Where Trouble Starts: Communication Breakdown in a Complex Emergency Call.

Emergency calls require efficient communication between caller and call taker to establish a need for assistance and dispatch help quickly. Analyzing communication processes at this first link in the emergency medical care chain has important implications for improving the quality of emergency care across the health system. This paper examines an interaction between a call taker and a caller requesting assistance at the scene of a family murder, using a hybrid interactional sociolinguistic approach to analysis. We also draw from court testimony. We demonstrate how several factors contribute to communication breakdown, prolong the call, and lead to the call taker doubting the credibility of the emergency. These include the caller's inability to frame a believable request for help nor clarify his stance concerning the emergency, an absence of urgency and emotion in his description of the incident, an extended focus on and repair of the incident location, and his dysfluent speech behaviors. We demonstrate how communication breakdown is co-constructed and compounded by system-related trouble. This call has useful implications for call-taker training and highlights that when an interaction goes wrong, it has a cascading effect on health care not only for those patients who need the help urgently but also for the efficient running of the health system as a whole.

Considerations for paediatric student-led telepractice in speech-language therapy: A pilot observational study from South Africa.

BACKGROUND: COVID-19 necessitated emergency telepractice for student-led speech-language therapy clinical practicals in training institutions, with limited preparation and evidence-based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. AIMS: Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student-led telepractice sessions in a diverse, resource-limited context. The broader goal of this project was to provide evidence-based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. METHODS & PROCEDURES: We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student-led paediatric telepractice sessions from a South African university clinic as part of a pilot study. OUTCOMES & RESULTS: We identified four overarching considerations for student-led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face-to-face contact. CONCLUSIONS & IMPLICATIONS: Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice. WHAT THIS PAPER ADDS: What is already known on this subject Many speech-language therapy (SLT) student clinicians had to transition quickly to telepractice service provision during COVID-19 with limited existing guidelines and support, especially in contexts where teletherapy is typically non-existent or difficult to access. Although there is some literature available on experiences of telepractice, there is very little evidence-based research which explores the mechanics of such sessions in real-time and which offers practical support to student clinicians and clinical educators engaging in this mode of service delivery. What this study adds This pilot study examined video-recorded, student-led, paediatric, speech-language teletherapy sessions to understand challenges and considerations involved in using telepractice as a clinical training tool. Findings show that additional preparation for telepractice sessions is required, particularly in contexts of poor digital literacy; students must learn to manage technology, especially when connectivity poses a challenge, and adapt therapy tasks for online work with clients; telepractice relies heavily on caregiver input and collaboration, more so than in in-person consultations, and this relationship requires careful management; and promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical yet challenging skills in telepractice. What are the potential or actual clinical implications of this work? Our findings highlight a need to teach telepractice pedagogy explicitly and support students practically in learning how to provide therapy effectively via this mode of service delivery. Observational methods for studying practices in recorded telepractice sessions can be used as part of a reflective approach to clinical training. Using already available data allowed us to unpack the 'messy reality' of clinical training using telepractice.

Complexities in interdisciplinary community engagement projects: some reflections and lessons from an applied drama and theatre project in diabetes care.

There is a growing interest in using drama techniques and theatrical performance to disseminate health information to lay audiences as part of community engagement projects. This process can be challenging for a number of reasons, however. In this paper, we describe the process and pitfalls of an interdisciplinary project involving the development and performance of a play about diabetes mellitus. The play formed part of a long-term, three-way community engagement project between social science, applied drama and a diabetes clinic in South Africa. Building on a framework derived from a number of applied drama methods, we elicited narratives from key 'storytellers' that were developed and embodied by actors in a new performance called Blood Sugars Creating this play provided insight into working in an interdisciplinary space and highlighted the importance of establishing shared goals and joint ownership of the project right from the outset. This was without doubt a challenging project and the complexities of finding common ground across three disciplines are not to be underestimated. In this paper, we explore the collaboration and its challenges, drawing on the framework of complexity theory. In particular, we examine the layers of complexity that emerged as a result of the interdisciplinary nature of the project and the demands of balancing the authenticity of the stories with the perceived requirements of health messaging. We consider the methodological, conceptual and ethical challenges of this type of research, and discuss some recommendations for teams taking on similar complex multidisciplinary research and intervention projects.

When seconds count: A study of communication variables in the opening segment of emergency calls.

The opening sequence of an emergency call influences the efficiency of the ambulance dispatch time. The greeting sequences in 105 calls to a South African emergency service were analysed. Initial results suggested the advantage of a specific two-part opening sequence. An on-site experiment aimed at improving call efficiency was conducted during one shift (1100 calls). Results indicated reduced conversational repairs and a significant reduction of 4 seconds in mean call length. Implications for systems and training are derived.

Managing language mismatches in emergency calls.

The complex linguistic profile of South Africa has the potential to limit the efficiency of emergency calls. Emergency services depend on rapid resolution of a call, dispatch of an ambulance and response at scene. Resolving language mismatches is a critical feature of everyday practice in such a setting. This study examined accommodation to language shifts in a call centre using conversation analysis methods. Three main call trajectories were identified and the analysis suggested marked differences in responsivity, reflecting attitudinal and societal stratification. Conversation analysis provided insight into communication barriers and contextual features, which have implications for training.