The reorganization of an emergency medical system means that we look for new locations of ambulance stations with the aim of improving the accessibility of the service. We applied two tools that are well known in the operations research community, namely mathematical programming, and computer simulation. Using the hierarchical pq-median model, we proposed optimal locations of the stations throughout the country and within large towns. Several solutions have been calculated that differ in the number of stations that are supposed to be relocated to new positions. The locations proposed by the mathematical programming model were evaluated via computer simulation. The approach was demonstrated under the conditions of the Slovak Republic using real historical data on ambulance dispatches. We have concluded that (i) the distribution of the stations proposed by the hierarchical pq-median model overcomes the current distribution; the performance of the system has significantly improved even if only 10% of the stations are relocated to new municipalities; (ii) the variant that relocates 40% of the stations is a reasonable compromise between the benefits and induced costs; (iii) optimizing station locations in big towns can significantly improve the local as well as the nationwide performance indicators; the response times in two regional capitals has reduced by more than 4 min.

Introduction: Efficient allocation of physician-staffed emergency medical services (EMS) is crucial for optimal resource use in urban prehospital systems. The rendezvous model differs fundamentally from the traditional ambulance model: It deploys a lighter, nontransport-capable, passenger vehicle that may offer operational advantages, although comparative evidence with regard to traditional models remains limited. In this study we aimed to evaluate the impact of a physician-staffed rendezvous model on response times and physician-staffed crew availability within the EMS system in Košice, Slovak Republic. Methods: We conducted a retrospective, cross-sectional study, analyzing all primary responses by physician-staffed EMS units in the Košice region from January 2023–March 2025. In August 2024, one of three traditional, physician-staffed transport units was replaced by a physician-staffed rendezvous unit, yielding a post-intervention system with two transport units and one rendezvouz unit, a faster, physician-staffed non-transport vehicle that provides specialized medical care on scene. We extracted time intervals in minutes—response time, time on scene, time to transport initiation, and total time until crew availability—from the national EMS database and compared them to the pre- and post-introduction of the rendezvous model. We analyzed data using non-parametric statistical tests (Mann-Whitney U test, Kruskal-Wallis test), and we conducted a multivariable ordinary least squares regression to adjust for potential confounders. Results: Of 11,347 eligible cases, 11,094 met the inclusion criteria (8,389 patients treated during the pre-intervention period and 2,705 during the post-intervention period). Of these, 488 patients (4.4% of the overall cohort and 18.0% of the post-intervention cases) were managed by the rendezvous unit. Following rendezvous unit implementation, the mean response time was reduced compared to that of the standard physician-staffed transport units (–0.77 minutes per response; P < .001). The rendezvous unit demonstrated reductions in time to crew availability across districts, with absolute decreases ranging from 11.12 to 18.01 minutes; these differences were statistically significant in all districts except the undefined/border region (P < .001 for each comparison). The time spent on scene was slightly longer for the rendezvous unit in most districts, although these differences did not reach statistical significance. The time to transport initiation showed mixed trends. Ordinary least squares regression confirmed the independent association between rendezvous unit implementation and shorter response times. Conclusion: Replacing a standard physician-staffed ambulance with a lighter, faster, non-transport rendezvous vehicle improved operational efficiency by reducing response times and expediting physician-staffed crew availability. These findings suggest that the rendezvous model can enhance system-level performance in urban EMS settings by supporting more flexible physician deployment and informing decisions on resource allocation within tiered prehospital systems.