A Systematic Review of Route Optimization

for Ambulance Routing Problem

A. Vijaya Lakshmi1(B) , Perike Chandra Sekhar1 , K. Suresh Joseph1 , and A. Sai Priya2
1 Department of Computer Science, Pondicherry University, Puducherry, India
[email protected]
2 Department of Computer Science, Bharathidasan Govt. College for Women, Puducherry, India

Abstract. Ambulance Routing Problem (ARP) is the part of Emergency Medical

Services (EMS), which provide timely medical help for those who are in need.
In Medical emergency situation, the key concern is, to provide early treatment.
Relocating patients quickly to neighboring medical facilities is extremely difficult
given the existing traffic situation and has to be rectified. A lack of EMS owing
to urbanization and several routing considerations such as the precise location
of the request, traffic problems, road width, and ambulance locations are few
of the difficulties. This paper summarizes a number of recent studies on ARP in
routing and the issues they raised. In this survey, Routing for Ambulance vehicles is
categorized as initiating ambulance from depot to injured location (response Time)
and routing from injured location to nearby medical Centre (Travel Time). And,
we highlighted challenging issues and constraints related to route optimization in
both above mentioned category. Also emphasized the less explored research area
like Interfacility hospital transfer and importance of incorporating safety metrics
during Ambulance Routing.

Keywords: Ambulance Routing Problem · Emergency Medical Services ·

Routing · Response Time · Safe Ambulance Routing · Route Optimization

1 Introduction
Recent years have seen EMS develop as a response to catastrophes such as rising accident
rates, population growth, urbanization, and daily demands. As annual demands continue
to rise, this is one of the most pressing issues that must be addressed immediately.
More than 1.5 million calls were made to the National Institute of Emergency Medicine
(NIEM) in 2016 [1]. Current prevailing pandemic situation facing more challenges in
many industries like health care and ambulance routing. Many medical emergencies
become tragedy because of delaying in medical treatment.so it is much needed to have
best ambulance routing service to save many lives. Providing lifesaving medical care as
quickly as possible is EMS’s first priority [2]. The preemption and route optimization
combined together to provide fastest travel time in ARP. Many methods like exact algo-
rithms, heuristics, Meta heuristic, Internet of Things, Artificial Intelligence are employed
in ARP problems to improve the performance. Various objective variables, like mini-
mizing distance, cutting expenses, reducing time, situating ambulances, dynamically

© The Author(s) 2023

R. Somashekhar et al. (Eds.): ICBDS 2022, AHSR 58, pp. 294–304, 2023.
https://doi.org/10.2991/978-94-6463-164-7_20
 A Systematic Review of Route Optimization 295

re-locating ambulances, and providing maximum coverage, are sought to optimize for
an enhanced EMS service. Ambulance route optimization is particularly difficult due
to the wide variety of variables that might affect it, from traffic to weather. To address
these difficulties, improved route optimization is necessary. In [3], they proposed smart
ambulance, which communicate with traffic light to made the travelling path congestion
free. Fastest arrival time, rather than total distance travelled, will be the primary metric
for optimizing routes. In order to deliver quick EMS, a dynamic routing optimization
strategy based on artificial intelligence is preferable than static strategies [4].
The article is organized as follows:
• Section II presents related works of ARP
• Section III gives overview of ARP and its category
• Section IV discussed about challenges and gaps in existing works
• Section V presents conclusion

2 Related Work

EMS plays a vital role in managing and providing medical assistance to a person who
needs a Medical Emergency. Increase in travel time and response time even lead to loss
of life in medical emergency. So, Route optimization plays an Crucial role in servicing
and saving Medical emergency needed person. Optimization is the methods of achieving
the highest possible attaining performance under some given constraints by minimizing
unsought factors and maximizing sought factors. Route Optimization suggest best route
by considering desired factors with minimum overall travel time. While in ARP there
are many challenges need to addressed and taken special concern of emergency medi-
cal service needed people while routing. It has many challenges like lacking of traffic
information, location information, speed, etc.
So many existing methods worked on Ambulance Route Optimization challenges.
Re- location of ambulances in response to traffic incidents to provide good response
time on demands and maximum coverage proposed Stochastic Emergency Vehicle
Redeployment Problem [5]. To increase the chance of patient survival, [6] proposed
integrated platform which combines smart ambulance routing with online patient mon-
itoring. To minimize travel delay, [7] proposed Wireless Sensor Network- Emergency
Vehicle Pre-emption based on Collection Tree Protocol. For intensive care and quick
response, [8] used ambulance availability information and time taken to reach accident
spot. A dynamic re-location of ambulances to minimize response time was reduced for
Maximum Coverage of a Location Problem [9]. In [10], author compared and summa-
rized various Ambulance routing problem and Ambulance Location Problem as both
information is needed to improve performance and the pre- emption models plays vital
role in reducing the travel time of ambulance by alerting other vehicles [11].
This papers exclusively surveyed the recent articles related to Route Optimization
for Ambulance from (2015 -2022) taken from publication databases like IEEE, Science
Direct, Research gate and ACM. And we summarized methods and models used for
optimization which is given in Table 1.
296 A. V. Lakshmi et al.

3 Route Optimization for Ambulance

Presently, EMS over ambulances is emergent due to amplified disasters and many health
issues. There is a requirement to attain and uphold ambulance services. The main dictum
is to save lives and afford medical assistance as profligate as possible. The improved
routing of ambulances can accomplish reckless services. In this paper we categories
ARP into two division as showed in Fig 1.
The Ambulance starts from its location to the location of a person in need as fast
as possible by navigation of the road (response time – Type 1) and services take person
from a remote location to the nearest hospital with the help of ambulances (Travel time-
Type 2) are two different routing of ambulance service. Both routing will affect the
overall travel time of the ARP. In second routing is more crucial than first one, as patient
boarded in ambulance should be taken to hospital not only with fastest arrival time but
also should consider safety concern and health condition of the patient.
The best ambulance routing can achieve fast EMS services based on time and distance
metrics. Time metrics will always achieve an optimal best solution. Many challenges
lack ambulance time where traffic congestion is the vital one. A good EMS will respond
in minimum time upon a request to reach injured location and takes back to a person’s
hospital in minimum time, i.e., minimum Total travel Time (TT), with minimum Waiting
Time (WT). The complete comparison study of recent works in ARP are presented in
Table 1.

Fig. 1. Ambulance route optimization

 A Systematic Review of Route Optimization 297

Table 1. Summarization of surveyed Papers

Ref Objective Method Data Set Merits Limitations Type

No.
[12] Total Travel Markov LTA Usage of Traffic Integration of Type 2
Time decision (Land Transport congestion estimation the stochastic
Process Model Authority) in Shortest path
Singapore problem into the
dynamic vehicle
routing problem
is a future
challenge
[13] Minimize GSM Simulation Categorizati on of Should be Type 1
response Time dataset patients implemented on
the real-
time data
[14] Overall Travel Petal Testbed from Reduced response Traffic Type 2
Time Algorithm, Augerat et al. time information and
Particle Swarm (1995), congestion not
Optmization Rochart and considered
(PSO) Taillard (1995)
and Golden etal.
(1998)
[15] Minimize the SAINT + Philadelph ia Communica tion of Need to do for Both
travel delay Delay- traffic managem vehicles using more accuracy
Reroute the constrained ent centre VANET and 4G LTE in traffic
other vehicles shortest path to TCC management
from accident (Dijkstra’s) Rerouting other
area. vehicles
[16] Minimize total Genetic public hospital Categorization of Not considering Type 2
travel cost Algorithm in the city of patients many constraints
(GA) Jendouba, and working
Tunisia with small
problem
instance
[17] Optimize path Ant Colony No Based on patient They have not Both
selection based optimization, implementation health condition, best justified by any
on traffic, GPS matching hospital is implementation
speed, given priority and simulation
availability,
position and
Minimize
total travel time
[18] Minimize the ε-constraint bi Tehran city Categorization of By meta Type 2
total response objective patients as red and heuristic can get
time method green based on more minimum
severity response time
furtherly
(continued)
298 A. V. Lakshmi et al.

Table 1. (continued)

Ref Objective Method Data Set Merits Limitations Type

No.
[19] Minimize busy fraction, Montreal city Reduced the response They considered Both
expected Simulator and suburb of time delay gap of the the response of
response time, DES, BRM, Laval,’ Quebec, ambulance. the ambulance,
To estimate and PSSM, Canada pseudo- but location
eliminate QTSSM, real data information is
ALDP EQTSSM missing; real-
busy fraction time
implementation
required
[20] Minimize time, Dijkstra’s, Not mentioned Classifying AHP and Focused only on Type 1
cost and effort. Geographic usage of GIS Using the ALP and
To find nearest Information AI Distance.
ambulance and Systems (GIS) But not focused
best on traffic
route. congestion.
[21] Minimize the PATcom, Simulation Vehicle2Vehic le and Real-time Type 2
total travel time, SUMO Vehicle2Infrastruture implementation
waiting time OMNet + + communication and many
and Veins IOT constraints
congestion should be
time. considered
[22] Minimize the Google API, Istanbul hospital Considering the Lack of Both
time Find List of database (150 hospital list database information and
nearest hospital hospitals hospitals) to know the nearest should consider
database one traffic
congestion.
[23] Minimize Advanced A* KR Puram Usage of RFID for The accuracy of Both
response time with Traffic Junction communication and RFID may not
Minimize travel Dispersion Bangalore work with parallel be the same
time and total index strategies and traffic always.
cycle IOT-RFID data Real-time
time implementation
is required.
[24] Minimize the EVP VANET Auckland city’s Response time Not Worked Both
response time SUMO arterial road reduced with Large data
and OMNET + network and real- world
Waiting time VEINS required
[25] Minimize the Internet of Simulation Worked with the Real-time Type 2
time travel, vehicle, traffic history data implementatio n
Traffic control SUMO and live data, Traffic is required.
efficiency clear-
out and fastest
driving path.
(continued)
 A Systematic Review of Route Optimization 299

Table 1. (continued)

Ref Objective Method Data Set Merits Limitations Type

No.
[26] Minimize time GPS, No dataset used Send a message with Focus on Both
of information Vibration GPS to the hospital reducing
reach. Sensor by response time
Detect accident. detection with a and real-time
sensor work.
[27] Minimize the Bat Algorithm- No data used to Accuracy in Real-time Both
distance, supply CNN support this information delivery implementation
emergency ResNet study using VANET is not done.
based on the Simulation Communication
available using may not be
accident MATLAB possible at all
data. times.
[28] Minimize the Dynamic Synthetic & Historic and real time There is a gap Type 2
travel time Dijkstra’s, Manhattan traffic flow data is between
Reinforcement Hell’s considered synthetic to real
Learning
Emergency
vehicle light
SUMO
[29] Minimize NSGA-II, Lorestan Categorizati on of Uncertainty in Type 2
response time Multi objective province patients in post- travel time,
Minimize the PSO hospital disaster gives better service duration,
latest service locations allocation of the and demands or
completion time ambulance. regroup.
(SCT) A
combination of
both methods
may give better
results.
[30] Interfacilit y Case study Taiwan City Categorised patients The patient care Both
hospital transfer as advanced life during IFT in
(IHT) support and basic Taiwan is
Life support inadequate
currently and
should
warrant
attention.
[31] Interfacilit y Survey 1990–2021 Summaries Methods, Not
hospital transfer advancement in IHT constraint have applicab
(IHT) to compared le
(continued)
300 A. V. Lakshmi et al.

Table 1. (continued)

Ref Objective Method Data Set Merits Limitations Type

No.
[32] Minimise Eppstien k- Simulation Finds trade of route Only Type 2
distance and shortest path between distance and communication
maximise Algorithm communication Coverage
communication coverage for constraint is
coverage continuous remote considered.
monitoring Need to address
Patients more metrics
related to safety

4 Discussion
From the survey, ARP challenges are classified as type 1 and type 2 problems. Where
type 1 deals with route optimization from ambulance location to accident path and type
2 deals with route optimization from accident spot to nearby hospital. For an efficient
EMS, whole journey starting from ambulance location to accident spot and taking patient
to hospital should be optimized. Only 35% of surveyed paper considered both path of
routing and still those works treated both path for optimization with same constraints
as shown in Fig 2. Only in few papers [22–24, 26, 27]they considered patient initial
diagnosis for searching appropriate hospital with needed facility in type 2 but this medical
condition was not considered for choosing appropriate route for patient.
In medical cases, some diagnosis condition needed safe route than shortest route.
Safety is also major concern need to be included as cost in Type 2 route optimization
in needed cases. Safety parameters like Road quality, Carbon emission level can be
included. And inclusion pre-emption technique in optimization problem provides better

Fig. 2. Comparison of existing work based on category

 A Systematic Review of Route Optimization 301

result and reduction of overall travel time. It is noted from the survey that, Inter facility
ambulance routing [30, 31] was least unexplored research dimension in ARP. Inter
facility ambulance service is a non-emergency medical service involves carrying patient
from one hospital to other specialized hospital. For that condition, it is needed to assure
the competence level is enough for patient expected medical needs. Then safe Route
comes into play more than fast and shortest route [32–35]. Safety factors like
• Road quality,
• Weather condition,
• Pollution,
• Accident-free zones
• Traffic Light free zone
are need to considered during route optimization for inter facility ambulance service.

5 Conclusion
This paper provides a detailed survey of ARP by focusing on several constraints and met-
rics. We categorized existing works based on their consideration of whole journey of ARP
from ambulance request to patient transfer to hospital. The comparison table describes
methods, limitation and benefits of existing works and a person in need of medical atten-
tion during a medical emergency cannot function without the help of emergency medical
services (EMS). Loss of life can occur in the event of a medical emergency because of
the prolonged reaction time and longer travel times. As a result, optimizing routes is
critical to reaching those who are in need of medical assistance quickly. Optimization is
a methodology for maximizing a desired outcome while reducing an undesirable one in
order to achieve the best feasible performance within specified limitations. Optimization
of travel routes recommends the fastest and most convenient path, taking into account a
variety of parameters. People in need of emergency medical services are a particularly
vulnerable group in ARP, and as such, great care must be given while planning routes.
It faces several obstacles, such as a lack of traffic information, geo-location data, speed
details, etc. Paper also suggested other important safety metrics like road quality, weather
conditions, pollution need to address in routing for Inter facility ambulance services.

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