THE demand by consumers for a voice in decisions which affect their lives can be observed in many sectors of Western society. The health industry is one of these, as practitioners in public health can well testify. The concept of consumer sovereignty which is one of the basic premises of the free market system has seen little application in health care decision making. Differences between physicians and patients on the values associated with different courses of medical and preventive actions are to be expected. The physician views the world through a web of medical ethics, professional norms, and a subjective view of the patient's life situation which the physician obtains in increasingly brief
In this paper a probabilistic branch and bound procedure is developed for the ambulance location problem. Information on system characteristics under various ambulance assignments and dispatch rules was provided by a digital simulation. The output of the simulation was also used to construct the objective function for the optimal location problem. The procedure was used to determine ambulance locations in Vancouver, Canada. Solutions obtained from the branch and bound procedure were verified by simulation runs.
DEAN H. UYENO is an associate professor of management science and of transportation m the Faculty of Commerce at the University of British Columbia m Vancouver, Canada. He received both his BSME degree (1965) and his MSE (1967) from the University of Washington, and his PhD (1971) m industrial engineering and Management Science from Northwestern.His primary research interests lie in transportation modeling and in the application of computer-based modeling to public systems, especially m health care. His current projects include Markov analysis applied to long-term health care, coal logistics systems, models for liner shipping in the Pacific, interactive school bus routing, emergency service location models, and MIS for cardiac care.Dr. Uyeno has worked as an engineering aide at Boeing and as a nuclear engineer for Douglas United Nuclear and General Electric. He is currently president of Candhu Enterprises, a firm which has assisted in designing ambulance systems for the major cities of western Canada. Dr. Uyeno has analyzed elevator systems, and has been involved m health care planning for extended care in a major hospital district.Dr. Uyeno has published a number of technical papers including a recent article in SIMULATION, entitled &dquo;Passim: Simulation with Pascal,&dquo; which he coauthored with W. Vaessen. He recently reviewed Simulation Modeling and Analysis by Law and Kelton forSIMULATION. He is currently working with W.G. Waters 11 on a book concerning coal logistics systems. ABSTRACT An ambulance location system was created for the British Columbia Provincial Ambulance Service. It was applied in the Capital Regional District (an area of about 937 square miles). The system helps administrators locate ambulances to improve response to calls. The system consists of three parts: a means to reduce data to manageable proportions, a P-Median model for the determination of rough locations, and a computer simulation model for fine tuning of locations. The system worked well. The method of data reduction proved both practical and efficient. The rough locations provided by the P-Median model provided an excellent starting solution. The simulation model was shown to be accurate in comparison with actual Capital Regional District data.The model was used with confidence to do a number of useful experiments concerning optimal ambulance locations and system response to changes in demand levels.The validated system was used to answer many "what if" questions such as those that follow: Are vehicles located in the best manner?If we move one unit to reduce complaints from area A, how will this affect service in area B?If we get more units, should we locate them incrementally or would it be better to relocate all bases? How much can we hedge against expected future demands?How should we space shifts?How should we determine the number of crews per shift?
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