OPTIC-ER: A Reinforcement Learning Framework for Real-Time Emergency Response and Equitable Resource Allocation in Underserved African Communities

Ambulance response is time-critical in out-of-hospital cardiac arrest (OHCA), where dispatchers must balance timely arrivals with limited fleet capacity. Static territories and deterministic travel-time estimates are vulnerable to dynamic congestion, while always-dual dispatch adds redundancy but consumes fleet capacity. We propose IDEAL (Intelligent Dual dispatch of Emergency AmbuLances), a selective dual-dispatch framework that sends a second ambulance only when the optimistic gap between primary and secondary paths exceeds a threshold. IDEAL learns context-specific edge travel times from trip-level dispatch records, including unobserved routes, using a weakly supervised bilevel representation network. We train the nonsmooth model with mini-batch conservative gradients and prove an asymptotic convergence guarantee. IDEAL models uncertainty via Burg-divergence perturbations to a shared metric in the learned representation space, thereby inducing correlated changes in edge travel times and learning context-specific radii from historical underprediction errors. For real-time decisions, IDEAL casts optimistic-gap computation as a difference-of-convex program and derives an efficient oracle with complexity guarantees. In collaboration with the Hong Kong Fire Services Department, we evaluate IDEAL using historical OHCA records and real-time adaptive simulations. The results achieve a stronger response-time/resource trade-off relative to all region-based and Google-based baselines.

Emergency vehicle (EV) response time is a critical determinant of survival outcomes, yet deployed signal preemption strategies remain reactive and uncontrollable. We propose a return-conditioned framework for emergency corridor optimization based on the Decision Transformer (DT). By casting corridor optimization as offline, return-conditioned sequence modeling, our approach (1) eliminates online environment interaction during policy learning, (2) enables dispatch-level urgency control through a single target-return scalar, and (3) extends to multi-agent settings via a Multi-Agent Decision Transformer (MADT) with graph attention for spatial coordination. On the LightSim simulator, DT reduces average EV travel time by 37.7% relative to fixed-timing preemption on a 4x4 grid (88.6 s vs. 142.3 s), achieving the lowest civilian delay (11.3 s/veh) and fewest EV stops (1.2) among all methods, including online RL baselines that require environment interaction. MADT further improves on larger grids, overtaking DT with 45.2% reduction on 8x8 via graph-attention coordination. Return conditioning produces a smooth dispatch interface: varying the target return from 100 to -400 trades EV travel time (72.4-138.2 s) against civilian delay (16.8-5.4 s/veh), requiring no retraining. A Constrained DT extension adds explicit civilian disruption budgets as a second control knob.

Emergency management assistance programs, such as relief distribution, are essential for delivering necessary supplies to affected communities. However, these programs operate in a decentralized network of local centers that face uncertain local demand and supply dynamics, resulting in inconsistent avail- ability of local services. Redistribution of supplies among these local centers reduces these imbalances, but the centers often make decisions independently, with limited information and disrupted transportation. This study develops CoRe-MARL, a cooperative multi-agent reinforcement learning (MARL) framework, by formulating a decentralized partially observable Markov decision process (Dec-POMDP). We treat each center as an agent that learns a redistribution policy to improve the service in the worst-case region and reduce the service gap across regions while protecting network-wide service. We incorporate a recurrent network that captures evolving supply and demand dynamics without direct observation, while multi-agent proximal policy optimization (MAPPO) enables centralized training and decentralized execution (CTDE). We evaluate the framework in a simulated environment with diverse trajectories, where exact dynamics are not observed by actors and the MAPPO critic. We compare the recurrent MAPPO with the recurrent independent PPO (IPPO) and a local only heuristic, and find that MAPPO reduces the service gap across local centers and enhances service for the worst-served center while maintaining competitive network-wide service. The recurrent MAPPO also shows consistent performance across diverse trajectory patterns, demonstrating its ability to adapt to evolving dynamics. The findings demonstrate the capability of cooperative learning for decentralized redistribution and improving equitable service under uncertain and evolving dynamics.