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UC Santa Cruz Electronic Theses and Dissertations UC Santa Cruz UC Santa Cruz Electronic Theses and Dissertations Title "Saving Lives; Living the Dream": Gender and Emotional Labor Among Ambulance-Based 911 Paramedics Permalink https://escholarship.org/uc/item/0nk646k8 Author McNamara, Megan Bethany Publication Date 2016 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California UNIVERSITY OF CALIFORNIA SANTA CRUZ “SAVING LIVES; LIVING THE DREAM”: GENDER AND EMOTIONAL LABOR AMONG AMBULANCE-BASED 911 PARAMEDICS A dissertation submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in SOCIOLOGY by Megan B. McNamara June 2016 The Dissertation of Megan McNamara is approved: ______________________________ Professor Steven McKay, Chair ______________________________ Professor Julie Bettie ______________________________ Professor Lisbeth Haas ______________________________ Tyrus Miller Vice Provost and Dean of Graduate Studies Copyright © by Megan B. McNamara 2016 ii TABLE OF CONTENTS Abstract __________________________________________________________ v Acknowledgements _________________________________________________ vii Chapter 1: Introduction 1. Introduction___________________________________________________ 1 2. EMS: A Unique Case Study for Gender and Work____________________ 7 3. Review of Literature___________________________________________ 10 4. Research Methods_____________________________________________ 34 5. Organization of Chapters_______________________________________ 50 Chapter 2: Overview of the Industry 1. Introduction _________________________________________________ 52 2. A Brief History of EMS in the United States_______________________ 53 3. Overview of the EMS Workforce in the United States________________ 60 4. The Structure of the Labor Process in EMS________________________ 67 5. A Day in the Life on the Ambulance______________________________ 83 6. The Arc of a 911 Call__________________________________________ 92 Chapter 3: The Labor Process on Scene: Relationships Between EMS Workers and Their Patients 1. Introduction ________________________________________________ 147 2. Non-emergencies: “Bullshit” Calls and Frequent Fliers ____________ 152 3. Suppressing and Generating Emotion on Medical Calls ____________ 160 4. Paramedics, Patients, and Race/Class ___________________________ 190 Chapter 4: The Labor Process in the Break Room: Paramedics’ Relationships with One Another 1. Introduction ________________________________________________ 215 2. Talking About Calls/Work _____________________________________ 224 3. Talking (But Not About Work) _________________________________ 249 iii Chapter 5: Social Reproduction and Paramedics’ Emotional Labor Off Duty 1. Introduction _______________________________________________ 274 2. Paramedics’ Relationship with Professional Pride ________________ 287 3. “Saving Lives; Living the Dream”: Reflections on Heroic Masculinity 290 4. Emotional Care Work: Toward a Reconfiguration of Heroism ______ 303 Chapter 6: Findings and Future Directions 1. Introduction _______________________________________________ 321 2. First Puzzle: Moving Beyond Gender Binaries ___________________ 322 3. Second Puzzle: Emotions, Gender, and Work ____________________ 328 4. Third Puzzle: The Intersection of Social Reproduction, Commitment, and Emotional Labor ___________________________________________ 335 5. Methodology: Moving Ethnography Beyond the Shop Floor ________ 341 6. Implications of Findings for EMS Workers ______________________ 346 References ______________________________________________________ 351 iv ABSTRACT: “SAVING LIVES; LIVING THE DREAM”: EMOTIONAL LABOR AND GENDER PERFORMANCE AMONG AMBULANCE-BASED 911 PARAMEDICS by Megan B. McNamara This project examines intersections of work, gender, and emotional labor among paramedics in Emergency Medical Services (EMS). Ethnographic research on gender and work analyzes labor through pre-gendered lenses: occupations are either masculinized or feminized, and the people who work those jobs are either in gender- matched occupations, or they are crossing over into occupations that have not traditionally been associated with their gender. EMS is a unique case in which workers are required to perform both masculinized and feminized labor in the context of the same job. Furthermore, EMS is relatively gender-integrated, which allows us to see how women and men engage emergency work/masculinity and care work/femininity in a single occupational setting. I investigate paramedics’ emotional labor and gender performance on the job using interviews, participant observation, and auto-ethnography conducted over eighteen months that I spent working as a paramedic on a 911 ambulance. Where labor process workplace ethnographies focus on workers’ experiences on the shop v floor, I argue that we must move into paramedics’ break room time and off-duty time when analyzing their social reproduction and commitment to EMS. I identify key challenges relating to their dignity and posit specific forms of emotional labor that neutralize those challenges while shoring up paramedics’ identities as “heroic.” I begin “on the shop floor” – on 911 calls – and expand my focus outward to encompass increasingly wider units of analysis. First, I set the context with a comprehensive survey of EMS and ambulance-based paramedics’ working conditions within the industry. Next, I explore the emotion work that paramedics deploy to protect their patients from stressful information. I then interpret the ways in which break room conversations allow medics to process emotionally challenging calls, vent anger over being “abused” by the public, and engage in intimacy-building practices that prepare them to work cooperatively in high-stress emergency situations. In the final section, I explore the retroactive emotion work that paramedics perform on themselves to return to work each day with their dignity intact. The conclusion includes a refashioned understanding of heroism incorporating both physical and emotional risk-taking. vi ACKNOWLEDGEMENTS My sincere thanks to Julie Bettie and Lisbeth Haas for expertise, guidance, and warm encouragement throughout the dissertation process. It has been a privilege and a pleasure to work with you! Thank you especially for your willingness to tolerate the pace of work – it was more than I had the right to ask, and I appreciate it. To Steve McKay: I am a different scholar, worker, writer, teacher, and activist for having spent the last 8 years learning from you. I count myself exceptionally lucky to have benefited from your mentorship. Thank you for pushing me to think harder, for being patient when I did not produce anything for long periods of time, and for always continuing to believe that I could. Your confidence in me was the bridge I needed to grow my own. And finally, for the steady and generous stream of moral support and pep talks: Nadia R., Laura H., Joe K., Ariana K., Claudia L., Ally S., Elana G., John F., Michelle P., Patricia G., Andy S., Ulises, Sarita, Rae, Shaun, Erin, Jimmy F., Tom D., Sami, Fatima, Mom, Dad, Haley, and Paul. vii CHAPTER 1: INTRODUCTION One thing that fucks me up more than anything else, like with a sudden traumatic code or an accident or something, is when we get called in the middle of lunch, and I think, like, when I ordered this sandwich, that person was driving down the road listening to their music and everything was fine. Now it’s ten minutes later and I’m trying to cram this sandwich into my mouth on the way to the call, but they’re dead. And I know they’re dead, but their dog doesn’t even know that they’re not coming home tonight. It trips me out…just knowing how fast life can disappear. It’s amazing. - Sean, 35 Sean is a typical paramedic. He loves some parts of his job and resents other parts. He takes pride in his work, despite being poorly paid compared to his colleagues on the fire department and in hospital emergency departments. He has worked on an ambulance medic for thirteen years – longer than most medics will stay “on the bus,” but far short of the two or three decades that a small percentage of his older colleagues have clocked. Unlike the characters in television depictions of Emergency Medical Services workers, Sean does not spend his workdays responding to calls as dramatic – and traumatic – as the one he describes in the quote above. He spends a lot of time doing paperwork, running non-emergent calls, trading friendly insults with his co-workers, and taking advantage of the occasional opportunity to nap before a busy 1 night. Sean puts his physical and mental health at risk every day that he comes to work, yet he feels that he enjoys less social prestige than firefighters who run far fewer calls but benefit from higher pay and a full public retirement. Sean’s wages in EMS support his feeling that he is not paid as much as comparable jobs in emergency services: the national wage median for paramedics was $780/week in 2012 (as compared to firefighting at $1068/week or nursing at $1097/week). Despite his desire for better pay and more respect, though, Sean isn’t planning to leave the industry. He sees himself as an emergency worker, and is proud of what he does. Sean’s understanding of his work mirrors that of his coworkers. Like most paramedics, he tends to place more emphasis on the “emergency” part of the job than on the “caring” part. Many other jobs fall into straightforward occupational categories: nursing is “care” work, for example, while
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