Rhetorical Work in Emergency Medical Services

Communicating in the Unpredictable Workplace

Elizabeth L. Angeli

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351599467
• Edition: 1
• Topic: Languages & Linguistics
• Subtopic: Communication Studies
• Index: Languages & Linguistics

NCTE-CCCC Best Book in Technical or Scientific Communication 2020

Rhetorical Work in Emergency Medical Services: Communicating in the Unpredictable Workplace details how communicators harness the power of rhetoric to make decisions and communicate in unpredictable contexts. Grounded in a 16-month study in the emergency medical services (EMS) workplace, this text contributes to our theoretical, methodological, and practical understandings of the situation-specific processes that communicators and researchers engage in to respond to the urgencies and constraints of high-stakes workplaces. This book presents these intricate processes and skills—learned and innate—that workplace communicators use to accomplish goal-directed activity, collaborate with other communicators, and complete and teach workplace writing.

1

THE SCENE SIZE-UP

This book explores the unobservable processes that facilitate written communication practices in unpredictable workplaces. In these workplaces, communicators rely on their senses, memory, and intuition to provide them with contextual, embodied information that prompts action, such as documenting medical events. In the unpredictable workplace of emergency medical services (EMS), the workplace that I studied, EMS professionals rely on their senses to see what factors may have contributed to a 911 call and led to a patient’s condition. Known as the “scene size-up” and as illustrated in this book’s cover image, these first seconds of an emergency response provide EMS professionals with crucial sensory information about how they should proceed with, and document, patient care. For example, if EMS professionals observe oxygen tanks upon walking into a patient’s living room, the patient most likely has a respiratory condition that may have led the patient to call 911. If EMS professionals respond to a car accident and observe a cracked windshield, a passenger probably hit her head on the windshield, which might have caused head trauma. In turn, EMS professionals take appropriate action to treat the potential trauma. These observations and details are the backstory for why EMS professionals were called for help; they contextualize and justify the treatment decisions that EMS professionals make, and they influence their written communication processes, practices, and products, which this book details.

Similarly, all research projects have a backstory, or a scene size-up, that contextualizes research methods and findings, yet these backstories are usually unwritten. As researchers, we might share them with one another in the hallways of conference venues, over coffee or lunch, or in the classroom with our students. In published scholarship, we tend to open publications by discussing the relevant literature, situating our work in scholarship but neglecting to situate it within the research context itself. But the literature is often not where research projects begin. They begin with people—and these people have stories. By publishing these backstage narratives (Barton 2004), we give voice and credence to these people and their influence on research projects (Walton, Zraly, and Mugengana 2015).

Like the scene size-up in EMS, the backstories of research projects are often crucial for readers to understand both a research project’s trajectory and the final product, a publication. Scholars have noted the value of these stories in technical and professional communication (TPC) because they solidify knowledge, facilitate mentoring and pedagogy, and disseminate professional values (Cushman 2015; Faber 2002; Graham 1995; Simmons 2007). Challenges, roadblocks, and detours shape a research project and impact the findings a researcher shares, serving as a research project’s exigence.

To detail this project’s scene size-up—its backstory—I open this book with my own introduction to EMS because this project was as much about researching writing practices in unpredictable workplaces as it was about building trust and relationships with one workplace: an EMS squad. The scene size-up shows the “expanded rhetorical situation[s]” that I managed, engaged with, and developed agency within during the project, serving as the first step of “rhetorical work” (Andersen 2014a, 142): the processes by which communicators “create and shape . . . communication for specific audiences in specific contexts for specific purposes” (Andersen 2014a, 118).

This project started with one question: “Liz, how does spending the summer in upstate New York sound?”

Stepping out of the Academy and into a Jumpsuit

It was the summer after my first year in my PhD program where I was studying rhetoric and composition, TPC, and the rhetoric of health and medicine (RHM). One of my professors, Michael Salvo, told me that Brenton Faber, a TPC scholar who was working at a hospital in Potsdam, New York, was looking for an intern to work on two projects: one at a hospital and one at a volunteer rescue squad. Michael thought I would be a good fit given my interests in medicine and TPC, and he asked me if I was interested in the projects, which—unbeknown to me, Michael, or Brent—would spark a research trajectory into EMS and would lead to this book.

Michael put me in touch with Brent, who shared with me that the hospital internship was Monday through Friday from 8:30am to 3:30pm for six weeks. I would help hospital management with technical writing assignments related to insurance data and patient intake forms. The volunteer rescue squad internship was in the evenings and on some weekends. Brent wanted to study the effects of global positioning system (GPS) devices on response times in rural areas, and to help him, I would find and purchase the best GPS devices for rural ambulances, and input and analyze response time data to see what—if any—effect the GPS devices had on response times. I would live in the campus apartments, which would mostly be empty for the summer, except for me and the college students who volunteered for local summer camps. With all the details in place, I signed the necessary agreement forms and prepared for my internship. In mid-June, I loaded up my Honda Civic with my luggage, some cookware and dishes, and my laptop. My mom joined me for the 13-hour drive from my graduate school apartment to my summer assignment in Potsdam.

On my first day of work, Brent gave me a tour of the hospital, and he brought me over to the rescue squad around lunchtime. There, in the ambulance garage, I met Steve and Joe, two people with whom I would work closely over the next six weeks. Steve was a paramedic, the only paid paramedic who worked for the volunteer squad. As the paid paramedic, Steve worked a regular day shift Monday through Friday. Joe was a firefighter and was working to earn his emergency medical technician (EMT) certification, and he also worked the regular day shift, driving the ambulance while Steve treated patients in the back.

The four of us talked for a bit, and they took me on a tour of the squad, which included the dispatch center, living quarters, and the office where I would spend most of my time. They showed me patient care reports (PCRs) that I would be using to track response times, and they gave me what I would now call a crash course in EMS: what it is, what they do, and why they do it. This tour exposed me to what Goffman (1959) and Barton (2004) refer to as the backstage of a workplace. In EMS, the dispatch center sets the stage, and dispatch and EMS professionals are the main stage players, with patients and 911 callers making guest appearances on their stage.

As Brent, Steve, and Joe continued the tour, they could tell that I was intrigued by this field. They also realized that they could not tell me everything I needed to know about EMS only by my reading reports; I would need to experience it. So, about 20 minutes into our conversation, Steve asked me, “You know that you could ride along in the ambulance with us?”

“Really?” I said. I could feel my eyes growing bigger with excitement. My adrenaline started to rush.

“Sure. You’ll get a feel for what we do. You would just need to sign some waivers and wear one of our jumpsuits,” Steve explained.

“Plus,” Brent added, “it will give you a better idea of how to measure the response times.”

“Okay, sure. Where do I get the jumpsuit?” I asked.

“We can get you one tomorrow. We have to get back to the hospital,” Brent directed as we left the office and headed down to the ambulance garage.

I was eager to return to the rescue squad the next day. I arrived at the squad around 4pm, and I met a few other rescue squad volunteers: Samuel, Carol, and Denise. We discussed the GPS project a bit, and they told me features that they would find helpful in a GPS, like easy interface navigation and a decent-sized screen. After discussing these criteria, Samuel shifted the conversation by asking me, “Aren’t we supposed to help you find a jumpsuit today?”

Samuel, Carol, and Denise led me into a storage room off the ambulance garage. As we made our way to the jumpsuits, Samuel explained the equipment we passed by, like a bag-valve mask and suction devices. The navy-blue one-piece jumpsuits were hanging on a clothes rack against a back wall, and Samuel pulled one off the rack. It had reflective strips on it and said “PVRS” (“Potsdam Volunteer Rescue Squad”) in big iron-on letters on the back. “Let’s see which one fits you,” Samuel said as he realized that the suit he held was too short for me.

Samuel, Carol, and Denise started sorting through the jumpsuits to find the longest one. I’m 5 ft 11, and they knew that their average suit would not cover my legs all the way. As they sorted through the suits, I stood back and looked at what they were wearing: dark cargo pants, which I later learned were made specifically for EMS professionals, a dark uniform shirt, and combat boots. I then looked down at what I was wearing: a skirt and heels. I packed business casual clothes for my internships, thinking that I would be in a workplace setting all day—not the back of an ambulance. I started to realize that I was unprepared for what the summer was about to offer.

“Here you go. Try this one on,” Samuel said as he handed me the longest jumpsuit they could find. “We’ll wait for you in the garage.”

They left the storage room and shut the door. I tried to put the jumpsuit on over my skirt and heels. I hopped around on one foot for a bit before realizing that I should have taken off my heels. Once I had the suit on, I looked for a mirror. Not finding one, I glanced down at my feet to see my brown heels poking out under the navy-blue jumpsuit. “I bet I look like a glamorous Ghostbuster,” I thought to myself.

I walked out of the storage room to see Samuel, Denise, Carol, Steve, and Joe waiting for me. “I guess I shouldn’t wear heels when I come here,” I joked as I shuffled closer to them looking down at my feet. They chuckled. Pensively I asked, “Do I need to buy combat boots?”

“Do you have sneakers or other closed-toe shoes you could wear? Those should work,” Carol replied.

“Yes, I do have those with me. I’ll keep them in my car,” I said. We all chatted a while longer before I headed to my apartment for the night.

The next day I started what would become my usual Monday through Friday schedule. I worked at the hospital from 8:30am till 3:30pm, and at 3:30pm, I drove to the squad and worked there until 6pm or 6:30pm. When I arrived at the squad, I would look for Steve and Joe, who were usually up in the office, which is where I spent most of my time inputting data and learning about EMS. I would walk into the office and ask, “Did I miss any responses today?”, half hoping they would say “no,” which they usually did; I was eager to see EMS in action. Then, after Joe and Steve had updated me on what they had done for the day or any patients they had responded to, I would pull out my laptop and organize the PCRs from which I inputted data. For the first couple of days that I worked at the squad, I asked Steve and Joe a lot of questions about all aspects of EMS, from the forms I was working with, to their most challenging EMS responses, to what they do when they’re not with patients (which included cleaning the squad, washing the ambulance, and taking inventory of supplies).

As I learned more about EMS, I started to feel a little more at home. The rescue squad must have felt the same way about me because, during my first week there, they gave me keys to the squad and my own pager, which would alert me if PVRS was responding to a patient anytime, day or night. I eventually went on a ride-along with Joe and Steve 10 days into my internship, which is detailed in Chapter 5. It was my first opportunity to witness the front stage of EMS, and in retrospect, it was the first time I saw key elements of rhetorical work in action, including EMS professionals’ ability to gather data, triage changing information, and, most importantly, treat patients. Seeing this rhetorical work in action drove me to want to study it more, and, perhaps more importantly, after seeing Joe and Steve help patients, I wanted to become a part of the EMS community so that I could help people.

Over the next few weeks and as I joined the crew on responses, I realized how many responsibilities EMS professionals have. I was surprised to learn how much of this responsibility was in their communication—remembering a patient’s medications, a patient’s living conditions, the smells that greeted them when they walked into a patient’s house, and the information verbally and nonverbally shared throughout a response. I continued to join the rescue squad volunteers on ride-alongs for the whole summer while I worked at the hospital. To follow hospital rules, I earned my first cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) certifications. I also was glad to earn these certifications because I no longer felt completely helpless during ride-alongs; if a patient needed CPR, I could do more than carry the medical bag, which was my primary job during ride-alongs.

I also rode along with Brent for a few responses, and they, too, proved to be eye opening but in different ways from riding with Joe and Steve. One weeknight, my pager beeped at 2am. Brent and a paramedic were on call that night, and I joined them as we responded to a patient with alcohol poisoning. Just as I had done with Steve and Joe many times before, Brent, the paramedic, and I arrived with the patient at the hospital emergency department (ED), which was housed in the same hospital where Brent and I worked during the day. The ED staff were his co-workers, and I noticed that Brent interacted with them smoothly; they spoke the same the language. He had this rapport with his co-workers in part because he had been there for a few years—but I also realized that he built this rapport by bringing patients to the ED at 2am with PVRS. Sure, he had a PhD in English, which I was also working toward, but he shared something in common with hospital staff: a genuine desire to help people, a commitment to the medical field, and medical training.

As a student studying RHM, I knew that I would be working with hospitals in the future as part of my research. Even just that summer, I worked with countless numbers of medical professionals and interacted with many patients at the hospital and the rescue squad. Most people at the hospital and rescue squad knew that I was Brent’s intern, and one of the first questions people would ask was something like, “Aren’t you getting a PhD in English? Why are you interning at a [insert either hospital or rescue squad]?” People would look at me bemused, trying to solve the equation “English + hospital/rescue squad = this girl?” I would give them a brief, 30-second description of TPC and RHM, sharing that I studied how medical professionals use language in writing and speaking. Usually people would find that response satisfactory; other times people just walked away with still-confused looks. And I realized that I was working in an area where I did not have credibility.

In the interest of full disclosure, I was at a crossroads at this point in my graduate work, the summer after my first year in my PhD program. I was unsure whether I wanted to pursue an academic career. I thought about going to work for a hospital or working as a medical writer. I had always been interested in the medical field; I worked as a veterinary assistant for a few years in college, and I had plans to go to veterinary medical school (until I took basic chemistry in college). Regardless of my career plans, I knew that it was important to me, personally and professionally, to step out of the academy and step into the hospital not just as a researcher, but as a healthcare provider. Steve, Joe, Brent, and the other rescue squad volunteers showed me that earning my EMT certification would help me with this step.

Becoming an EMT

My brief glimpse into EMS and hospitals prompted me to earn my EMT-basic (EMT-B) certification. I had always wanted to contribute to the medical field; that was one reason why I studied RHM. The EMT-B certification allowed me to be a part of the medical field—to know the language and to know how to care for patients, even at a basic level—without having to earn a medical de...

Table of contents

• Cover Page
• Rhetorical Work in Emergency Medical Services
• Attw Book Series in Technical and Professional Communication
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• List of Tables
• Foreword
• Acknowledgments
• List of Abbreviations
• 1 The Scene Size-up
• 2 Managing the Unpredictable Workplace through Rhetorical Work
• 3 A Rhetorical History of a Developing Field
• 4 Studying the Unpredictable Workplace
• 5 Using Multisensory Invention in the Unpredictable Workplace
• 6 Integrating Distributed Cognition, Memory, and Writing into the Unpredictable Workplace
• 7 Preparing Communicators for Unpredictable Workplaces
• References
• Bibliography of Secondary Research
• Index