Where Trouble Starts: Communication Breakdown in a Complex Emergency Call.

Emergency calls require efficient communication between caller and call taker to establish a need for assistance and dispatch help quickly. Analyzing communication processes at this first link in the emergency medical care chain has important implications for improving the quality of emergency care across the health system. This paper examines an interaction between a call taker and a caller requesting assistance at the scene of a family murder, using a hybrid interactional sociolinguistic approach to analysis. We also draw from court testimony. We demonstrate how several factors contribute to communication breakdown, prolong the call, and lead to the call taker doubting the credibility of the emergency. These include the caller's inability to frame a believable request for help nor clarify his stance concerning the emergency, an absence of urgency and emotion in his description of the incident, an extended focus on and repair of the incident location, and his dysfluent speech behaviors. We demonstrate how communication breakdown is co-constructed and compounded by system-related trouble. This call has useful implications for call-taker training and highlights that when an interaction goes wrong, it has a cascading effect on health care not only for those patients who need the help urgently but also for the efficient running of the health system as a whole.