Acute flow maintaining instruction giving in medical emergency calls
49 C HAN HAR HJÄRTINFARKT VAD SÄGER DU:? HE HAS HEART ATTACK WHAT ARE YOU SAYING:?
50O→Men kan du svara på mina frågor? But can you answer my questions?
51 C VADÅ FÖ:R? WHY?
52 O Därför att det är bra för ambulanspersonalen att veta så Because it is good for the ambulance personell to know as
53 mycket som möjligt. much as possible.
Extract 8:3 taken from the end of the medical emergency call displays elaborated negotiations between the emergency call operator and the caller. At line 48, the emergency call operator asks the caller how long the patient has been having the heart attack in order to collect patient status data for the ambulance crew which is on their way to the patient. The caller does not answer the question which is a problem for the emergency call operator because this means that the caller is not participating in the interview activity of the medical emergency call. Instead the caller launches a repair in response to the inquiry. The previous inquiry by the emergency call operator is treated as a trouble-source by the highly distressed caller and she produces with increased volume the reason for the call again and questions the preceding turn by the emergency call operator at line 49. The emergency call operator response to the repair initiation is not an explanation but a coercive request to the caller to answer the questions (50). The recommendation question at line 50 is an acute flow maintaining instruction implying that the caller should participate in the emergency call interview and answer the questions in order for the social order of the emergency call to function. The caller responds by questioning this social order and the interrogation activity in the emergency call with a “WHY” at line 51.
A problem for the emergency call operator is then to get the caller to continue to answer the interview questions of the medical emergency call. The questioning by the caller is as a result followed by the emergency call operator’s explanation and formulation of the reason for this interview activity at lines 52-53 which closes the questioning-explanation sequence. The acute flow maintaining instruction is here as in other examples of this interactive phenomenon not given as a part of the interview activity but interspersed in other medical emergency call activities. It is a coercive form of instruction where the outcome is forced upon the caller. The caller is instructed to obey the emergency call operator and follow the emergency call order of the emergency control centre. In medical emergency calls call-takers expect callers to function as cooperating and compliant connection partners between patients and call-takers.
Instructing the caller to calm down (1 of 51 cases)
Another type of acute flow maintaining instruction giving is requesting the caller to calm down which is shown in Extract 8:4.
Extract 8:4 [Bleeding and breathing difficulty on the train track] (1A) W=Bystander (another person at the emergency site besides the caller)
33 C Det stämmer han ligger ju här skicka en ambulans. It’s correnct he lies here send an ambulance.
34N→Men ja måste ju veta var det är nånstans om du lugnar ner dej lite nu. But I need to know where it is located if you calm down a little bit now.
35 N [Location] säger du? [Location] you say?
36 C Ja. Yes.
When the anxious caller requests an ambulance at line 33 the nurse provides an explanation and instructs the caller to calm down with an acute flow maintaining instruction placed in the end of the call. The nurse gives the instruction in order to find out the exact location of the emergency (34). Call-takers have the organisational mandate to grant ambulance service. When the ambulance decision has not been made and the call-taker needs to collect additional data about the incident in order to make the ambulance decision and the caller requests an ambulance in an earlier position of the call (line 33) an explanation by the nurse of why more questioning is important becomes relevant (line 34). The caller does not respond verbally to the instruction requesting the caller to calm down. Instead the nurse launches a location confirmation request (35) which the caller responds positively to (36).
Call-taker explanation when the caller does not follow the social order of medical emergency calls (1 of 51 cases)
Another type of acute flow maintaining instruction giving is related to when the caller is procedurally out of line by requesting an ambulance in the middle of the interview. In the majority of the medical emergency calls in this data corpus callers request ambulances in the beginning of the medical emergency calls with the implication that call-takers initiates the medical emergency call interview in order to collect details about the possible emergency. In the end of the call the call-taker grants or declines the ambulance request. This is viewed by call-takers as a normal occurrence. When a caller interrupts the interview activity by requesting an ambulance inside the interview phase of the medical emergency call the call-taker
views this as a problem with the immediate consequence that the call-taker gives an acute flow maintaining instruction functioning as a solution to the problem. When the caller requests an ambulance at line 33 the nurse steers the caller to comply with the medical emergency call norms. She does this in order to make the caller follow the social order of the emergency control centre and gather information about where the incident occurs. She is here doing an acute flow maintaining instruction with an explanation about that she needs to know where the emergency is located at line 34. Directing the caller to listen (1 of 51 cases)
The final case of acute flow maintaining instruction giving is about the fundamental practice of listening in medical emergency calls which is exhibited in Extract 8:5.
Extract 8:5 [Dizzy and stomach pain] (20A)
18 C Va sa du? What did you say?
19O→Lyssna på mej nu. Listen to me now.
20 C Ja. Yes.
A prerequisite to deliver instructions in medical emergency calls is that callers listen to call-takers and can hear what they are saying. If this is not the case call-takers request callers to listen. In the excerpt above the caller expresses not having heard what the emergency call operator said. The emergency provides an acute flow maintaining instruction through a directive (19) placed in the middle of the call which the caller replies to by an unmarked acknowledgement (20).
I have here provided an analysis of key points of acute flow maintaining instruction giving in medical emergency calls including an overview of its character and social patterns. The features are distinctive to the medical emergency call context. In this interactive context call-takers give rapid acute flow maintaining instructions about how callers should respond to the institutional context and the normative modus operandi of well-worked phone manner in emergency calls. Some degree of compliance by callers is necessary in order to manage components that obstruct the flow in medical emergency calls. The acute flow maintaining instruction giving functions as a form of caller regulation practice in which call- takers direct and explain how the callers should act and orient in emergencies. In this procedure call-takers with the organisational mandate to make ambulance dispatch decisions encourage callers to fully participate in the emergency response
work and comply with the norms and requirements of medical emergency calls. This makes acute flow maintaining instruction giving highly asymmetric in character. The examples of acute flow maintaining instruction giving in the data are similar in regards to content, form, placement and response.