Introduction
Medical emergency call interactions are highly time-sensitive, and call-takers must capture relevant information from the caller accurately in the least possible time. Communication difficulties in these interactions may directly impact the efficiency of the emergency call, which can be detrimental to the efficiency of emergency services dispatch. This thesis examines caller entitlement as one phenomenon that can impact emergency call efficiency. How callers interactionally produce and negotiate entitlement to emergency services can affect the emergency call trajectory in various ways and potentially become detrimental to efficient emergency call handling.

Methods
Using Conversation Analysis (CA), I investigated caller entitlement in medical emergency calls to the Western Cape Emergency Medical Dispatch (EMD) call centre, a public South African Emergency Medical Service (EMS) call centre. Audio emergency call recordings formed the data corpus for this study. I analysed two types of social actions that callers use to display their entitlement stance interactionally - requests for assistance and complaints - and explored how callers designed them; moments in calls they were produced; the type of callers producing them; and call-takers’ response types. I also included a case study analysis of the trajectory of a single written complaint email written to the EMD call centre by a caller. For this case study analysis, I used CA as the primary analytic method while drawing from the Appraisal Framework to analyse the trajectory of the complaint.

Results
This thesis shows how callers orient to their knowledge of the public South African healthcare context in their entitlement displays. I found only a few instances of strong or high caller entitlement across the data corpus. Strong entitlement was mainly displayed by professional callers, and the topic of these strong entitlement displays related to either resource constraints or perceived call-taker inefficiency. I found that in nearly half of my sample, callers downgraded their degree of entitlement in response to call-takers’ references to resource constraints. These findings suggest that callers’ orientation to the public South African healthcare context may preclude them from displaying strong entitlement. This orientation to context is further shown by how entitlement is negotiated between caller and call-taker, based on their mutual understanding of the context.

Conclusion
Callers to this public South African EMS call centre seem to understand how resource constraints in this context can impact emergency service delivery. They orient to this understanding in how they “do” entitlement in emergency call interactions, which influences the most effective way for call-takers to address caller entitlement to ensure efficient call handling. These findings highlight the importance of considering the influence of both the institutional and the broader socio-political context when developing training material for effective and efficient communication practices for call-takers. This study also demonstrates the value of CA as both an investigative tool to pinpoint and understand communication issues in emergency calls and its potential value as a training tool for call-takers to ensure the efficient exchange of information in emergency call interactions.

Key Words: Emergency Medical Dispatch Call Centres, Emergency Calls, Entitlement, Medical