By Leila Merrill
NEW YORK — Columbia University engineers are working with the Fire Department of New York to improve EMS response operations and to help balance local hospitals’ capacity loads.
FDNY’s services have been sorely stretched during the pandemic, and the department has been developing a number of innovations in its EMS system to reduce response time to potentially life-threatening medical emergencies.
These efforts can have a big effect on EMS care in the city because of the department’s size. FDNY oversees New York City’s 911 EMS system and operates two-thirds of the nearly 450 ambulances in NYC’s 911 system directly. In addition, 198 fire engine companies provide medical responses.
One of its most critical innovations is how to improve its approach to deploying its EMS resources to minimize response time.
In January, FDNY launched an ambulance system optimization process designed by Columbia engineers in collaboration with FDNY analysts and subject matter experts that was integrated with existing FDNY computer-aided-dispatch functionality. The new system is the result of an earlier Columbia Engineering collaboration with the NYC Department of Transportation to analyze traffic data and a new optimization process designed to mitigate ambulance overcrowding at a single hospital or groups of hospitals while neighboring hospitals have capacity.
Optimizing transports when hospitals are predicted to be overloaded is viewed as a “planning ahead” approach to hospital overload, and it is designed to minimize the need for hospital redirection or hospital diversion requests, which remain in place as last-resort options to relieve overwhelmed emergency departments.
FDNY has been working with the Columbia Engineering team, which is led by Andrew Smyth, Robert R.W. and Christine S. Carleton Professor of Civil Engineering and Engineering Mechanics; and Henry Lam, associate professor of industrial engineering and operations research, for almost two years.
“Our DOT project was a perfect fit with what the FDNY needed,” says Smyth, who is also the chair of the Smart Cities Center at Columbia’s Data Science Institute. “We already had developed a program for the DOT that gave us very high resolution of traffic speed distributions of every street in NYC by time of the day and day of the week. Understanding ambulance traffic behavior throughout the city and spotting new patterns gave us a headstart on optimizing the EMS. Our new pattern for FDNY EMS is shaving about a minute off ambulance trips from incident locations to hospitals for thousands of emergencies.”
FDNY has also created a new approach to managing analytics so it can consolidate efforts to analyze EMS innovations. That includes three collaborative teams specializing in Data Quality, Operations Research, and Geographic Information Systems.
Lam’s group was already working with Smyth’s team to layer a load-balancing optimization program on top of Smyth’s traffic pattern. Lam’s program suggests hospital destinations for 911 patients that alleviate the workloads of overwhelmed hospitals while still ensuring short trips, thus optimally balancing the demand and supply of patient intakes at a city-wide level. Beneath this program, which runs daily on the FDNY’s CAD, is a data-driven optimization algorithm that integrates predictive models of incidents, hospital capacities, and travel times. Lam’s group worked closely with FDNY to back-test the algorithm via simulation modeling and data from the pandemic surge, before the FDNY launched it on Jan. 13.
“The integration of operations research and AI in this project has created a powerful approach to improve the EMS system,” Lam said. “It provides a solution to safeguard hospital loads across the city against future incident surges.”
Kat Thomson, FDNY assistant commissioner, Management Analysis and Planning, added, “This new approach also integrates the concept of optimization directly into the EMS system, and it is very intuitive to stakeholders. Where the FDNY was historically taking corrective action on already overwhelmed emergency departments, this new approach provides the opportunity for the FDNY analytics team to plan ahead, analyze projected overload against actuals on a rolling basis, and validate results in near real time using data visualization. Data outputs of the optimization also facilitate communication on the initiative between hospitals and the agency.”
The initiative uses FDNY 911 transport data and hospital bed availability data from the New York State Department of Health’s daily Health Electronic Response Data System survey. Lam’s optimization algorithm assesses gaps between staffed hospital bed supply and demand based on predicted transports in the vicinity of the receiving hospitals for the next day, with the assumption that 40% of ambulance transports will result in an admission.
FDNY runs the optimization each evening after receiving that day’s HERDS data. The output of the optimization is put in place by each evening and is in effect for the next 24 hours.