  The optimisation in the ambulance dispatching process is significant for
patients who need early treatments. However, the problem of dynamic ambulance
redeployment for destination hospital selection has rarely been investigated.
The paper proposes an approach to model and simulate the ambulance dispatching
process in multi-agents healthcare environments of large cities. The proposed
approach is based on using the coupled game-theoretic (GT) approach to identify
hospital strategies (considering hospitals as players within a non-cooperative
game) and performing discrete-event simulation (DES) of patient delivery and
provision of healthcare services to evaluate ambulance dispatching (selection
of target hospital). Assuming the collective nature of decisions on patient
delivery, the approach assesses the influence of the diverse behaviours of
hospitals on system performance with possible further optimisation of this
performance. The approach is studied through a series of cases starting with a
simplified 1D model and proceeding with a coupled 2D model and real-world
application. The study considers the problem of dispatching ambulances to
patients with the ACS directed to the PCI in the target hospital. A real-world
case study of data from Saint Petersburg (Russia) is analysed showing the
better conformity of the global characteristics (mortality rate) of the
healthcare system with the proposed approach being applied to discovering the
agents' diverse behaviour.
