Patient assessment in emergency medical services: complexity and uncertainty in street-level patient processing

Though still a relatively nascent public function, emergency medical services (EMS) agencies have come to constitute a core local government service. The potentially life-saving interventional and palliative treatments provided by EMS personnel are inarguably vital for positive short- and long-term patient outcomes, yet our understanding of the behavior of these individuals during service interactions is limited. This exploratory research begins to narrow this gap in our understanding of street-level bureaucrats in EMS organizations by analyzing semi-structured interviews of paramedics recounting uncertain and complex accounts of street-level patient processing. Results indicate that factors such as paramedic communication skills, influential bystanders with key incident information, and patient identity serve to shape street-level interactions with patients.