'On the inside I'm grossed out and wanting to puke': Exploring professional facework and emotional labour as impression management tools in rural emergency medical services.

This article examines how emergency medical services (EMS) providers in rural Appalachia manage professionalism through facework and emotional labour while serving underserved communities. Drawing on ethnographic data from two county-wide EMS organizations, the study reveals that EMS providers frequently encounter face threats arising from inappropriate patient requests and unintentional negligence by organizational partners, which challenge their professional identity. To maintain professionalism, EMS providers employ impression management strategies involving both preventive and corrective facework, utilizing emotional labour through surface and deep acting to navigate the emotional and "dirty" aspects of their work. The findings contribute to organizational communication theory by highlighting emotional labour as a key tool in managing professionalism amid the complex demands of rural EMS, and suggest practical implications for interorganizational collaboration and EMS training focused on boundary management and patient-centered care.