Identifying Toxic Leadership in EMS Organizations

Derrick E. Jacobus
Derrick E. Jacobus, MA, NRP, FP-C

Think of the worst place you have ever worked. Without knowing where, I could imagine that it involved de-personalized, authoritarian, “boss” type management styles. This organization rarely rewarded the good but was quick to highlight the bad. These managers took the credit for the work from you and your co-workers. This behavior has cost the organization hundreds of thousands of dollars in civil lawsuits, lost productivity, low morale and high employee turnover.

You are a tenured paramedic in XYZ Emergency Medical Services. After decades of dysfunction, a new, younger program director has now taken the corner office. Your department is now seeing a dramatic change at the top levels with new philosophies and ideas.


You have been identified as a potential new leader by the transition team assigned to lead the 911 and transportation functions of your organization. You are enrolled in a leadership development program. After being in the emergency medical services field for over 20 years, you now find yourself wearing different shoes. You progress in the program and the ideas presented are alien to you. None of them have been practiced in your organization in the past. You begin hearing all of these new phrases, “servant leadership,” “value-based leadership” and “work-life balance.” As a member of Generation X, you thought this position would be discipline and telling people what to do. And what is with the new title? It is a manager, not a leader…right?! This is not how it used to be!


Any supervision or leadership class almost always highlights the positivity about leading a team. Rarely do they stress the dark side of leadership styles. These styles include being destructive, toxic, abusive and ineffective.1 These theories can support an exhaustive journal article, but here we will focus on the toxic leader.

Broken organizations usually have “bosses” managing subordinates’ daily activities (aka “micromanaging”) instead of a team mentality. This style is the lowest form of leadership and does not work well in the current workforce. A term has been coined for this facet of leadership, toxic leadership.2 Toxic leaders typically work to please themselves or against the goals of their organizations, resulting in a dysfunctional environment.3

Toxic leaders consistently use flawed behaviors to deceive, intimidate, coerce, or unfairly punish others for getting what they want for themselves. These behaviors are self-centered, narcissistic approaches to managing others. Toxic leaders will always believe that they are smarter than everyone. These leaders are arrogant and infatuated with themselves.4 When the toxic leader creates a hostile workplace, it results in negative but pervasive consequences that trickle down and create a stressful environment that adversely affects the subordinate’s professional and personal life.3

The findings also show that toxic managers do not realize their toxicity themselves. They mostly focus on their success while ignoring their long-term and permanent harm to the employees.5 Hence, these types of leaders cannot see their own faults and deficiencies; thus, they cannot become better leaders. When confronted with their behaviors, they are quick to deny these characteristics. These leaders also do not care about the effects of their attitude and behavior on others.6 The idea of a toxic leader is reasonably new and has been recognized over the past decade.

Toxic leaders have long been a staple in military ranks, static organizations and public safety.7 In any social media platform, use the #toxicleadership, and most of the results are military and public-safety based. These “bosses” are put into place and intimidate subordinates to get the job done and take as much credit as they can for themselves. To put it into perspective, you put a group of non-progressive, traditional, self-centered “bosses” with one who values a team approaches on an island and is told to survive with what they have. Who is going to be the one that people will gravitate to? If you are on that island, who do you want to associate yourself with to survive the longest?

Why do toxic leaders exist? In the journal article by Betty Glad (2002) titled, Why Tyrants Go Too Far: Malignant Narcissism and Absolute Power, the author discusses that in the traditional sense, most leaders are narcissists. A destructive narcissist projects their own devalued self-image on other people. The same person attack’s subordinates as a means of maintaining a precarious psychological stable platform. The idea of a toxic leader presenting with a borderline personality disorder is also introduced as they have “no real attachment to others, and thus no capacity for empathy.”8 In addition, these toxic leaders fail to embrace the lifelong learning concept and instead push the notion that they are the holder of all the answers.4

Organizations typically defer decision making to those of a higher rank in a top-down management style. When the organization’s structure is broken at the top, it begins to leak through the cracks and eventually begins to rot the walls and eventually down to the foundation to irreparable damage. Does this sound familiar? If this dysfunctional cycle of thinking is not corrected or addressed, you quickly have an entire village of inhabitable buildings.

One theory that toxic leadership persists in EMS is because job performance is traditionally evaluated in a top-down fashion. This top-down structure means that toxic leaders can influence and control subordinates. Toxic leaders are also pretty good at currying favor with their superiors. Hence, toxic leaders remain in place and are even promoted, despite their unhealthy ways.9

Organizations have an administrative and social responsibility to address toxic leader behaviors and provide resources to employees to counteract toxic leadership to create a more positive work environment where employees can find work rewarding and fulfilling.10 If left uncorrected, toxic leaders can quickly drive down an organization.

Results of a Toxic Workplace

Employee Stress

Working in any field of public safety is a tremendously stressful career. Add that to the whirlwind events of 2020, and you have catastrophic results. Emergency medical services have begun to introduce resiliency into the mindset of our providers. The stress is compounded by already increased rates of mental illness, marital breakups and suicide.

Toxic leaders typically have perfectionist behaviors, which causes them to fear failure and, therefore, do not take any risks. This behavior leads to a focus on productivity instead of creativity or initiative. When you have a productivity-driven toxic leader continually pushing for more transport volume or dynamically staging crews without any empathy for the crew themselves, will eventually lead to provider stress and burnout.4

A Norwegian study explained that employees of toxic leaders who are repeatedly exposed to several negative emotions while interacting with destructive or toxic leaders result in feelings of violation, uncertainty, belittling, and frustration.11 This leads to a poor employee-supervisor relationship that aggravates employee feelings of loyalty, emotional stability, and decreased job satisfaction and turnover. Another study mirrored the results, adding that toxic leaders cause trauma that can influence employees long after they stop reporting to a toxic leader.

According to the United States Department of Health and Human Services (2014), trauma is a single event, numerous events, or a sustained experience resulting in stress and stress-related disorders. All types of trauma can create responses from the individuals who experienced the trauma. Additionally, trauma can continue to influence individuals much after the experience ended. This trauma can cause an emotional reaction in the way they were treated and can invoke painful memories.12

Employee Retention

It is no secret that job satisfaction is a significant factor between not being appreciated and employee turnover. This is true in several research findings.13 A toxic leader’s behaviors are contradictory to the common theoretical traits of the younger Millennial (Generation Y) and Generation Z workforce. For these generations, the ideal job will appeal to their core characteristics. Some of these characteristics have been defined as multitasking, engagement, home-work life balance, individualized attention, instant reward, and fostering a team environment. In order for them to enjoy a given job, they must find the experience exciting and feel engaged beyond their office work.14

Gen. Jim Mattis wrote in his book, “Call Sign Chaos” (an excellent read for any aspiring leader), “Value initiative and aggressiveness above all. It’s easier to pull the reins back than to push a timid soul forward.”15 A common way to engage these new generations is to give them ownership of their work through leadership opportunities. Employers must make “high potential” employees feel like they are not only part of the future, but they control the future.

More often than not, employees will only feel like they have leadership potential when they are explicitly made to feel this way. Organizations can accomplish this by having specific programs in place to move employees toward positions of leadership. Organizations cannot only put people in positions and trust them to become influential leaders. This proactive way of thinking is the opposite of the way a toxic leader functions. As toxic leaders are allowed to continue in an organization, it may directly correlate to employee retention and high turnover rates. Therefore, decreasing productivity and profit overall.14

Workplace Harassment

Workplace bullying is defined as workplace harassment or emotional abuse. It refers to the most prominent and subtle negative behaviors encompassing the retaliation, intimidation, and harm equipped with consistency, which is exhibited by a group or individual to another group or individual at work in an organization.11

Toxic leaders participate in these behaviors in a variety of ways. When a toxic leader withholds information to an employee relevant to a task or provides regular criticism and lack of praise, this is coined “task-related” bullying. This leader may withhold information from one employee and provide it to another, a sense of favoritism. “Person-related” bullying is when a toxic leader spreads rumors or make insulting remarks about a person. This could be to the person directly or to a separate group of employees. “Social exclusion” is the behavior that excludes an employee. For example, if a toxic leader hosts a monthly happy hour for her direct reports and consistently excludes certain employees, this is a form of workplace harassment.11

Employee Satisfaction

Despite having a toxic leader in place, most employees will stick to an organization’s mission and values to make a commitment to the work that they do. Having a toxic leader at the top negatively affects the view of the organization, from the inside and out, and the leadership team as a whole. Trust plays a vital role in constructing the foundation for cooperation between the leadership team and the employees. Employees who direct report to a toxic leader typically have trust issues in the workplace. Employee trust is a significant concern for most organizations that are seeking a competitive advantage. When this is lost, employee satisfaction is lost as well.16


Resilience is defined as the capacity to recover from difficult life events.17 This definition can change depending on the source, but generally, we move on from adversity in our career in EMS and life as a whole. Toxic leaders can sometimes break down one’s ability to find our inner strength to overcome the constant adversity. This leads to taking steps to seek professional counseling, therapy, and behavior modifications. In one study, employees of toxic leaders have begun taking medications to allow them to cope with the workday or have sought inpatient therapy. This study also highlighted the lasting effects of a decline in health while reporting to a toxic leader.12

Providers in stressful environments tend to seek out coping mechanisms. Some of the physical and psychological problems experienced included mental stress, hypertension, personal medical complications, weight gain, and excessive drinking and smoking.16 These coping mechanisms lead to increased time off, decreased productivity, staffing difficulties and high costs of providing medical benefits.

More from the Author

Leadership in 2021

Leadership is a funny word. It is one of the few words in the English language that can have different meanings depending on whom you are speaking. Those definitions may vary wildly depending on the generation and culture of the person you are speaking with. Leadership is a living, breathing thing and has countless different philosophies. There is no textbook to tell you what to do in a given situation. It is contextual and should vary from situation to situation to address the problem at hand.

Leadership is not telling people what to do. Leadership is not a title; it is an action. Leadership is not a noun; it is a verb. When you have the opportunity to lead a team, the term “leader” is not given. It is earned. It is the way you treat and interact with those around you. It is a combination of traits and behaviors that drive people to want to follow. Traits such as integrity, vision, influence, praise, self-awareness, listening, supporting and, most of all, empathy! The workforce that you will be leading has a different philosophy than prior. Priorities in life differ. This philosophy swing must also change how we lead our employees. Before you correct, you must connect. Know the people that you are leading.

Reading this will not give you every answer you need to be a leader. It is simply impossible. Leadership is evolutionary and is driven by change in society, politics and the needs of your subordinates.

How do you know what type of leader to be? Look at your organization. There are several different philosophies. A leadership philosophy is fundamentally a belief system that guides your decision-making. It consists of your core principles, perspectives, and values. Typically, an organization will adopt one or more types of philosophies to develop new leaders. Your leadership style should not necessarily be a direct mirror of the organization, rather a personalized and unique approach making it authentic to you.

Accountability. Just because you are in a position where you can guide people does not give you all the answers. As a leader, take accountability for your actions. When you get asked a question that you don’t have the answer to, defer the answer, be humble, and find the answer to the questions. As a leader, you will never have all the answers. You will never make all of the correct decisions. Right or wrong, take accountability for your actions. Don’t blame everyone else for that decision; take responsibility for what occurred on your team, learn from the mistakes, and formulate a plan with your team to improve. You get to take credit, but you must also take accountability.

Some quotes to part ways with that I believe are the fundamentals of leadership.

Rosalyn Carter said: “A leader takes people where they want to go, but a great leader takes people where they ought to be.”

Gen. Jim Mattis said: “You cannot allow your passion for excellence to destroy your compassion for them as human beings.”


According to the Pew Research Center18, the following definitions of the Generations described in this article are as follows:

Silent: Born between 1928-1945

Boomers: Born between 1946-1964

Generation X: Born between 1965-1980

Millennials (Generation Y): Born between 1981-1996

Generation Z: Born between 1997-2012

The author certifies that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


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