It’s the Little Things that Matter: Tacit Knowledge in the Field of Paramedicine

Abstract

Paramedicine is continuous, complex, and systematically misunderstood by the outside world. Multiple sources of media only capture the thrilling, life-saving aspects of paramedicine but fail to address the subtle nuances that provide a source of meaning for clinicians. This fundamental gap points directly to the notion of tacit knowledge in paramedicine: the knowledge built through the little things that constitute the ordinary fabric of a paramedic's working day. It cannot be fully verbalized, learned through certification, or contained in any protocol. This thesis seeks to address this knowledge from the inside, namely the texture of the job as it is actually lived, the environment working as the medium for which paramedic knowledge and identity are forged, and to what extent that environment becomes internalized in the bodies of clinicians who inhabit it over time. Through ethnographic fieldwork with both 911 and mobile integrated health (MIH) paramedics and their respective supervisors in the Greater Boston area, I argue that paramedic knowledge is tacit knowledge. It is through the ritualistic, daily practices coupled with the internalization of the duty which paramedics have that ultimately disproves the division between the fields as nothing more than a cultural myth. This research aims to expand the current confines of medical anthropology in hopes of sparking exploration into a field of medicine that has yet to be explored.