Computers & Operations Research 40 (2013) 1972–1978

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Computers & Operations Research

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A stochastic optimization model for real-time

ambulance redeployment
Joe Naoum-Sawaya a,n, Samir Elhedhli b
a
Engineering Management Program, American University of Beirut, Beirut, Lebanon
b
Department of Management Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada

a r t i c l e i n f o a b s t r a c t

Available online 26 February 2013 When ambulances are engaged in responding to emergency calls, the ability to respond quickly to
Keywords: future calls is considerably compromised. The available ambulances are typically relocated to
Emergency medical systems reestablish maximal coverage. We present a two-stage stochastic optimization model for the
Integer programming ambulance redeployment problem that minimizes the number of relocations over a planning horizon
while maintaining an acceptable service level. We conduct computational testing based on the real
historical data from the Region of Waterloo Emergency Medical Services. The results show that the
optimal relocation strategies can be computed within 40 s of computational time for a desired service
level of 90%.
& 2013 Elsevier Ltd. All rights reserved.

1. Introduction
Ambulance deployment is a challenging problem encountered
in emergency medical services (EMS). In practice, ambulance
deployment is done at two levels. At the strategic level, the
locations of the ambulance stations are determined taking into
account the long term growth of the population. Many factors,
such as the aging population and the expected rise in demand for
medical services affect the long term planning of ambulance
deployment. At the operational level, ambulance dispatching
and redeployment are planned. Ambulance dispatching is the
process of determining the ambulances that should respond to a
received emergency call. Typically, when some ambulances are
engaged in responding to emergency calls, the ability to respond
quickly to future calls is compromised. The redeployment pro-
blem consists of relocating the available ambulances to reestab-
lish maximum coverage. Coverage refers to the area that can be
serviced within a certain amount of time by an available ambu-
lance. In 2006–2007, the Region of Waterloo Emergency Medical
Systems (ROWEMS) accounted for 25,877 redeployment which
constituted 27% of the total number of ambulance activities for
that period. The current performance standard for ROWEMS
requires that 90% of emergency calls should be reachable by an
ambulance within 10 min and 30 s. A new Ambulance Act
Regulation which requires that an ambulance should arrive on
scene in less than 8 min has been recently introduced. Since
n
Corresponding author.
E-mail addresses: joe.sawaya@aub.edu.lb (J. Naoum-Sawaya),
elhedhli@uwaterloo.ca (S. Elhedhli).
adding new ambulances is associated with a very high cost, EMS
managers are relying on increasing the utilization of the current
fleet by employing advanced decision support systems to help
them achieve better redeployment strategies. Currently, reloca-
tions in ROWEMS are made using a preplanned compliance table
which indicates where the ambulances should be located given a
certain number of available ambulances. The compliance table
does not take into account the time of day, does not indicate
which ambulances should be moved, and relies on the experience
of the operator when making the relocation decisions.
As thoroughly presented in Brotcorne et al. [3], ambulance
location models can be classified into two main categories: the
deterministic models that are typically used at the planning stage
and the probabilistic models that account for the fact that
ambulances cannot be always available to respond to emergency
calls. Early ambulance location optimization models focused on
static and deterministic strategies used for long term planning.
The set covering location problem (SCLP) presented by Toregas
et al. [19] aims at minimizing the number of ambulances needed
to cover a certain area. The maximal covering location problem
(MCLP) presented by Church and ReVelle [5] maximizes the area
that can be covered given a fixed number of ambulances. Both the
SCLP and the MCLP consider single coverage in which a given
point is covered if it can be reached within t min by an
ambulance. Other models introduced by Hogan and ReVelle [13]
and Gendreau et al. [9] assume double coverage which requires
that all the demand be covered within t1 minutes while a certain
fraction of the demand be covered within t2 minutes. Although
the SCLP, the MCLP, and the double coverage models are used for
long term planning, they unrealistically assume that all the
ambulances are always available when an emergency call is

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 J. Naoum-Sawaya, S. Elhedhli / Computers & Operations Research 40 (2013) 1972–1978 1973

received. The maximum expected covering location problem Indicies, parameters, and sets:
(MEXCLP) of Daskin [7] accounts for ambulance unavailability
and maximizes the expected value of coverage given a fixed i: index for ambulances, i A I.
number of ambulances. Extensions for MEXCLP have been pre- j: index for ambulance stations, j A J.
sented in Batta et al. [2], ReVelle and Hogan [17], and Ball and t: index for time periods, t A T.
Lin [1]. Another line of research uses queuing theory to analyze s: index for scenarios, s A S.
the EMS probabilistic models. The hypercube model which was Cj ¼ the capacity of station j.
introduced in Larson [15] has been extensively applied by Burwell N ¼total number of calls.
et al. [4], Goldberg [12], and Takeda et al. [18] to analyze EMS U(t) denotes the set of time periods t 0 A T, where an ambulance
systems. Moreover, Zaki et al. [20] and Ingolfsson et al. [14] will not be available if it responds to the call at time period t.
8
adopted simulation to closely model EMS systems.
< 1 if assigning ambulance i to station j requires a
>
More recently, dynamic ambulance relocation models aimed relocation,
dij ¼
for short term operational planning were introduced. The >
:
0 otherwise:
dynamic relocation models take into account the current location
8
of the ambulances to provide a redeployment strategy that < 1 if a call is received in time period t of scenario s
>
reestablishes maximum coverage after an ambulance is dis- ajts ¼ and is reachable within target time fromstation j,
patched. Dynamic relocation models are repeatedly solved in real >
:
0 otherwise:
time, and since it is critical to find a relocation strategy in a very
8
short time, heuristics have been typically applied. Gendreau et al. > 1 if ambulance i can reach station j before time period
>
>
[10] presented a double coverage model for dynamic relocation < t ðif ordered to relocateat time t ¼ 0 from
and applied a tabu search algorithm for solving the resulting r ijt ¼
>
> its current locationÞ,
>
:
model. They also consider practical features such as avoiding 0 otherwise:
moving the same ambulance in successive redeployments, avoid- (
ing repeated round trips between the same two locations, and 1 if a call is received in time period t in scenario s,
avoiding long trips. Gendreau et al. [11] formulated and solved a gts ¼
0 otherwise:
dynamic problem arising in the relocation of physician vehicles.
Maxwell et al. [16] presented a dynamic programming model for
the ambulance relocation problem and an approximation is ri ¼ Cost of relocating ambulance i.
constructed to account for the high-dimensional state space of l ¼ Cost associated with not servicing an emergency call
the problem. The approximation is tuned using simulation. within the desired time.
In this paper, we propose a two-stage stochastic program ps ¼ Probability of scenario s occurring.
for the ambulance relocation problem. In the first stage, the p ¼ Percentage of calls that should be reached within the
model minimizes the number of relocations, while in the second target time.
stage, it minimizes the number of calls that are not reached Decision variables
within the desired service time. The presented formulation (
models time explicitly for a given planning horizon. This permits 1 if ambulance i is assigned to station j,
yij ¼
the modeling of some complicating features such as the shift 0 otherwise:
8
schedules of the ambulances and the typical change in demand
< 1 if ambulance i is assigned to the call received in time
>
during the day. xits ¼ period t of scenario s,
The rest of this paper is organized as follows. The stochastic >
:
0 otherwise:
optimization model is presented in Section 2. Computational tests
are presented in Section 3. Section 4 concludes.

The two-stage stochastic program is formulated as follows:

!
2. A two-stage stochastic programming formulation XX X X X
min ri dij yij þ l ps 1 xits , ð1Þ
iAI jAJ sAS tAT iAI
We model the ambulance redeployment problem as a two-
stage stochastic program based on the scenarios [6]. In the first X
s:t: xits  ðr ijt ajts yij Þ r0, 8i A I, 8t A T, 8s A S, ð2Þ
stage, the model determines the optimal placement of the
jAJ
ambulances. These decisions are made prior to knowing the exact
location of future emergency calls. The uncertainty in the location X
xits þ xit0 s r1, 8i A I, 8t A T, 8s A S, ð3Þ
of the emergency calls is represented by a finite set of scenarios 0
t A UðtÞ
that represent the second stage of the model, where each scenario
X
contains a random outcome for the locations of the emergency xits r gts , 8t A T, 8s A S, ð4Þ
calls. Second stage decisions model the assignment of ambulances iAI
to emergency calls. The objective of the model is to minimize the X
number of ambulance relocations while meeting a minimum yij r C j , 8j A J, ð5Þ
performance level. The scenarios are formed based on the histor- iAI
ical data. Emergency Medical Services keep detailed historical XXX
data of all the ambulance activities which constitute a valuable xits Z pN, ð6Þ
iAI t ATsAS
asset that we use in our relocation model. For instance, the
historical data contains the exact location, time of the day, and
yij A f0,1g, xits A f0,1g, 8i A I, 8j A J, 8t A T, 8sA S: ð7Þ
the ambulance travel time. Therefore a scenario can be built by
looking at the number and location of calls for a particular day. The objective function has two components. The first stage
To model the dynamic relocation problem, we define the minimizes the number of relocations while the second stage
following notation: minimizes the number of emergency calls that are not serviced
1974 J. Naoum-Sawaya, S. Elhedhli / Computers & Operations Research 40 (2013) 1972–1978
within the target time. Similar to Gendreau et al. [10], parameter ri
is a penalty coefficient associated with relocating ambulance i. A
large penalty is hence enforced on ambulances that have been
relocated frequently in the past or on ambulances that are close to
the end of their shifts. We note that the penalty coefficients are
updated each time the model is solved. Constraints (2) indicate
that ambulance i can service a call within the desired time if it is
assigned to a station from which the call can be reached within the
target time. We note that if ambulance i is not currently at station j
and is ordered to relocate to station j, parameter rijt ensures that
the relocation travel time of ambulance i is accounted for and
hence ambulance i is not considered present at station j before it
actually arrives. Constraints (3) ensure that if ambulance i is
assigned to service the call of time period t then this ambulance
will be unavailable for all the time periods t 0 A UðtÞ. Constraints (4)
ensure that at most one ambulance is assigned to each call.
Constraints (5) ensure that the maximum number of ambulances
assigned to station j does not exceed its maximum capacity Cj.
Constraints (6) indicate that at least p% of the calls should be
reached within the target time. We note that constraints (6) can be
dropped from the model if no service level is enforced.
Generating scenarios for the model is relatively easy since all
EMS keep detailed historical data. For our computational testing,
the Region of Waterloo EMS provided us with 2 years of historical
data consisting of 95,840 calls. In the cases where historical data
is not available, simulation can be used to generate the scenarios
as in Domenica et al. [8].
2.1. Length of the time periods
To calculate the length of each of the time periods t A T, we
assume that the emergency calls arrive according to a Poisson
distribution with arrival rate l calls/hour. The probability of
having 0 or 1 call in a time period t is then
Pð0Þ þ Pð1Þ ¼ elt þ ltelt ¼ ð1 þ ltÞelt :
For small lt, elt can be approximated as elt I1lt. Consider-
ing that the time periods should be short enough to guarantee
that the probability of having 0 or 1 call is at least 1E, Eq. (8)
leads to
ð1þ ltÞð1ltÞ Z 1E,
2
1l t 2 Z 1E, ð10Þ
pffiffiffi
implying that the time period should be at most ð E=lÞ. As an
example, for E ¼ 0:01 and l ¼ 2 calls/hour, the time period should
be of length less than 3 min which implies 20 time periods for a
planning horizon of 1 h.
3. Computational results
Problem (1)–(7) is implemented in Matlab and solved using
CPLEX 11.0. There are two important sets of decision variables in
the formulation. These are the assignment of ambulances to
stations (variables yij) and the assignment of ambulances to calls
(variables xits). If the ambulances are assigned to stations, the
problem reduces to identifying which calls are serviced within the
target time. Since the number of yij variables is smaller than the
number of xits variables, it is desired to first branch on yij. CPLEX
was setup to first branch on the first stage variables yij before
branching on the xits variables.
The test instances are generated from the historical data that
were provided by ROWEMS. The region of Waterloo has a
2
geographic area of 1382 km and is displayed in Fig. 1. The region
is divided into 76 squares, each with an area of 25 km2. These are
in turn divided into 25 unit squares that are identified by a unique
Universal Transverse Mercator (UTM). The historical data indi-
cates the UTM address of each emergency call. To test our model,
we generated 128 problems by randomly sampling the historical
data. The target service time Tmax was set to 10 min 30 s, the
travel times were computed using a constant vehicle speed
of 50 km/h, and the distances are computed based on the
Euclidean norm. We evaluate the quality of the solution in terms
of the percentage of emergency calls that are reached within
target time and in terms of the number of relocations. To account
for the change in the arrival rates of emergency calls, the day is
divided into 48 periods of 30 min each and the arrival rates are
calculated for these periods. Given the arrival rates, the planning
horizon should be split to time periods of t ¼1 min to guarantee
a probability of 99% that 0 or 1 call is received in each time period
(see Section 2.1 for the details). Finally, the number of ambu-
lances for each shift is given. The historical data are summarized
in Table 1. We notice that the rate of emergency calls increases
from 6:00 a.m. until noon, peaks at 11:00 a.m. and 1:00 p.m., is
stable in the afternoon and the evening, and starts to decrease at
around 8:00 p.m. until 6:00 a.m. (Fig. 2).
Computational results for 30 tests occurring at different times
of the day are shown in Table 2. Column (1) indicates the test
number. Column (2) indicates the time of the day. Columns (3),
(4) and (5) indicate the number of ambulances on duty, the
number of time periods in the planning horizon and the number
of generated scenarios respectively. The number of relocations is
displayed in Column (6), the service level is displayed in Column
(7), and finally the computational time in seconds is displayed in
Column (8). The planning horizon is fixed to 120 periods (2 h) and
50 emergency call scenarios are generated for each of the tests. The
number of ambulances on duty is set to the actual number of
ambulances on shift. The computational results show that the
optimal relocation strategy is computed in less than 39 s. The
service level for the computed relocation strategies varies between
ð8Þ 91% and 96% of calls serviced within the 10 min 30 s time limit. The
number of relocations varies between 1 and 4. Being able to solve
the redeployment problem in less than 40 s gives the ROWEMS an
edge in improving the performance of their service and more
importantly it maintains its service level above 90%.
In Table 3, we evaluate the effect of the planning horizon on
ð9Þ
the performance of the algorithm. We conduct two separate tests,
the first occurring at 3:00 (tests 31–72) and the second occurring
at 14:00 (tests 41–50). For tests (31–40), we set the number of
Fig. 1. Region of Waterloo.
 J. Naoum-Sawaya, S. Elhedhli / Computers & Operations Research 40 (2013) 1972–1978 1975

Table 1
Summary of the historical data.

Time of day Emergency calls Ambulances on Time Emergency calls Ambulances on

arrival rate per shift arrival rate per shift
hour hour

6:00–6:30 2.02 7 18:00–18:30 4.86 16

6:30–7:00 2.34 8 18:30–19:00 4.64 16
7:00–7:30 2.68 8 19:00–19:30 4.84 15
7:30–8:00 3 9 19:30–20:00 4.22 15
8:00–8:30 3.82 10 20:00–20:30 4.26 13
8:30–9:00 3.72 10 20:30–21:00 4.08 13
9:00–9:30 4.7 12 21:00–21:30 4.04 11
9:30–10:00 4.86 12 21:30–22:00 4.02 11
10:00–10:30 4.98 12 22:00–22:30 3.58 11
10:30–11:00 5.12 12 22:30–23:00 3.14 11
11:00–11:30 5.14 12 23:00–23:30 3.18 11
11:30–12:00 4.74 12 23:30–00:00 2.84 11
12:00–12:30 4.86 14 00:00–00:30 2.76 9
12:30–13:00 4.94 14 00:30–1:00 2.72 9
13:00–13:30 5.12 14 1:00–1:30 2.64 9
13:30–14:00 5.06 14 1:30–2:00 2.72 9
14:00–14:30 4.78 14 2:00–2:30 2.66 9
14:30–15:00 4.82 14 2:30–3:00 2.48 9
15:00–15:30 4.84 15 3:00–3:30 1.98 8
15:30–16:00 4.76 15 3:30–4:00 1.8 8
16:00–16:30 4.56 16 4:00–4:30 1.62 7
16:30–17:00 4.54 16 4:30–5:00 1.56 7
17:00–17:30 4.72 16 5:00–5:30 1.62 7
17:30–18:00 4.74 16 5:30–6:00 1.62 7

Fig. 2. Change in the expected number of emergency calls during a 24 h period.

ambulances on duty to 7, vary the planning horizon from 70 to
160 min in steps of 10, and fix the number of scenarios to 50. We
notice that this change has little effect on the computational time
which varies between 29 and 33 s, with no increase in computa-
tional time as the number of time periods increases. The service
level varies between 90% and 97% while the number of relocations
varies between 1 and 2. For tests (41–50), the number of
ambulances on duty is set to 14 and the planning horizon is
varied between 70 and 160. Similar to tests (31–40) we notice
that the increase in the planning horizon has little effect on the
computational time, being between 31 and 36 s. The service level
varies between 91% and 97% and the number of relocations varies
between 0 and 2.
In Table 4, we evaluate the effect of the number of ambulances
on the performance of the algorithm. We conduct two separate
tests, the first occurring at 8:00 (tests 51–61) and the second
occurring at 12:00 (tests 62–72). The number of ambulances is
gradually increased from 5 to 15, the planning horizon is fixed to
120 min, and the number of scenarios generated for each test is
set to 50. The results show that the computational time is
between 27 and 40 s. As expected, the number of relocation
decreases as the number of ambulances decreases.
In Table 5, we evaluate the effect of the number of scenarios on
the performance of the algorithm. We vary the number of
scenarios between 20 and 160 in steps of 10. We conduct two
separate tests, the first occurring at 2:00 (tests 73–87) and the
second occurring at 14:00 (tests 88–102). For (tests 73–87), the
computational time increases from 28 to 44 s while the service
level varies between 90% and 97%. The number of relocations is
low and varies between 0 and 2 relocations. For (tests 88–102),
the computational time increases from 35 to 43 s while the
service level varies between 90% and 97% and the number of
1976 J. Naoum-Sawaya, S. Elhedhli / Computers & Operations Research 40 (2013) 1972–1978

Table 2 Table 4
Computational results for tests occurring at different times of the day. Evaluating the effect of the number ambulances on duty.

Test Time Ambulances Time Number of Relocations Service CPU Test Time Ambulances Time Number of Relocations Service CPU
of day on duty periods scenarios level (s) of day on duty periods scenarios level (s)
(1) (2) (3) (4) (5) (6) (7) (8) (1) (2) (3) (4) (5) (6) (7) (8)

1 06:02 7 120 50 2 93 27 51 08:00 5 120 50 3 92 27

2 07:15 8 120 50 2 92 29 52 08:00 6 120 50 3 95 28
3 07:19 8 120 50 2 93 34 53 08:00 7 120 50 3 96 32
4 07:28 8 120 50 3 96 29 54 08:00 8 120 50 3 92 32
5 08:22 10 120 50 2 94 27 55 08:00 9 120 50 2 91 35
6 08:34 10 120 50 2 91 31 56 08:00 10 120 50 4 91 33
7 08:55 10 120 50 1 91 27 57 08:00 11 120 50 2 90 37
8 10:04 12 120 50 2 95 32 58 08:00 12 120 50 2 95 38
9 10:27 12 120 50 2 96 29 59 08:00 13 120 50 1 94 36
10 10:30 12 120 50 2 92 34 60 08:00 14 120 50 0 94 39
11 10:59 12 120 50 1 93 26 61 08:00 15 120 50 0 92 38
12 12:31 14 120 50 1 94 30
Min 0 90% 27
13 13:21 14 120 50 1 91 36
Avg. 2.09 92.91% 34.09
14 14:00 14 120 50 2 92 30
Max 4 96% 39
15 14:12 14 120 50 1 91 27
16 14:27 14 120 50 2 92 27 62 12:00 5 120 50 3 96 27
17 15:01 15 120 50 2 93 22 63 12:00 6 120 50 3 93 28
18 16:31 16 120 50 1 94 27 64 12:00 7 120 50 2 95 28
19 17:53 16 120 50 1 92 36 65 12:00 8 120 50 2 90 32
20 19:36 15 120 50 2 93 22 66 12:00 9 120 50 3 94 32
21 21:57 11 120 50 3 92 34 67 12:00 10 120 50 2 95 33
22 22:15 11 120 50 3 91 35 68 12:00 11 120 50 2 91 37
23 23:56 11 120 50 4 91 30 69 12:00 12 120 50 1 96 35
24 00:54 9 120 50 2 95 39 70 12:00 13 120 50 1 94 38
25 01:27 9 120 50 2 93 29 71 12:00 14 120 50 0 92 38
26 02:58 9 120 50 2 93 35 72 12:00 15 120 50 0 90 40
27 03:48 8 120 50 3 91 22
Min 0 90% 27
28 04:12 7 120 50 1 94 33
Avg. 1.73 93.27% 33.45
29 05:23 7 120 50 1 92 33
Max 3 96% 40
30 05:53 7 120 50 1 92 27

Min 1 91% 22
Avg. 1.87 92.73% 29.97
Max 4 96% 39
relocations varies between 0 and 2 relocations. The computa-
tional results show a clear increasing trend in the computational
time as the number of scenarios increases.
In Table 6, we evaluate the impact of the new Ambulance Act
Regulation which requires that an ambulance should arrive on scene
Table 3 in less than 8 min and compare the results against the current
Evaluating the effect of the number of time periods in the planning horizon.
requirement of 10 min and 30 s service time. As expected, the new
Test Time Ambulances Time Number of Relocations Service CPU stricter requirements have a negative impact on the service level
of day on duty periods scenarios level (s) and the number of relocations. With an 8 min service time, the
(1) (2) (3) (4) (5) (6) (7) (8) service level is always lower than the desired 90% level. For that we
had to lower the required service level (constraint (6)) to 80% so that
31 03:00 7 70 50 1 93 29
the model becomes feasible. On average, the service level is 84.85%
32 03:00 7 80 50 2 90 32
33 03:00 7 90 50 2 93 33 while with a 10 min 30 s service time the service level is 92.08%. The
34 03:00 7 100 50 2 92 32 relocations also increase as the service time is decreased. On average
35 03:00 7 110 50 1 97 32 with an 8 min service time, the number of relocations is 3 compared
36 03:00 7 120 50 2 97 29
to 1.38 for the 10 min 30 s service time standard.
37 03:00 7 130 50 1 95 31
38 03:00 7 140 50 1 91 29
Finally, we test if the 90% service level with 8 min service time
39 03:00 7 150 50 2 92 21 can be attained if new ambulances are added. The results are
40 03:00 7 160 50 2 94 30 shown in Fig. 3. As expected, adding ambulances increases the
Min 1 90% 29 service level. The service level increases from 84.93% to 87.05%
Avg. 1.6 93.4% 30.8 with 10 additional ambulances however fails to reach the 90%
Max 2 97% 33 required service level even if 20 ambulances are added. Most
41 14:00 14 70 50 1 91 31 importantly, these results suggest that with the new service time
42 14:00 14 80 50 1 96 35 standard, ROWEMS will fail to meet the required 90% service level
43 14:00 14 90 50 0 93 36 even if additional ambulances are added to the fleet and therefore
44 14:00 14 100 50 1 95 35
45 14:00 14 110 50 0 97 34
ROWEMS should seek other options such as building new stations
46 14:00 14 120 50 1 95 35 and relocating existing ones in order to meet the minimum
47 14:00 14 130 50 2 96 34 service levels. In fact, ROWEMS have started another study to
48 14:00 14 140 50 1 93 34 find new station locations that improve their service level.
49 14:00 14 150 50 0 91 32
50 14:00 14 160 50 1 91 36
3.1. Using the Manhattan metric to compute the travel distance
Min 0 91% 31
Avg. 0.8 93.8% 34.2
Max 2 97% 36
Besides the Euclidean norm, the Manhattan metric is typically
used to estimate the travel distances. In some regions and mostly
 J. Naoum-Sawaya, S. Elhedhli / Computers & Operations Research 40 (2013) 1972–1978 1977

in downtown areas, the road network has a geography that Manhattan metric and compare them to using the Euclidean
resembles to a rectangular grid where a Manhattan metric distance. The results are shown in Table 7. We notice that the
provides a more realistic estimate of the travel distances. In this problems that use the Manhattan metric have a higher number of
section, we evaluate the results that are obtained when using the relocations and a lower service level than the problems that use
the Euclidean distance. This is since the distances estimated using
Table 5 the Manhattan metric are typically larger than those estimated
Evaluating the effect of the number of scenarios. when using the Euclidean distance. For tests 116–128, using the
Manhattan metric achieves an average number of relocations of
Test Time Ambulances Time Number of Relocations Service CPU
1.69 and an average service level of 91%, while for the same
of day on duty periods scenarios level (s)
(1) (2) (3) (4) (5) (6) (7) (8) problems, by using the Euclidean distance the number of reloca-
tions is 1.38 and the service level is 92.15% on average.
73 02:00 12 100 20 1 94 28
74 02:00 12 100 30 1 90 31
75 02:00 12 100 40 0 96 33
4. Conclusion
76 02:00 12 100 50 1 95 32
77 02:00 12 100 60 1 95 35
78 02:00 12 100 70 2 92 34 In this paper, we considered the ambulance relocation pro-
79 02:00 12 100 80 0 97 36 blem for Emergency Medical Services, an important problem that
80 02:00 12 100 90 1 95 37 aims to maximize the efficiency of the Emergency Medical Service
81 02:00 12 100 100 0 93 38
82 02:00 12 100 110 1 91 38
Units by redeploying available ambulances to reestablish max-
83 02:00 12 100 120 1 95 37 imum coverage when some ambulances are responding to emer-
84 02:00 12 100 130 0 92 39 gency calls. Since relocations constitute a large portion of
85 02:00 12 100 140 1 95 38 ambulance activities, we presented a stochastic optimization
86 02:00 12 100 150 1 93 42
model that minimizes the number of relocations over a planning
87 02:00 12 100 160 1 94 44
horizon while maintaining an adequate service level. The sto-
Min 0 90% 28 chastic optimization model was based on the historical data that
Avg. 0.8 93.8% 36.13
Max 2 97% 44
is typically available for Emergency Medical Services and consti-
tutes a valuable resource for efficient planning.
88 14:00 14 100 20 1 93 35
Computational testing conducted using real data from the
89 14:00 14 100 30 0 95 38
90 14:00 14 100 40 2 93 36 Region of Waterloo EMS showed that the optimal relocation
91 14:00 14 100 50 1 96 38
92 14:00 14 100 60 1 95 37
93 14:00 14 100 70 1 97 37
94 14:00 14 100 80 0 90 38
95 14:00 14 100 90 0 93 38
96 14:00 14 100 100 0 93 39
97 14:00 14 100 110 1 95 39
98 14:00 14 100 120 1 94 40
99 14:00 14 100 130 0 90 39
100 14:00 14 100 140 1 96 40
101 14:00 14 100 150 1 93 42
102 14:00 14 100 160 1 96 43

Min 0 90% 35
Avg. 0.73 93.93% 38.6
Max 2 97% 43
Fig. 3. Service level.

Table 6
8 min vs 10 min 30 s service time.

Test Time of day Ambulances on duty Time periods Scenarios Service time

8 min 10 min 30 s

Relocations Service level CPU (s) Relocations Service level CPU (s)

103 7:32 8 100 50 4 82 35 2 92 32

104 7:56 8 100 50 2 88 29 2 92 29
105 7:40 9 100 50 3 83 33 2 93 36
106 10:25 12 100 50 2 82 32 2 92 33
107 11:04 12 100 50 3 86 33 1 91 37
108 12:32 14 100 50 3 84 29 1 92 29
109 14:17 14 100 50 4 87 33 1 90 31
110 15:56 15 100 50 4 85 37 1 92 34
111 21:29 11 100 50 2 83 25 0 94 28
112 22:40 11 100 50 3 86 31 1 91 27
113 23:11 11 100 50 3 88 22 1 92 25
114 1:18 9 100 50 2 84 28 2 94 25
115 4:55 8 100 50 4 85 27 2 92 29

Min 2 82% 22 0 90% 25

Avg. 3 84.85% 30.31 1.38 92.08% 30.38
Max 4 88% 37 2 94% 37
1978 J. Naoum-Sawaya, S. Elhedhli / Computers & Operations Research 40 (2013) 1972–1978

Table 7
Manhattan metric vs Euclidean norm.

Test Time of day Ambulances on duty Time periods Scenarios Manhattan metric Euclidean distance

Relocations Service level CPU (s) Relocations Service level CPU (s)

116 6:35 8 100 50 2 92 28 2 92 29

117 6:54 9 100 50 2 91 28 2 93 30
118 7:25 9 100 50 2 90 28 1 90 26
119 8:33 10 100 50 1 90 28 1 94 27
120 10:50 12 100 50 2 90 33 2 90 31
121 11:45 12 100 50 2 92 29 1 92 30
122 12:35 14 100 50 1 92 29 1 92 29
123 14:30 14 100 50 0 91 32 1 95 33
124 20:30 13 100 50 2 93 30 2 93 30
125 21:30 11 100 50 2 91 30 1 91 28
126 22:00 11 100 50 2 90 30 1 93 23
127 5:25 7 100 50 3 90 26 2 92 23
128 6:00 7 100 50 1 91 29 1 91 29

0 90% 26 1 90% 23
1.69 91% 29.23 1.38 92.15% 28.31
3 93% 33 2 95% 33

strategies can be computed within 40 s of computational time. To
the satisfaction of the ambulance crews, the number of reloca-
tions was low for a planning horizon of 2 h.
Acknowledgments
The authors would like to thank Armann Ingolfsson for
suggesting the maximum length of the time period of Section
2.1 and the Region of Waterloo Emergency Medical Services for
providing the historical data and the support for this research.
This research is also financially supported by the Natural Sciences
and Engineering Research Council (NSERC) and the Mathematics
of Information Technology and Complex Systems (MITACS).
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