Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so o... more Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. Methods: We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300). After calculating tract-level median ambulance response time (MART), we used ordinary least squares (OLS) regression to estimate a conditional average relationship between neighborhood poverty and MART and quantile regression to condition this relationship on 25th, 50th, and 75th percentiles of MART. We also specified each of these outcomes by five dispatch priorities and by three intervention severities. For each model, we estimated the associated changes in MART per 10 percentage point increase in tract-level poverty while adjusting for emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, most of our tests suggested tract-level poverty was negatively associated with MART. Our baseline OLS model estimates that a 10 percentage point increase in tract-level poverty is associated with almost a 24 s decrease in MART (−23.55 s, 95% confidence interval [CI] −33.13 to −13.98). Results from our quantile regression models provided further evidence for this association. Second, we did not find evidence that ambulances are relatively late to poorer neighborhoods when specifying MART by dispatch priority. Third, we were also unable to identify a positive association between tract-level poverty and MART when we specified our outcomes by three intervention severities. Across each of our 36 models, tract-level poverty was either not significantly associated with MART or was negatively associated with MART by a magnitude smaller than a full minute per estimated 10 percentage point increase in poverty concentration. Conclusion: Our study challenges the commonly held assumption that ambulances are later to poor neighborhoods. We scrutinize our findings before cautiously considering their relevance for ambulance response time research and for ongoing conversations on the relationship between neighborhood poverty and prehospital care.
Background: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utili... more Background: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. Methods: We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories. For each model, we estimated the incident rate ratios for 10 percentage point increases in tract-level poverty while controlling for geographic patterns in race, citizenship, gender, age, emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, tract-level poverty was positively associated with ambulance contacts (incident rate ratio [IRR] 1.45; 95% confidence interval [CI] 1.34 to 1.57). Second, poverty was positively associated with low severity contacts (IRR 1.48; 95% CI 1.35 to 1.61), medium severity contacts (IRR 1.38; 95% CI 1.28 to 1.49), and high severity contacts (IRR 1.40; 95% CI 1.30 to 1.51). Third, poverty was positively associated with 12 primary impression categories: abdominal (IRR 1.48; 95% CI 1.36 to 1.61), altered level of consciousness (IRR 1.37; 95% CI 1.25 to 1.50), cardiac (IRR 1.28; 95% CI 1.14 to 1.42), overdose/intoxication (IRR 1.59; 95% CI 1.40 to 1.81), pain (IRR 1.56; 95% CI 1.41 to 1.73), psych/behavioral (IRR 1.50; 95% CI 1.34 to 1.67), respiratory (IRR 1.42; 95% CI 1.29 to 1.56) seizure (IRR 1.52; 95% CI 1.38 to 1.68), stroke (IRR 1.14; 95% CI 1.01 to 1.28), syncope/near syncope (IRR 1.23; 95% CI 1.12 to 1.36), trauma (IRR 1.44; 95% CI 1.31 to 1.58), and general weakness (IRR 1.31; 95% CI 1.20 to 1.42). Conclusion: Our study suggests poverty is a positive, strong, and enduring predictor of ambulance contacts at the neighborhood level. The relationship between neighborhood poverty and ambulance utilization should be considered at multiple levels of EMS decision making.
This article reimagines poverty governance as a labor process. Extending theories of bureaucratic... more This article reimagines poverty governance as a labor process. Extending theories of bureaucratic fields and street-level bureaucracies, the proposed model suggests that the state manages the poor through fragmented activities embedded in horizontal and vertical relations of production. I use an ethnography of 911 ambulance operations in a single California county to advance this perspective. From plugging gunshot wounds to moving sidewalk slumberers, ambulance crews interact with a mostly impoverished clientele base by transforming spaces in bodies and bodies in spaces. This two-sided governance puts the ambulance in recurrent contact with the hospital emergency department and the police squad car. Across these institutions, ambulance crews struggle with their nurse and police counterparts over the horizontal shuffling of burdensome work, shaping the life chances of their subjects in the process. At the same time, bureaucratic and capitalistic forces from above activate a lean ambulance fleet that is minimally wasteful and highly flexible. This verticality structures clientele processing through the ambulance and fuels tensions across the frontlines of governance. In an effort to advance theory and fill an empirical gap, this article proposes a new model for understanding the management of marginality and highlights an overlooked case of poverty regulation.
Roughly 700,000 people are released from American prisons every year, yet we know little about th... more Roughly 700,000 people are released from American prisons every year, yet we know little about their ground-level experiences at or near the moment of exit. This ethnographic study fills part of the gap by examining the aspirations and corresponding actions of soon-to-be-released prisoners, ''short-timers.'' While previous research suggests this population wants a ''successful reentry,'' few have detailed such a desire beyond its obvious mismatch with life chances. I show that in addition to verbalizing lucid hopes and plans for the ''straight life,'' short-timers act in reference to these aspirations while incarcerated by drawing on two meager resources: family and penitentiary. Such aspirations and actions are not markers of ignorance. Instead, I argue that they signal a practical orientation in a world where staff dominate inmates. In friction with the durable forces of inmate objectification, short-timers can use future-oriented perceptions and practices to realize some degree of selfhood. Meanwhile, their custodians, who are never committed to despotic control or total mortification, impose complementary lessons in personal responsibility through the discourse of prisoner reentry. Besides spotlighting a rarely studied moment in prison, I offer a model for how prisoner subjectivity emerges as both a rejection and product of penal power.
This article details the principles and practices animating an “ethnographic” method of teaching ... more This article details the principles and practices animating an “ethnographic” method of teaching social theory. As opposed to the traditional “survey” approach that aims to introduce students to the historical breadth of social thought, the primary objective of teaching ethnographically is to cultivate students as participant observers who interpret, adjudicate between, and practice social theories in their everyday lives. Three pedagogical principles are central to this approach, the first laying the groundwork for the two that follow: (1) intensive engagement with manageable portions of text, (2) conversations among theorists, and (3) dialogues between theory and lived experience. Drawing on examples from our experiences as graduate student instructors for a two-semester theory sequence, we offer practical guideposts to sociology instructors interested in integrating “living theory” into their own curricula by clarifying how each principle is put into action in course assignments, classroom discussions and activities, and evaluations of student learning. We conclude by encouraging sociology departments and instructors to consider the potential benefits and drawbacks of offering social theory courses built around in-depth readings of and conversations between social theorists and the social world.
This article details the principles and practices animating an “ethnographic” method of teaching ... more This article details the principles and practices animating an “ethnographic” method of teaching social theory. As opposed to the traditional “survey” approach that aims to introduce students to the historical breadth of social thought, the primary objective of teaching ethnographically is to cultivate students as participant observers who interpret, adjudicate between, and practice social theories in their everyday lives. Three pedagogical principles are central to this approach, the first laying the groundwork for the two that follow: (a) intensive engagement with manageable portions of text; (b) conversations among theorists; and (c) dialogues between theory and lived experience. Drawing on examples from our experiences as Graduate Student Instructors for a two-semester theory sequence, we offer practical guideposts to sociology instructors interested in integrating “living theory” into their own curricula by clarifying how each principle is put into action in course assignments, classroom discussions and activities, and evaluations of student learning. We conclude by encouraging sociology departments and instructors to consider the potential benefits and drawbacks of offering social theory courses built around in-depth readings of, and conversations between, social theorists and the social world.
Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so o... more Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. Methods: We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300). After calculating tract-level median ambulance response time (MART), we used ordinary least squares (OLS) regression to estimate a conditional average relationship between neighborhood poverty and MART and quantile regression to condition this relationship on 25th, 50th, and 75th percentiles of MART. We also specified each of these outcomes by five dispatch priorities and by three intervention severities. For each model, we estimated the associated changes in MART per 10 percentage point increase in tract-level poverty while adjusting for emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, most of our tests suggested tract-level poverty was negatively associated with MART. Our baseline OLS model estimates that a 10 percentage point increase in tract-level poverty is associated with almost a 24 s decrease in MART (−23.55 s, 95% confidence interval [CI] −33.13 to −13.98). Results from our quantile regression models provided further evidence for this association. Second, we did not find evidence that ambulances are relatively late to poorer neighborhoods when specifying MART by dispatch priority. Third, we were also unable to identify a positive association between tract-level poverty and MART when we specified our outcomes by three intervention severities. Across each of our 36 models, tract-level poverty was either not significantly associated with MART or was negatively associated with MART by a magnitude smaller than a full minute per estimated 10 percentage point increase in poverty concentration. Conclusion: Our study challenges the commonly held assumption that ambulances are later to poor neighborhoods. We scrutinize our findings before cautiously considering their relevance for ambulance response time research and for ongoing conversations on the relationship between neighborhood poverty and prehospital care.
Background: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utili... more Background: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. Methods: We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories. For each model, we estimated the incident rate ratios for 10 percentage point increases in tract-level poverty while controlling for geographic patterns in race, citizenship, gender, age, emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, tract-level poverty was positively associated with ambulance contacts (incident rate ratio [IRR] 1.45; 95% confidence interval [CI] 1.34 to 1.57). Second, poverty was positively associated with low severity contacts (IRR 1.48; 95% CI 1.35 to 1.61), medium severity contacts (IRR 1.38; 95% CI 1.28 to 1.49), and high severity contacts (IRR 1.40; 95% CI 1.30 to 1.51). Third, poverty was positively associated with 12 primary impression categories: abdominal (IRR 1.48; 95% CI 1.36 to 1.61), altered level of consciousness (IRR 1.37; 95% CI 1.25 to 1.50), cardiac (IRR 1.28; 95% CI 1.14 to 1.42), overdose/intoxication (IRR 1.59; 95% CI 1.40 to 1.81), pain (IRR 1.56; 95% CI 1.41 to 1.73), psych/behavioral (IRR 1.50; 95% CI 1.34 to 1.67), respiratory (IRR 1.42; 95% CI 1.29 to 1.56) seizure (IRR 1.52; 95% CI 1.38 to 1.68), stroke (IRR 1.14; 95% CI 1.01 to 1.28), syncope/near syncope (IRR 1.23; 95% CI 1.12 to 1.36), trauma (IRR 1.44; 95% CI 1.31 to 1.58), and general weakness (IRR 1.31; 95% CI 1.20 to 1.42). Conclusion: Our study suggests poverty is a positive, strong, and enduring predictor of ambulance contacts at the neighborhood level. The relationship between neighborhood poverty and ambulance utilization should be considered at multiple levels of EMS decision making.
This article reimagines poverty governance as a labor process. Extending theories of bureaucratic... more This article reimagines poverty governance as a labor process. Extending theories of bureaucratic fields and street-level bureaucracies, the proposed model suggests that the state manages the poor through fragmented activities embedded in horizontal and vertical relations of production. I use an ethnography of 911 ambulance operations in a single California county to advance this perspective. From plugging gunshot wounds to moving sidewalk slumberers, ambulance crews interact with a mostly impoverished clientele base by transforming spaces in bodies and bodies in spaces. This two-sided governance puts the ambulance in recurrent contact with the hospital emergency department and the police squad car. Across these institutions, ambulance crews struggle with their nurse and police counterparts over the horizontal shuffling of burdensome work, shaping the life chances of their subjects in the process. At the same time, bureaucratic and capitalistic forces from above activate a lean ambulance fleet that is minimally wasteful and highly flexible. This verticality structures clientele processing through the ambulance and fuels tensions across the frontlines of governance. In an effort to advance theory and fill an empirical gap, this article proposes a new model for understanding the management of marginality and highlights an overlooked case of poverty regulation.
Roughly 700,000 people are released from American prisons every year, yet we know little about th... more Roughly 700,000 people are released from American prisons every year, yet we know little about their ground-level experiences at or near the moment of exit. This ethnographic study fills part of the gap by examining the aspirations and corresponding actions of soon-to-be-released prisoners, ''short-timers.'' While previous research suggests this population wants a ''successful reentry,'' few have detailed such a desire beyond its obvious mismatch with life chances. I show that in addition to verbalizing lucid hopes and plans for the ''straight life,'' short-timers act in reference to these aspirations while incarcerated by drawing on two meager resources: family and penitentiary. Such aspirations and actions are not markers of ignorance. Instead, I argue that they signal a practical orientation in a world where staff dominate inmates. In friction with the durable forces of inmate objectification, short-timers can use future-oriented perceptions and practices to realize some degree of selfhood. Meanwhile, their custodians, who are never committed to despotic control or total mortification, impose complementary lessons in personal responsibility through the discourse of prisoner reentry. Besides spotlighting a rarely studied moment in prison, I offer a model for how prisoner subjectivity emerges as both a rejection and product of penal power.
This article details the principles and practices animating an “ethnographic” method of teaching ... more This article details the principles and practices animating an “ethnographic” method of teaching social theory. As opposed to the traditional “survey” approach that aims to introduce students to the historical breadth of social thought, the primary objective of teaching ethnographically is to cultivate students as participant observers who interpret, adjudicate between, and practice social theories in their everyday lives. Three pedagogical principles are central to this approach, the first laying the groundwork for the two that follow: (1) intensive engagement with manageable portions of text, (2) conversations among theorists, and (3) dialogues between theory and lived experience. Drawing on examples from our experiences as graduate student instructors for a two-semester theory sequence, we offer practical guideposts to sociology instructors interested in integrating “living theory” into their own curricula by clarifying how each principle is put into action in course assignments, classroom discussions and activities, and evaluations of student learning. We conclude by encouraging sociology departments and instructors to consider the potential benefits and drawbacks of offering social theory courses built around in-depth readings of and conversations between social theorists and the social world.
This article details the principles and practices animating an “ethnographic” method of teaching ... more This article details the principles and practices animating an “ethnographic” method of teaching social theory. As opposed to the traditional “survey” approach that aims to introduce students to the historical breadth of social thought, the primary objective of teaching ethnographically is to cultivate students as participant observers who interpret, adjudicate between, and practice social theories in their everyday lives. Three pedagogical principles are central to this approach, the first laying the groundwork for the two that follow: (a) intensive engagement with manageable portions of text; (b) conversations among theorists; and (c) dialogues between theory and lived experience. Drawing on examples from our experiences as Graduate Student Instructors for a two-semester theory sequence, we offer practical guideposts to sociology instructors interested in integrating “living theory” into their own curricula by clarifying how each principle is put into action in course assignments, classroom discussions and activities, and evaluations of student learning. We conclude by encouraging sociology departments and instructors to consider the potential benefits and drawbacks of offering social theory courses built around in-depth readings of, and conversations between, social theorists and the social world.
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as graduate student instructors for a two-semester theory sequence, we offer practical guideposts to sociology instructors interested in integrating “living theory” into their own curricula by clarifying how
each principle is put into action in course assignments, classroom discussions and activities, and evaluations of student learning. We conclude by encouraging sociology departments and instructors to consider the potential benefits and drawbacks of offering social theory courses built around in-depth readings of and conversations between social theorists and the social world.
as graduate student instructors for a two-semester theory sequence, we offer practical guideposts to sociology instructors interested in integrating “living theory” into their own curricula by clarifying how
each principle is put into action in course assignments, classroom discussions and activities, and evaluations of student learning. We conclude by encouraging sociology departments and instructors to consider the potential benefits and drawbacks of offering social theory courses built around in-depth readings of and conversations between social theorists and the social world.