Magazine / Emergency & Crisis Management Sep 6, 2021 9:00:00 AM

Ambulance Position: the Lombardy system

An efficient vehicle positioning is extremely important for emergency response. AREU, the Regional Emergency Agency of Lombardy, who had the task of adjusting the regional emergency response system knows this well. The reorganization had a wide scope and considerable changes and improvements, both inside the PSAP and in the field.

This transformation was presented at the EENA 2019 conference.

AREU and the vehicle repositioning

There were three main points for the development of a new emergency vehicle allocation structure:

  1. Creation of a system of mobile points called "columns": parking optimization in flexible docking stations for the vehicles.

  2. Monitoring with a BI system: understand performance and evaluate how to redistribute resources.

  3. Technological upgrade: new tools for better communication.


Ambulances: how the column system works

AREU first examined the data collected in the previous months including PSAP response times and vehicle travel times. This was needed to re-organize vehicles in a series of flexible docking stations, called "columns". 

The ambulances were moved from their usual parking spaces, located inside the hospital or municipal parking lots, and placed in strategic points. These could be anywhere: parks, intersections, sidewalks of busy streets.

The column position was arranged to allow all patients to reach a care facility within the time limits defined by law (20 minutes). 

The aggregated data took into account a number of variables: time of day, date, geography, season, to provide the best combination of resources. This was essential to obtain optimal coverage of the area, in compliance with the criteria of economy and fairness.

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Monitoring and Review

The monitoring involved a trial phase to test what effects this new allocation would have in real life. During routine operations, for example, a column may find itself empty when the ambulance is activated.

The test phase made it possible to define the protocols for the relocation of the other units so that the area remained equally covered. The situation was tested to verify its effectiveness and feasibility. 

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The information went into AREU's Business Intelligence company portal, where it is aggregated and shown in real-time. This reporting and monitoring are still ongoing to constantly assess the system and adjust it if needed.

Reports are prepared on a daily, weekly, and monthly basis and sent to the various stakeholders. The information is available to everyone and follows common analysis criteria and can easily be consulted when necessary.

According to the new system, Milan has been reorganized into 42 columns, able to cover 90% of the population in less than 8 minutes.

Ambulance relocation system in Lombardy: the results

The new system of emergency vehicles position, together with new protocols and call filtering, clearer KPIs and a rebalancing of the resources, gave immediate positive results.


The data highlighted in the image, taken from one of the daily reports processed by the BI system, shows the average amount of minutes, which a very severe or mildly severe patient takes to reach the hospital. The values include the average of two minutes needed to answer the call, collect data and send the correct unit.

In this new system, the vehicle arrives at the location very quickly, reducing the time by almost half compared to the previous situation. 

In Milan now only 3% of patients arrive beyond the time limit (20 minutes). Most of them reach the hospital in a maximum of 12 minutes (including the call).

The most recent results show a huge improvement, demonstrating the effectiveness of the new column system.

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