Abstract
In this paper we study the coordination of Emergency Medical Service (EMS) for patients with acute myocardial infarction with ST-segment elevation (STEMI). This is a health problem with high associated mortality. A “golden standard” treatment for STEMI is angioplasty, which requires a catheterization lab and a highly qualified cardiology team. It should be performed as soon as possible since the delay to treatment worsens the patient’s prognosis. The decrease of the delay is achieved by coordination of EMS, which is especially important in the case of multiple simultaneous patients. Nowadays, this process is based on the First-Come-First-Served (FCFS) principle and it heavily depends on human control and phone communication with high proneness to human error and delays. The objective is, therefore, to automate the EMS coordination while minimizing the time from symptom onset to reperfusion and thus to lower the mortality and morbidity resulting from this disease. In this paper, we present a multi-agent decision-support system for the distributed coordination of EMS focusing on urgent out-of-hospital STEMI patients awaiting angioplasty. The system is also applicable to emergency patients of any pathology needing pre-hospital acute medical care and urgent hospital treatment. The assignment of patients to ambulances and angioplasty-enabled hospitals with cardiology teams is performed via a three-level optimization model. At each level, we find a globally efficient solution by a modification of the distributed relaxation method for the assignment problem called the auction algorithm. The efficiency of the proposed model is demonstrated by simulation experiments.
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Bandara, D., Mayorga, M. E., McLay, L. A.: Optimal dispatching strategies for emergency vehicles to increase patient survivability. Int. J. Oper. Res. 15(2), 195–214 (2012)
Behzadia, N., Salinero-Fortb, M. A., de Blasc, A., Taboadaa, M., Pérez de Islad, L., López-Sendóne, J. L.: Prehospital thrombolysis: Two years experience of the community of madrid emergency services (summa 112). Rev Esp Cardiol (Engl Ed). 65(10), 960–961 (2012)
Bertsekas, D. P: Auction algorithms for network flow problems: A tutorial introduction. Comput. Optim. Appl. 1(1), 7–66 (1992)
Bertsekas, D. P.: Auction algorithms. In: Encyclopedia of Optimization, pp. 128–132 (2009)
Bertsekas, D.P.: The auction algorithm: A distributed relaxation method for the assignment problem. Ann. Oper. Res 14(1), 105–123 (1988)
Billhardt, H., Fernandez, A., Lemus, L., Lujak, M., Osman, N., Ossowski, S., Sierra, C.: Dynamic coordination in fleet management systems: Toward smart cyber fleets. Intel Syst IEEE 29(3), 70–76 (2014)
Billhardt, H., Lujak, M., Ossowski, S., Bruns, R., Dunkel, J.: Intelligent event processing for emergency medical assistance. In: Proceedings of the 29th Annual ACM Symposium on Applied Computing, pp. 200–206. ACM (2014)
Billhardt, H., Lujak, M., Sánchez-Brunete, V., Fernández, A., Ossowski, S.: Dynamic coordination of ambulances for emergency medical assistance services. Knowl.-Based Syst. 70, 268–280 (2014)
Bradley, S., Hax, A, Magnanti, T: Applied mathematical programming (1977)
Brooks, S. C., Schmicker, R. H., Rea, T. D., et al.: Out-of-hospital cardiac arrest frequency and survival: Evidence for temporal variability. Resuscitation 81(2), 175–181 (2010)
Cannon, C.P., Gibson, C.M., Lambrew, C.T., Shoultz, D.A., Levy, D., French, W.J., Gore, J.M., Weaver, W.D., Rogers, W.J., Tiefenbrunn, A.J.: Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA: J. Amer. Med. Assoc. 283(22), 2941–2947 (2000)
Cardoen, B., Demeulemeester, E., Beliën, J.: Operating room planning and scheduling: A literature review. Eur. J. Oper. Res. 201(3), 921–932 (2010)
Chevaleyre, Y., Dunne, P. E., Endriss, U., et al.: Issues in multiagent resource allocation. Informatica 30(1), 2006
Chevaleyre, Y., Endriss, U., Estivie, S., Maudet, N.: Multiagent resource allocation with k-additive utility functions. In: Proc. DIMACS-LAMSADE Workshop on Computer Science and Decision Theory, Annales du LAMSADE, pp. 83–100 (2004)
Cugola, G., Margara, A.: Processing flows of information: From data stream to complex event processing. ACM Comput. Surv. (CSUR) 44(3), 15 (2012)
De Luca, G., Suryapranata, H., Ottervanger, J. P., Antman, E. M: Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction every minute of delay counts. Circulation 109(10), 1223–1225 (2004)
Dilaveris, P, Synetos, A., Giannopoulos, G., et al.: Climate impacts on myocardial infarction deaths in the athens territory: The climate study. Heart 92(12), 1747–1751 (2006)
Domnori, E., Cabri, G., Leonardi, L.: Coordination issues in an agent-based approach for territorial emergence management. In: 2011 IEEE Workshops of International Conference on Advanced Information Networking and Applications (WAINA), pp. 184–189. IEEE (2011)
Endriss, U., Maudet, N., Sadri, F., Toni, F.: On optimal outcomes of negotiations over resources. In: AAMAS, vol. 3, pp. 177–184 (2003)
Gendreau, M., Laporte, G., Semet, F.: A dynamic model and parallel tabu search heuristic for real-time ambulance relocation. Parallel Comput. 27(12), 1641–1653 (2001)
Giordani, S., Lujak, M., Martinelli, F.: A distributed algorithm for the multi-robot task allocation problem. In: Trends in Applied Intelligent Systems: Proc. of the 23rd Internat. Conf. on Ind. eng. and other Applications Of Applied Int. Systems, Volume 6096 of Lecture Notes in Artificial Intelligence, pp. 721–730. Springer-Verlag (2010)
Guerriero, F., Guido, R.: Operational research in the management of the operating theatre: A survey. Health Care Manag. Sci. 14(1), 89–114 (2011)
Henderson, S. G: Operations research tools for addressing current challenges in emergency medical services. Wiley Encyclopedia of Operations Research and Management Science (2011)
Herlitz, J., Eek, M., Holmberg, M., Holmberg, S.: Diurnal, weekly and seasonal rhythm of out of hospital cardiac arrest in sweden. Resuscitation 54(2), 133–138 (2002)
Jollis, J. G, Granger, C. B., Henry, T. D, et al.: Systems of care for st-segment–elevation myocardial infarction: A report from the american heart association mission: Lifeline. Circ. Cardiovas. Quality Outcomes 5(4), 423–428 (2012)
Kriszbacher, I., Boncz, I., Koppán, M., Bódis, J.: Seasonal variations in the occurrence of acute myocardial infarction in hungary between 2000 and 2004. Int. J. Cardiol. 129(2), 251–254 (2008)
Kuhn, H. W: The hungarian method for the assignment problem. Naval Res. Logis. Q. 2(1–2), 83–97 (1955)
Lee, J. H., Chae, S. C., Yang, D. H., et al.: Influence of weather on daily hospital admissions for acute myocardial infarction (from the korea acute myocardial infarction registry). Int. J. Cardiol. 144(1), 16–21 (2010)
Leiza, J. R. G., de Llano, J. M. A., Messa, J. B. L., et al.: New insights into the circadian rhythm of acute myocardial infarction in subgroups. Chronobiol. Int. 24 (1), 129–141 (2007)
Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, M., Dai, S., De Simone, G., Ferguson, T. B., Ford, E., Furie, K., Gillespie, C., et al.: Heart disease and stroke statistics 2010 update a report from the american heart association. Circulation 121(7), e46–e215 (2010)
López, B., Aciar, S., Innocenti, B., Cuevas, I.: How multi-agent systems support acute stroke emergency treatment. In: IJCAI Workshop A2HC, pp. 51–59 (2005)
López, B., Innocenti, B., Busquets, D.: A multiagent system for coordinating ambulances for emergency medical services. Intel. Syst. IEEE 23(5), 50–57 (2008)
Lujak, M., Billhardt, H.: Coordinating emergency medical assistance. In: Agreement Technologies, pp. 597–609. Springer (2013)
Lujak, M., Billhardt, H., Ossowski, S.: Optimizing emergency medical assistance coordination in after-hours urgent surgery patients. In: Bulling, N. (ed.) Multi-agent systems, volume 8953 of LNCS, pp. 316–331. Springer (2015)
Manfredini, R., Manfredini, F., Boari, B., et al.: Seasonal and weekly patterns of hospital admissions for nonfatal and fatal myocardial infarction. Amer. J. Emer. Med. 27(9), 1097–1103 (2009)
Martens, P. R, Calle, P., Van den Poel, B., Lewi, P., Belgian Cardiopulmonary Cerebral Resuscitation Study Group, et al.: Further prospective evidence of a circadian variation in the frequency of call for sudden cardiac death. Intensive Care Med. 21(1), 45–49 (1995)
Mingo, S., Goicolea, J., Nombela, L., et al.: Angioplastia primaria en nuestro medio. análisis de los retrasos hasta la reperfusión, sus condicionantes y su implicación pronóstica. Revista española de cardiología 62(1), 15–22 (2009)
Instituto nacional de estadistica. Defuncines según la causa de muerte, año (2009). http://www.ine.es/prensa/np664.pdf, February 2011
Rais, A., Viana, A.: Operations research in healthcare: A survey. Int. Trans. Oper. Res. 18(1), 1–31 (2011)
Rathore, S.S., Curtis, J.P., Chen, J., Wang, Y., Nallamothu, B.K., Epstein, A.J., Krumholz, H.M., et al.: Association of door-to-balloon time and mortality in patients admitted to hospital with st elevation myocardial infarction: National cohort study. BMJ: British Med. J., 338 (2009)
Rodríguez, J. Á., Flores, I. C., Rodríguez, J. B., et al.: Reperfusión del infarto agudo de miocardio con elevación del segmento st en la comunidad de madrid
Sen, A. K.: Collective choice and social welfare, vol. 11. Elsevier (2014)
WHO Fact sheet No. 310. http://www.who.int/mediacentre/factsheets/fs310/en/, May 2014
Soon, C Y, Chan, W X, Tan, H C: The impact of time-to-balloon on outcomes in patients undergoing modern primary angioplasty for acute myocardial infarction. Sing. Med. J. 48(2), 131 (2007)
Steg, P.G., James, S.K., Atar, D., et al.: Esc guidelines for the management of acute myocardial infarction in patients presenting with st-segment elevation the task force on the management of st-segment elevation acute myocardial infarction of the european society of cardiology (esc). Eur. Heart J. (2012)
Takahashi, M., Kohsaka, S., Miyata, H., et al.: Association between prehospital time interval and short-term outcome in acute heart failure patients. J. Card. Fail. 17 (9), 742–747 (2011)
Terkelsen, C. J., Sørensen, J. T., Maeng, M., et al.: System delay and mortality among patients with stemi treated with primary percutaneous coronary intervention. JAMA: J. Amer. Med. Assoc. 304(7), 763–771 (2010)
Van de Werf, F., Bax, J., Betriu, A., et al.: Management of acute myocardial infarction in patients presenting with persistent st-segment elevation. Eur. Heart J. 29 (23), 2909–2945 (2008)
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Lujak, M., Billhardt, H. & Ossowski, S. Distributed coordination of emergency medical service for angioplasty patients. Ann Math Artif Intell 78, 73–100 (2016). https://doi.org/10.1007/s10472-016-9507-9
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DOI: https://doi.org/10.1007/s10472-016-9507-9
Keywords
- EMS coordination
- Ambulance coordination
- Angioplasty
- PCI
- Distributed optimization
- Auction algorithm
- Emergency medical assistance