Managing Medical Emergency Calls

University dissertation from Lund : Lund University Open Access

Abstract: This dissertation is a conversation analytic examination of recurrent practices of interaction in medicalemergency calls. The study expands the analytical focus in past research on emergency calls betweenemergency call operators and callers to pre-hospital emergency care interaction on the phone betweennurses, physicians and callers. The investigation is based on ethnographic fieldwork in a Swedish emergencycontrol centre. The data used for the study consists primarily of audio recordings of medical emergency calls.Fundamental procedures in medical emergency calls examined in the dissertation are: (1) questioning; (2)emotion management; (3) risk management and (4) instruction giving. Emergency call-takers ask questions toelicit descriptions by callers of what is happening and to manage symptoms of patients to help keep them safeuntil ambulance crews arrive. In the questioning practice about acutely ill or injured patients call-takers usemainly yes-no questions and clarify problems by questioning callers making a distinction between defined andundefined problems. The analysis reveals four core types of emotion management practices: (1) call-takerskeep themselves calm when managing callers’ social displays of emotions; (2) promising ambulanceassistance; (3) providing problem solving presentations including emergency response measures to concernsof callers, and (4) emphasising the positive to create hope for callers. Call-takers use seven key procedures tomanage risk in medical emergency calls: (1) risk listening through active listening after actual and possiblerisks; (2) risk questioning; (3) risk identification; (4) risk monitoring; (5) risk assessment; (6) making decisionsabout elicited risk and (7) risk reduction. Instruction giving using directives and recommendations isaccomplished by call-takers in four main ways: (1) acute flow maintaining instruction giving when callers areprocedurally out of line; (2) measure oriented instructions for patient care and emergency responsemanagement; (3) organisational response instructions and (4) summarising instruction giving. Callers routinelyacknowledge risk identifications and follow instructions delivered by call-takers to examine statuses and lifesigns of patients such as breathing, movement and pulse, and perform basic first aid and emergency responsemeasures.The findings generated from this study will be useful in emergency call-taker training in carrying out interactiveprocedures in medical emergency calls and add to the larger research programmes on on-telephoneinteraction between professionals and citizen callers. This is an essential book for pre-hospital emergency careproviders and institutional interaction researchers and students.