Reorganization of an Emergency Medical System in a Mixed Urban-Rural Area

The reorganization of an emergency medical system means that we look for new locations of ambulance stations with the aim of improving the accessibility of the service. We applied two tools that are well known in the operations research community, namely mathematical programming, and computer simulation. Using the hierarchical pq-median model, we proposed optimal locations of the stations throughout the country and within large towns. Several solutions have been calculated that differ in the number of stations that are supposed to be relocated to new positions. The locations proposed by the mathematical programming model were evaluated via computer simulation. The approach was demonstrated under the conditions of the Slovak Republic using real historical data on ambulance dispatches. We have concluded that (i) the distribution of the stations proposed by the hierarchical pq-median model overcomes the current distribution; the performance of the system has significantly improved even if only 10% of the stations are relocated to new municipalities; (ii) the variant that relocates 40% of the stations is a reasonable compromise between the benefits and induced costs; (iii) optimizing station locations in big towns can significantly improve the local as well as the nationwide performance indicators; the response times in two regional capitals has reduced by more than 4 min.