Routes, Routines and Emotions in Decision Making of Emergency Call Takers

Emergency call takers listen to callers expressing mundane errands, but also to callers who describe severe accidents, agony and deaths. The emergency setting is further complicated by having to perform triage under time-pressure, but without possibilities of seeing the patient. The setting rests on an imperative of speedy management—there are few or no possibilities to postpone or reconsider decisions. At the same time, the mode of communication (telephone) may cause overflow or insufficient information, resulting in an uncertain and ambiguous decision setting. A focal point for the organization is therefore the individual capability of conducting triage. However, call takers are also helped by organizational routines, which are manifested in decision support systems, in order to navigate this uncertain and ambiguous setting. Taken together, the emergency setting brings a tension to the fore—how does this emotional setting, with features of vivid and interruptive experiences that possibly detour normative decisions, interact with routines that are supposed to provide for both stability and that recurrent decisions can be made under similar conditions? Drawing on the fields of psychology, decision making, organization theory and communication theory the tension is investigated by a series of four studies. The first study is a field study of the emotional landscape of emergency call taking. Emergency call takers rated callers’ emotional expressions in authentic emergency calls, the level of intensity and expressed need for help. The second study is an experiment, using a speech sample from authentic emergency calls in order to find out whether expressed emotion and intensity contribute to perceived need for help. The third study focuses on management strategies of call takers. More specifically, how do emergency call takers manage double-faced emotional management—i.e., their own and the caller’s emotions—simultaneously? The fourth study focuses on how call takers make decisions, more specifically how call takers use intuitive and emotional capabilities to complement or challenge rational aspects of the decision support systems. The studies reveal that certain emotions occur more often than others and that the level of intensity of expression contributes to perceived help need. Call takers have also developed specific emotional management strategies in order to cope with both callers’ and their own emotions. Finally, call takers were found to use rational and formal routines as well as non-formal, intuitive and emotionally based individual routines in order to derive their decisions. These findings are put into organizational context in terms of implications for emergency call taking. Limitations to the development of situation-specific expertise and obstacles for organizational learning are identified. Also, emergency call taking would benefit from drawing on knowledge found outside of the medical domain. However, the most important finding is that interpretation of emotional expressions in callers’ voices can trigger modifications of the triage routine in use.Disp. June 12