I am a Professor of Management at the University of York, England. My interest in ambulances and paramedic work is derived from research I have conducted into England’s National Health Service. This is a ‘free at the point of use’ service which, at its best, provides world-class care to citizens without charge. But the system is terribly underfunded. I am always struck by paramedics’ growing clinical ability, compassion, and devotion to their patients. But equally, I’m alarmed by the extent to which ambulance organizations are desperately overstretched, to the point where the system–and its workers face extreme everyday challenges.
I wrote
The Paramedic at Work: A Sociology of a New Profession
This excellent read is the first of a recent wave of new books about paramedics and ambulance services. Mike Corman takes us into the working world of ambulance crews in Alberta, Canada. Participant observation provides detail and analysis of how the pre-hospital system operates and how paramedics and technicians interpret and make sense of their roles within it.
I was particularly impressed with the discussions of conflict within what is a rather patchworked and sometimes poorly coordinated system. Ambulance crews frequently complain of what they see as inappropriate call handling and dispatching, they resent the data-driven micromanaging of their work according to target response times, and they often anticipate conflict with receiving hospitals. Corman rightly argues that ambulance work is the ‘canary in the mine,’ revealing health systems' structural inequalities and limitations.
In Paramedics On and Off the Streets, Michael K. Corman embarks on an institutional ethnography of the complex, mundane, intricate, and exhilarating work of paramedics in Calgary, Alberta.
Corman's comprehensive research includes more than 200 hours of participant observation ride-alongs with paramedics over a period of eleven months, more than one hundred first hand interviews with paramedics, and thirty-six interviews with other emergency medical personnel including administrators, call-takers and dispatchers, nurses, and doctors. At the heart of this ethnography are questions about the role of paramedics in urban environments, the role of information and communication technologies in contemporary health care…
Josh Seim wrote a powerful book about the complex roles of paramedics and ambulances in US cities. What I particularly enjoyed about this text was the way in which it understands the ambulance crew, not so much as the heroic life-savers of TV lore, but rather as downtrodden workers in a broken system of poverty management.
Working as an EMT and documenting his experiences, Seim brilliantly shows how the disjointed and crumbling healthcare system of the United States is failing its citizens and its emergency workers. The EMTs and paramedics of a private ambulance company in Agonia County do their best to serve the public, but they are in very trying conditions. Although the US pre-hospital system is quite different from what I’m familiar with in the UK, I also found dozens of issues that I can relate to.
What is the role of the ambulance in the American city? The prevailing narrative provides a rather simple answer: saving and transporting the critically ill and injured. This is not an incorrect description, but it is incomplete.
Drawing on field observations, medical records, and his own experience as a novice emergency medical technician, sociologist Josh Seim reimagines paramedicine as a frontline institution for governing urban suffering. Bandage, Sort, and Hustle argues that the ambulance is part of a fragmented regime that is focused more on neutralizing hardships (which are disproportionately carried by poor people and people of color) than on…
Blood of the White Bear
by
Marcia Calhoun Forecki,
Virologist Dr. Rachel Bisette sees visions of a Kachina and remembers the plane crash that killed her parents and the Dine medicine woman who saved her life. Rachel is investigating a new and lethal hantavirus spreading through the Four Corners, and believes the Kachina is calling her to join the…
I loved reading this book, another recent one on ambulances and paramedics. It uses qualitative sociological methods to explore the inner workings of the pre-hospital health system and its workers. Chris Prener, an experienced EMT, took an immersive, ethnographic approach to studying the sociology of ambulance work in Chapman City.
Prener shows how urban EMS is moving away from its roots as an emergency response system for critically ill and injured patients and becoming more of a community care system, mostly used by vulnerable and neglected populations. Perhaps the most interesting element of the book is its portrayal of the reluctance of ambulance practitioners to embrace these changes. A very insightful book about the messiness and conflict that often reside amid work occupations and healthcare systems.
Presents a unique view of social problems and conflicts over urban space from the cab of an ambulance.
While we imagine ambulances as a site for critical care, the reality is far more complicated. Social problems, like homelessness, substance abuse, and the health consequences of poverty, are encountered every day by Emergency Medical Services (EMS) workers. Written from the lens of a sociologist who speaks with the fluency of a former Emergency Medical Technician (EMT), Medicine at the Margins delves deeply into the world of EMTs and paramedics in American cities, an understudied element of our health care system.
Like…
This book is engrossing. Because of its fascinating setting, it is unique among the new wave of sociological or anthropological books on paramedic work. Jusionyte has written a remarkable ethnography about paramedics and EMTs working in the US-Mexico borderlands.
While much of the details of ambulance work are familiar, this setting is novel, alien, and disturbing. The book is a powerful critique of the militarization of borders and why this is detrimental, divisive, and degrading. Jusionyte writes with great style and panache; it’s a gripping story crafted in a polemical but persuasive fashion.
I learned a great deal about how the distinctiveness of geographical and political settings can massively influence and shape occupational culture and worker behavior. This is a creative and original work.
"Jusionyte explores the sister towns bisected by the border from many angles in this illuminating and poignant exploration of a place and situation that are little discussed yet have significant implications for larger political discourse."-Publishers Weekly, STARRED Review
Emergency responders on the US-Mexico border operate at the edges of two states. They rush patients to hospitals across country lines, tend to the broken bones of migrants who jump over the wall, and put out fires that know no national boundaries. Paramedics and firefighters on both sides of the border are tasked with saving lives and preventing disasters in the harsh…
Blood of the White Bear
by
Marcia Calhoun Forecki,
Virologist Dr. Rachel Bisette sees visions of a Kachina and remembers the plane crash that killed her parents and the Dine medicine woman who saved her life. Rachel is investigating a new and lethal hantavirus spreading through the Four Corners, and believes the Kachina is calling her to join the…
This is where it all began–to my knowledge, this book is the very first book-length sociology of ambulance work. Like its successors, Metz’s book is based on ethnographic research methods. Published in 1981, and given the changes that have enveloped paramedicine in the last twenty years, this book is now very dated.
But what I found fascinating was that many important elements and controversies of ambulance work described here remain relevant today. Metz and his colleagues in an EMS provider company regularly muse about the mismatch between the intended design of the EMS system as an emergency system and the reality of the kinds of calls they are sent to.
As such, it anticipates debates taking place forty years later. How can ambulance services be managed and directed best? To what level should we train our ambulance responders? Who calls ambulances and why? What is an ‘appropriate’ use of an ambulance service? What is the ambulance for?
Ambulance services and paramedics perform critical roles in contemporary healthcare economies. Trained to work in the field and respond rapidly to emergencies, societies have come to increasingly rely on ambulance services to deliver urgent care. Never has this need been more acute than in recent years given intense social inequality, overstretched and underfunded health systems, and deadly pandemics.
Leo McCann offers the first book-length study of the paramedic profession in England. Based on in-depth interviews and ethnographic observation, The Paramedic at Work provides a detailed account of the complex realities of work in this fascinating occupation. Chapters explore the nature of work 'out on the road', the peculiarities of ambulance organizational culture, the intensity of workplace stress and burnout, and the current and future trajectory of paramedic professionalism. The book documents the unique paradoxes experienced by those employed in this line of work. Ambulance staff are trained to handle life-threatening trauma and disease, but most callouts consist of unplanned primary care. Paramedic work features wide autonomy but is also bound into an array of micromanaging performance indicators. Paramedics are trusted and respected in society but the profession is poorly understood and employers can be unsupportive. However, no matter how intense the personal struggles can be, paramedic work also offers rare opportunities for meaningful and socially valued work. This book shows that the role and status of the paramedic is rapidly moving from a manual occupation rooted in first aid and transportation, to a clinical profession of increasing scope, versatility, and social respect.
