A Sustainable Model for Emergency Medical Services in Developing Countries: A Novel Approach Using Partial Outsourcing and Machine Learning.

introductionUnlike Western countries, many low- and middle-income countries (LMIC), like India, have a de-centralized emergency medical services (EMS) involving both semi-government and non-government organizations. It is alarming that due to the absence of a common ecosystem, the utilization of resources is inefficient, which leads to shortage of available vehicles and larger response time. Fragmentation of emergency supply chain resources motivates us to propose a new vehicle routing and scheduling model equipped with novel features to ensure minimal response time using existing resources. MATERIALS AND

methodsThe data set of medical and fire-related emergencies from January 2018 to May 2018 of Uttarakhand State in India was provided by GVK Emergency Management and Research Institute (GVK EMRI) also known as 108 EMSs was used in the study. The proposed model integrates all the available EMS vehicles including partial outsourcing to non-ambulatory vehicles like police vans, taxis, etc., using a novel two-echelon heuristic approach. In the first stage, an offline learning model is developed to yield the deployment strategy for EMS vehicles. Seven well researched machine learning (ML) algorithms were analyzed for parameter prediction namely random forest (RF), convolutional neural network (CNN), k-nearest neighbor (KNN), classification and regression tree (CART), support vector machine (SVM), logistic regression (LR), and linear discriminant analysis (LDA). In the second stage, a real-time routing model is proposed for EMS vehicle routing at the time of emergency, considering partial outsourcing. RESULTS AND DISCUSSION: The results indicate that the RF classifier outperforms the LR, LDA, SVM, CNN, CART and NB classifier in terms of both accuracy as well as F-1 score. The proposed vehicle routing and scheduling model for automated decision-making shows an improvement of 42.1%, 54%, 27.9% and 62% in vehicle assignment time, vehicle travel time from base to scene, travel time from scene to hospital, and total response time, respectively, in urban areas.