Space, place, and disorder in urban Emergency Medical Services work

Emergency Medical Services (EMS), which are available to virtually all American communities, form physical connections between individual patients and city- and county-level health resources. They therefore provide distinct connections between individuals and place and are uniquely suited to address questions relating to the role that neighborhoods play in structuring individual health outcomes. By combining field observations, qualitative interviews, and quantitative as well as GIS analyses of sketch map and dispatch data, this project analyzes the way place structures EMS work. During downtime between calls, certain neighborhoods provide opportunities for Emergency Medical Technicians (EMTs) and Paramedics to rest and recharge. Downtime also opens providers both to conflict when their presence conflicts with other users' constructions of who should use public areas of cities.;This conflict also manifests itself in the role EMS providers play in managing a variety of social and medical problems, particularly homelessness and substance use. These issues underscore the role of the EMS system as part of the social safety net, a role that stands in contrast to the official construction of the EMS system as an acute care network. Providers respond to homelessness by participating in the informal exclusion of individuals who are street homeless from particularly neighborhoods, a different side of conflicts over the use of urban space. Providers' perceptions are further complicated by spatial stigmas that they hold about certain neighborhoods in addition to perceptions that stigmatize illnesses and certain patients, like homeless individuals. These stigmas intersect and open providers to "getting burned" when their biases lead to the misattribution or downplaying of symptoms. This underacknowledged role as "street level social workers" illustrates the ways in which neighborhoods structure work routines that in-turn can have significant impacts on patients. Such a view of urban EMS work adds to our understanding of how a variety of stigmas affect individuals, how neighborhood stigmas arise, and how inter-neighborhood institutions play a role in structuring opportunity for urban residents.