Priority Assignment in Emergency Response
- 1 August 2012
- journal article
- Published by Institute for Operations Research and the Management Sciences (INFORMS) in Operations Research
- Vol. 60 (4), 813-832
- https://doi.org/10.1287/opre.1120.1075
Abstract
In the aftermath of mass-casualty events, key resources (such as ambulances and operating rooms) can be overwhelmed by the sudden jump in patient demand. To ration these resources, patients are assigned different priority levels, a process that is called triage. According to triage protocols in place, each patient's priority level is determined based on that patient's injuries only. However, recent work from the emergency medicine literature suggests that when determining priorities, resource limitations and the scale of the event should also be taken into account in order to do the greatest good for the greatest number. This article investigates how this can be done and what the potential benefits would be. We formulate the problem as a priority assignment problem in a clearing system with multiple classes of impatient jobs. Jobs are classified based on their lifetime (i.e., their tolerance for wait), service time, and reward distributions. Our objective is to maximize the expected total reward, e.g., the expected total number of survivors. Using sample-path methods and stochastic dynamic programming, we identify conditions under which the state information is not needed for prioritization decisions. In the absence of these conditions, we partially characterize the optimal policy, which is possibly state dependent, and we propose a number of heuristic policies. By means of a numerical study, we demonstrate that simple state-dependent policies that prioritize less urgent jobs when the total number of jobs is large perform well, especially when jobs are time-critical.Keywords
This publication has 21 references indexed in Scilit:
- Triage in the Aftermath of Mass‐Casualty IncidentsPublished by Wiley ,2011
- An approximate dynamic programing approach to the development of heuristics for the scheduling of impatient jobs in a clearing systemNaval Research Logistics (NRL), 2010
- Prioritizing Patients for Evacuation from a Health-Care FacilityTransportation Research Record: Journal of the Transportation Research Board, 2009
- Evacuation of a Maternal-Newborn Area During Hurricane KatrinaMCN: The American Journal of Maternal/Child Nursing, 2008
- SCHEDULING IMPATIENT JOBS IN A CLEARING SYSTEM WITH INSIGHTS ON PATIENT TRIAGE IN MASS CASUALTY INCIDENTSProbability in the Engineering and Informational Sciences, 2008
- A New Resource-Constrained Triage Method Applied to Victims of Penetrating InjuryJournal of Trauma: Injury, Infection & Critical Care, 2007
- Katrina: Lessons from the AftermathHospital Topics, 2006
- Mass-casualty Triage Systems: A Hint of ScienceAcademic Emergency Medicine, 2005
- Precise Formulation and Evidence‐based Application of Resource‐constrained TriageAcademic Emergency Medicine, 2005
- On the optimal allocation of service to impatient tasksJournal of Applied Probability, 2004