Local expertise and landmarks in place reformulations during emergency medical calls

•In emergency calls, establishing location is a critical but challenging task.•Trouble may arise due to misspeaks, recipient recognition and system trouble.•Place reformulations are facilitated by a shared geographical membership.•Use of landmarks appears to promote call efficiency.

Establishing location, or where an ambulance is needed, is a critical feature of emergency calls. We describe how callers and call-takers in a South African Emergency Medical Service (EMS) reformulate place references when trouble arises. We used Conversation Analytic (CA) principles to examine audio-recorded emergency calls, and analysed focus group discussions with EMS personnel about location challenges. Our analysis confirms that place reformulations may arise from misspeaking or recipient recognition. We identify another pattern: trouble with the system, where matching a caller's description of place to the location options on a computerised programme proved challenging for call-takers. The use of landmarks as part of shared membership seems to promote call efficiency, and systems need to be context-specific and informed by local expertise. Finally, we discuss training implications.