Kikuchi, Tatsuru (2025): Emergent Dynamical Spatial Boundaries in Emergency Medical Services: A Navier-Stokes Framework from First Principles.
Preview |
PDF
MPRA_paper_126726.pdf Download (8MB) | Preview |
Abstract
Emergency medical services (EMS) response times are critical determinants of patient survival, yet existing approaches to spatial coverage analysis rely on discrete distance buffers or ad-hoc geographic information system (GIS) isochrones without theoretical foundation. This paper derives continuous spatial boundaries for emergency response from first principles using fluid dynamics (Navier-Stokes equations), demonstrating that response effectiveness decays exponentially with time: $\tau(t) = \tau_0 \exp(-\kappa t)$, where $\tau_0$ is baseline effectiveness and $\kappa$ is the temporal decay rate. Using 10,000 simulated emergency incidents from the National Emergency Medical Services Information System (NEMSIS), I estimate decay parameters and calculate critical boundaries $d^*$ where response effectiveness falls below policy-relevant thresholds. The framework reveals substantial demographic heterogeneity: elderly populations (85+) experience 8.40-minute average response times versus 7.83 minutes for younger adults (18-44), with 33.6\% of poor-access incidents affecting elderly populations despite representing 5.2\% of the sample. Non-parametric kernel regression validation confirms exponential decay is appropriate (mean squared error 8-12 times smaller than parametric), while traditional difference-in-differences analysis validates treatment effect existence (DiD coefficient = -1.35 minutes, $p < 0.001$). The analysis identifies vulnerable populations—elderly, rural, and low-income communities—facing systematically longer response times, informing optimal EMS station placement and resource allocation to reduce health disparities.
| Item Type: | MPRA Paper |
|---|---|
| Original Title: | Emergent Dynamical Spatial Boundaries in Emergency Medical Services: A Navier-Stokes Framework from First Principles |
| Language: | English |
| Keywords: | Emergency Medical Services, Spatial Boundaries, Response Time, Demographic Heterogeneity, Navier-Stokes Equations, Continuous Functional Framework, Non-Parametric Estimation |
| Subjects: | C - Mathematical and Quantitative Methods > C1 - Econometric and Statistical Methods and Methodology: General > C14 - Semiparametric and Nonparametric Methods: General C - Mathematical and Quantitative Methods > C2 - Single Equation Models ; Single Variables > C21 - Cross-Sectional Models ; Spatial Models ; Treatment Effect Models ; Quantile Regressions C - Mathematical and Quantitative Methods > C5 - Econometric Modeling > C51 - Model Construction and Estimation I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health R - Urban, Rural, Regional, Real Estate, and Transportation Economics > R5 - Regional Government Analysis > R53 - Public Facility Location Analysis ; Public Investment and Capital Stock |
| Item ID: | 126726 |
| Depositing User: | Tatsuru Kikuchi |
| Date Deposited: | 07 Nov 2025 02:18 |
| Last Modified: | 07 Nov 2025 02:18 |
| References: | \begin{thebibliography}{99} \bibitem[Abadie et al.(2010)]{abadie2010synthetic} Abadie, A., Diamond, A., and Hainmueller, J. (2010). \newblock Synthetic control methods for comparative case studies: Estimating the effect of California's tobacco control program. \newblock \emph{Journal of the American Statistical Association}, 105(490), 493--505. \bibitem[Acheson(1990)]{acheson1990elementary} Acheson, D. J. (1990). \newblock \emph{Elementary Fluid Dynamics}. \newblock Oxford University Press. \bibitem[Anselin(1988)]{anselin1988spatial} Anselin, L. (1988). \newblock \emph{Spatial Econometrics: Methods and Models}. \newblock Springer. \bibitem[Ativie et al.(2020)]{ativie2020systematic} Ativie, F., Kekeç, D., Sørensen, J. T., et al. (2020). \newblock A systematic review of prehospital response time and survival in out-of-hospital cardiac arrest. \newblock \emph{Resuscitation}, 148, 6--16. \bibitem[Athey(2019)]{athey2019machine} Athey, S. and Imbens, G. W. (2019). \newblock Machine learning methods that economists should know about. \newblock \emph{Annual Review of Economics}, 11, 685--725. \bibitem[Batchelor(2000)]{batchelor2000introduction} Batchelor, G. K. (2000). \newblock \emph{An Introduction to Fluid Dynamics}. \newblock Cambridge University Press. \bibitem[Bia and Mattei(2023)]{bia2023handbook} Bia, M. and Mattei, A. (2023). \newblock \emph{Handbook of Matching and Weighting Adjustments for Causal Inference}. \newblock Chapman and Hall/CRC. \bibitem[Blackwell and Kaufman(2009)]{blackwell2009emergency} Blackwell, T. H. and Kaufman, J. S. (2009). \newblock Response time effectiveness: Comparison of response time and survival in an urban emergency medical services system. \newblock \emph{Academic Emergency Medicine}, 9(4), 288--295. \bibitem[Boutilier et al.(2017)]{boutilier2017optimizing} Boutilier, J. J., Brooks, S. C., Janmohamed, A., et al. (2017). \newblock Optimizing a drone network to deliver automated external defibrillators. \newblock \emph{Circulation}, 135(25), 2454--2465. \bibitem[Busso et al.(2013)]{busso2013assessing} Busso, M., Gregory, J., and Kline, P. (2013). \newblock Assessing the incidence and efficiency of a prominent place based policy. \newblock \emph{American Economic Review}, 103(2), 897--947. \bibitem[Butts and Gardner(2023)]{butts2023difference} Butts, K. and Gardner, J. (2023). \newblock Difference-in-differences with spatial spillovers. \newblock Working paper. \bibitem[Canto et al.(2012)]{canto2012association} Canto, J. G., Rogers, W. J., Goldberg, R. J., et al. (2012). \newblock Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. \newblock \emph{JAMA}, 307(8), 813--822. \bibitem[Carr et al.(2017)]{carr2017disparities} Carr, B. G., Branas, C. C., Metlay, J. P., Sullivan, A. F., and Camargo, C. A. (2017). \newblock Access to emergency care in the United States. \newblock \emph{Annals of Emergency Medicine}, 54(2), 261--269. \bibitem[Church and ReVelle(1974)]{church1974maximal} Church, R. and ReVelle, C. (1974). \newblock The maximal covering location problem. \newblock \emph{Papers of the Regional Science Association}, 32(1), 101--118. \bibitem[Claesson et al.(2017)]{claesson2017unmanned} Claesson, A., Fredman, D., Svensson, L., et al. (2017). \newblock Unmanned aerial vehicles (drones) in out-of-hospital cardiac arrest. \newblock \emph{Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}, 25(1), 1--9. \bibitem[Conley(1999)]{conley1999gmm} Conley, T. G. (1999). \newblock GMM estimation with cross sectional dependence. \newblock \emph{Journal of Econometrics}, 92(1), 1--45. \bibitem[Daskin(1995)]{daskin1995network} Daskin, M. S. (1995). \newblock \emph{Network and Discrete Location: Models, Algorithms, and Applications}. \newblock John Wiley \& Sons. \bibitem[Diez Roux and Mair(2010)]{diez2001neighborhoods} Diez Roux, A. V. and Mair, C. (2010). \newblock Neighborhoods and health. \newblock \emph{Annals of the New York Academy of Sciences}, 1186(1), 125--145. \bibitem[Dinh et al.(2013)]{dinh2013redefining} Dinh, M. M., Russell, S. B., Bein, K. J., et al. (2013). \newblock The Sydney Triage to Admission Risk Tool (START) to predict emergency department disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia. \newblock \emph{BMC Emergency Medicine}, 13(1), 26. \bibitem[Donaldson and Hornbeck(2016)]{donaldson2018railroads} Donaldson, D. and Hornbeck, R. (2016). \newblock Railroads and American economic growth: A "market access" approach. \newblock \emph{Quarterly Journal of Economics}, 131(2), 799--858. \bibitem[Fan and Gijbels(1996)]{fan1996local} Fan, J. and Gijbels, I. (1996). \newblock \emph{Local Polynomial Modelling and Its Applications}. \newblock Chapman \& Hall/CRC. \bibitem[Fotheringham et al.(2003)]{fotheringham2003geographically} Fotheringham, A. S., Brunsdon, C., and Charlton, M. (2003). \newblock \emph{Geographically Weighted Regression: The Analysis of Spatially Varying Relationships}. \newblock John Wiley \& Sons. \bibitem[Garrison et al.(2019)]{garrison2019geospatial} Garrison, H. G., Runyan, C. W., Tintinalli, J. E., et al. (2019). \newblock Emergency department surveillance: An examination of issues and a proposal for a national strategy. \newblock \emph{Annals of Emergency Medicine}, 28(5), 504--511. \bibitem[Gelfand et al.(2003)]{gelfand2003spatial} Gelfand, A. E., Kim, H. J., Sirmans, C. F., and Banerjee, S. (2003). \newblock Spatial modeling with spatially varying coefficient processes. \newblock \emph{Journal of the American Statistical Association}, 98(462), 387--396. \bibitem[Green(2004)]{green2004reducing} Green, L. V. and Kolesar, P. J. (2004). \newblock Improving emergency responsiveness with management science. \newblock \emph{Management Science}, 50(8), 1001--1014. \bibitem[Guagliardo(2004)]{guagliardo2004spatial} Guagliardo, M. F. (2004). \newblock Spatial accessibility of primary care: Concepts, methods and challenges. \newblock \emph{International Journal of Health Geographics}, 3(1), 3. \bibitem[Hsia et al.(2011)]{hsia2011disparity} Hsia, R. Y., Srebotnjak, T., Kanzaria, H. K., et al. (2011). \newblock System-level health disparities in California emergency departments: Minorities and Medicaid patients are at higher risk of losing their emergency departments. \newblock \emph{Annals of Emergency Medicine}, 59(5), 358--365. \bibitem[Keele and Titiunik(2015)]{keele2015geographic} Keele, L. J. and Titiunik, R. (2015). \newblock Geographic boundaries as regression discontinuities. \newblock \emph{Political Analysis}, 23(1), 127--155. \bibitem[Khan and Bhardwaj(2011)]{khan2011geographic} Khan, A. A. and Bhardwaj, S. M. (2011). \newblock Access to health care: A conceptual framework and its relevance to health care planning. \newblock \emph{Evaluation \& the Health Professions}, 17(1), 60--76. \bibitem[Kikuchi(2024a)]{kikuchi2024unified} Kikuchi, T. (2024a). \newblock A unified framework for spatial and temporal treatment effect boundaries: Theory and identification. \newblock arXiv preprint arXiv:2510.00754. \bibitem[Kikuchi(2024b)]{kikuchi2024stochastic} Kikuchi, T. (2024b). \newblock Stochastic boundaries in spatial general equilibrium: A diffusion-based approach to causal inference with spillover effects. \newblock arXiv preprint arXiv:2508.06594. \bibitem[Kikuchi(2024c)]{kikuchi2024navier} Kikuchi, T. (2024c). \newblock Spatial and temporal boundaries in difference-in-differences: A framework from Navier-Stokes equation. \newblock arXiv preprint arXiv:2510.11013. \bibitem[Kikuchi(2024d)]{kikuchi2024nonparametric1} Kikuchi, T. (2024d). Nonparametric identification and estimation of spatial treatment effect boundaries: Evidence from 42 million pollution observations. \textit{arXiv preprint arXiv:2510.12289}. \bibitem[Kikuchi(2024e)]{kikuchi2024nonparametric2} Kikuchi, T. (2024e). Nonparametric identification of spatial treatment effect boundaries: Evidence from bank branch consolidation. \textit{arXiv preprint arXiv:2510.13148}. \bibitem[Kikuchi(2024f)]{kikuchi2024dynamical} Kikuchi, T. (2024f). Dynamic spatial treatment effect boundaries: A continuous functional framework from Navier-Stokes equations. \textit{arXiv preprint arXiv:2510.14409}. \bibitem[Kikuchi(2024g)]{kikuchi2024healthcare} Kikuchi, T. (2024g). Dynamic Spatial Treatment Effects as Continuous Functionals: Theory and Evidence from Healthcare Access. \textit{arXiv preprint arXiv:2510.15324}. \bibitem[Kline and Moretti(2014)]{kline2014people} Kline, P. and Moretti, E. (2014). \newblock People, places, and public policy: Some simple welfare economics of local economic development programs. \newblock \emph{Annual Review of Economics}, 6(1), 629--662. \bibitem[Larsen et al.(1993)]{larsen1993predicting} Larsen, M. P., Eisenberg, M. S., Cummins, R. O., and Hallstrom, A. P. (1993). \newblock Predicting survival from out-of-hospital cardiac arrest: A graphic model. \newblock \emph{Annals of Emergency Medicine}, 22(11), 1652--1658. \bibitem[LeSage and Pace(2009)]{lesage2009introduction} LeSage, J. and Pace, R. K. (2009). \newblock \emph{Introduction to Spatial Econometrics}. \newblock Chapman and Hall/CRC. \bibitem[Mann et al.(2015)]{mann2015structure} Mann, N. C., Kane, L., Dai, M., and Jacobson, K. (2015). \newblock Description of the 2012 NEMSIS public-release research dataset. \newblock \emph{Prehospital Emergency Care}, 19(2), 232--240. \bibitem[McCormack and Coates(2013)]{mccormack2013ambulance} McCormack, R. and Coates, G. (2013). \newblock A simulation model to enable the optimization of ambulance fleet allocation and base station location for increased patient survival. \newblock \emph{European Journal of Operational Research}, 247(1), 294--309. \bibitem[McCoy and Hsia(2013)]{mccoy2013geographic} McCoy, C. E. and Hsia, R. Y. (2013). \newblock Geographic variation and financial risk in emergency medical services. \newblock \emph{Health Services Research}, 48(5), 1665--1682. \bibitem[McLafferty and Grady(2012)]{mclafferty2012rural} McLafferty, S. and Grady, S. (2012). \newblock Immigration and geographic access to prenatal clinics in Brooklyn, NY: A geographic information systems analysis. \newblock \emph{American Journal of Public Health}, 95(4), 638--640. \bibitem[Meretoja et al.(2014)]{meretoja2014reducing} Meretoja, A., Keshtkaran, M., Saver, J. L., et al. (2014). \newblock Stroke thrombolysis: Save a minute, save a day. \newblock \emph{Stroke}, 45(4), 1053--1058. \bibitem[Mobley et al.(2006)]{mobley2006geographic} Mobley, L. R., Root, E. D., Finkelstein, E. A., et al. (2006). \newblock Environment, obesity, and cardiovascular disease risk in low-income women. \newblock \emph{American Journal of Preventive Medicine}, 30(4), 327--332. \bibitem[Müller and Watson(2022)]{muller2022spatial} Müller, U. K. and Watson, M. W. (2022). \newblock Spatial correlation robust inference. \newblock \emph{Econometrica}, 90(6), 2901--2935. \bibitem[Müller and Watson(2024)]{muller2024spatial} Müller, U. K. and Watson, M. W. (2024). \newblock Spatial unit roots and spurious regression. \newblock \emph{Econometrica}, 92(5), 1661--1695. \bibitem[Newgard et al.(2010)]{newgard2010national} Newgard, C. D., Schmicker, R. H., Hedges, J. R., et al. (2010). \newblock Emergency medical services intervals and survival in trauma: Assessment of the "golden hour" in a North American prospective cohort. \newblock \emph{Annals of Emergency Medicine}, 55(3), 235--246. \bibitem[Pagan and Ullah(1999)]{pagan1999nonparametric} Pagan, A. and Ullah, A. (1999). \newblock \emph{Nonparametric Econometrics}. \newblock Cambridge University Press. \bibitem[Pasquill and Smith(1983)]{pasquill1976atmospheric} Pasquill, F. and Smith, F. B. (1983). \newblock \emph{Atmospheric Diffusion}, 3rd edition. \newblock Ellis Horwood Limited. \bibitem[Peleg and Pliskin(2004)]{peleg2004optimal} Peleg, K. and Pliskin, J. S. (2004). \newblock A geographic information system simulation model of EMS: Reducing ambulance response time. \newblock \emph{American Journal of Emergency Medicine}, 22(3), 164--170. \bibitem[Saver(2006)]{saver2006time} Saver, J. L. (2006). \newblock Time is brain—quantified. \newblock \emph{Stroke}, 37(1), 263--266. \bibitem[Seinfeld and Pandis(2016)]{seinfeld2016atmospheric} Seinfeld, J. H. and Pandis, S. N. (2016). \newblock \emph{Atmospheric Chemistry and Physics: From Air Pollution to Climate Change}, 3rd edition. \newblock John Wiley \& Sons. \bibitem[Viscusi(2018)]{viscusi2018pricing} Viscusi, W. K. (2018). \newblock Pricing lives: Guideposts for a safer society. \newblock \emph{Princeton University Press}. \bibitem[Vukmir(2006)]{vukmir2006survival} Vukmir, R. B. (2006). \newblock Survival from prehospital cardiac arrest is critically dependent upon response time. \newblock \emph{Resuscitation}, 69(2), 229--234. \end{thebibliography} |
| URI: | https://mpra.ub.uni-muenchen.de/id/eprint/126726 |

