# Agreement Technologies for Coordination in Smart Cities
## 3 Applications
### Distributed Coordination of Emergency Medical Service for Angioplasty Patients  
Based on the World Health Organization data, ischemic heart disease (IHD) is the single most frequent cause of death, killing 8.76 million people in 2015, and one of the leading causes of death globally in the last 15 years [50]. It is a disease characterised by ischaemia (reduced blood supply) of the heart muscle, usually due to coronary artery disease. At any stage of coronary artery disease, the acute rupture of an atheromatous plaque may lead to an acute myocardial infarction (AMI), also called a heart attack. AMI can be classified into acute myocardial infarction with ST-segment elevations (STEMI) and without ST elevation (NSTEMI). Effective and rapid coronary reperfusion is the most important goal in the treatment of patients with STEMI. One of the reperfusion methods is angioplasty or primary percutaneous coronary intervention (PCI). It is the preferred treatment when feasible and when performed within 90 min after the first medical contact [51; 52]. Due to insufficient EMS coordination and organisational issues, elevated patient delay time--defined as the period from the onset of STEMI symptoms to the provision of reperfusion therapy--remains a major reason why angioplasty has not become the definitive treatment in many hospitals. Conventional EMS procedure in assisting AMI emergencies is the following. Patients are diagnosed in the place where they suffer chest pain: at their momentary out-of-hospital location or at a health centre without angioplasty. In both cases, the emergency coordination centre (ECC) applies first-come first-served (FCFS) strategy and locates the nearest available (idle) ambulance with advanced life support (ALS) and dispatches it to pick up the patient. After the ambulance arrives to the scene and diagnoses AMI by an electrocardiogram, the ambulance confirms the diagnosis to the ECC, which has real-time information of the states of ambulances. The ECC applies FCFS strategy for hospital and cardiology team assignment by locating the nearest available hospital with a catheterisation laboratory and alerting the closest hospital cardiology team of the same hospital. The improvements of the EMS coordination in the literature were achieved both by novel fleet real-time optimisation and communication methods, using new multiagent models (see, e.g., [44; 52; 53; 54; 55]). Despite an exhaustive quantity of work on the optimisation of EMA, to the best of our knowledge, there is little work on optimisation models for the coordination of EMS when the arrival of multiple EMS actors needs to be coordinated for the beginning of the patients' treatment. This is the case with STEMI patients assigned for angioplasty treatment where, in the case of multiple angioplasty patients, the FCFS strategy discriminates the patients appearing later. EMA coordination for STEMI patients includes the assignment of three groups of actors: assignment of idle ambulances to patients, assignment of catheterisation laboratories in available hospitals to patients receiving assistance in situ, and assignment of available cardiology teams to hospitals for the angioplasty procedure performance. All of the three assignments need to be combined in a region of interest such that the shortest arrival times are guaranteed to all patients awaiting angioplasty at the same time. In continuation, we present the solution approach from [52], which presents a coordination model for EMS participants for the assistance of angioplasty patients. The proposed approach is also applicable to emergency patients of any pathology needing prehospital acute medical care and urgent hospital treatment. We concentrated on the minimisation of the patient delay, defined as the time passed from the moment the patient contacts the medical ECC to the moment the patient starts reperfusion therapy in the hospital.