A Strategy to Solving Difficult Problems Facing EMS Managers

In the September issue, I made the assertion that EMS is a wicked problem, and we need tools and methods to deal with the “wickedness”–the root problem. The next time you hear someone say, “The problem is “¦ ,” think about what the person is actually saying. Did the person describe the root problem or, as is often the case, did they just talk about a problem that’s really a consequence of another, deeper problem?


For example, someone tells you, “The problem is we don’t have enough paramedics.” Is this statement actually true? If so, why is it true? Consider the following aspect of the “too few paramedics” dilemma: How many paramedics do we really need? There are multiple answers to this question. Some might say we need one ALS responder or ambulance for every 100,000 population. Others might say we need one paramedic on every apparatus. Yet others could argue we already have too many paramedics, and others might take the position we don’t need paramedics at all. I can make a case for each of these positions. Which position is correct? The answer to the question will be different according to the perspective of the person answering.

The inherent complexity of paramedic staffing levels and other EMS management issues, such as EMS system design, practitioner education, etc., makes it hard to solve problems when the problems are in fact consequences of deeper problems.


If we accept the fact that wicked problems can’t be solved, but we still have to do something to address the wickedness in some of our problems, the question is: What do we do? As Horst Rittel and Melvin Webber wrote in their 1973 paper “Dilemmas in a general theory of planning,” published in Policy Sciences: “Formulating the problem by tracing it to its sources is the first step in solving a wicked problem.”

I’ve found the most common approaches to taking this first step is through collaboration, dialog, systems and design thinking, and creativity working with broad groups of stakeholders in order to first work to clarify a problem’s cause(s).

That means we must begin with identifying the stakeholder groups and representatives of each group who will participate in the process and get them to the table. Once we’ve identified the right people, we can adopt one of several techniques such as dialog mapping,1 creative problem solving,2 or transdisciplinary imagination,3 among others, to guide the process. Stakeholder organizations and their representatives will have to make a commitment in time and energy. The work is hard and time consuming; however, the rewards of successful creative collaboration and dialog make the investment worth the time and work.


Wicked problems are a part of our modern world. We can’t avoid them. We must acknowledge when we’re faced with tough problems and take steps to make progress toward understanding the complexity involved in order to get at its roots. I’ve only barely scratched the surface of this topic, and I challenge you to do some research, dig deeper, and review publications in this area. Then take steps to bring the right people together to begin the collaboration and conversations needed to move forward.


1. Conklin J: Dialogue mapping: Building shared understanding of wicked problems. John Wiley & Sons: Chichester, England, 2009.

2. Reali PD: H2 [How to] solve wicked problems: Getting started with creative problem solving. OmniSkills Press: Charlotte, N.C., 2010.

3. Brown VA, Harris JA, Russell JY, editors: Tackling wicked problems through transdisciplinary imagination. Earthscan: Washington, D.C., 2010.

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