Quantifying the Impact of Ambulance Ramping: A Multi-Year Analysis of Victorian Emergency Medical Services Cases

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.

The ambulance service is the main transport for diseased or injured people which suffers the same acceleration forces as regular vehicles. These accelerations, caused by the movement of the vehicle, impact the performance of tasks executed by sanitary personnel, which can affect patient survival or recovery time. In this paper, we have trained, validated, and tested a system to assess driving in ambulance services. The proposed system is composed of a sensor node which measures the vehicle vibrations using an accelerometer. It also includes a GPS sensor, a battery, a display, and a speaker. When two possible routes reach the same destination point, the system compares the two routes based on previously classified data and calculates an index and a score. Thus, the index balances the possible routes in terms of time to reach the destination and the vibrations suffered in the patient cabin to recommend the route that minimises those vibrations. Three datasets are used to train, validate, and test the system. Based on an Artificial Neural network (ANN), the classification model is trained with tagged data classified as low, medium, and high vibrations, and 97% accuracy is achieved. Then, the obtained model is validated using data from three routes of another region. Finally, the system is tested in two new scenarios with two possible routes to reach the destination. The results indicate that the route with less vibration is preferred when there are low time differences (less than 6%) between the two possible routes. Nonetheless, with the current weighting factors, the shortest route is preferred when time differences between routes are higher than 20%, regardless of the higher vibrations in the shortest route.

Emergency Departments (EDs) are critical access points in healthcare systems, yet they face persistent pressure from unpredictable patient demand, seasonal surges, and non-urgent visits. Effective ED planning requires forecasts at multiple decision-making levels: hospitals need local demand estimates for staffing and bed management, regions require forecasts to coordinate healthcare units, and national authorities need system-wide projections for capacity planning. However, most existing approaches forecast ED demand independently at a single level, ignoring the hierarchy linking hospitals, regions, and national systems. This can produce incoherent predictions, where hospital-level forecasts do not aggregate consistently to regional or national demand. We propose HierSTT, a hierarchical Transformer-based framework for coherent multi-level ED forecasting. HierSTT jointly predicts hospital, regional, and national level demand in a single end-to-end model. A Temporal Fusion Transformer captures national dynamics, while spatio-temporal Transformer encoder-decoder modules model regional and hospital demand conditioned on higher-level forecasts. A coherence-aware loss penalizes cross-level inconsistencies during training. We further introduce a nationwide Portuguese ED dataset covering 81 hospitals across 5 regional health administrations, with heterogeneous covariates at each level. Experiments show that HierSTT reduces average WAPE by 32% relative to the best non-hierarchical deep learning baseline and outperforms all classical hierarchical reconciliation methods, while producing near-coherent predictions across levels. Additional resources associated with this work are available at https://github.com/FilipaLino/HierSTT.