Saving lives, saving face: mitigated directives during out-of-hospital cardiac arrest resuscitation

Abstract This paper investigates the occurrence and structures of mitigation of directives issued during the early minutes of out-of-hospital cardiac arrest resuscitation attempts, drawing on a dialogue analysis approach based on Searle’s Speech Act Theory. We transcribed the first 5 min of 40 pre-recorded, real-life resuscitation attempts. Line-by-line dialogue annotations, based on a bespoke dialogue annotation scheme, were applied to the dialogue transcripts to extract verbal orders or directives. Results revealed that directives made up about 25 % of the dialogue in these early minutes of real-life cardiac arrest resuscitation attempts. Three quarters of all directives were mitigated to an extent, forming a continuum of mitigated strategies. Some structures of mitigation carried ambiguous meanings and were found to delay target actions. The use of mitigation strategies also added length to directives, thus consuming extra time during the resuscitation attempts. Using softeners and affective terms appeared to be the best way to counterbalance the social imperative of politeness, with the communicative pressure of optimal efficiency.