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Equity-constrained dispatching models for emergency medical services

机译：紧急医疗服务的权益约束调度模型

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Purpose - The purpose of this paper is to apply agent-based modeling and simulation concepts in evaluating different approaches to solve ambulance-dispatching decision problems under bounded rationality. The paper investigates the effect of over-responding, i.e. dispatching ambulances even for doubtful high-risk patients, on the performance of equity constrained emergency medical services. Design/methodology/approach - Agent-based modeling and simulation was used to evaluate two different dispatching policies: first, a policy based on maximum reward, and second, a policy based on the Markov decision process formulation. Four equity constraints were used: two from the patients' side and two from the providers' side. Findings - The Markov decision process formulation, solved using value iteration method, performed better than the maximum reward method in terms of number of patients served. As the equity constraints conflict with each other, at most three equity constraints could be enforced at a time. The study revealed that it is safe to over-respond if there is uncertainty in the risk level of the patients. Research limitations/implications - Further research is required to understand the implications of under-responding, where doubtful high-risk patients are denied an ambulance service. Practical implications - The need for good triage system is apparent as over-responding badly affects the operational budget. The model can be used for evaluating various dispatching policy decisions. Social implications - Emergency medical services have to ensure efficient and equitable provision of services, from the perception of both patients and service providers. Originality/value - The paper applies agent-based modeling to equity constrained emergency medical services and highlights findings that are not reported in the existing literature.
机译：目的-本文的目的是将基于主体的建模和仿真概念应用于评估在有限理性下解决救护车调度决策问题的各种方法。本文研究了过度响应（即即使为可疑的高危患者也派遣救护车）对公平约束的紧急医疗服务的绩效的影响。设计/方法/方法-基于代理的建模和仿真用于评估两种不同的调度策略：第一，基于最大奖励的策略，第二，基于马尔可夫决策过程公式的策略。使用了四个公平约束：两个来自患者方面，两个来自提供者方面。调查结果-使用价值迭代方法求解的马尔可夫决策过程公式在服务的患者数量方面比最大奖励方法更好。由于公平约束相互冲突，一次最多可以实施三个公平约束。该研究表明，如果患者的风险水平不确定，则过度反应是安全的。研究的局限性/含义-需要进一步的研究以了解反应不足的含义，在此情况下，可疑的高危患者被拒绝提供救护车服务。实际意义-由于响应过度会严重影响运营预算，因此对良好的分类系统的需求显而易见。该模型可用于评估各种调度策略决策。社会影响-紧急医疗服务必须从患者和服务提供者的角度出发，确保高效，公平地提供服务。原创性/价值-本文将基于代理的模型应用于股权受限的紧急医疗服务，并突出显示了现有文献中未报告的发现。

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