I AM THE DRAGOMAN: EMS TRANSLATIONS AND BOUNDARY OBJECTS IN NATIONAL PREPAREDNESS
Robinson, James L.
Maniscalco, Paul, National Center for Biomedical Research and Training
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Emergency medical services (EMS) in the United States is highly localized, arising from the historical efforts of local entrepreneurs, with local resources, perceptions and expectations. Early EMS development was spurred by strong federal leadership and funding for capacity building, but since the early 1980s, EMS has suffered from an absence of both, resulting in a patchwork of thousands of persistent local EMS interpretations. This study evaluates EMS through the framework of Boundary Object Theory, demonstrating that EMS is what Star and Griesemer refer to as a “boundary object,” around and within which multiple communities of practice interact. A case study of a local EMS agency as a community of practice demonstrates that it is indeed an organizational community of practice, and part of a larger EMS—and specifically out of hospital EMS community of practice. These communities of practice contribute to a coherent collective meaning of the EMS object at some analytical levels, but EMS perceptions do not scale from the local level to national preparedness policy. The consequences are discordant EMS preparedness policy and gaps in national preparedness, exacerbated by a lack of standardized methods and consolidated federal leadership for EMS. Recognizing out of hospital EMS as a discipline with a defined domain, its inclusion in preparedness policy development, and the return of federal leadership in EMS are recommendations.
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