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原文传递 Improving Rural Emergency Medical Services (EMS) through Transportation System Enhancements Phase.

题名：	Improving Rural Emergency Medical Services (EMS) through Transportation System Enhancements Phase.
作者：	Qin, X.; He, Z.; Samra, H.
关键词：	Improvements, Emergency medical services (EMS), Rural areas, Highway engineering, Acute medical care, First responder capabilities, National EMS Information System (NEMSIS)
摘要：	Providing acute medical care outside of the hospital, Emergency Medical Services (EMS) is crucial in rural environments where hospitals are not close by and are difficult to access. Establishing EMS performance measures is critical in improving a rural community’s access to these services and eliminating systemic inequalities; however, an absence of quantitative performance analysis leads to challenges in developing attainable objectives and service metrics. Hence, the main objectives in this study are as follows: 1) to establish more specific, data-driven, and rural EMS performance-based measures 2) to increase the utilization of rural EMS resources through station planning and location optimization 3) to identify key variables contributing to response time, specifically, en route time This study used the National EMS Information System (NEMSIS) South Dakota data to exemplify two approaches to establishing data-driven performance measures for each rural EMS provider. The measures—timely service and service coverage—are both dependent on mobility and the accessibility of the transportation network in which a suggested 8-minute response time zone is calculated for every provider. Service coverage is measured by the coverage ratio, which is the number of emergency calls within the 8-minute zone over the total number of emergency calls responded. Timely service is gauged by the percentage of emergency calls that were actually responded to in less than 8 minutes within the 8-minute zone. The results of performance measures help to identify the specific areas for improvements and needed resource and training. If the service provided by the current EMS provider is not sufficient, the stations can either be relocated or augmented to increase the service coverage and quality. Maximizing ambulance coverage area and minimizing en route time are two different goals for strategically locating EMS stations. Maximizing ambulance coverage can be treated as the maximal covering location problem (MCLP) that maximizes the demand served within a specified time or distance for a given number of stations. Minimizing en route time is the location set covering problem (LSCP) that aims to minimize the number of facilities when all demands are met. The two objectives influence each other in such a way that reducing the average en route time for uncovered demand areas may decrease the total coverage ratio. The balance can be achieved through optimizing a bi-objective covering location model that considers not only the coverage rate but also the en route time equity. Case studies were performed for Todd County, a less populous county with relatively high demand, and Minnehaha County, a populous county with moderate demand to demonstrate the varying optimal solutions under different constraints. The factors contributing to en route time were thoroughly reviewed and 13 key variables were identified, including six variables that are specific to 911 calls (e.g., case type, response, mode, location type) and seven variables that characterize the service provider (e.g., professional/volunteer, unit hour utilization, road connectivity). Among several regression models developed and evaluated, the Geographically Weighted Regression (GWR) model was found to produce the best goodness-of-fit and provide additional insights into the particular spatial patterns of coefficient estimates that can be used to explore the influence of unobserved heterogeneity among EMS providers.
总页数：	Qin, X.; He, Z.; Samra, H.
报告类型：	科技报告