Background Ascertaining the appropriate clinical urgency of a 999 call is vital to ensure optimal resource utilisation. With numbers of calls to ambulances services for lower-acuity situations continuing the rise, it is necessary to accurately identify early that the help needed is not always exactly the same as the help asked for. Undertaking effective prioritisation can be further complicated when the patient is not the caller. This study seeks to explore how a detailed analysis of dialogue between call-taker and caller might better understand how talk is used to convey and respond to expectations and anxieties.
Method Audio recordings of 45 telephone calls made through the ‘999’ system to an NHS Ambulance Trust were transcribed according to Jeffersonian Notation, and analysed in accordance with the theory and conventions of Conversation Analysis (CA). CA is a well-established inductive method that focuses on extracting sequential patterns in high-quality recordings of interactional data. CA involves the search for communication actions and/or formats that form evidence of systematic usage that can be identified as a ‘practice’.
Results Analysis focussed on the opening sequence following the question “tell me exactly what happened”. Various phenomena contained within the subsequent dialogue are identified, including how the concept of ‘preference organisation’ can aid understanding of how certain triage dispositions might occur. Examples of how callers attempt to ‘repair’ talk, and offer ‘resistance’ to the perceived trajectory of the dialogue are also explored.
Conclusion Even in very structured and partially-scripted interactions, revealing patterns of naturalistic utterances do occur. People use talk in 999 calls in distinct and definable ways to try and convey their expectations. Further focussed exploration of how people use the mechanics of talk in these situations is proposed, with the aim of identifying how cases might be managed differently through more nuanced triage questioning strategies.
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