Administration and Leadership

Navigate the EMS Leadership Highway with Confidence and Humility

Issue 7 and Volume 41.

Throughout my career, particularly during my 21 years of travel as the editor-in-chief of JEMS, I’ve had the opportunity to visit EMS systems of all sizes, get acquainted with individuals in key management and leadership roles and, more importantly, hear from street personnel.

I’m able to feel the energy level in each system because good and bad management impressions are palpable. In many systems, crews are eager to tell me why they’re happy to work under their managers and supervisors and, in others, they clam up when I ask about their management team, often, I believe, because they fear retribution if they express themselves.

Regardless, I’m often able to read their frustration level as we discuss their organization and its leadership.

EMS Insider, our monthly electronic management newsletter, has been redesigned and is full of management and mentoring material because we realize the need for good management practices and good EMS managers. EMS leaders are greying and retiring. In many systems, in addition to eating their young, managers aren’t properly recruiting or cultivating replacements.

I see a lot of struggling EMS systems, with some that are spiraling out of control due to poor or ineffective managers. Anyone can be a manager, but it takes a long, conscious effort to be an EMS leader. If you want to be a true leader, you have to be prepared for career-long challenges, and in many cases, disappointments, failures and perhaps several job moves to stay ethically intact and make a difference.

EMS can be a brutal profession with lots of politics, backstabbing, discriminatory practices, labor resistance and people who will challenge your best intentions and every move.

That said, being an EMS leader is tremendously rewarding because of the real and potential impact you can make. Having been in management roles throughout my career, I wouldn’t trade it for anything because despite all the challenges and roadblocks, it’s better to lead and fail than to be led by failure.

Gold Nuggets

Successful EMS organizations have leaders who possess several “gold nuggets”: priceless traits that foster success. Most aren’t born with them but, rather, acquire them over time.

The first gold nuggets of solid leadership are humility, sincerity and acceptance that the organization exists because of the sum of its parts and not just because of one person’s presence at the head of the organization.

Good leaders remember where they came from, don’t forget the trials and tribulations of the street crews, and realize (and accept) that if they operate their organization in the proper manner and with the proper focus, their organization can, and will, survive without them.

This is a scary thing for many managers because they fear if they’re not perceived (and feared) as the boss, they can be overthrown-an incomprehensible thought to the egotistical manager who feels that those who make the rules or control the finances rule the kingdom.

Jim Page often said that good leaders should get fired at least once in their career to stay grounded. He was when he refused to give in to the demands of a small faction in North Carolina way back in the ’70s when, as the state’s first EMS director, he wouldn’t budge on their lobbying to have EMT tests read to illiterate students.

He stood his ground, citing the need for EMTs to be able to read suicide notes, maps, pill containers and EMS textbooks to perform their many functions in the field, and was fired by the governor for his ethical position.

He then moved to New Jersey and the Advanced Coronary Treatment (ACT) Foundation, where he postulated the need for paramedics in New Jersey to the disdain of first aid squads that didn’t want them. They tried to get the pharmaceutical companies that funded the ACT Foundation to fire Jim, but they wouldn’t.

That political overthrow attempt caused Jim to buy Paramedics International magazine and turn it into JEMS, a venture and medium that would allow Jim to tell it like it was.

In my case, I spent 20 years building the EMS system in Eastern Pennsylvania and had state bureaucrats try to stop me from being involved in street medicine. So I left bureaucracy to become the first operations director of another large EMS agency. The problem was that I replaced a chief who also served as the president of the agency’s volunteer board of directors. As you can imagine, I was second guessed on many things.

I turned those sour lemons into sweet fruit by doing my homework before every standard operating procedure or program initiative. I continued fighting to make sure the crews were safe and satisfied with their work, and not managed like indentured servants, forced to take late transfers when they had children waiting to be picked up at daycare.

Leaders Aren’t Bosses

I hate the word “boss” and never liked being called one, because anybody can be a boss, but it takes a special person to be a leader.

Good leaders see themselves as part of the organization and not the top person in the organization. I came to appreciate this while being mentored by several people, including my dad and Jim, two dedicated, visionary leaders who were players/coaches in the game of EMS. They never felt they were better, smarter, more creative or more motivational than the people they worked with, even though they clearly were.

You see, leadership is contagious. By virtue of their deliberate, determined style and their unselfish approach, they gained the trust and respect of their peers and coworkers who, in turn, worked hard to emulate them and succeed in the tough and often political world of EMS.

An EMS leader once told me, “Be careful whose feet you step on today because they’re connected to the ass you might have to kiss tomorrow.” In your zest to lead, you’ll be stabbed in the back and led into traps by individuals in your organization who disagree with your vision, policies or approaches, or are jealous of your success. Some factions will also work toward the demise of a progressive leader to open the door for a new, more conservative, less progressive approach.

To put it more bluntly, individuals who like the status quo will do whatever it takes to suppress the fire that burns fiercely in your heart.  

Stay Grounded

A leader should never lose sight of their early days in the field and the challenges and frustrations of the troops performing the work on a day-to-day basis. To develop and maintain a progressive EMS system, an EMS leader has to stay grounded and never lose touch with the street. If you lose touch with the street, your street personnel will lose touch with you.

You have to continually listen, observe and “school” yourself on what’s occurring from the roots of the tree to the top branches. Although EMS leaders must be well-versed in Medicare changes, billing practices and budgetary constraints, they also need to be aware of and concerned about the needs of the rank-and-file members of the organization. This means everyone from the fleet mechanics to the call-takers, the supply officers, to the administrative assistants.

These spokes in your wheel are what keep the system rolling and, if ignored or dissatisfied, can cause your wheels to wobble.


Successful leaders use solid and consistent communications, a total staff integration approach and a non-egotistical attitude about organizational management.

In Jay Fitch’s insightful and brutally honest June JEMS leadership article “Learning to Dance With an Elephant,” he presents 10 areas that are harming many systems and need to be addressed. It’s a must-read for all current and future EMS leaders.

People say that gold is always bright and brilliant. But I believe the gold nuggets presented here can tarnish if once bright and brilliant EMS leaders fail to remember their roots, allow their ego to eat their brains or forget that the street providers are the fuel for the machine.