Essential Factors for Producing a High-Quality EMS System



Gary Ludwig, MS, EMT-P | From the December 2012 Issue | Thursday, December 6, 2012

There’s a famous Clint Eastwood movie called The Good, the Bad and the Ugly. In the movie, a bounty-hunting scam joins two men in an uneasy alliance against a third in a race to find a fortune in gold buried in a remote Civil War cemetery.

The title of this movie is certainly applicable when we talk about EMS systems. I have seen and heard of the good, the bad and the ugly when it comes to EMS systems. when I’ve met with others at conferences, read e-mails from readers and co-workers and done consulting work, as well as from my role as chair of the EMS Section for the International Association of Fire Chiefs.

An old saying with EMS goes, “Once you have seen an EMS system, you have seen an EMS system”—meaning that all EMS systems are similar. That may be true, but I also think there are critical factors that differentiate them.

In the case of fire departments, the success of the EMS system doesn’t necessarily depend on the person running the EMS system but on the fire chief. The fire chief sets the tone. They can reject the EMS mission, tolerate the EMS mission, accept the EMS mission or embrace the EMS mission. Unless the fire chief embraces the EMS mission, the EMS system cannot be good, and may very well fall into the bad or ugly categories.

The same is applicable to other EMS system models. In third-service operations, the city or county manager must embrace the EMS mission for the system to be good. In hospital-based EMS systems, if the chief executive officer of the hospital sees EMS as nothing more than an extension of the emergency room, it has the potential to be a bad or ugly EMS system.

In the case of private ambulance services, it can be assumed that the owner of the company embraces the EMS mission, but other factors such as profit margins can interfere with their judgment. I’ve seen owners of private ambulance companies who fall into both categories, including one owner who had his employees rewash disposable supplies in order to save money.

The majority of EMS managers, regardless of being fire-based, third-service, hospital-based, private or other, usually report to a boss (such as the fire chief) who has other responsibilities besides overseeing EMS. For an EMS system to be good, not only does the EMS manager need to embrace the EMS mission, but their boss does also.

Another component that makes an EMS system good is having the right person in the manager seat. It’s like driving a school bus. If the bus driver has no clue how to operate the bus, start the engine, open and close the doors, monitor the kids on the bus, know the route they want to travel, and do it within the allotted time, the kids are going to get to school or home late—or worse.

The same applies to the EMS manager. If they don’t have a clue about operating the EMS system, how to manage people, how to interact with others in the community, how to operate a budget—or if they’re not up on current issues in EMS—the EMS system is going to look bad. Combine that with a boss who doesn’t embrace the EMS mission, and you will have definitely have an ugly EMS system.

EMS systems that are good have an EMS manager who embraces the EMS mission with passion, is well-read and informed on EMS issues, attends conferences to learn about the latest innovations, and is always looking to move the EMS system forward and stay on the cutting edge of EMS delivery systems.

Good EMS systems also have a set of core values to which almost everyone in the organization subscribes.

Good EMS systems have good people in subordinate positions underneath the EMS manager, who not only look at it as a job, but as something for which they’re responsible. When they see it as their responsibility, they are more committed to making sure things are addressed and that the organization maintains its quality.

EMS systems that are good don’t happen by accident. There’s a commitment from the top down, which in turn leads to everyone in the organization being committed to performing at a high level.

Mobile Category: 
Administration and Leadership

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Related Topics: Administration and Leadership, EMS system, EMS mission, EMS Manager, core values, Jems Leadership Sector

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Gary Ludwig, MS, EMT-P

is a deputy fire chief with the Memphis (TN) Fire Department. He has over 35 years of fire, EMS, and rescue experience. He is also the immediate past Chair of the EMS Section for the IAFC. He can be reached at


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