An evaluation of ambulance service performance using a Geographic Information System

The accessibility, distribution and utilization of emergency health care services have a great impact on the effectiveness, efficiency and equity of health service delivery. The impact of these factors is heightened by the fact that ambulance resources, which are an important component of emergency health care, are often insufficient, resulting in performances below those required to respond reliably to emergency calls from demand areas. Measures of realized geographic accessibility of ambulances to call locations are of considerable importance in planning the deployment of this service as they allow planners to account for response time variations, often caused when ambulances are not available at the station closest to a call. However, the current body of related research does not adequately address important spatio-temporal analytical issues that are the result of this variation in response performance, for assessing realized geographic accessibility. This thesis examines these analytical deficiencies in order to assist emergency health service planners and decision-makers improve accessibility and response performance to target populations. Towards this end, it examines issues related to assessing accessibility for emergency health-care service delivery. It also examines the current use of Geographic Information System (GIS) technology to improve service delivery. An analytic model and GIS design framework is developed in order to provide a conceptual framework for assessing realized geographic accessibility. Further, it develops statistical and geographical modeling methods and outputs into a GIS-based application, to operationalize the analytical model and GIS design framework. In this context, a design methodology is proposed to develop a user-centred, task-based Graphical User Interface (GUI) to facilitate the navigation of a user through the components of the application in a decision support environment. The research methodology is applied to evaluate the usefulness of the application and its approach with a case study using empirical data from the Ontario Ministry of Health