Scheduling operating rooms of multiple hospitals considering transportation and deterioration in mass-casualty incidents

In mass casualty incidents, patients need to be evacuated to nearby hospitals as soon as possible, and a surge in demand for emergency medical services then occurs. It would result in ambulance offload delays, i.e., no emergency operating room is available when the ambulance arrives at a hospital, and thus the patients cannot be treated immediately. In this paper, we aim to solve a combinatorial problem of patient-to-hospital assignment and patient surgery sequence considering patient deterioration and ambulance offload delay during a mass casualty incident. A mixed-integer programming model is proposed. The objective is to minimize the completion time of all patients’ surgeries. For solving such a problem, some structural properties of our studied problem are derived, and a heuristic is developed to solve the single operating room scheduling problem considering ambulance offload delay and patient deterioration based on these structural properties. A hybrid Firefly Algorithm-Variable Neighborhood Search algorithm incorporating the heuristic method is proposed to solve it. Our proposed algorithm can solve the problem within a short computation time, and the computational results demonstrate the superiority of our proposed algorithm over the compared algorithms.