Lights, Siren, and Action:
A Dramatistic Analysis of Ambulance Crews

Kandi Walker
University of Louisville



Abstract

This study investigates the communication of ambulance crews from Kenneth Burke's Dramatistic theoretical perspective. By employing the pentad to the context ambulance crews, the dynamic social dramas of the crews being "on stage and back stage" are apparent. More specifically, this study analyzed a participant observer's discoveries of the communicative actions and interactions found in ambulance crews, revealing how the ambulance crews construct their reality of "being and doing ambulance crew".

Introduction

"Social life is in many respects not an intentional product of
its constituent actors, in spite of the fact that day to day conduct
is chronically carried on in a purposive fashion. It is in the study of
the unintended consequences of action ... that some of the most
distinctive tasks of the social sciences are found."

- Anthony Giddens, 1984, p. 343

Riding in ambulances was a new experience for me. I had several naive notions going into my first shift. My thoughts carried me from hoping that the crew would be friendly to anxiously wondering if I would see "911" television drama. My main thought though was just making it through the first night handling the foreign subculture of attitudes and behaviors that would contribute to the color of this new experience.

It was 6:30 am and my first shift as ride-along was about to begin. I managed to arrive early to my first day as a ride-along. I was a bit nervous venturing in this new terrain but I found confidence to walk in the door with a half smile trying to disguise the lack of sleep the night before and nervousness I felt. I looked down to make sure my shirt was tucked in, my belt centered, and I had all the appropriate paper work.

I opened the door to an off-going crew who looked as if they had seen better days and an on-going crew who had not managed to pull themselves together yet. Papers were flying, faxes were coming in, guys were tucking in their shirts, and the girls were pulling their hair in pony-tails. To my surprise, I could not find anyone that seemed unoccupied for me to ask where I was to go and what I was supposed to do. I took a second look around and realized that I felt as if I was seeing the backstage of a performance with the curtain rising in minutes. For example, the off going crew was summarizing the night before to the new crews as if telling them how the audience and actors were the night before. Several crew members were restocking the ambulances as if they were constructing a new stage for a new performance.

After taking a deep breath and contemplating what my role would be in this drama, I quickly made my way down the long bare corridor that reminded me of a college boy's first apartment. I knew with bare cement on the walls and the half matched and worn in furniture scattered for comfort surrounding the television that this section of the room was definitely the back stage of the drama. There were no frills, no extras, just the necessities to perform the drama.

Once the crew members noticed that a new person was in the room they quickly introduced themselves one at a time. They seemed to be receptive with their smiles and open fisted hand shakes. One paramedic informed me of the day's events and what they were doing to prepare for it. He informed me the ambulance crew I would be riding with would be leaving soon to go to the Northern district stationed at a fire house after they were adequately stocking the ambulance for the shift. After the off-going crew left, five people were left counting myself. At this moment the "Oh my God" feeling returned back in my stomach. What if we have a call? I was now part of the unpredictable world of ambulance work.

My crew, consisting of a young woman and man asked me if I wanted a refresher course of the ambulance and I anxiously said yes. They showed me where to sit (yeah, I face backwards) and the materials they sometimes will ask me to grab for them (all in arms length). We started the engine and we were off to our station.

As we were traveling, I noticed the distinct smell of disinfectant. I was in a miniature hospital emergency room. I had all the equipment that I had noticed in the ER such as the EKG machine, oxygen, a gurney, masks, gloves, tubings, and bandages to name a few at my disposal. My visual and olfactory senses were put to a halt as the crew began to ask me questions. "Who are you?" "What do you do?" "What do you study?" "Do you have any questions?" "Where are you from with that accent?" All I can think of is my one short statement I had prepared to give about my presence. "I am a student wanting to learn from your vast emergency care knowledge" (I was hoping I would make a laugh from the start). I proceeded to tell them I was studying the communication patterns and strategies used by patients and family members (including observers, friends, etc) during an emergency. This answer seemed to take the pressure off of the crew and relieve me of any further answers (besides they did not believe I was from New York). But honestly, I did not know what I was examining. Since I was taking a grounded theory approach to this investigation I did not know what aspects of the ride-along would be examined.

We arrived at the fire station and I followed the crew to the large size sofas that seemed to call out "Come sit on me. I am broken in and very comfortable." I sat down on the short couch and started to tie my shoestring on my boot. The woman EMT next to me was flipping through the television stations and stopped on every talk show. The man paramedic was laying down not paying attention to the television or us. He seemed to want to discretely take a nap. However, the television and napping session was cut short due to the arrival of the moment I had been waiting for and dreading all morning: we had a call. I could not tell if it was one of three beepers or one of the two telephones that called for us but nonetheless, the crew was triggered to stand to their feet and switch from casual role to health care provider role instantly.

After several calls, I noticed the ambulance crew seemed to have dual roles they portrayed during the day. They were informal, relaxed, and easygoing when at the station and when they had a call they would activate their ambulance role. I was amazed at how calm the ambulance crew remained as they traveled to the unknown destination. They were as steady as if they were going to pick up bread at the store instead of traveling to an unknown scene where anything should be expected. I tried to follow their calm nature but my heart raced with every call, sweat formed in my palms, and it never failed I always had a full bladder when going on a call. At the beginning of every run I became invisible I do not think the crew remembered I was in back. The EMT was busy driving while the paramedic had map in hand giving directions. After the directions were clear they looked back at me, which was not too hard since I had wormed my way in the back seat to stick my head between the small opening that connected the back and front compartments of the ambulance. They asked if I had any questions with every call. "How do you stay so calm when going on a call?", I asked as we were driving to a call. They gave each other a brief look and the paramedic answered, "We are trained to stay calm and besides we've done this a few more time than you. If we panic then there will be no way the patient will remain calm. We need to make sure we make it to the place safely and able to perform our duties." I was satisfied with that answer and the conversation soon turned to the song that was on the radio.

In the brief quite episodes of time while traveling to the different calls, I began to contemplate how ambulance crews "do ambulance crew". Then I realized it was through communication (verbal, nonverbal, language, etc.) ambulance crews created the persona of being on a call or relaxing at the station. Communication allowed for the ambulance crews to play the role needed at a specific time. Therefore, the purpose of this paper is a focus on the ambulance crew's communication during and between calls (being on and off stage). Specifically, this investigation employs the Grounded theory (Strauss and Corbin, 1990) methodological approach and Kenneth Burke's Dramatistic theoretical approach (pentad) to explore the ambulance crews construction of the social drama of being and doing ambulance crew.

"It is in the performance of an expression that we re-experience,
re-live, re-create, re-construct, and re-fashion our culture. Their
performance does not release a preexisting meaning that lies
dormant in the text. Rather, the performance itself is constitutive."

- Edward Bruner, 1986, p. 11

Burke's dramatism is a "method of analysis and corresponding critique of terminology designed to show that the most direct route to the study of human relations and human motives is via a methodical inquiry into cycles or clusters of terms and their functions" (1968, p.445). Dramatism is a systematic approach to give order and interpretation to human behavior. As Foust (1996) points out dramatism has two fundamental assumptions. The first assumption states, "language constitutes action" (p. 455). The second assumption states that "humans develop and present messages in much the same way that a play is presented" (Foust, 1996, p. 456). These assumptions assert that language and communication "provide a clue to our motive or why we do what we do" (Foust, 1996, p. 456).

Burke furthered the dramatistic approach to human behavior by developing the pentad. The pentad is a five dimension framework to study what Burke considered the most key concept in dramatism, the act. The following section discusses each of the five aspects of the pentad: act, scene, agent, agency and purpose.

The act is considered the metaphorical center of the pentad, which all other aspects of the pentad circulate around and through. The act, embedded in the scene are the actions performed by the agents. The act specifically "names what took place, in thought or deed" (Burke, 1969, p.3). In relation to the ambulance crew, the act is the combination of communicative actions and interactions that take place within the scene of being on stage and back stage.

The scene is the when and where of the situation. According to Burke the scene is "the background of the act, the situation in which it occurred" (Burke, 1969, p. 4). An example of the scene in the context of this study was the ambulance, the station, the hospital, or the scene of the accident or emergency (e.g., house, highway, car).

The agent of the pentad refers to the who of the situation. "What person or kind of person performed the act" (Burke, 1969, p.4). The agents of this study includes the EMT, the paramedic, other ambulance crews, the hospital staff, the patient, and the individuals surrounding the patient (e.g., the family, witnesses to the emergency, friends).

The fourth key term of the pentad is agency. Agency describes the how of the situation or "the means or instrument the agent used" (Burke, 1969, p.5). The ambulance crew uses many agencies including: medical devices, the ambulance, communication, and communication services (radios, beepers, telephones) to construct being and doing ambulance crew.

The fifth and final key term of Burke's dramatistic pentad is purpose. The purpose is the why of the situation or the motive for the act. In terms of this study the purpose refers to medical treatment, healing, communication, and filling down time of this social drama.

"There is a sort of a spirit world that coexists with the world of empirical
observation, and you have to get in touch with that world ...
You don't use a crystal ball, though I'd like one that
worked - but you do clear your mind and listen to what isn't said
and see things that aren't there."

- Nelson DeMille,
The General's Daughter

This research employs the methodology of grounded theory, a subset of qualitative methodologies (Glaser & Strauss, 1967). Grounded theory refers, "to research procedures which produce descriptive data: people's own written or spoken words and observable behavior" (Bogdan & Taylor, 1975, p.4). This methodology allows for inductively derived theory to emerge (Strauss & Corbin, 1990), emphasizing the natural setting (Denzin & Lincoln, 1994) and acknowledging the research to be studied holistically instead of as isolated variables (Bogdan & Taylor, 1975). Grounded theory is an inductive process wherein theory is generated from the data collected. This approach allows for observations and interviews of ambulance crews and patients, in order to gather information and examine the data as it emerged. The grounded theory approach to explore this phenomena presents a structure for identifying unknown concepts that uncovered how meaning is constructed and performed by ambulance crews and patients.

The ambulance crew is the primary emergency medical care providers outside of the hospital. The sequence of events of a health care situation involves someone notifying the ambulance company or more commonly dialing 911. Emergency medical dispatchers give careful tedious instructions to the ambulance crew over the radio and the ambulance crew is on their way to the scene. Firefighters and/or the police may already be at the scene to provide initial care or serve as escorts into the scene. Once at the scene, the ambulance crew surveys the situation for personal safety and safety of the patient and bystanders. Patient assessment is the primary responsibility (Stoy, 1997) of the ambulance crew. The crew must administer the basic medical care according to the patient's needs. "This approach allows for rapid management of life-threatening injuries and illnesses and helps to relieve the patient's discomfort" (Stoy, 1997, p. 10).

Once the patient is assessed and the basic medical care is given, the next step is to prepare the patient for transport. When needed the patient is carefully placed on the gurney and lifted into the ambulance. A passenger is allowed to ride in the front of the ambulance while transporting the patient. Meanwhile, the paramedic prepares the patient for the hospital or administers more medical services. When the ambulance is in close proximity of the hospital, the paramedic calls the hospital to inform them of their approximate arrival time, the patient status, and medical care given by the paramedic.

Finding an emergency service system (ambulance service) that would allow me to conduct research with their ambulance crews was not easy. After several phone calls, meetings, and extensive paperwork I was admitted to ride with a company. The organization requires several precautionary steps before I could begin the ride-along. First, I had to show proof of having a TB shot and a round of Hepatitis B shots (I have encountered that to conduct research a little pain must be endured). Second, I was required to take a Blood Pathogen course. In this course, I was shown videos, given lectures, and required to answer verbal quizzes. Third, I was required to supply the company with thorough paperwork, statement of my purpose, a letter to the manager and a Confidentiality agreement. Fourth, I was fitted for a mask (required on minimal cases) and gloves (required on all cases) as part of my uniform. My uniform involved wearing dark pants/jeans, black boots, and a white starched shirt. I was informed to wear my hair back and wear little to no jewelry.

The last precautionary step was a tour of the ambulance. The emergency service system I was involved with had recently purchased new ambulances, smaller than the old ones. The newer ambulances were the size of a regular van. The inside was a tight squeeze only equipped with room for the ambulance crew, the patient, and the ride-along. During my tour of the ambulance, I was instructed that I would often be asked to retrieve equipment in emergency cases, therefore I was given a short course on the equipment in the ambulance and where to locate the equipment. the information regarding each one." seats in the driver compartment were a soft comfortable gray type. They sat higher than other vans. The knee room was a bit cramped. The metal roof gave me the impression of a cold sterile environment.

The inside of the ambulance embodied two compartments: the driver compartment and the "critter compartment"/patient compartment. When I encountered the driver compartment for closer inspection I first noticed the many radios that were above and between the driver and passenger. I was told that an ambulance team consistently "listens to two to four radios at one time". I was also told that I may think I have become "schizophrenic because I would be able to decipher the radios and process the information regarding each one.

The next compartment I investigated was the "critter compartment" or the patient compartment. The front and back compartments are separated by a small opening, probably 2 x 4 foot space. The medical equipment was tightly grounded to fixtures and the floor. All equipment "has its place" for safety reasons.

Considering I would be working with a high risk health field the extra precautions and suggestions were eagerly received and highly warranted. The entry into my site of study was a bit extensive due to the precautionary steps I had to endure, but the company was cooperative and willing to allow me to ride.

The setting in which I have described and will continue to describe is an ambulance company in a metropolitan area of the Western United States. The ambulance company has a headquarters and seven post stations to cover the entire city. Each ambulance crew consists of two members: Emergency Medical Technician (EMT) and a paramedic. The difference between the EMT and the paramedic is the amount of education. EMTs (basic and intermediate) can perform a limited amount of medical services (e.g., medical interviews, check vital signs, vascular access, or advanced airway management). While, the paramedics are educated to perform a broader array of medical services (full advanced life support) on patients.

Participant observation was the principal method of data collection for this research. Participant observation allows an unobtrusive entry into examining the entire situation as it intrinsically occurred. Rather than becoming a full observer, participant observation gave allowance to interact with the ambulance crew, patient, and other to learn about the interaction from their point of view. Bernard (1994) states participant observation, involves establishing rapport in a new community; learning to act so that people go about their business as usual when you show up; and removing yourself every day from cultural immersion so you can intellectualize what you've learned, put it into perspective, and write about it convincingly. (p. 137)

Participant observation allowed observation and participation with the ambulance crew, patient, and other as well as the creation of a record regarding what was learned from the perspective of a communication researcher. The participant observer methodology was chosen because it addressed the awareness that someone else was in the situation but did not hinder their interaction.

I deliberately chose the participant observation form of data collection rather than observer participant. A participant observer can "go native" and does not have to tell the parties involved what he/she is researching. Observer participant, on the other hand, usually tells the parties involved what is being examined and researched (Bernard, 1994). For the purpose of this research, the ambulance crew knew research was being conducted and the patients and other were informed there was a student observing. The ambulance crews in this research commonly have students in training participating in ride-alongs, therefore, the participant observer blended into the environment being observed.

Further, participant observation is one of the few known research methods that can provide the intimate understanding that comes from directly observing and listening to people. Participant observation also gives an opportunity to have a intuitive understanding of what happens. In short, participant observation helps give meaning to the observations. In this research, observations were made of the interactions between the ambulance crew, patient, and other and between the ambulance crews in order to investigate the communication actions and interactions.

Further, a major strength of this type of methodology is the lack of apriori assumptions that could influence the data collection and analysis. However, since bias is a concern of any research, participant observation acknowledges these tendencies and includes self-reflection to address any biases that may have occurred.

For logistical purposes, I (the participant observer) was introduced to each patient and other as a student. If the patient seemed weary of having another person in the back, I rode in the front of the ambulance with the EMT. In the course of data collection I usually sat in the back of the ambulance with the Paramedic and patient wearing the ambulance company coat, in order to be unobtrusive and actively observe the interaction. Further, due to training and certification I was able to take vital signs of patients that were not in emergency situations and interact with them along with the Paramedic.

This project is not studying different ambulance companies but rather communication actions and interactions occuring during a typical day. In fact, the unit of analysis is the communicative actions and interactions between the ambulance crews and ambulance crews with patients and other. Despite the seemingly low number of ambulance crews (in this case only six), the number of actual interactions (107) provides a rich and complex data set for analysis.

The time frame for my ride-along program began in mid-January and continued through early March. The time of day ranges from 6:30 am -6:00 am shifts to 7:00 am- 1 pm different days a week. The total observation time is 87 hours. The unit of analysis, as stated previously, is the communicative actions and interactions occurring during the research (N= 107 total communication actions and interactions, n= 49 total interactants).

Since my goal was to avoid being obtrusive, note taking was performed between calls and during down time. Tape recording of the actual interactions were also made and detailed notes about the communicative actions and interactions were written between calls. After this form of note taking was completed, conversation with the ambulance crews resumed, paying particular attention to their communicative patterns and strategies as well. Detailed notes were the goal; therefore, conversation took place simultaneously while note taken was performed. Formal interviews were not an option but several informal semi-structured conversations emanated from participating in the observation. The conversations were recorded in most cases, or otherwise detailed notes were recorded.

"The uniqueness of man ... lies not in his ability to perceive ideas, but
to perceive that he perceives, and to transfer his perceptions
to other men's (women's) minds through words."

- Albert Einstein

The tape recorded interactions and detailed notes were transcribed and analyzed in order to identify the emanating concepts that were manifested in the communicative actions and interactions. Particular attention was given to how each party verbalized and enacted the communicative actions and interactions to create the social drama.

The following analysis is based on Burke's Dramatistic pentad (1966). After listening, transcribing, examining, and summarizing the data, the pentadic analysis of communication became evident in the ride-alongs. Although 107 interactions were recorded, one example that epitomizes the dramatistic pentad will be used. This example best represents the construction of being and doing ambulance crew through communication. Therefore, the following section analyzes the communicative actions and interactions of ambulance crews with patient and other in order to construct and enact a social drama.

The following example illustrates the communicative actions and interactions of one ambulance crew while being on stage on back stage within context of Burke's dramatistic pentad. As the example indicates, the ambulance crew was back stage preparing for the next call (being on stage) when the call was received, they responded to the call in "emergency medical service" character, performed the necessary actions, and transferred back to their "casual" character back stage.

Example:

The ambulance crew and I were at the ambulatory post talking with two other crews before we went to the North post. The crews were harassing each other on the location of each ambulance that day. The North post was the least wanted post in the district due to the unfriendly fire fighters they interact with at the station. The ambulance crews were joking with each other saying things such as "If you would cut your hair you wouldn't get the North post" (the post rotated among the crews, the hair was not a predictor of who got the post) or "you look rough, did the bar through you out this morning or did you choose to look that bad". The women were also a part of the jokes and badgering by commenting, "Man, are you putting on a few pounds or are you helping your wife carry the baby today?" I asked one of the EMT's why badgering existing, she replied stating, "It helps to relieve some of the stress we have during the day. It's also just fun. It keeps the air light. . . Noone ever gets their feelings hurt. We know when to draw the line."

The badgering stops while the crew talks about different aspects of their life outside of ambulance work. However, my crew did not stay after the harassing stopped because the crew was ready for breakfast. They asked if anyone wanted to join us but everyone had other plans before the invite.

Once we arrived at a small strip mall restaurant we ordered food and sat down to eat the meal. The conversation was the dating situation of the EMT. "Do you like her or just taking up time?" asked the paramedic. "I don't know. She's got this body . . . but she doesn't have any ambition." As the conversation proceeded, the ambulance crew finished their meal. I looked down at my plate and realized that I wasn't a quarter of the way through with it. As I was taking another bite, the radio announced a call. We immediately took our plates to the garbage and left the establishment.

When we were in the ambulance the paramedic asked for further details of the patient and directions to the house. The EMT starting driving in one direction and quickly circled in the middle of the intersection and drove the other direction. The characters of the EMT and the paramedic diverted to health care providers and not casual friends hanging out together. The conversation was centered directly on the patient and with the medical service.

As the ambulance crew walked in the front door of a three story high society neighborhood, the crew was greeted by a Chinese grandmother still in her pajamas with two small children on either leg. She motioned in the direction where the police and firefighters went to help the patient. The ambulance crew walked down a steep flight of stairs that entered into the lower level of the house. This level had a wonderful patio and view of a lake and the mountains. The ambulance crew turned the corner of the Chinese decor house and found an elderly man in bed unconscious with two Chinese young ladies, in their mid thirties, at the head of his bed. The three firefighters and two policemen separated leaving a walkway for the paramedic and EMT to start their work. "What's going on here?" asked the paramedic of the policemen and firefighters. After a brief description of the situation the paramedic and EMT began work on the patient. The questioning session promptly began of the daughters since the patient was unconscious. The paramedic and EMT asked the daughters questions such as, "What happened today?", "What is his medical history?", "What medications is he on?", "Has his medications changed recently?", "Is he feeling any pain right now?", and "What is his normal condition?" The daughters of the patient were acting hysterical (not making complete sentences, fidgeting, waving their hands in the air, and talking in a high pitch tone) trying to give the appropriate information. However, since the daughters did not speak complete English, answers were given sporadically. The police men were also asking questions regarding where the daughters were when the man became sick and one firefighter was asking questions in regards to how to get the man up the stairs.

The paramedic began working on the elderly man with a soft but firm touch. The paramedic was asking the man questions, getting near the man's face making direct eye contact. The daughter spoke in broken English saying the elderly man could not understand the paramedic because he did not speak any English. He then asked her to stand next to the bed and translate for him. Although she could not understand everything the paramedic said, they were able to communicate through tone of voice, body language, and pointing to objects in the room (e.g., medications, food, clothing).

The paramedic never once broke character of informed health care provider, even though this was a life or death situation. He never treated patient as if he could not speak English or could not hear him (at this point, the patient was still unconscious). The paramedic continued to describe each step, explaining each medical process he was performing on the elderly man. For example, when the paramedic was applying the "stickers" for an EKG printout the paramedic said, "Papa, I am going to put some stickers on your chest, they are going to be a bit cold but they will help us see how your heart is doing." The man did not acknowledge the paramedic despite the paramedic's attempt to explain each aspect of the statement by pointing to the stickers, the EKG machine, his heart, and a EKG printout.

The paramedic was also calling the man "Papa", the name the daughters were calling out during the process. When the paramedic used this name, a more personalized treatment seemed to occur. The paramedic gave eye contact and soft touches to the arm and shoulder of the man. After each touch the patient seemed to relax more (his breathing rate slowed down and his muscles were not as tense). The EMT did not have much contact with the patient but was helping the paramedic with the machinery and finding the best was to get the patient up the steep flight of stairs into the ambulance. During this part of the episode, the paramedic and EMT seemed to calm the daughters by asking them to run errands and giving them pertinent health information about their father when possible (calm refers to a slower vocal pace, composure more at ease, and less hyper activity). By explaining the process to the patient and daughters the tension in the air seemed to disappear as well.

Once the police had cleared the room of furniture, the firefighter, EMT, and paramedic carried the elderly man up the flight of stairs, outside, and into the ambulance. While the process of transporting the patient from his room to the ambulance the paramedic suggested a hospital (the closest one) for the patient. The daughters grabbing their purses agreed to the hospital and said, "we'll follow you in our car".

After the patient was in the ambulance, the paramedic and EMT began further medical treatment on the elderly man. The daughters stood at the back of the ambulance with their faces pressed up against the windows, their faces were tense and their eyes showed they were scared. Their pecking at the window and asking questions through the glass showed the need for information and concern they had for their father. "(knock , knock on the window pane) Is he OK? What are you doing? Why did you do that?" were a few of the questions the daughters were asking outside the door. After the ambulance crew was at a point in their treatment where they could talk, the EMT opened the side door and informed the daughters of the patient's condition. The EMT stated, "Your father has been put on more oxygen and blood was taken for the hospital. We're going to transport him now to the hospital." The daughters looked at each other and one daughter decided to ride with the ambulance crew. During the course of the transport to the hospital, the daughter watched her father through the small space that connected the front and back compartment. The EMT tried to keep her occupied by asking her to complete necessary paperwork but these tasks did occupy her for very long.

After the needed "cocktail" was given (cocktail refers to a medication given that reverses the affects of medication) to the patient, he began to gain consciousness. The paramedic said that the new medication was perhaps the reason for the sudden decrease in health. The patient's vital signs, and several EKG printouts were taken during the transport in order to assess the patient's condition. The paramedic continued to work on "Papa" but was having trouble communicating, "Papa, are you feeling any pain?" was repeated countless times during the transport but the patient did not understand. The paramedic asked the daughter the word for pain, "tong" and continued to work with the patient. "Tong?, Papa" was substituted for the previous statement and the patient began to respond to the paramedic.

The paramedic and patient were communicating mostly through nonverbals, the few word the patient knew of English and the few words the paramedic was learning of Chinese. The nonverbals consisted of showing the patient the oxygen-powered ventilation device and showing how the "air mask" worked (by first acting as if the paramedic was putting it on himself then putting it on the patient). The patient started to pull at the sheet that was covering him conveying that he was cold. The paramedic soon put another blanket on the man. Once the ambulance was close to the hospital the EMT called the Emergency Room and handed the mike back to the paramedic. The paramedic informed the hospital of the patient's condition, patient's history, and any medical treatment performed on the patient.

When the ambulance arrived at the hospital, the patient was transported to a room and a clarification and more detailed account of the patient's condition was given to the nurse by the paramedic. The patient's family kept asking questions, and the EMT tried to answer when he could. For instance, "How is my dad, is he going to be OK?" The EMT responded, "We are doing the best we can, he seems to be coming around, now the hospital and physician will treat him." The EMT walked away to clean the ambulance and change the sheets on the gurney. The paramedic completed the necessary paper work and walked outside with the EMT and began to construct the next social drama, being back stage.

The EMT and paramedic were greeted by several other ambulance crews talking about their calls back stage. "Did you get a good one?" or "Bring in a good one?" were the first questions asked of the different ambulance crews. I asked several ambulance crews what qualifies a good call. A good call refers to the ambulance crew using their skills. As one paramedic stated, "It seems ironic that a good call demeans the patients but if a life threatening emergency occurs you want it to be on your shift so you can use your skills." In my opinion, good calls resemble a "Rescue 911" episode. Confirming this point, one EMT stated that "although gore and mayhem is not needed for a good call, it does help!"

The ambulance crew traveled back to the fire station talking about topics ranging from the their jobs (e.g., their last patient, emergency and non-emergency calls, their hours, their uniform) to current events (e.g., their dating situation, current ballgames, future goals/plans). Their casual conversation depicted that they were in "casual character". For instance, the paramedic laughingly was telling a story from the night before saying, "everytime I meet new people, they always ask me what's the grossest thing I've ever seen? I don't know what the interest is?" The EMT agreed that he was tired of being asked about the different cases he sees.

Once the ambulance crew arrived at the fire station, they quickly sat on the different couches that were arranged around a big screen television. They flipped through the different channels stopping on the various "emergency shows" (e.g., Cops, Emergency 911). They laughed at the different scenes reflecting on their job stating "the general public thinks everyday is like these shows. They would be disappointed if they knew we rarely get those types of cases. Especially in {city name}, we usually get the psychos, not the blood and guts." These comments led them into a conversation concerning emergency cases and non-emergency cases.

The ambulance crew had a problem with people calling 911 requesting an ambulance for non-emergency cases. For instance, the EMT stated, "I don't want to go on the calls where they are wasting our time, our skills, and the tax payers money". Although the crew asserted they did enjoy running calls, the crew would prefer to be able to use their skills more effectively and run emergency calls. The paramedic recalled one case (in which I was with the crew) about the over use of ambulances to transport non-emergency patients. "The guy from up north (an earlier call that day that reported having chest pains), we knew he wasn't in an emergency. I still can't believe the wife said 'while you are here, you probably should take him'. We told her he was't in any danger and that she could drive him into the hospital to get checked out. But we ended up taking him anyway." The ambulance crew did try to explain to the wife that her husband was not in an emergency situation and it might be economically wiser to forego the ambulance.

The conversation of the ambulance crew quickly turned to food when a commercial of a restaurant was on the television screen. The crew decided to call a couple of the other ambulances in the area to eat at a their "regular restaurant". At the restaurant the joke telling and badgering of the crews was as natural as having a napkin with their meal. For instance, one EMT ordered a large portion of country fried steak. The others joked that he was from the hills and didn't get out much. The restaurant workers knew the ambulance crews and gave them extra attention and extra food with their meals. "Need any more coffee" was said 13 times by 4 different waitresses in the course of the thirty minute meal. As the ambulance crew and I were half way in our meal ( I was beginning to eat much faster), we had a call.

I have noticed that Muphy's Law applied to ambulance crews a great deal. If the crew wanted to get a call they either go to the bathroom or try to have a meal. Every time I tried to eat something, the ambulance received a call. The ambulance crews seemed to laugh about never getting to sit down to a meal because of calls. One female EMT told me, "If you day has been slow and you want to get a call, just order food or begin cooking a good meal. You are guaranteed a call." I have noticed that the ambulance crews eat extremely fast because of this fact.

After we threw money on the table for the food we were off to the next call. This call was a call in the lower end of the district. The EMT was driving and the paramedic had a map in hand trying to confirm the location of the patient. After struggling for the directions, the ambulance crew was heading to the patient. The ambulance crew immediately switched to "health care" character and many of the jokes and badgering stopped. The crew listened carefully to their radio for the status of the patient from the 911 which determined what siren if any would be used and if the lights would be used. After hearing the status of the patient (a tempted suicide) the paramedic comically stated, "I guess it's time for lights, siren and action!"

To analyze, I chose to illustrate the different aspects of the pentad in the above example. The first aspect of Burke's dramatistic pentad is act. Act is the focal concern in which all other aspects of the drama centered around in the context of the ambulance crew. When the ambulance crews are on stage the act of the drama is the health and illness of the patient (when the ambulance crews were on a call they were considered to be on stage). For instance during the call of the Chinese man, the act consisted of assessing the patient, performing the necessary medical treatments (e.g., giving oxygen, giving a "cocktail"), and transporting the patient to the hospital. The act was the heart of the scene in which all the other actions and behaviors focused around.

When the ambulance crew is on stage, act has specific communication that signifies it. For example, the paramedic and EMT's dialogue consisted of information concerning the well-being of the patient. In the case of the elderly man, statements such as, "We need to check his vitals" or "Has his condition changed since last night?" were examples of the crew centering their communication around the act.

Act is also found when the ambulance crews are back stage. Before the elderly man's call, the act was being at the ambulatory station conversing with other ambulance crews and eating at the restaurant. After the call, the act consisted of being at the fire station and eating at the restaurant. The communication that comprised these acts were casual informal talk, mostly consisting of teasing each other. The act was the centralized event that allowed for the communication of being back stage or on stage.

The scene of the ambulance crews changes numerous times while being on stage because their services were requested at different locations. During the example given above, the scene was the high society three story house overlooking a lake and the mountains. The specific scene was the elderly man's bedroom comprised of his bed, dresser, closet, desk, and television stand. The scene was the location for the act to occur. The scene changed in the midst of the above act due to transporting the patient to the hospital. The scene transferred to the ambulance where further medical attention was given then to the hospital. The communication between the paramedic and EMT changed as rapidly as the scene. While traveling to the house, the crew engaged in dialogue concerning the directions of the house and what they were expecting to find. Once at the house, the conversation changed to directly caring for the patient and transporting him to the hospital.

Although the scene changes a multitude of times while the ambulance crews are on stage, the scene while backstage is not as varied. When the ambulance crew was back stage the scene did change from the fire station, the ambulance post, and restaurants. The above example illustrates how the scene changed from joking with the other crews at the ambulatory post and restaurant to being called on stage. After performing, the crew transferred back to casual mode where the scene consisted of going to the fire station and eating at a restaurant. The scene did not have much impact on the conversation except for the difference between the scenes where they were on stage and back stage.

The agent aspect of the drama is enacted by the ambulance crews, the patients, stand-byers, family, friends, other ambulance crews, and hospital staff while on stage. The example given shows the agents while performing on stage involved the grandmother directing the crew where the patient could be located in the house, the patient, the firefighters, the policemen, the daughters, and myself. Specifically, the paramedic, due to his training, was the agent that had the lead in this drama. He directed the other agents to do a specific task or asked for assistance with the medical treatment. The EMT also had an important role in the case of the elderly man. He prepared the machinery and gained information from the daughters. He was also the agent that directly assisted the paramedic in treating and assessing the patient. The patient's role in this social drama was the sick character. He was the reason the other agents were at the scene. The daughters roles were to aid the ambulance crew in assessing the patient's condition. They were to translate when needed and give pertinent information concerning the health of their father. The policemen and firefighters were at the scene as the agents to evaluate the scene, and to help the ambulance crew when needed. My role in this drama was limited. I was asked to retrieve the emergency kit, move furniture, and carry needed medical equipment that would not fit on the gurney. When the patient arrived at the hospital, the agent involved was the nurse. She was to take the needed information to further aid the patient. The agents were an important aspect due to the serious nature of this act. The communication employed by the agents to construct the being and doing of ambulance crew and to construct this social drama while on stage were direct medical statements and questions, concern remarks, and directions to aid the patient. The communication was intense by the tone of voice used and the quickness of each move made by the ambulance crew.

Agent is also enacted by the ambulance crews when back stage. Other agents included restaurant employees, other ambulance crews, and myself. Before the call was received the agents were with the other ambulance crews at the ambulatory post. The agents were involved in aimless conversation to fill time and to relieve the tension of the job. After the call, the agents involved were my ambulance crew and myself to start. We were sitting at the fire station involved in light conversation about general opinions the public has about their job. When at the restaurant, the agents included the restaurant workers and other ambulance crews. Their communication also was light in nature to pass time, make friendships, and to gain repeat business of the ambulance crews. Being and doing ambulance crew back stage consists of agents that communicate in casual mode and sometimes enjoying the company of other crews. The agents have a tight bond with each other perhaps due to the long hours with each other, therefore silence also plays a key aspect in constructing the agent's role.

Agency describes the different means or instruments used during this research project. Ambulance crews use several differing agencies while on stage. For instance, the angencies consisted of the radios, medical devices, the ambulance, and most importantly their medical knowledge. In the context of the elderly man, the ambulance crew used their radios to receive the call, drove their ambulance to arrive at the location, used medical devices on the Chinese man, and used medical knowledge to help the man in his current condition. The communication that surrounded the agencies were more direct statements, such as "hand me the med bag" or "we need 700 cc doses of oxygen". The commands of instruction and information were given with a stern certainty which portrayed a serious in charge mode of the ambulance crews.

The agencies while the ambulance crews are back stage are not as plentiful. For example, the ambulatory station was an agency for the crews to meet and have small talk. The agencies included backstage allowed the ambulance crews to break the serious character and return to relaxed mode. Another example of agency back stage included the restaurant and the dialogue that occurred while eating. The agency included the location because of the low level of stress associated with their eating establishment. But more importantly, the agency was the conversations that emerged because of the characters of "relaxing" they were enacting. The conversation, which included badgering, joking, and small talk, was the means for them to enact their social relaxed character.

The purpose of the ambulance crews is perhaps the most critical and significant aspect. The purpose while the ambulance crews are on stage ranged from saving lives to comforting the patient and other. In the example of the elderly man, the purpose or motive of the ambulance crew was to save the life of the man and give him the medical attention needed. The purpose seems casual on paper, however, when performing medical procedures on an unconscious patient, the not knowing is highly intense. The communicative acts such as using nonverbal communication, using highly scientific machinery, and direct vocal inflections with the patient assisted in the construction of doing ambulance crew in a life or death situation.

The purpose of the ambulance crew in the example given was also to perform psychological first aid to the daughters. The ambulance crew's motive was to gain information from the daughters that would help them treat their father. In order to gain information, that had to give information to the daughters so they were able to communicate more clearly. For instance, the ambulance crew needed to know what medications the man had taken in the past 24 hours but the daughters were too worried about their father and could not concentrate on the question. The paramedic began conveying the information they knew about the patient, decreasing the daughters uncertainty. The daughters were then able to answer the questions asked by the paramedic, EMT, firefighters, and policemen.

The purpose of the ambulance crews while backstage is not as substantial. The purpose of the ambulance crews' backstage performance was to pass the time, eat, or create friendships with other ambulance crews. Before the call was received, the ambulance crew was passing time with other ambulance crews, laughing and joking at and with each other. When eating the ambulance crew was fulfilling a necessary need of eating. After the performance of being on stage was over and the crew was able to return back stage, the purpose was to relax after an intensely stressful situation. They talked with other ambulance crews about their day, about life outside of ambulatory work, and proceeded to eat with fellow colleagues. Backstage communication surrounding the purpose was to create a non-threatening, non-stressful atmosphere in order to relieve the stress of being on stage.

"Come now; and let us reason together."

- Isaiah 1:18

The findings of this study provide an increased understanding of ambulance crews and how they construct the social drama of being and doing ambulance crew. Through the Burkian dramatistic pentad the being and doing of ambulance crew came alive. The ambulance crews are no longer doing a job, but performing their role in the social drama. However, this social drama is unique in that it involves life or death. In addition, the example given highlights the process of employing communication to construct the different tenets of the pentad.

This study reveals ambulance crews consciously using communicative actions and interaction while being on stage and back stage. The ambulance crews have a complex task of constructing a health interaction; incorporating the needed interpersonal side of medicine while attending to the medical tasks while being on stage. This study also reveals that the complexity of ambulatory work does not stop after each call. In contrast, ambulance crews have a complex task to relieve the stress and pressure of their job while being back stage. Therefore, this study reveals that ambulance crews are constantly constructing the social drama for the moment. Although conclusions drawn from this limited sample size cannot extrapolate to ambulance crews, in general, the conclusions provide insight in to the types of issues raised during the construction of such a complex career.

The findings of this data provide health communication scholars and rhetoricians with fertile qualitative data for understanding the communicative actions and interactions of ambulance crews. The unique contribution of this study is that it identifies the specific tasks, concerns, communication, and expectations of ambulance crews. The results of this study accomplish the goal of promoting a greater understanding of ambulance crews. However, further research could provide additional insight in to the influence and importance the communicative actions and interactions of ambulance crews have in constructing their social drama.

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