The Value of Time and Location Commitment for Decentralized Emergency Medical Services

Abstract

Problem definition: Emergency medical services (EMS) in many low- and middle-income countries utilize decentralized platforms coordinating independent ambulance providers. However, significant operational challenges arise from uncertainty in provider time availability and unpredictable idle locations. These uncertainties hinder reliable service coverage and negatively impact patient outcomes. Using data from our partner Flare in Nairobi, Kenya, we investigate the relative effectiveness of enhancing provider temporal commitment (time availability) versus spatial commitment (strategic location) to improve system coverage.Methodology/results: We employ optimization models adapted for ambulance commitment uncertainty, a detailed case study analysis, data-driven simulations, and a game-theoretic model. Our findings quantify a stark "cost of decentralization": the coverage provided by Flare's approximately 340 loosely committed ambulances could potentially be matched by fewer than 15 optimally deployed fully committed units. We find that enhancing spatial commitment generally yields higher marginal returns for improving coverage than solely increasing time availability. Adding just five optimized, location-flexible ambulances increased coverage substantially in simulation (e.g., by approximately 5\% over the baseline fleet) and reduced service variability. Simulations confirm the practical impact of interventions and validate model assumptions, while a game-theoretic model offers generalizable insights; both approaches align in highlighting the significant value of spatial coordination. Managerial implications: For managers and decision-makers overseeing decentralized EMS platforms, prioritizing strategies that improve spatial coordination offers an efficient path to enhancing service reliability and performance. Actionable strategies include targeted incentives that encourage providers to relocate strategically or deploy a small fleet of location-flexible, platform-controlled units to fill critical coverage gaps. Our framework offers practical tools for managers to identify coverage gaps and assess the potential impact of such interventions in resource-constrained settings, ultimately aiming to enhance emergency response.