## 6 Patient Transfer Logistics  
This section presents the development of the IoT-based smart bus system which can support the timely movement of reassigned patients from a bus stop near the source facility to the destination facility. This can help prevent putting a further strain on the already fragmented ambulatory services in many clinics. Since upon arrival patients are triaged and get treated in order of urgency, then in order of arrival, the patients that are re-assigned are the least critical, such that they can manage to carry themselves to the nearest bus station. Figure 5: Training phase in the decentralized system. Hospital logistics generally differentiate between three main flows: Patient, information and material flows. The patient flows run in three directions: Towards the hospital or inbound, within the hospital or internal and away from the hospital or outbound. As pointed out above, the goals of the above proposed system are to predict future patient loads. Furthermore, in the case of excess patient loads, we propose that excess loads should be re-assigned to nearby facilities that have a minimal load as a way to control overcrowding and reduce the number of patients that leave health facilities without receiving medical care. However, the re-assigning of patients will imply a need for transportation for the patient to move from one facility to another. The two most commonly employed modes of transfer of patients are ground transport, with the inclusion of ambulances, and mobile intensive care units (MICUs) [84]. Here we assume the existence of a scheduled bus transport system. A bus journey involves such stages as waiting, queuing and transferring from the origin point to the final destination. These stages are impacted by the services rendered and transportation network resources. Three stages exist at which transit services can affect passengers [85]. These stages are:  
Origin-point stage: At this level, passengers wait for the next bus. Passenger waiting time can be longer than expected due to irregular headway or technical issues that might affect the bus. Moreover, all passengers may not board the arriving bus due to capacity limitation. Upon being queried, the proposed smart bus system will provide passengers with information regarding the position of the bus, travel time estimate and information about the number of vacant seats in the bus. This information will help passengers to plan their waiting time accordingly. Boarding stage: At this stage, the passenger services time (PST) is a function of passenger demand. A boarding passenger's wait-time must allow passengers in the bus to alight. Here, we assume that near each health facility there is a boarding stage. Arrival stage: The arrival stage is the stage where passengers reach their final destination. Their arrival can be on time, ahead or delayed based on the deviation from the timetable. For the patients, the arrival stage will be the stage near the destination facility where the patient has been referred. Various solutions exist that are used to track data related to the departure and arrival times of buses. Radio frequency (RF) transceivers [86] are installed on buses and bus stops to enable buses to communicate their location to bus stops. The estimated arrival time of the bus is calculated by microprocessors at the bus stops. The calculated time is displayed on screens that are installed at the stages. Some solutions employ SMS services on global system for mobile communication (GSM) modules to transmit bus positions to databases. GPS tracking devices are mounted on buses to provide location data. Sending of data to the database is via the hyper text transfer protocol [87; 88]. Alternatively, location data can be streamed from android devices in the bus. The bus location and travel time approximation can be accessed through android devices or web portals. Unfortunately, some of these systems cannot handle an increase in requests. The bandwidth demand for sending the data from buses to servers is high.