Emergency Medical Services Strategic Design: A Comprehensive Multiobjective Approach to Ensure System Sustainability and Quality

Emergency medical services (EMSs) are critical to reducing fatalities and improving patient outcomes in emergencies such as traffic accidents, where response time is a decisive factor. This study proposes a comprehensive and systematic approach to designing and optimizing EMS systems tailored for urban traffic accidents. By integrating Geographic Information Systems (GISs), hypercube queuing models, Economic Value Added (EVA) calculations, and multi-criteria decision-making (MCDM) techniques, we developed a model that balances service efficiency, financial sustainability, and equitable access to emergency care. The hypercube queuing model was applied to estimate key performance metrics, such as response time, coverage, and the GINI index for equity, under varying numbers of ambulances and demand scenarios. In addition, EVA was calculated for different configurations of leased and owned ambulances, offering a financial perspective to assess the viability of public–private partnerships (PPPs) in EMSs. Using the fuzzy Analytic Hierarchy Process (AHP) and CoCoSo (Combined Compromise Solution) methods, this study identified the optimal number of ambulances required to minimize response time, maximize coverage, and ensure financial sustainability. The proposed approach has been applied to a real case in Colombia. Furthermore, integrating leased ambulances offers a financially viable solution with positive EVA values that guarantee the long-term sustainability of the public–private partnership. This paper advances the literature by providing a practical framework for optimizing EMS systems, particularly in developing countries where financial constraints and resource limitations represent significant challenges. The proposed methodology improves service efficiency and economic sustainability and ensures equity in access to life-saving care.