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Intelligent Ambulance Management System in Smart Cities

Conference Paper · September 2020

DOI: 10.1109/ICEE49691.2020.9249959

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 2020 International Conference on Electrical Engineering (ICEE)
September 25-27, 2020, Istanbul, Turkey
Intelligent Ambulance Management System in
Smart Cities
Tugay Akca
Istanbul Kultur University
Computer Engineering Department
Istanbul/Turkey
tugayakca96@gmail.com
Emre Kocyigit
Yildiz Technical University
Computer Engineering Department
Istanbul/Turkey
kocyigit.emre.30@gmail.com
Abstract—According to the United Nations' expectation, the
total population of the cities will be doubled in the next three
decades. This accelerating growth causes crucial problems in the
main components of both traditional cities and smart cities. To
increase the living quality of the residence in smart cities, enabling
a clean, healthy, and sustainable environment are the major fields
for the smart cities' managers and directors. One of the main
infrastructures of the smart city is identified as smart health,
which can be enabled with the use of modern technologies such as
Internet of Things, especially for accessing the patients when they
need help. In this Project, a smart ambulance management system
is proposed in a smart city environment. If a patient needs an
ambulance, the operator finds the nearest ambulance and direct it
to the patient. The coordinates of ambulances are dynamically
traced by the system, and Google Maps, as a third-party service,
is used in order to calculate the shortest path to the casualty. After
reaching to the patient, the expert (doctor or nurse) investigates
the situation and finds the best available hospital by the proposed
system. The experimental results showed that the proposed system
finds the best solution in an acceptable time.
Keywords— smart health, smart cities, shortest path, IoT,
ambulance deployment
I. INTRODUCTION
The technology that has been developing rapidly since the
beginning of the 2000s has begun to take a crucial role in every
field of human life such as communication, business,
entertainment, and health. If technology is used wisely and
efficiently, its impact on human life will be positive and the
acceleration of development will ascend. Today's people
request to access the information they need as soon as possible
and need to live in a comfortable, ecological, fast and clean
environment. This kind of requests and requirements lead to the
creation of new concepts like smart city concept. The Smart
City Concept has emerged because traditional city
infrastructure is not capable of solving the problems caused by
the increasing population and consumption amount. A smart
city is a collection of IoT devices, which collect and use big
data from citizens for making their life easier, more productive
and secure.. The analysis and processing of big data arising with
the increase of IoT devices is very important in the management
of the smart city and main purpose of it is reducing costs and
978-1-7281-8292-6/20/$31.00 ©2020 IEEE
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Ozgur Koray Sahingoz
Istanbul Kultur University
Computer Engineering Department
Istanbul/Turkey
sahingoz@gmail.com
Mucahid Tozal
Istanbul Kultur University
Computer Engineering Department
Istanbul/Turkey
1301020460@stu.iku.edu.tr
resources while providing comfortable and healthy
environment.
Smart health system, which provides fast and sophisticated
health service, is vital component of smart city concept. Smart
hospitals, smart ambulances, quick response to patients and
finding the fastest way to the hospital are backbone elements of
the system. Hence, it is essential to conduct a study on the
subject. To receive the patients to the most suitable hospital in
the fastest way, a smart ambulance application was carried out
in smart city concept. Major ingredients of a smart city are
shown in Figure 1 and providing smart health is one of the most
concerning ingredients.
Fig 1 Ingredients of a smart city
In addition to increase in the human population, the number
of needs has increased in many areas at the right rate. Increasing
population, consumption and emerging new disease types
increase the number of needs in the health sector. Thanks to
technological development, treatment methods have been
found for previously untreated diseases. Technological studies
continue to day-by-day. If humanity exists, there will always be
a need for the health sector. One of the critical issues in the
health sector is to perform the first intervention to the patient as
soon as possible and reaching the hospital in the fastest way
after completing this intervention. If this critical point fails to
function correctly, the patient may die. An important issue is to
correctly examine a patient, in which enough information must
be obtained about the patient because correct treatment saves
lives.
 Smart Ambulance application in Smart Cities is developed
based on these two critical issues in the health sector, and this
application has brought solutions to these points. Smart
ambulance application in smart cities keeps the density
information of the hospitals in the database to work regularly
and systematically. Eventually, it keeps the positions of
ambulances on the system. There were positive developments
in the health sector with the smart ambulance system in smart
cities. The first of these developments is about speed. The speed
of directing and transportation of ambulances to the patient
requesting emergency assistance has increased. Another
improvement has been improved the accuracy of the first
treatment performed after the patient is reached. Because the
patient has the option to give information about the situation
quickly through the application requesting help, these
situations, developed with the smart ambulance system in smart
cities, have contributed significantly to human health.
The smart ambulance application in smart cities has a great
contribution to the health sector and has an optimum level of
applicability. Hospitals in smart cities, which want to
implement this system, should share their doctor capacity and
density information with the system. In addition to this
information, the smart ambulance application in smart cities
needs a mobile phone inside the ambulances to keep the
information, location of the ambulances and store them in the
system. Apart from this knowledge, additional information will
be given to the system by the patients. The main reasons for the
emergence of the smart ambulance system in the health sector
in smart cities are to reach the patient calling for emergency call
in the fastest way and to perform the most accurate first
treatment. After this process, it is another aim to realize the
patient to the most suitable hospital in the fastest way. In smart
cities, the smart ambulance application has 3 interfaces.
The first interface was created for the admin. Admin shows
the location of the patients requesting calls from this interface
and other information entered. Admin can see locations of
ambulances on the system instantly, except for patient
information. The second interface of the smart ambulance
application in smart cities was created for ambulances. The
authorized person in the ambulances can see the surrounding
hospitals on this map and control the density of these hospitals
through the system. In addition, ambulances can access the
patient's location determined by the admin. The third interface
of the application was created for users. A user can send the
necessary information to the system by filling checkboxes and
text fields via the (patient) interface. Moreover, an address is
requested from the user, the location is automatically taken in
the background when the call is made from the application.
Intelligent Ambulance Management System in Smart Cities is
shown in Figure 2.
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Fig 2 Intelligent Ambulance Management System in Smart Cities
In the presentation of this Project, user calls the ambulance
by entering the required information. At the end of this request,
the required information entered by the user must be seen in the
admin's interface. Hospital information and the traffic
information can be accessed from the ambulance's interface.
II. LITERATURE SURVEY
There are few surveys have been written in this topic. Many
of them were built after 2000. Some of the projects that offered
different solutions had common goals with the Smart
Ambulance. Those who had enough literature research were far
from the state of technology today. Among the general topics
are smart city applications, and their connections with systems
are examined and investigated. It is necessary to deal with
reviews related to these in layers. The system, software,
hardware, availability, durability, stability, maintainability
studies for smart cities were reviewed.
In [9] contributors accentuated that Smart City is one of the
vital problems in the next coming years; because it is estimated
that more people will be immigrate into city from rural areas and
by 2040 cities are populated by 70% of the world's population.
This will give rise to city management issues like traffic,
parking, capacity programming. Therefore, there is a need to
figure out the upcoming issues and find a way to resolve all of
them by resource planning. The data is gathered set on city
infrastructure and the attitude of people in the city. This big data
is investigated to make informed determination to give the grade
of life to the citizens. It is applied as the evolution of a smart
city. Information Communication Technology supplies real-
time cultivable data. Based on this knowledge, applications can
be developed to have a more hypermetropic demonstration of
the Smart City. Online banking, online shopping, and distant
video transmission are some of the applications of Smart City.
One of the concepts used to improve the city building and its
resources; Intelligent City is staminal in city management,
development and uses data and communication technology for
city evolution and fast rise. These cities are organized to boost
more business and industrial rise, so increasing economic
progress and improving the living standard of the occupants [1].
It bids multiple amenities to the city like better shipping in the
city, more job opportunities, less traveling time cost, a
wholesome environment, better healthcare, less crime, etc.
Smart City is a notion that works with sensors and data analytics
to improve the standard of life in the cities. Smart City deals with
challenges like traffic, parking, capacity projection, etc. and
resolves them to maintain better city facilities to their citizens
 [2]. ICT is becoming common in the cities and dealing with
Smart City application areas. Smart City is using big data to
create smart communication systems that help decision-making
capabilities. With powerful data resources and data analytics
tools it can be architect real-time services for the citizens in
crowded cities. Big data and analytics has changed the way
keeping data and processing the data efficiently. Now this
important data is not only used to get the major trends
knowledge but also used to give notice the future. It is
meaningful in planning the future of the intelligent cities. Data
is investigated to build up action plans from the predicted
results.
In this paper, multiple datasets for traffic management and
parking management have been evaluated by using data
analytics solutions to find a pattern in a historical knowledge.
Based on the research; the data is further analyzed by machine
learning tools, analyzing tools and algorithms to give notice the
future behavior and help on taking decision. Machine learning
and Analytics tools for Data Analytics as well as Mining
algorithms from Python library are used for data analyzing and
generating new data. This paper gives us the details of some
area applications of Smart City listed as "Smart City Traffic
Management" and "Smart City Parking Management".
In [10], trauma is stated as one of the main death causes in
large cities. The delay in the process of transferring patients to
the emergency department seriously affects the trauma
especially in developing countries. Their work explains a frame
for the emergency event reporting system, which detects nearby
persons and their smartphones, and aggregately notify
emergencies. . People who are close to the case can stimulate
the progress of sending vital information such as coordinates,
number of casualties and point of injuries. The system that
processes the received information sends the route to the patient
and the nearest hospital information to the ambulances in order
to provide efficient solutions.
Authors of [11] stated that sophisticated healthcare
programs are required in real world systems. Emphasizing the
necessity of using developing technological equipment in
accidents and health cases as in many areas, the authors
proposed a smart ambulance system integrated with big data
and internet of things. In this way, they aimed to reduce the
mortality rate in their studies.
The rise of industrialization and urbanization has resulted in
big connect increase within the population, invariably leading
to a rise within the variety of vehicles on the road. The ensuing
traffic congestion and traffic jams are the most important
obstacles for emergency vehicles like ambulance carrying
important patients as these emergency vehicles can't reach their
destination in time, ensuing into a loss of human life. To solve
this drawback to some extent, we've got apparently come back
up with Smart ambulance using IR sensors for an ambulance
[12]. The recommended system clears the tie-up by turning all
the red lights to green on the trail of the ambulance, hence
helping in clearing the traffic and supply means towards its
destination. The system consists of an connect android
application that registers the ambulance on its network. In case
of emergency scenario, if the car stops on its means, the
application sends an associate emergency command to the
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traffic signal server and additionally the direction wherever it
needs to move with this position with the aid of the world
Positioning System (GPS). The closest signal is known based
upon this position of the ambulance and that signal is formed
green until the ambulance passes by and later it regains its
original flow of management. During this way, it acts sort of a
safeguard project because it saves time throughout emergencies
by the traffic lights.
Even the slightest delay in first aid is quiet vital. Therefore,
the delay of ambulances can lead to death of the patients or
casualties who need to brought to the emergency department of
hospitals. Major reason of this delay is traffic jam and the traffic
jam is common part of metropolitan life. In addition to the
traffic congestion, drivers usually will not take any action until
they hear and understand the ambulance and its direction. In
[13] contributors propose a system, which communicates with
drivers, ambulances and emergency center, and alerts the
drivers about the ambulance’s route. They also made an initial
questionnaire that shows the transportation time of patients can
be decreased by their proposal.
M. N. Ashmawy et al. presents an integrated platform,
which provides best route for ambulances and observe patient
status until the hospital, in [14]. The objective of the platform
is descend the probability of death due to fast arrival of
ambulance to the casualty and providing vital data of patient to
the doctor who is in charge of saving the injured patient.
Furthermore, the doctor can inform and direct the paramedics,
and learn the paramedic’s first evaluation and observation via
the platform. Herewith, the doctor and the hospital can prepared
the necessary staff and materials. In addition to all, the platform
uses machine learning to analyze the data to reinforce the
decision-making process in their work.
In [5] author also focused on the ambulance management
system, the project shows a outline for the design of an
autonomous ambulance management system with real-time
patient monitoring, using IoT. Deciding the nearest hospital,
finding the optimal route, sending important IoT provided data
to hospital in this study’s proposal. Moreover, sophisticated
elements of traffic management procures smooth pass for
ambulances in order to save the life of casualty. In [6] authors
study on solution for the problem of ambulances’ delay due to
the intensity of traffic. Unfortunately, the ambulance stuck in
traffic cost a human life. They propose a model which use A*
algorithm to find the best route and to reach an injured people,
in order to save their lives. The contributors of [7], developed a
smart ambulance approach alarm system that informs other
vehicles about the position of the ambulance via IoT to generate
efficient solutions. They also used cloud-based platform while
considering the security concerns of the ambulances and other
drivers.
Finally, S. H. Sankar [8] proposed a model that both detects
the accident instantly in order to shorten the transportation time
of the patient, as well as preventing delay in ambulances, and
manage ambulances to direct them to the accident point. After
an accident happened, the in-vehicle module notifies the main
server about the accident and the server finds the optimal route
for the ambulance. Ambulance driver will be supported by the
application to reach the patient as soon as possible. By this
 means, transportation time can be decremented and saving Android operating systems. Besides, we will start working as
human life rate can be incremented. soon as possible for IOS and DESKTOP versions.
III. PROPOSED SYSTEM In Figure 3, a person calls an ambulance. A person can give
information about his situation. After that, the emergency will
We did research and used algorithms for our Project to be be caught from the admin panel. In Figure 4 screenshot is
beneficial for the health sector. To correctly understand the free showing the screen of the ambulance user. There are multiple
database service provided by Google and to follow the hospital marks, and if the admin assigned an emergency, its
instructions correctly, we have benefited from the Google been located with a black mark in real-time. when the hospital
firebase documentation [1]. Since speed was critical in our icon is clicked, as mentioned in Figure 5, we come across
Project, it was very important for us to direct the ambulances information about the hospital. When the phone icon is clicked,
from the most accurate route, so we provided calculations using the call to the contact number of the hospital occurs. Clicking
the haversine formula for the distance between the ambulance the arrow icon creates a route to the target hospital via google
and the hospital ambulance. maps. The distance and transportation time to the hospital
ο‫׎‬ ʹ ࢤߣ appears in the upper right corner. The hospital address is at the
ഥ ൌ ૛ࢇ࢘ࢉ‫ ܖ ܑܛ‬ቆට‫ܖܑܛ‬૛ ቀ
ࢤ࣌ ቁ ൅ ܿ‫ ‹• ݂׎ݏ݋ܿ ݏ׎ݏ݋‬ቀ ቁቇ(1) bottom.
૛ ૛

• οߪ ൌ ‫݈݁݃݊ܣ݈ܽܿ݅ݎ݄݁݌ܵݎ݋݅ݎ݁ݐ݊ܫ‬
• ο‫ ׎‬ൌ ‫ ͳ݁݀ݑݐ݅ݐܽܮ‬െ ‫ʹ݁݀ݑ݀݅ݐܽܮ‬
• ‫׎‬௦ ൌ ‫ͳ݁݀ݑݐ݅ݐܽܮ‬
• ‫׎‬௙ ൌ ‫ʹ݁݀ݑݐ݅ݐܽܮ‬
• οߣ ൌ ‫ ͳ݁݀ݑݐ݅݃݊݋ܮ‬െ ‫ʹ݁݀ݑݐ݅݃݊݋ܮ‬
As shown Equation 1 the haversine formula [2] determines
the great-circle distance between two points on a sphere given
their longitudes and latitudes. Important in navigation, it is a
special case of a more general formula in spherical
trigonometry, the law of haversine that relates the sides and
angles of spherical triangles. Since we preferred to use the dart
language together with the flutter platform, we have benefited
from the related documentation. [3]. We searched for cost of
the Project. For every API request, there is need for a price.
That is the small part of costing plan. We understood that we
Fig 3 Screen of Call Ambulance
should make a request as possible as little. With this system we
developed, we will ensure that individuals who are in urgent
intervention are directed to the most suitable hospital in the
fastest way. To achieve this goal, we will first need 3 different
users, these are Admin, Ambulance, and the person who needs
urgent intervention.
Admin: Admin will be able to see the locations of
ambulances and those who need urgent intervention. It will
ensure that the closest ambulance is directed to the person who
needs urgent intervention. Ambulance User: Ambulance User
will be able to see the information of the nearest hospitals and
hospitals to deliver the person who needs intervention to the
hospital in the fastest way. Patient: The patient will call for
emergency help. Creating a database in our Project, we used the
firebase platform provided by Google, which is the world's
largest search engine for free. Google Firebase gives us
opportunities such as real-time database, Authentication, and
Test Lab. We can explain. The No SQL method has given us a
great speed in the Project because of its flexible structure and Fig 4. Location of Ambulance and Patient
high speed of reading and writing data.
We keep user information, hospital information, and
ambulance information in the database. Following the hospital
locations in the database saved us a lot of time and wasting time
on google maps and played a significant role in the fast listing
of the hospitals. Our system is currently actively working on

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 Fig 8. Direction to hospital

IV. EXPERIMENTAL RESULTS

Fig 5. Location of Ambulance and Patient
In Figure 6, information such as the suitability of the
operating theater, emergency response suitability of each
hospital is also shown each hospital can be called directly. In
Figure 7, hospital locations marked, and all the collection of
hospitals can be reached from Smart Ambulance application. In
Figure 8, directions created for hospitals.
In the application, doing the fastest way was the key for us.
For this reason, we have minimized the duration calculations,
such as determining the fastest route, to a minimum. To ensure
this, we take the hospital locations from the database and list
the hospitals closest to the patient (in the range we have
determined) and the way we reach them in the fastest way.
While making these calculations, we used the haversine
formula. First, we calculate direct distance, then we make a
matrix distance request with Google API [4]. Calculation
processes take approximately 2 seconds and are listed in a list.
Search is making application can work actively in all android
versions. The application works on both iOS and android.
Flutter providing a huge platform with a high stability. Search
was made among 150 hospitals in Istanbul using the haversine
method and the google distance matrix API. 2 seconds is a
success after trying a lot of method which are using currently.
Algorithm compares the distance and duration between
ambulance and patient also ambulance and hospital. If the
hospital number is 150 or more; the tested spectrum of search
is between 2 and 3 seconds. The method which is applied taking
user's location and calculates as the crow flies. Second step is if
the distance between locations is below the 10.000 km search
is applied with Google Distance Matrix API. So, the aim is
decreasing the total number of hospitals which are not in real
spectrum. As result time cost is better.

Fig 6. Information and call screen. TABLE 1 TESTED SYSTEM SPECIFICATIONS

Device CPU Resolution Cap. Mem.
Name
Pixel 3a Google APIs Intel 1080x2220 4.3 gb 2 gb
Atom
Pixel 2 Google Play Intel 1080x1920 4 gb 2 gb
HuaweiP20 Quad-core 2.36 GHz 1080x2280 64 gb 4 gb
Lite ARM Cortex A53
Samsung A8 4x1.8 GHz Cortex 1080x1920 16 gb 3 gb
A53
An application program interface (API) is a set of routines,
protocols, and tools for building software applications.
Basically, an API specifies how software components should
Fig 7. Hospitals from Google Maps.
interact. Additionally, APIs are used when programming
graphical user interface (GUI) components.

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 A. System Test Results
Testing Device is Google Pixel, and the API level is 29. All
the values are tested for 5 minutes. Results documented and
displayed in Fig 10 by measuring CPU Test, Graphics Test,
Memory Test, and Network Test.
Fig 9 System Test Results
B. Performance Test
Testing Device is Google Pixel, and the API level of the
device is 29. All data were tested for 5 minutes and 11 seconds.
Results are documented and render time shown in Fig 11. The
first demonstration time was calculated as 815 ms. Portrait
mode selected for performance testing. Missed vertical
synchronization is 58% of render time. There was not high
latency. Slow UI thread calculated as 62% also slow draw
commands calculated as 6%. Slow bitmap uploads could not
find. The distribution of UI render time is shown in Fig 11.
Fig 10 Performance Test Results
C. Database Test
Testing Device is Google Pixel, and the API level is 29. All
the values are tested for 5 minutes and 11 seconds. Total Reads
are 453. There is a payment policy after 50.000 reads. The
document reads usage is saving for each reading process, and
document writes usage is saving for each writing process. After
usage, there is no error report. The test is successful.
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Fig 11 Database Usage Results
V. CONCLUSIONS AND FUTURE WORKS
In this project, we aimed to reach the patient who needs
urgent intervention in the fastest way, and transfer the casualty
to the most appropriate hospital for the interventions. We have
designed an interface that shows hospital information and
ambulance locations online in the firebase database we have
created for these goals so that whenever a patient call is
received, the nearest ambulance admin user will be directed.
To speed up the procedures after the ambulance reaches the
patient, we kept the information of the locations of the hospitals
and what interventions can be done in our database, thanks to
this filtering feature, we have sorted the most suitable hospitals
according to the time they can reach and direct them to the
shortest period. This study has produced successful results
considering the reaction and transportation time. To improve
this project, more information can be obtained from the
hospitals, and other sophisticated elements of IoT like smart
traffic devices. Finally, this project is an indication that human
life is more important than anything and the more people
intervene; the more lives will be saved. Additionally, the
location of the ambulances can be chosen using an intelligent
algorithms which has the optimum coverage areas as mentioned
in [15], and ambulances can be accepted as sensors and a
publish subscribe based communication mechanism can be set
up for being used in multi-functional applications[16].
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