Administration and Leadership, Columns

Being an EMS Leader Comes with Risks

Issue 1 and Volume 40.

I’m often asked what my favorite job has been in EMS. Believe it or not, that’s a difficult question to answer because you first have to drill down to what they mean by “favorite” to be able to give the appropriate answer.

First, I have to say EMS is my life’s work, and there’s no aspect of EMS I don’t love and feel passionate about.

My overall response is probably similar to many others in EMS. I love talking to (and helping) people in their time of need, whether it’s an emergency or not.

Not every patient appreciates what you’re doing for them, particularly when they’re emotionally upset, struggling to breathe, in pain, under the influence of mind-altering substances or handicapped by a mental problem. That’s the second reason I, and most of my peers, love EMS: there’s always a challenge or barrier that needs to be hurdled.

Part of the fun is breaching the walls that stand in your way to success, whether they be a complex medical situation, a “broken” trauma patient who needs to be rapidly held together (stabilized) and taken to the right facility, or applying for and getting a big contract or grant to expand or approve your system.

My time on the street, teaching classes, designing ambulances and creating innovative EMS programs (or crafting JEMS editorial) that make a difference for patients and make life safer, better and more efficient for the crews are probably the aspects of EMS I could call my favorites.

But, the reality is that I, and most of my friends who are EMS managers and true EMS leaders, probably like our roles in those areas the most because it’s where you can make the most impact, or at least put a dent in the framework of an EMS system.

First, it’s always nice to be the manager or boss because you’re personally able to make key decisions that influence EMS and you can somewhat control your own destiny. I say “somewhat” because my intent with this month’s column is to point out that EMS management and leadership isn’t only fulfilling and challenging, but also often very dangerous and personally painful.

Success and advocacy for change in an EMS system can be a minefield for well-informed and well-intentioned leaders. Three of the past six winners of the prestigious James O. Page Leadership Award have been kicked in the teeth and either demoted in their agencies for being too successful, or for pushing positive change or an agenda too ambitious for their organization.  

I advocate that energetic and ambitious EMS personnel jump into the EMS management pool if they want to make a difference. But you need to be aware that the water is cold, and there are sharks aplenty in the pool; many of which will bite at you and try to take you down throughout your career.

Your employer, board members or politicians will support you when you make decisions they favor. And your employees and senior staff will support you when you implement their pet projects or give them favorable reviews on performance evaluations. But they can turn on you as quick as a snake when decisions don’t go their way, promotions aren’t approved, or you fail to move in the direction they advocate.

It’s all part of the job and you have to be ready for arrows to be shot in your direction if you shoot some toward them. And, like in war, snipers are always looking for officers and leaders to take out.

Leadership and success is a double-edged sword. People will be happy you’ve brought fame and prosperity to their organization and then, when you least expect it, someone who wants to be at the top, or who’s jealous of your accomplishments as an EMS leader, will try to topple you from your post. It’s happened for decades and will probably happen for centuries to come.

True leaders have to pick their employer(s) or post(s) wisely to have true tenure in EMS and be ready to move on if they’re hand-tied, frustrated or demoted to stop what I call “dousing their fire of progress or passion of position.”

I have many close friends in EMS who’ve been bridled by their organization for moving too fast with policies or procedures, being too progressive with a status quo workforce, or demoted because of a boss, coworker or union leader’s jealousy or insecurity.

EMS leaders have to understand and accept that there’s little they can do to stay out of the sights of these snipers. If you want to be a true EMS leader, you have to stay focused and dedicated to the task and make decisions based upon what’s best for your patients and customers first, what’s best for your organization and staff second, and what’s best for yourself last.

If you reverse this order or sacrifice your principles, you’ll often still lose respect or your position, but it will probably occur faster.

But the message I send to you isn’t all bad because history has shown that true EMS leaders bubble to the top of the pool. If you maintain your principles, do the right things and innovate throughout your career, you’ll be recognized, recruited and hired by other organizations that will save you from the jaws of the sharks and allow you to continue to progress, manage and lead in EMS.