4th International Workshop on Planning of Emergency Services

Theory and Practice

HOSPITAL

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Sponsors

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Welcome

We are more than delighted to welcome you at the “4th International Workshop on Planning of Emergency Services” at Delft University of Technology.

Over the past few years the need to enhance cost efficiency and to deliver top quality emergency care at affordable cost has been well-recognized in the emergency sector. The use of advanced planning techniques and dispatching policies has been gaining momentum rapidly, catalyzed by exciting and promising developments in the area of dynamic ambulance management. At the same time, the spectacular developments in areas such as data processing, high-performance computing, and operations research have opened up tremendous possibilities for enhancing the efficiency and improving the quality of emergency services.

The main goal of the workshop is to bring together researchers and practitioners who are active in the field. To this end, we have succeeded in putting together an excellent technical program with keynote talks by world-leading researchers, Laura Albert (University of Wisconsin-Madison) and Jo Røislien (University of Stavanger), supplemented with a variety of invited and contributed talks covering a range of topics by both practitioners and researchers from academia.

On Monday June 19, the main focus will be on the scientific progress in the field, and Tuesday June 20 is the Practitioners’ Day, where the main focus will be on the needs raised by practitioners working in the emergency sector.

The workshop will be held in Delft, a city in the Netherlands located to the north of Rotterdam and south of The Hague. Delft is known for its historic town center with canals, Delft Blue pottery, the Delft University of Technology, the painter Johannes Vermeer and the scientist Antony van Leeuwenhoek, and its association with the royal House of Orange-Nassau.

We wish you a pleasant and rewarding stay in Delft.

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General information

Venue The entire program of the conference takes place in the Mekelzaal at the Science Centre Delft, Mijnbouwstraat 120, 2628 RX Delft.

Public transport The public transport network of Delft consists of buses, trams and trains. The trams and buses ride up to 0:30. Because Delft is a rather small city, you can also easily get around by foot. To plan your journey, visit www.ns.nl (trains only) or www.9292.nl (door to door). Route The train station closest to Science Centre Delft is Delft Central station.

From there, it takes approximately 10 minutes to get to Science Centre

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Delft by bus 37 (to Delfgauw), bus 60 (to Nootdorp), and bus 64 (to Delft), which you have to exit at bus stop “Michiel de Ruyterweg”, and bus 40 (to Rotterdam), bus 55 (to Zoetermeer), bus 69 (to Technopolis) and bus 174 (to Rotterdam Noord), which you have to exit at bus stop “Julianalaan”. Science Centre Delft is at 15 minutes walking distance from Delft Central station. If you come by car, parking at Science Centre Delft is for free. If there are no parking spaces available anymore at Science Centre Delft, there are also parking spaces at Zuidplantsoen.

Tickets Train tickets can be bought in the vending machines at the stations. Not all of them accept coins or credit cards, but there is at least one per station that does. For bus or tram, the best is to buy a disposable chip card in the vending machines at the train station or in buses and trams. Taxi There are also taxis available at Delft Central station. From Delft Central station to Science Centre Delft the price will be around €9.

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Registration desk The registration desk is located at the entrance of the Mekelzaal. Opening hours: • Monday : 09:00 – 13:00 • Tuesday : 09:00 – 12:30 Internet access To access the internet, connect to the network ‘EMS workshop’ by using the password ‘tudelft2017’. The eduroam network is also available at the workshop venue and in the city center.

Contact information Our website: www.tudelft.nl/EMSworkshop Our phone number: +31 (0)15 27 86266 Coffee breaks & lunches The coffee breaks and lunches will take place in the Mekelzaal of the Science Centre Delft. During the lunch break on Tuesday, you will have the possibility to visit the exhibition of the Science Centre Delft. Conference dinner

Monday, June 19, 19:00 Restaurant Van der Dussen Bagijnhof 118 2611 AS Delft

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Keynote speakers Laura Albert Laura A. Albert, Ph.D., is the Assistant Dean for Graduate Studies in the College of Engineering and an Associate Professor of Industrial & Systems Engineering at the University of Wisconsin-Madison. She received her Ph.D. from the University of Illinois at Urbana-Champaign. Her research interests are in the field of operations research, with a particular focus on discrete optimization with application to homeland security and emergency response problems. Dr. Albert’s research has been supported by NSF, DHS, and the Department of the Army, Sandia National Laboratory, and she has been awarded an NSF CAREER award. She has authored or co-authored 45 publications in archival journals and refereed proceedings. Her research has been awarded several honors, including four best paper awards. Dr. Albert is the INFORMS Vice President for Marketing, Communication, and Outreach. She has also served as the President of Women in OR/MS (WORMS, a forum of INFORMS), the President of the INFORMS Section on Public Sector Operations Research, and a member of the INFORMS Strategic Planning Committee, Finance Committee, and IT committee. Dr. Laura Albert is a Department Editor for IIE Transactions and has been on the Editorial Boards for Risk Analysis, International Transactions on Operational Research, and OMEGA. Dr. Albert is a member of INFORMS, IIE, the Society for Risk Analysis, Tau Beta Pi, and Alpha Pi Mu. She recently served on a National Research Council Committee. She is the author of the blogs “Punk Rock Operations Research” and “Badger Bracketology.” You can find her on twitter at @lauraalbertphd.

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Jo Røislien Jo Røislien is a Professor of medical statistics at the University of Stavanger, Norway. He holds an MSc in industrial mathematics (1998) and a PhD in geostatistics (2004), before turning to biostatistics and medical research where he did his postdoc, and has since co-authored almost 100 peer reviewed research papers within the health sciences. His focus has been on the introduction and application of non-traditional mathematical and statistical methods into various medical research fields, ranging from gait analysis and addiction, to obesity and public health. For the last years his work has focused on pre-hospital critical care, collaborating with the Norwegian Air Ambulance Foundation. Røislien is one of Scandinavia’s most renowned science communicators, and has hosted several science TV-series for a general audience in Norway and Scandinavia, on mathematics, statistics, engineering and life sciences.

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Program Monday June 19 Keynote Talk 10:00 – 11:00 Delivering emergency medical services: research, theory, and application Laura Albert Researchers have been developing optimization models and methods to locate ambulances for more than 40 years. A body of literature for locating and dispatching ambulances has grown to lift simplifying assumptions and address important issues overlooked in the early research models in this area. However, many research challenges remain. In this talk, Dr. Laura Albert will discuss her research in emergency medical service systems that has resulted in several key insights into how to allocate scarce public resources for responding to health emergencies. She will focus on how to use optimization models and algorithms to effectively leverage patient triage information when determining how to locate and dispatch ambulances. Research in this area provides important guidance into how emergency medical service departments should use scarce resources to balance of patients with different priorities given that triage information regarding patient needs is dynamic. She will also discuss emergency medical service performance measures and insights obtained from putting the results into practice in a real world setting.

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EMS data analysis 11:30 – 13:00 Emergency event forecasting Niki Matinrad One aim for emergency medical services is to provide quick and efficient medical treatment and transportation to out-of-hospital patients. To achieve this, proper resource management is necessary, and a key factor is to have information about the expected demand for service. In this study, a forecasting model for daily medical emergencies is presented. In order to achieve high precision, influencing variables such as socio-economic aspects and population distribution are taken into account. Furthermore, the model should be able to incorporate real-time data such as weather forecasts and road and traffic conditions, if such data is available. A generalized preparedness measure for increased situational awareness in emergency management Tobias Andersson Granberg Preparedness, defined as the ability to respond to emergencies both now and in the future, can be assessed using a preparedness measure, thus enhancing the situational awareness for emergency managers such as ambulance dispatchers. Different emergency resources contribute to the preparedness in different ways. For fire and rescue services, the type of vehicle and the available equipment have to be matched to the type of emergency. For ambulances, it is necessary to consider varying availability, and the same applies for volunteers whose availability is uncertain. A generalized preparedness measure is presented, capable of modelling the contribution of any emergency resource.

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Misuse of emergency services? Nuno Cardoso Patients are frequently transported to Emergency Departments (EDs) by ambulance. Some of these patients may not meet the criteria for an urgent response, leading to unavailability of emergency transportation resources and unnecessary overload of EDs. We collected one year of ED admissions in a Portuguese hospital system composed by two hospitals, and have analyzed the data of patients that were transported by ambulance to access their severity (according to Manchester’s triage), outcome, length of stay in ED, and type of ambulance used. Our results indicate that a significant proportion of these admissions did not meet the required emergency criteria thresholds. Real-time emergency deployment 14:00 – 15:30 Optimization model for flood evacuation with bridge capacities Anika Kinscherff We present an optimization model for evacuation planning after flooding which is based on dynamic network flows, but considers additionally the impact of bridges. Since bridges are vulnerable to flooding and other hazards, this can have an impact on the load a bridge can carry. Hence, we consider networks that can deal with two types of arcs: Regular transit arcs and bridge arcs, for which aggregated arc capacities have to be taken into acount. We present exact methods as well as a heuristic, and report on computational results on random networks and street networks. (Partially supported by BMBF, No. 13N13198.)

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A two-phase optimization approach to the ambulance dispatching and relocation problem Ana Sofia Carvalho Decision-making is essential in the Emergency Medical Service (EMS) context. We focus on real-time decisions by solving the ambulance dispatching and relocation problem. These problems are considered in a two-phase optimization approach: dispatching decisions assign ambulances to emergencies and, then, the optimal redistribution of existing available ambulances is defined. To face the huge level of uncertainty involved, we use a preparedness function which, although being a simple measure, is capable of securing a long-term efficiency, evaluating the future ability of the system to handle potential emergencies. The Portuguese case of EMS is used as a case study. Relocation and dispatching approaches for the German EMS system Melanie Reuter-Oppermann In this talk we study if ambulance relocations and different dispatching rules can be applied in German practice in order to improve the performance, i.e. reduce response times. We discuss promising approaches that were adapted to the German EMS system in order to model that emergency doctors are often called to the scene in addition to an ambulance and that in case of several patients also multiple ambulances are necessary. We use test instances that were generated for German EMS regions based on a data analysis to study the impact of the underlying network structure on the performance.

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AED location models 16:00 – 16:45 Strategic location of automated external defibrillators Derya Demirtas Out-of-hospital cardiac arrest is a significant public health issue, and treatment, namely, cardiopulmonary resuscitation and defibrillation, is very time sensitive. Automated external defibrillators (AEDs) are deployed in public settings for bystander use in order to improve survival rates. In this study, we develop models to guide the deployment of public AEDs. Our models generalize existing location models and incorporate differences in bystander behaviour. We formulate three mixed integer nonlinear models and derive equivalent integer linear reformulations or easily computable bounds. We compare our locations to the actual AED locations in Toronto, and show that the optimization outperforms the existing approach. Optimizing the deployment of automated external defibrillators on a large scale by a data-driven algorithmic approach Arthur Nazarian Out-of-hospital cardiac arrests are a major public health problem, being responsible for 6 million deaths annually worldwide. However, public automated external defibrillators (AEDs) considerably improve survival by reducing the time to defibrillation. This study improves upon existing literature by introducing an effective polynomial time algorithm for deploying AEDs to minimize the total time to defibrillation. The algorithm accounts for uncertainty in future cardiac arrest locations and temporal availability of AEDs. We apply our methodology using data from North Holland and Twente regions and show potential for significant improvements. This is the first study on data-driven AED location in the Netherlands.

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Pitches 16:45 – 17:30 During this session, pitches of 5 minutes are given on current or future research by:

• Tobias Andersson Granberg • Nuno Cardoso • Derya Demirtas • Niki Matinrad • Melanie Reuter-Oppermann • Krisjanis Steins • Nancy ter Bogt

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Tuesday June 20 Keynote Talk 10:00 – 11:00 From politics to mathematics: Exploring air ambulance base locations in Norway Jo Røislien Norway has a nationwide physician manned air ambulance service with 12 bases, established through historical local engagement from the 1970s. Government requirements state that 90% of the population should be reached within 45 minutes. Using the Maximal Covering Location Problem (MCLP) facility location optimization model we estimate optimal helicopter base locations, both in green field scenario and conditioning on the current base structure. The whole population could be reached in 45 minutes or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases.

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Invited talks 11:30 – 12:30 RBS Care features and architecture Henk Post RBS Care is developed in cooperation with Witte Kruis. RBS Care has been developed from the ground up as a modular based service, in order to easily update or exchange parts of the system as required. A brief insight in the main modules of RBS Care will be presented. Furthermore, some of the features of RBS Care will be shown during the presentation:

• Tools for the (re)positioning of emergency vehicle depots. • Assignment of emergency vehicles to an A1/A2 call. • Dynamic repositioning of emergency vehicles. • The B-planning tool that is currently under development will

also be highlighted.

From mathematics to life: translating models to real situations Javier Salguero One of the many motivations to develop mathematical models is explaining and solve real life problems. Modeling involves making simplifications and assumptions in order to isolate the problem from everything that is not essential to it and make it solvable. Using it in real life applications requires considering many non-mathematical factors as well as reevaluating the assumptions made to develop the model. In Stokhos BV, we have experience in converting an academic project into a commercial and practical solution that improve the efficiency of ambulance services and reduce the time needed by ambulance to reach patients.

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Invited talks 14:00 – 15:00 Serious gaming for dispatchers Melle Schreij Dispatch City is a serious game designed for dispatchers in the Netherlands. The gameplay of Dispatch City will be shown in this workshop. In this game students and employees get to play different scenario’s in a fictive region. By playing Dispatch City dispatchers learn how to react when a similar scenario takes place while they are working. Besides that, they also learn the principles of Dynamic Ambulance Management. In this workshop the added value of serious games for education and training purposes will be discussed. Furthermore, the results of a first evaluation study on Dispatch City will be presented. Looking ahead: future developments in the demand for ambulance care Geert Jan Kommer Some future developments in EMS are difficult to foresee. Others, however, are more clear and can be anticipated upon. For instance, if we look at the demographic patterns of the demand for ambulance services in the past and combine these with demographic projections for the future, we can foresee impressive increase numbers for the demand of ambulance services. On top of this comes the autonomous trend in the demand for services. For certain types of ambulance care this autonomous trend is more dominant than the demographic factor. The autonomous trend is partly related to substitution of emergency care from other EMS-providers, such as GP’s in out of office hours. The challenge for the future organization of EMS-services is to manage the future demand for ambulance services, and in general, EMS-services, in an efficient way, making use of upcoming technologies and new organizational models.

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List of participants

Name Affiliation Karen Aardal Delft University of Technology Laura Albert University of Wisconsin-Madison Tobias Andersson Granberg Linköping University Jasper Bos University of Twente Nuno Cardoso Universidade do Minho Ana Sofia Carvalho CMAF-CIO Universidade de Lisboa Derya Demirtas University of Twente Rolf Egberink Acute Zorg Euregio Antonio Esteves Universidade Minho Anika Kinscherff University of Kaiserslautern Geert Jan Kommer RIVM Thomas Krafft Maastricht University Niki Matinrad Linköping University Arthur Nazarian University of Twente

Jerry Overton Maastricht University & International Academies for Emergency Dispatch

Krista Peeters Academie voor Ambulancezorg Henk Post Transdev Bert Quak Transdev Melanie Reuter-Oppermann Karlsruhe Institute of Technology Rasmus Ringdahl Linköping University Jo Røislien University of Stavanger Javier Salguero Stokhos Melle Schreij Academie voor Ambulancezorg David Silva Universidade Minho Remko Stam ANWB Krisjanis Steins Linköping University Nancy ter Bogt Acute Zorg Euregio Martin van Buuren Stokhos Pieter van den Berg Rotterdam School of Management Rob van der Mei CWI Theresia van Essen Delft University of Technology Onno Warnaars ANWB

Program at a glance

Monday June 19th Tuesday June 20th

09:00 - 09:30 Registration & coffee

09:30 - 10:00 Welcome & opening Registration & coffee

10:00 - 10:30 Keynote lecture: Laura Albert

Keynote lecture: Jo Røislein

10:30 - 11:00

11:00 - 11:30 Coffee break Coffee break

11:30 - 12:00 EMS data analysis Invited talks

12:00 - 12:30

12:30 - 13:00 Lunch & Visit Science Centre Delft

13:00 - 13:30 Lunch

13:30 - 14:00

14:00 - 14:30 Real-time emergency deployment

Invited talks

14:30 - 15:00

15:00 - 15:30 Closing session

15:30 - 16:00 Coffee break Drinks

16:00 - 16:30 AED location models & Pitches

16:30 - 17:00

17:00 - 17:30

17:30 - 18:00

18:00 - 18:30

18:30 - 19:00

19:00 - end Conference dinner