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The Systemic Affect of Critical Incidents on Emergency Medical Service Personnel Communication Using Ethnography and Autoethnography

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The Systemic Affect of Critical Incidents on Emergency Medical Service Personnel Communication Using Ethnography and Autoethnography I’M FINE: SYSTEMIC AFFECT OF CRITICAL INCIDENTS IN EMERGENCY MEDICAL SERVICE PERSONNEL COMMUNICATION Aaron Sterling Deason Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Doctor of Philosophy in the Department of Communication Studies, Indiana University July 2020 Accepted by the Graduate Faculty of Indiana University, in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Doctoral Committee ______________________________________ John Parrish-Sprowl, PhD Chair ______________________________________ Elizabeth Goering, PhD April 24, 2020 ______________________________________ Lynn Pike, PhD ______________________________________ Krista Hoffmann-Longtin, PhD ii © 2020 Aaron Sterling Deason iii DEDICATION Mary Lee Deason is my biggest cheerleader, nonunderstanderer of my ramblings but pretends to listen listener, constant fire lighter, and all-around cuddly love of my lifer. She has tolerated an EMS career then an academic journey that started off with a 41-mile move to complete only my bachelor’s but ended up with an 1100 mile move into the frozen Hoosier tundra for 5 years before coming home…I don’t know if she would have asked me out for our first date in August 1997 if she had known this would happen. With all my heart!!! Justin…our original child. You have endured more than any child should have to…but turned out ok. I am glad he lived because after a shittacular day at the office, I would come home and hold him for hours… Proud of my little Marine. OOHRAH!!! John, Bryan, Bryce, and Brionna Kay… Y’all came into my life and brought joy. You challenged me to become a better dad than the first time. Mom, Dad, D’ann, Jeff, Michelle, Mark, Kym, Les, and Nathan… you can’t make this up!!! So many great times and memories. We sang. We played. We are a family Kay- you are the best mother-in-law I’ve ever had. Thank you for allowing me to take your daughter on the journey. Thank you for your support and love. Tabitha Hardy… You saved my life!!! You gave hope when the zombie slogged into the office. You are a wonderful mentor and a friend. John Parrish-Sprowl… You are the scholar/teacher/mentor I want to be when I grow up. Thank you for being my Obi Wan... and keeping me off the ledge time after time. You helped me become ME…and gave me the confidence to roar!!! Elizabeth Goering… metaphors and exploring!!! I am glad YOU tolerated such a horrible research assistant. You gave me hope more that you know…and a way to write chapters 8 and 9. I think Lakoff and Johnson would approve! iv Lynn Pike… for allowing me to play in the Sociology world and tolerating my rants. We finally used the ice cream maker!!! Krista Hoffman Longtin… the bubble thing was genius. It helped me organize this crazy idea. Drs. Cali, Kidd, Matthews, and Velten… thanks for the helping me begin the process of becoming smarter. You deserve medals for your patience!!!! Billy Joe, Frankie, Randy, Tracy …I am glad we worked before cell phones had cameras… The fun we had saving lives!!! Medics - Thanks for sharing your stories so freely… and listening to mine, too. Deanna Johnson… for getting people to shift focus. Candance and Sara… I know you HAD to listen. Thank you for challenging my notions. Jeff Dill… Thanks for sharing the suicide data and all the work you do to combat mental illness in emergency services. To all my students over the past 8 years who have endured/tolerated my ramblings and stories in class…. especially Claudialicia, Donna, Shanna, and John Henry Finally, Dr Pepper bottlers in Indiana and Texas for keeping me fueled up… and saner-ish! v ACKNOWLEDGEMENT Thank you to all the haters. The constant scoffs and scorns have fueled my entire academic journey. I love you anyway! vi Aaron Sterling Deason I’M FINE: SYSTEMIC AFFECT OF CRITICAL INCIDENTS IN EMERGENCY MEDICAL SERVICE PERSONNEL COMMUNICATION EMS personnel experience emotionally charged calls, such as CPR, trauma, or domestic violence. This study examined the changes on communication by these events. Communication Complex metaframework allowed use of other disciplines. There is a lack of scholarship surrounding EMS communication. Research from other military and other fields was translated into the EMS community. Mental illness is a growing concern in EMS as 37% contemplate suicide and 6% complete it. Part of understanding the affect is an exploration of how the culture of EMS (i.e. training, traditions, machismo) shapes the way new EMS are acculturated. EMS have repeated exposure to trauma over a career. These exposures change communication patterns. Using a three-chapter autoethnography, I was able to examine my communication and mental status changes from rookie until retiring 14 years later with PTSD and constant suicidal ideation. Ethnographic interviews of veteran EMS provided insight into the old school ideology of emotional repression and shelving. I analyzed using the NREMT Patient Assessment skill sheet as a guide in a three- step process to discover and reassess themes. The primary survey indicated common job- related stressors- pedi calls and staffing problems. The secondary survey revealed themes of emotions, senses, and support. Finally, the reassessment revealed subtle changes in EMS culture, including decreased PTSD stigma, increased resiliency training, and increased administrative support. Future research could examine the effect of spousal support and changes in cultural emotional suppression. The goal is to develop programs to help allies understand the emotionality in EMS and create dedicated support structures to increase EMS mental health. John Parrish-Sprowl, PhD, Chair vii TABLE OF CONTENTS List of Pictures ....................................................................................................................x Introduction ..........................................................................................................................1 Chapter One: Mental Health and Communication...............................................................5 Communication as a START toward a holistic communication model ..................7 Intercultural Understanding ...................................................................................12 Communication Complex as a Holistic Answer ....................................................13 Chapter Two: Communication and EMS Culture ..............................................................20 EMS as a subculture in Medicine ..........................................................................21 History of EMS ......................................................................................................23 Organization Level in EMS ...................................................................................24 Training ..................................................................................................................24 The covert culture ..................................................................................................26 The Written, Oral, and Mental Narratives .............................................................28 #communicationfail ...............................................................................................29 #healthcommunicationWIN ...................................................................................31 Chapter Three: Trauma and Health Care Providers ...........................................................33 Communication Complex and Health Communication ........................................34 Researcher within the Researched? .......................................................................35 Emotions are NOT good in EMS ...........................................................................38 Posttraumatic Stress Disorder (PTSD)...................................................................39 What is a Health Communication Scholar to do? ..................................................43 Epilogue to a Nightmare ........................................................................................44 Chapter Four: Finding EMS Communication ....................................................................45 Critical Incidents and Mental Health .....................................................................47 #AllMethodsMatter #exceptthosethatdont .............................................................52 A Researcher’s Paradise: Etically Emic Exploration Extravaganza ......................58 The Researched: Ethnography as a Method ...........................................................60 The Researcher: Autoethnography as a Method ....................................................61 Doing It My Way ...................................................................................................63 Not a conclusion but a START ..............................................................................64 Chapter Five: Coloring Outside the Lines: Tales of a Dyscommuniholic.........................65 Miscommunication or Dyscommunication? .........................................................66 An Unflinching Stare Inward .................................................................................67 The training and life of a Paramedic ......................................................................69 Dyscommunication is… .........................................................................................71 Tales and “Tells” of Dyscommunication ...............................................................73
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