out. The fourth stage is the Geospatial Analysis stage in which Buffers around each ERV‘s location of
variable radius with respect to traffic volume created and then query has been done for the spatial
intersection between the Buffer zones and RTI2008.

4. Geodatabase of Road Traffic Injury & Associate Data

Road Traffic Injury Research & Prevention Centre, collecting RTI data from five major Trauma Centre of
Karachi. That RTI data used for Geospatial analysis in which the exact location of every injury by means
of latitude and longitude position considered in database, resulting, ―A-Spatial data base‖ converted into
―Spatial database‖. Figure 1 shows the spatial pattern of RTI (Road Traffic injuries 2008 data), which
reflects the clusters of injuries around major arterials, which is very dense in urban center while sparsely
on remote area of Karachi.

Proceedings of IEDC 2010, 1-3 July, 2010 413 IEDC-522-088

4.1. Identification of Ambulance Placement location

The second primary requirement of our case is the layer of ERV‘s locations, there are numerous NGO‘s
organized their services in Karachi majors are Edhi &Chippa while others remarkable are Aman
foundation, KKF, Al-Khidmat, Al-Mustafa etc. A handheld GPS based survey has been conducted for
identification of Ambulance location along major arterial of Karachi, and then incorporated with GIS as
shown in figure 2.

Figure 1. Spatial Distribution of RTI of year 2008 in Karachi Urban area

Proceedings of IEDC 2010, 1-3 July, 2010 414 IEDC-522-088

 Figure 2. Spatial distribution of ERV’s (ambulance) location in Karachi Urban area

5. Geospatial Analysis

5.1. Spatial Intersection between RTI and Buffer zones

Using Road traffic injury (RTI) database file from Road Traffic Injury Research & Prevention Centre,
having detail of all injuries occurred in several location of Karachi City in the year 2008 have been
spatially analyzed in Geomedia.pro Software. Spatial Intersection is used in GIS for correlating two
features, (point) feature as an accident location and town geometrically represented by (Polygon) on map.
In this paper polygon feature used as a based layer of Buffer Zones around ERV‘s placement location
while point feature class used as an accident locations.

Buffers such as area of different radius around a map have been created within and outskirt area of
Karachi City. The purpose of creating buffers of different radius sizes was to accommodate variation in
traffic volume or flow pattern of vehicles in congested areas. Larger radius of buffer created along the
periphery of Karachi City, which covered accidents records along with ERV‘s location on remote areas or
towns such as hub, gadap town, and keemari town etc.Whereas buffer of smaller radius created within the
city, where numbers of accidents have been analyzed for smaller distances.

By using command of (contained by) intersection between above mentioned features has been displayed
in Figure 3 , in which feature point shows only those injuries which occupied by buffer zones of ERV‘s
such that if accidents occurred within the buffer zone, then ambulance can easily reach to the victim place
w.r.t its location nearer to the zone.

Proceedings of IEDC 2010, 1-3 July, 2010 415 IEDC-522-088

Figure 3 also illustrate that most of the accidents occurred in urban area occupied by multiple numbers of
2 km buffer radius. Many buffers of 2 km radius somehow overlapping each other which illustrating that
ambulances are located at the closest point of black spots. If the accidents occurred within the range of 2
km or more, so that ambulances located at two different but closest locations can easily reached to the
point of incident and might be able to reduce the time of affectees to reach the hospital.

Figure 3. Buffer catchments areas and Road Traffic Injuries over Karachi Urban area

5.1.1. Mode of Arrival within catchment area of ERV’s Locations

Injuries within the buffer zones captured by different modes of vehicles tabulated in Table 1, which
shows the proportions of response by different agencies and private against road crashes. In the research
important finding is response of ambulance is effective especially in capturing of fatal/serious injuries. In
fatalities it is much effective and accounts 59% of total fatalities within the catchments area of ERV‘s
location, while in general it share of 23% only and major share comes by privately and have a share of
69%.

5.1.2. Effectiveness of ERV’s Locations

Table 2, shows the compressions of effectiveness of ERV‘s location, It has been found that 10 accidents
occurred in Hub chowki in the year 2008 brought to the urban area by ambulance and 2 accidents from
other sources out of total 12 number of accidents. It has been observed that locations which is on outcast
of Karachi, highlighting the absence of government trauma centres in remote areas of Karachi because
non government designated hospital do not take the serious road traffic injuries, due to the absence of
MLO (medical legal officer). As Table 1 show the major part of injuries captured by ambulance are fatal

Proceedings of IEDC 2010, 1-3 July, 2010 416 IEDC-522-088

so may be more travel time covered by ambulance due to the absence of trauma centres in remote areas is
one of the major cause of death.

Table 1. Proportions of response to accidents by different agencies

Mode of
Arrival Fatal Fatal Percentage Minor Serious Grand Total Percentage
Ambulance 389 59% 2341 1124 3854 23%
Others 61 9% 2341 1124 3854 23%
Police 25 4% 113 42 180 1%
Private 121 18% 10215 1269 11605 69%
Public 64 10% 409 157 630 4%
Grand Total 660 100% 13440 2772 16872 100%

Table 2. Compressions of effectiveness of ERV’s location

Grand
PLACE Ambulance Others Source Total Percentage of Ambulance
Hub Chowki 10 2 12 83.33%
Baldia No 4 117 90 207 56.52%
Hawksbay Roads 16 14 30 53.33%
Mauripur Road 302 275 577 52.34%
Toll Plaza 56 58 114 49.12%
Star Gate 143 166 309 46.28%
Malir Kala Board 107 147 254 42.13%
Tower 218 316 534 40.82%
Edhi Home Sohrab Goth 215 361 576 37.33%
Korangi No 5 166 290 456 36.40%
Ghani Chowrangi 190 381 571 33.27%
4-K Chowrangi 186 373 559 33.27%
Nagan Chowrangi 320 661 981 32.62%
Nipa Chowrangi 110 265 375 29.33%
Metroville 43 117 160 26.88%
Qayyumabad 208 575 783 26.56%
Fine House 84 240 324 25.93%
Clifton Schon Circle 197 674 871 22.62%
Gurumander 138 478 616 22.40%
Tariq Road 48 167 215 22.33%
Front of Liaquat National 194 790 984 19.72%
Sabzi Mandi 183 822 1005 18.21%
Orangi Town 54 249 303 17.82%
Numaish Chowrangi 119 561 680 17.50%
Star Chowrangi 58 333 391 14.83%
Liaquatabad No 10 54 399 453 11.92%
A.O Clinic 185 2299 2484 7.45%
Civil 83 1145 1228 6.76%
Jinnah 50 770 820 6.10%
Grand Total 3854 13018 16872 22.84%

Proceedings of IEDC 2010, 1-3 July, 2010 417 IEDC-522-088

5.2. Spatial Difference between RTI and Buffer zones

Spatial Difference is a technique in GIS, which subtracts features from undesired area, for analysis of
response against road crashes in those areas that are outside from catchment area of ERV‘s location.
Figure 5 shows the injuries in darker color that spatially doesn‘t contain in any Buffer.

Figure 5. Shows the spatial difference between RTI and ERV’s catchments area

5.2.1 Mode of Arrival

Table 3 shows the proportions of response by different agencies and private against road crashes that are
beyond in catchment area of ERV‘s location also shows that effectiveness of ambulance is relatively high
in fatalities and over all injuries as compare with Table 1.

Proceedings of IEDC 2010, 1-3 July, 2010 418 IEDC-522-088

 Table 3. Shows the Mode of Arrival Beyond from Buffer in Trauma centre

Mode of Arrival Fatal Percentage Minor Serious Grand Total Percentage

Ambulance 260 68.06% 1054 605 1919 25.47%
Others 1 0.26% 3 1 5 0.07%
Police 11 2.88% 82 26 119 1.58%
Private 80 20.94% 4490 624 5194 68.95%
Public 30 7.85% 199 67 296 3.93%
Grand Total 382 100.00% 5828 1323 7533 100.00%

6. Critical Spatial Distribution of Trauma Centers in Karachi Urban

One of the other major factors of road deaths is the spatial distribution of government-designated Trauma
centres. Government designated trauma centre ensure all kind trauma facilities as well as legal necessities,
although many 24 hours emergency care centres fulfill the need of at least primary trauma care but due to
the absence of MLO (medical legal officer) they could not allowed road accident injured patient in their
trauma centre. Figure 5 clearly shows some completely and some partially towns that are situated outside
the buffers of trauma centers.

Figure 6 shows the buffer of 10km around government designated trauma centres, however drive of 10km
is enough for city as Karachi ,where flow of traffic is random not a single road in Karachi have dedicated
emergency lane, ambulance driver have to adventure driving to take patient in trauma centre. This spatial
distribution shown in figure 6 might be fulfilling the need of trauma facilities in 1980‘s or before but not
now, for rapid growing Karachi.

Figure 6. Service areas from which a hospital draws most of its patients

Proceedings of IEDC 2010, 1-3 July, 2010 419 IEDC-522-088

6.1. Discussion on spatial distribution of Trauma Centres.

Figure 7, shows that 97.18% of road fatal accident reported in Trauma Centres without taken any medical
aid & travel more than 10 km, while the travel times was calculated is 30 minutes within a maximum of
10 km and for more than 10km/remote areas of Karachi, travel time to reach in Trauma centre must be
higher (Channa, et al. 2008)...However role of ambulance is somehow effective in the sense of
transference of patient from accident location to trauma centre; its share is around 45.48%. Normally,
when a road accident occurs, an eyewitness or any other person reported to the Ambulance service
provider‘s call centre (Edhi/Chippa) especially Edhi & Police has dedicated free numbers; 115 for Edhi
and 15 for Police, after this ambulance dispatches by different agencies due to the lack of communication
among these agencies resulting in over-allocation of resources to capturing a accident. So there is a need
of centralize control room or Post Accident Management Board (PAMB), where all stakeholders of
Ambulance service providers & Traffic police are sit together. It is also observed during the GPS (Global
Positioning Satellites) survey to identifying location of Ambulance placement location, different NGO‘s
positioned their ambulance are very close to each other, so there is need to develop some standards about
ambulance placement along the arterials as well as Ambulance deputation service, this can be easily
handled if a board like PAMB developed. Other unfortunate legacy of ambulance service is the
ambulance staff with no training of first aid or basic life support. The ambulances should normally
equipped with radio, and sensing device so that in emergency cases proper route management can be done
with the controller room ultimately ambulances can reach on time to the point of incident even in a
congested traffic.

Other important finding is the spatial distribution of Trauma Centres in Karachi there are five major
Trauma centres in Karachi which were organized by different agencies (different governments and
Private) . Spatial distribution shows these hospitals are within range of 5.0 to 10.5 km. of each other‘s and
the travel times to the trauma centre is an average of 13.3 minutes (+ 7.1). (Channa, et al. 2008). These
spatial distribution of Trauma centres served the whole city may be in 1980-90‘s but these distribution
doesn‘t nullified need of new Trauma center especially in remote areas of Karachi. The RTI data of Road
Traffic Injury Research & Prevention Centre highlighted the hospitals which is located in remote areas of
Karachi and serve first aid facility to Road accident victims.
120.00%

99.52%
100.00% 97.18%
93.72%

80.00%
71.39%

60.00%

40.00%

28.61%

20.00%

6.28%
2.82%
0.48%
0.00%
After Primary Medical Aid Travel more than 10 Km. without Primary Medical Aid Travel more than 10 Km
Fatal 2.82% 97.18%
Serious 28.61% 71.39%
Minor 0.48% 99.52%
Total 6.28% 93.72%

Figure 7. Proportions between injured, travel more than 10km with and without taken first aid

Proceedings of IEDC 2010, 1-3 July, 2010 420 IEDC-522-088

 100%

90%
11
42
80%
543
9

70%
863
60%

50%
46
18
40%
4
386

30%

20%
266
29 4
10% 179 6

30
0%
Ambulance Others Police Private Public
Minor 543 42 9 863 11
Serious 386 46 4 266 18
Fatal 179 29 4 30 6

Figure 8. Effectiveness of Ambulance beyond 10 km from Trauma centers

7. Conclusion

This paper attempted to correlate with ERV‘s stations and distance from Trauma Centers (Hospital
Service area) with frequency of injuries in their catchment areas. GIS techniques was used to analyze the
effectiveness of ERV‘s in response of road crashes within and beyond their specified catchment area, as
shown in section 5,of the paper. It was observed that their response in very serious injuries was relatively
effective within or beyond the catchment areas. Furthermore spatial distribution of trauma centres and
their service area is seems to be critical, as more than 97% of fatal accidents were reported in any
government designated trauma centre without providing any medical aid and travel at least 30 minutes for
distance of more than 10 km from accident location & trauma centre. The effectiveness of ERV‘s station
and their response for transferring victim to trauma centre may be sustainable in remote areas of Karachi,
but due to more travel time their response was not found effective to save lives, so need of trauma centres
are highlighted in remote areas of Karachi, using GIS and identification of the routes. For this it is
recommended that government should develop hospital in remote areas of Karachi or alternatively declare
few additional hospitals as a Primary Trauma Centres with enhanced emergency trauma management
facilities; specifically 100 Bed Hospital National Highway, Baqai University Hospital Super Highway,
Murshid Hospital Hub River Road along Eastern, North-eastern & North-western bounds of Karachi,
respectively. Secondly Ambulance Service facilities to be upgraded as per international standards and its
operation to be regulated under a body / board jointly managed by stakeholders & government body.

8. Acknowledgements

We are deeply indebted to Dr. Mir Shabbar Ali, Dr. Mudasir Hassan Arsalan, Mr. Ameer Hussain and all
members of RTI team for their assistance, useful suggestions and benevolent guidance.

Proceedings of IEDC 2010, 1-3 July, 2010 421 IEDC-522-088

 9. References

Brodsky H.Geograpkic (1990), ―Perspectives on Improving Emergency Notification in Road Accidents.

Washington‖ DC; AAA Foundation for traffic Survey;
Channa, et al 2008) ―Transport time to trauma facilities in Karachi: an exploratory study,‖
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657275/
Cole TB. Global Road Safety crisis remedy sought: 1.2 million killed, 50 millions injured annually.
JAMA. 2004;291(21):2531-2532. Doi: 10.1001/jama.291.21.2531
Moore, David, Spatial Planning Solutions, ―GIS in Emergency Planning A Spatial Analysis of
Ambulance Services‖ http://www.spatial.ie/downloads/GIS%20in%20Emergency%20Planning.pdf
Nantulya N and Reich M. BMJ (2002 ;) 1139-1141 ―The neglected epidemic Road Traffic Injuries in
developing countries‖.
Road Traffic Injury research and Prevention Centre (2008) ―A journey from injury towards intervention‖
Road causalities report 2008.
Zaheer-ul-Islam.M(2006) Presentation on ― Transport Management in Karachi‖.
www.cleanairnet.org/caiasia/1412/articles-71120_malik.ppt -14 Sep 2006.

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Proceedings of IEDC 2010, 1-3 July, 2010 422 IEDC-522-088

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