Thesis (M.P.A.)--University of Hong Kong, 1999. / Includes bibliographical references. Also available in print.

Thesis (M.Arch.)--University of Hong Kong, 1998. / Includes special report study entitled : Design on slope. Includes bibliographical references. Also available in print.

The objective of this research was to study the operation of the ambulance service in the Greater Vancouver Regional District. Attention has been focused on operational policies which affect the system's ability to respond to calls, especially to emergency calls. The stated objective was accomplished by first reviewing the current demand for emergency ambulance services and the present operations. Next deterministic models were investigated and used to give "initial" locations of depots. Finally a computer simulation model was developed and used to conduct experiments, examining alternative ambulance systems. This research revealed that 1. computer simulation is an effective tool for analysing ambulance systems, and 2. there is a need for more emergency ambulance services, including more paramedics, in the Greater Vancouver Regional District. / Business, Sauder School of / Graduate

Bakgrund: Många av de patienter som insjuknar i stroke kommer till sjukhus med ambulans. Ambulanssjuksköterskors bedömning kan ha betydelse för att dessa patienter ska få ett snabbt omhändertagande och tidig behandling, vilket kan minska risken för bestående funktionsnedsättning och lidande samt påverka framtida livskvalitet. Som stöd i bedömningen finns idag behandlingsriktlinjer. Syfte: Syftet var att undersöka ambulanssjuksköterskors bedömning av patienter som drabbats av stroke avseende träffsäkerhet, samt skillnader i bedömning mellan de som bedömts ha stroke och de som ej bedömts ha stroke. Metod: Retrospektiv studie där journaler granskats med en kvantitativ ansats. Studiens urval bestod av patienter som skrivits ut från ett medelstort sjukhus i Västsverige under 2015, med ett vårdtillfälle där huvuddiagnos stroke angetts och som åkt ambulans till sjukhus med initial bedömning av en ambulanssjuksköterska, vilket resulterade i 454 journaler att granska. Resultat: För alla patienter med stroke som inkluderats i studien hade endast 52% av patienterna bedömts av ambulanssjuksköterskor ha stroke. Primär och sekundär bedömning var gjord i hög grad för alla patienter. Signifikanta skillnader fanns kring hur strokespecifika symtom var bedömda. Symtom från ansikte, arm eller ben, påverkan på tal och ögon var i högre grad bedömt i gruppen där ambulanssjuksköterskor bedömt att patienter drabbats av stroke. Huvudvärk, yrsel och illamående bedömdes i högre grad i gruppen ej stroke. Slutsatser: Mer forskning inom området behövs för att öka andelen patienter med stroke som identifieras av ambulanssjuksköterskor.

published_or_final_version / abstract / Public Administration / Master / Master of Public Administration

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

In this thesis, we propose an optimization model to assist the Region of Waterloo Emergency Medical Services (EMS) to meet the new provincial land ambulance response time standard. The new land standard requires multiple response time thresholds which are based on the acuity of the patient determined at the time the 911 call is made. The performance of an EMS system is affected by many factors, including the number of ambulances deployed, their locations, and the dispatching strategy that is employed. The number of ambulances available over the course of the day varies when ambulance crews start and end their shifts, and when ambulance crews are called out or return from a call. In order to maintain coverage, it is therefore desirable to locate ambulances in stations as a function of how many are available, and the geography and frequency of potential calls. This may result in relocation of ambulances whenever there is a change in the number of available vehicles. This research provides a compliance table indicating how many ambulances to locate at each station when the number of available ambulances is given. We explore two main objectives: 1) maximizing the expected coverage for all patients, and 2) maximizing the coverage for the most acutely ill patients. Constraints include the number of available ambulances, the response time requirements, and service level constraints for each acuity level. In this study, we conducted an empirical analysis of ambulance response times, travel times to a hospital, and time spend at the hospital. We used two years of EMS data from July 2006 to June 2008 for the Region of Waterloo (ROWEMS). Based on this study, we show that using the binomial distribution to represent the number of busy ambulances suggested by Gendreau et al. (2006) is only valid for low utilization rates. The problem of allocating available ambulances among candidate stations is formulated as a Mixed Integer Non-linear Problem (MINLP) model that includes the priority of calls and multiple daytime periods. Computational results using the ROWEMS data will be presented. A detailed comparison shows that the predictions obtained from our model are often as good as the Approximate Hypercube (AH) model, but with a simpler and quicker procedure. The model proposed in this thesis can also be used as a planning tool to find promising candidate locations for new ambulance stations.

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

In this thesis, we propose an optimization model to assist the Region of Waterloo Emergency Medical Services (EMS) to meet the new provincial land ambulance response time standard. The new land standard requires multiple response time thresholds which are based on the acuity of the patient determined at the time the 911 call is made. The performance of an EMS system is affected by many factors, including the number of ambulances deployed, their locations, and the dispatching strategy that is employed. The number of ambulances available over the course of the day varies when ambulance crews start and end their shifts, and when ambulance crews are called out or return from a call. In order to maintain coverage, it is therefore desirable to locate ambulances in stations as a function of how many are available, and the geography and frequency of potential calls. This may result in relocation of ambulances whenever there is a change in the number of available vehicles. This research provides a compliance table indicating how many ambulances to locate at each station when the number of available ambulances is given. We explore two main objectives: 1) maximizing the expected coverage for all patients, and 2) maximizing the coverage for the most acutely ill patients. Constraints include the number of available ambulances, the response time requirements, and service level constraints for each acuity level. In this study, we conducted an empirical analysis of ambulance response times, travel times to a hospital, and time spend at the hospital. We used two years of EMS data from July 2006 to June 2008 for the Region of Waterloo (ROWEMS). Based on this study, we show that using the binomial distribution to represent the number of busy ambulances suggested by Gendreau et al. (2006) is only valid for low utilization rates. The problem of allocating available ambulances among candidate stations is formulated as a Mixed Integer Non-linear Problem (MINLP) model that includes the priority of calls and multiple daytime periods. Computational results using the ROWEMS data will be presented. A detailed comparison shows that the predictions obtained from our model are often as good as the Approximate Hypercube (AH) model, but with a simpler and quicker procedure. The model proposed in this thesis can also be used as a planning tool to find promising candidate locations for new ambulance stations.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy