Titrating the Rig: How Paramedics Work in and on Their Ambulance

Abstract

In this article, I take readers inside of an ambulance and explore how paramedics work in and on their "apparatus unit" to make it a workable fit. This taken-for-granted work is important because much is at stake in the back of the ambulance, particularly in relation to quality of care and safety. I draw on data from an institutional ethnography into the socially organized work and work settings of paramedics, which included more than 200 hr of observations and more than 100 interviews with paramedics. The findings shed light on the situated work processes of paramedics as they orient and respond to their "apparatus unit" and enact quality and safety in practice. This article adds to the sociological literature on work and occupations as well as safety and quality in health care of an increasingly important group of health care and emergency services professional.

Research: Emergency medicine residents’ acquisition of point-of-care ultrasound knowledge and their satisfaction with the flipped classroom andragogy

“…The students then assimilate and apply this knowledge outside the lecture-room environment. The lecturing approach in delivering knowledge seems to be a popular approach among millennial learners, followed by learning through collaborative learning and learning by doing [5][6][7].…”

“…Demands on the healthcare system are rapidly increasing due to population age and growth, igniting an increased reliance on paramedics to carry out assessments and treatments traditionally performed by physicians [4]. Unlike the controlled environment of the emergency department or operating room, a paramedic work ecosystem can be described as austere, subject to immense variability in setting, lighting, and noise [5]. Workspaces range broadly from an ambulance or helicopter to an elevator, staircase, curbside, grocery store aisle, or living room floor [5].…”

“…Unlike the controlled environment of the emergency department or operating room, a paramedic work ecosystem can be described as austere, subject to immense variability in setting, lighting, and noise [5]. Workspaces range broadly from an ambulance or helicopter to an elevator, staircase, curbside, grocery store aisle, or living room floor [5]. Prehospital providers formulate diagnoses based on impartial information with no access to medical records [5].…”

“…Workspaces range broadly from an ambulance or helicopter to an elevator, staircase, curbside, grocery store aisle, or living room floor [5]. Prehospital providers formulate diagnoses based on impartial information with no access to medical records [5]. Auscultation is one of the few assessments available to paramedics; however, it is difficult to perform in the back of a moving ambulance or on a crowded street [5].…”

“…Prehospital providers formulate diagnoses based on impartial information with no access to medical records [5]. Auscultation is one of the few assessments available to paramedics; however, it is difficult to perform in the back of a moving ambulance or on a crowded street [5]. The diagnostic potency of ultrasound, its portability, and ease of use are well-suited features for translation to the unpredictable arena of prehospital medicine [6].…”