Adaptive emergency medical services allocation
Crafting the patient safety net in prehospital emergency care
Thesis publication
Hill, P. Adaptive emergency medical services allocation: crafting the patient safety net in prehospital emergency care. Doctoral thesis. Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset. Stockholm, 2026.
The EMS safety net under uncertainty
The thesis examines how dispatch work, patient vulnerability, and system delay mechanisms interact in prehospital emergency care.
Plain-language summary
Ambulance systems cannot send every resource everywhere at once. The thesis studies how EMS organisations decide who should receive help first, who can safely wait, and how delays and risks are distributed when demand is high.
Scientific contribution
The thesis contributes a systems-oriented view of EMS allocation that links dispatch stewardship, time-sensitive triage, response-time variability, and responsible use of routine operational data.
Interpretation boundary
The thesis does not support direct automation claims or immediate deployment of data-driven models. Operational translation requires prospective evaluation, governance, human-factors design, and safeguards against unintended consequences.
The four studies
Emergency medical dispatchers and scarce capacity
Qualitative interview study showing that prioritisation under ambulance scarcity is best understood as stewardship of scarce response capacity, including reassessment, queue governance, geographic coverage, and coordinated collaboration.
Study IBreathing-problem missions and nonlinear risk
Exploratory machine-learning study of response time, age, sex, and high-risk time-sensitive conditions.
Study IIInfection suspicion and high-risk triage
Retrospective study of concordance between dispatch suspicion, on-scene phenotype, and time-sensitive triage.
Study IIIResponse-time variability
Large-scale observational analysis of system delay mechanisms in emergency medical services.
Study IVThesis-level conclusions
- The dispatch queue should be understood as a safety-critical virtual waiting room.
- The safety meaning of waiting is heterogeneous and interacts with patient vulnerability and call type.
- Response time is a systems metric shaped by interacting operational and environmental conditions rather than a simple function of distance.
