Deng Yufan, Zhang Yumeng, Pan Jay
HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Risk Manag Healthc Policy. 2021 Apr 30;14:1791-1802. doi: 10.2147/RMHP.S304475. eCollection 2021.
Rational location of emergency medical service (EMS) facilities could improve access to EMS, and thus assist in saving patients' lives and improving their health outcomes. A considerable amount of spatial optimization research has been devoted to the development of models to support location planning in the context of EMS, with extensive applications in policy making around the world. However, in China, studies on the location of EMS facilities have not been paid enough attention to, let alone their practical applications. This paper conducted location optimization for EMS facilities in Chengdu, one of the biggest cities in southwest China with more than 16.5 million population, aiming to optimize the EMS system by adding (upgrading) a minimum number of EMS facilities to achieve a given population coverage.
Location optimization was conducted according to regional health policy goal for the EMS system in Chengdu, China, 2017. The nearest-neighbor approach was used to calculate the shortest travel time based on geographical information system (GIS). The location set covering model was used to formulate the optimization problem under China's context, and genetic algorithm (GA) was employed to determine the optimized locations.
The results showed that a minimum number of 55 new facilities were required to upgrade to EMS facilities to achieve the policy goal of 90% population coverage of EMS within 15 minutes. Access to EMS also improved substantially in terms of shortest travel time after facility upgrading. The weighted median shortest travel time to EMS facilities in Chengdu decreased by 14.57%, from 6.45 minutes to 5.51 minutes.
Our study showed that the solution could effectively achieve the policy goal of population coverage with a minimum number of new EMS facilities. Our findings would support evidence-based decision-making in future EMS planning in China.
合理布局紧急医疗服务（EMS）设施可改善获得EMS的机会，从而有助于挽救患者生命并改善其健康结局。大量空间优化研究致力于开发模型，以支持EMS背景下的选址规划，并在全球政策制定中得到广泛应用。然而，在中国，对EMS设施选址的研究尚未得到足够重视，更不用说其实际应用了。本文对中国西南部最大城市之一、拥有超过1650万人口的成都的EMS设施进行了选址优化，旨在通过增加（升级）最少数量的EMS设施来优化EMS系统，以实现给定的人口覆盖率。
根据中国成都2017年EMS系统的区域卫生政策目标进行选址优化。采用最近邻算法，基于地理信息系统（GIS）计算最短出行时间。运用位置集覆盖模型在中国背景下构建优化问题，并采用遗传算法（GA）确定优化后的位置。
结果表明，至少需要55个新设施升级为EMS设施，才能实现15分钟内EMS覆盖90%人口的政策目标。设施升级后，在最短出行时间方面，获得EMS的机会也有了显著改善。成都前往EMS设施的加权中位数最短出行时间减少了14.57%，从6.45分钟降至5.51分钟。
我们的研究表明，该解决方案能够以最少数量的新EMS设施有效实现人口覆盖的政策目标。我们的研究结果将支持中国未来EMS规划中的循证决策。
