Finding the Future EMS Leaders


Over on the JEMS: Today in EMS group on LinkedIn, there’s been an interesting discussion about EMS supervisors. To say that there are wildly differing views would be a gross understatement. One group holds that EMS supervisors are an incompetent lot, selected for their positions because (maybe) they were good clinicians, or they stuck around long enough or because they’ve had their lips conveniently close to the posterior portion of the boss’s anatomy.


Another group (well, mostly me) takes the view that we have some serious leadership issues in EMS but that lots of good supervisors are mixed in with the bad. And most of our organizations at least try to develop individuals into competent supervisors, either before or after promotion. I thought I’d use this column to share my thoughts on the issue and more importantly, to get the thoughts of our readers on the subject. I will confess up front to some selfish motives: I’m personally and professionally committed to improving the state of leadership development in EMS, so all the input that I can get without paying for it is gratefully received.

Problem Source
I think the problem begins with our organizations, generally speaking. EMS folks who are good at what they do, clinically, are typically independent, inquisitive thinkers who believe that they can solve the problem (whatever the problem) better than the next guy. We have to be that way to survive in the world in which we work. We maintain that characteristic as we start to move up.

Medics become bosses because they think they can make the organization run better than the past or the present guy in the seat. If we can’t do it in the organization we work in today, we quit and start a competitor. So we have lots of independent, free-thinking organizations that don’t have a lot of capital, staying power or bench strength. We remain small (most EMS agencies operate two to five ambulances), independent, weak and … unable to offer our staff any sort of career development.

Once we get beyond a couple of trucks, the owner(s) start to need help. But there’s hardly any money, because we want to think we can operate without any taxpayer money—the evil subsidy. So they heap additional duties on those who they know can perform: the good clinicians. Soon, those clinicians are “supervisors,” but they’ve never had a minute of management training or education, nor have they demonstrated any ability to lead other medics. And so the cycle begins. Organizations merge or get bought out, and people stay in their positions or promote upward as the organization grows—in a macabre, Darwinian process of self-selection. Unfortunately, our line personnel become the victims of our informal “self-development” programs. They pay the price for our trial and error. It’s well documented that employees don’t quit their company, they quit their supervisor. So we pay the price in high employee turnover.

Because doing things the same way over and over again and expecting a different result is one definition of insanity, we might be just a little bit crazy. There also might be a character or philosophy thing in play: The employees think owners and managers are greedy and don’t care. I hope that’s not the case, and that those in leadership positions recognize that good supervision is a cornerstone of a good organization. Unnecessary turnover costs money—probably less than it would cost to train and test-drive future leaders. So if it were all about money, we’d probably have a plethora of well-trained supervisors, leaders and managers.

A Near-Perfect World
I must confess that I live in a great EMS world. The agency I work with has great first-line supervisors. All are experienced career paramedics with a variety of education and training in their backgrounds. They’re good—some are outstanding—clinicians. They’re good, trained incident commanders. I can sleep well at night knowing events will be handled in a competent, professional manner. They support their troops when I or the other “west wing guys” become overly demanding or frustrated; they coach for performance improvement; they carry equipment, lift patients and drive crews to the hospital when the situation calls for it.

They stand between their medics and belligerent outsiders and don’t tolerate anybody who might think they can act abusively toward a medic. They solve problems. They mentor people. They get along famously with their police and fire counterparts. And they each have an associated duty—each district is responsible for certain functions, like managing fleets or buildings or scheduling—and collateral duties. One is the public information officer; one is the special events coordinator; one runs the Hazardous Materials Medical Emergency Rescue team.

I’d like to have more of them, and I do what I can to develop them as supervisors. They go to courses at the National Fire Academy, at Texas Engineering Extension Service, at conferences and community colleges, and they supervise development programs that our county human resources staff presents. We spend four full days per year doing supervisor continuing education. And yes, I think that lots of EMS agencies have people like this.

What do you think? In your agency, do first-line supervisors “have the back” of the crews? Do they perform important functions? Do they solve problems and set an example for new employees? Or are they “tools” of thoughtless managers, berating troops to achieve compliance with meaningless or profit-oriented performance measures? Have they forgotten what it was like to hump a stretcher or mop an ambulance? What do you see?

Most importantly, if first-line supervision is a problem, what do you think we should do to fix it?

Bring it on! The nice thing about an online column is the ability to get feedback and have discussion. I’m waiting with baited breath.




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