An exploration of emotional labour and emotion work in emergency pre-hospital care
Authors:   , Williams Angela 
Published: November 2021

This thesis explores emotional labour and emotion work in the context of the emergency ambulance service. The emergency medical service (EMS) provides constant response to life threatening situations and complex health care issues in the pre-hospital care setting. The emotional challenges of this type of health care work in the context of high demand is a crucial, though somewhat neglected area of research attention. Hochschild’s theory on emotional labour (1983, 2003) and Goffman’s (1959) dramaturgical concepts of front stage and backstage are utilised, supplemented with features of discourse and conversational analysis. An ethnographic approach involving 280 hours of participant observation over a 10-month period and 24 in-depth interviews with EMS crews in one busy, urban, inner city ambulance station serving a large geographical area in the UK has been utilised to explore the emotional challenges of this work and the local ways of dealing with these. The study findings suggest that EMS crews appraise and categorise their front stage work in positive and negative ways. Positive calls are expressed through local descriptors such being able to ‘make a difference’ and perceived ‘genuine’ need for the EMS and appear alongside emotions such as excitement which some crews suggested helped them deal with the more mundane types of work. Negative call appraisal was associated with questions of legitimacy of need for emergency assistance and predicated on normative ideologies. Crews constructed and populated categories displaying features of identity work, moral work and “negotiated order” (Strauss, Schatzman, Ehrlich, Bucher, & Sabshin, 1963), mobilizing their perceptions of the role of the EMS and the kind of work they should be doing. Negative categorisation was associated with frustration necessitating emotional labour by crews in the disguise and suppression of emotion and appeared to influence the interactions between them and patients. The backstage setting in the form of the crew room was a central, regular, social gathering point where frontline frustrations were shared and processed through moaning, complaining, talking and humour. The crew room was a setting to talk to each other about difficult calls; where reflection was verbalized in questioning if they had done the ‘right’ thing and where reassurance was sought from colleagues. The reflexivity displayed by crews in the backstage setting appeared to emphasise positive affirmations rather than challenge and contributed to a sense of group identity. This thesis offers new understandings of the challenges of the frontline EMS role, emotional labour and emotion work and drawing on participant observation, offers tentative implications these appear to have for crews’ interactions with those who use the service. The backstage context and behaviours represent local ways in which frontline role challenges appear to be expressed and managed from the perspective of those who are directly involved in it. The findings of this thesis offer unique contributions to the theory of emotional labour and emotion work in the emergency pre-hospital care context. These have implications for the inclusion of the concepts of emotional labour and emotion work in pre- and post-registration paramedic curricula, organisational recognition of the emotional demands of emergency ambulance work and staff support and for further research into the emotional challenges of this type of work.