Street Medicine—Assessment Work Strategies of Paramedics on the Front Lines of Emergency Health Services

Abstract

This article is based on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes in a major City in Canada. Drawing on more than two hundred hours of observations and more than one hundred interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. The multiplicity of interfacing social, demographic, locational, and situational factors that shape and organize the work of paramedics are analyzed. In doing so, this article provides insights into the complex work of an understudied yet ever-important profession in health care.

Driving to Work: The Front Seat Work of Paramedics to and from the Scene

“…Once paramedics arrive at a scene, the work that unfolds is contextual and multifarious (Corman ). Furthermore, there is much work that paramedics do in the back of the ambulance that goes into successfully transporting a patient to the hospital.…”

“…As a result, paramedics are constantly at work orienting towards the potentialities that their work setting might activate. Like other work processes paramedics do (see Corman ), their work orientation in the front of the ambulance shifts with and is shaped by the unfolding of events; the crew on their way to and from the scene orient to their environment both inside and outside of the ambulance in ongoing, recursive ways. As such, and like the work of the Micronesian navigator, what paramedics do in the front seat of an ambulance is best described as situated actions organized by both “material and social circumstances” (Suchman :70).…”

“…In doing so, I bring to the fore the intricate physical, mental, emotional and embodied work that paramedics do in the front of their ambulance, “apparatus unit” or, more colloquially, “rig.” This article therefore draws attention to an ever‐important group of front‐line health care workers and a unique component of their work practices—driving. I argue that this front seat work is neither simple nor straightforward; like other work processes of paramedics, such work is organized by the unfolding of socially significant information that paramedics deem important (Corman , ).…”

From Extreme to Mundane? The Changing Face of Paramedicine in the UK Ambulance Service

“…The most recent example at the time of writing is new legislation enabling paramedics patient's family or other bystanders watching triage and treatment efforts (eg, Brady, 2015;Clompus and Albarran, 2016). Paramedics are also commonly the targets of violence from patients and their families and bystandersincluding intimidation, sexual harassment, verbal, physical and sexual assault (eg, Corman, 2017;Maguire et al, 2018;van Erp et al, 2018). Taylor et al (2016: 156) suggest male paramedics especially may under-report such violence for fear of appearing weak.…”

The bargaining of professionalism in emergency care practice: NHS paramedics and higher education

“…In Canada, the paramedic role has been adapted in order to meet the growing demand for emergency care services as well as the increasingly long waiting time for medical care and the ever-inflating costs of health care (Corman 2016). In Australia, paramedics developed greater medical skills as part of the solution for providing primary healthcare in small rural communities (O’Meara et al 2012).…”