Community Engagement in Action: How Writing Fits in to Local EMS Agencies

By Liz Angeli

​​For the past decade, I’ve worked with emergency medical services (EMS) agencies and fire departments to bring writing studies research to a field where writing impacts continuity of patient care, can cost millions in lost revenue, and is under addressed in training. My main goal for the departments I work with is to cultivate a culture of writing so that providers focus more on their writing process than on the product they complete at the end of a 911 call. And, as you might guess, my work involves a lot more than researching writing.
 
My current research projects focus on providers in training and providers in the field. For providers in training, I’m working with the Milwaukee Fire Department to build a writing curriculum that will be integrated into their three-year cadet training program. Originally, it was going to be delivered in person over a series of 90-minute sessions, but with COVID-19, I pivoted from in-person instruction to an online platform that could be delivered asynchronously. So, I reduced the number of sessions to pilot the online platform, testing early and often. We’ll launch the platform this summer.

At the Milwaukee Fire Department’s Training Academy piloting activities for a writing curriculum. Photo by Liz Angeli.

​For providers in the field, I’m working with the Kenosha Fire Department on two related studies that have one goal: to improve providers’ audience awareness. To do that, we interviewed EMS report readers to learn what they need in an EMS report to continue patient care. We also changed the interface on the electronic report writing platform to prompt providers to respond to audience expectations. Data analysis is currently underway.
 
When I started these studies, I returned to writing studies basics, especially audience awareness and writing process. In the EMS and fire service community, this language is new, and these concepts opened doors to present new ideas about writing. I often say to EMS providers and firefighters, “What I’m telling you isn’t new. First responders don’t go into the field because they love to write and want to write every day. Writing is hard. But why is writing in the field hard? How can we change mindsets to make it less difficult? How can you see yourself as a writer the minute the tones go off and dispatch tells you where to go?”
 
A research participant once told me, “EMS is 20% adrenaline and 80% routine, waiting for the other 20% to happen.” In some ways, that sums up my research. Twenty percent of my time is spent in the field, and 80% is spent making sense of what happened in the field and preparing to go back out. I write emails, applications, and research article drafts. I make phone calls and bring newly assigned Lieutenants and Captains up to speed on projects I’m running at their departments. I sign liability waivers to do ride alongs and wait to hear back on approvals, data collection, and participation rates.
 
The other 20% is out “in the field” to observe writing in situ. Field work locations include administration offices where we work out logistics, EMS training classrooms where I introduce studies or deliver writing training, and fire stations where I introduce the research studies and ask for participation. For one study, I accompanied the Division Chief of EMS and Medical Director on three rounds of seven station visits. That’s 21 station visits total over three full 8-hour days where I met the department’s providers, introduced the study, answered questions, and encouraged participation. Usually we met crews at the station, but some crews were out on calls. In those cases, and when permissible, we literally met crews wherever they were, as you can see in this photo. We met a crew in a school parking lot where they were testing the school’s fire alarms.

With Dr. Tom Grawey (left), Medical Director of the Kenosha Fire Department, conducting station visits. Photo by Chief Jim Poltrock.

Field work also includes ride alongs that last 4-24 hours, depending on my schedule and how long the department has approved me to stay, and they start at the fire station where I meet the crew I’ll ride with. When the crews aren’t responding to patients, we’re at the station where crews catch up on paperwork, clean the station, or prepare meals.  These moments are interrupted abruptly when the tones go off: The crew is dispatched to a patient, and I quickly gather my research materials to observe writing-in-action. I carry a small notebook and pen with me, I wear a 24-hour watch to timestamp observations so I can align them with the report’s timestamps, and my turnout gear pant pockets carry a supply of medical exam gloves [I have not been on ride-alongs since COVID-19 began]. Usually I ride in the back of the ambulance with the “boss” of the crew, the patient, if we’re transporting them, and sometimes another crew member or a police officer, depending on the nature of the call.
 
The field and the back of the ambulance hold some of the most beautiful acts of compassion and empathy I’ve been honored to witness as a writing researcher. Medic and fire crews bringing a man back to life after her suffered cardiac death in a grocery store check-out line. A medic student holding an infant’s hand. A long-time medic comforting a scared elderly patient by leaning close to him, holding his hand, saying, “It’s ok to cry. We’re going to take good care of you.” A team of medics swiftly managing a gunshot victim’s excruciating pain levels and assuaging her fears, “We got you, we got you. We’re getting to the ER as fast as we can. Hang on.”
 
I find myself moved to tears remembering these moments. As they happened, though, I quietly held space in gratitude for all that I witnessed. And, in a sense, that summarizes what community engagement looks like for me: bearing witness to human interaction at its most vulnerable and learning how writing fits in.
 
 
Liz Angeli, Ph.D. is a leading expert in first responder documentation practices and education. She is Associate Professor of English at Marquette University where she teaches writing and rhetoric courses, and her first book, Rhetorical Work in Emergency Medical Services: Communicating in the Unpredictable Workplace, won Best Book in Technical or Scientific Communication from the Conference on College Composition and Communication. Liz also serves as a spiritual director, and you can learn more about her work on her website.