It’s Time For A Culture Change in EMS

Article after article discusses why paramedics are constantly leaving one organization and making lateral moves to another. The range of reasons you read about include personality, stress, compensation, and call-volume, just to name a few.

However, there are few articles that address the ugly truth of our industry: employees leave their managers, not their jobs.

If you look within departments, you’ll find paramedics that have been doing this difficult job for decades, and more than likely have jumped laterally from one organization to another.

As a leader, the number one question we should be asking is, “Why are paramedics, who have decades of experience, not dedicating their time to one place?”

If you haven’t asked yourself this question, or you choose to disregard it, you may be part of the reason why paramedics leave.

It’s a Business

Regardless of the excuses, it’s a business. There are technical, strategic, financial and operational aspects of business. What makes EMS departments any different? It’s the lack of leadership, poor management, and the failure to innovate.

There are directors, administrators and chiefs that are riding the desk at the bottom end of a bell-curve for a career, and there’s no one stepping up to maintain the bottom line. Leaders don’t want to make waves that could jeopardize their seat, and they don’t want to train employees to do their job for fear of being replaced. This behavior affects patient quality, employee retention, and the overall poor standard plaguing EMS nationwide.

Here are a few areas that EMS leaders can focus on to become the 21st century leaders our agencies need.

The Self-Aware Leader

This is where everything begins and, unfortunately, ends. We often see current leaders who spent their entire careers working hard to “make it” to the top. They learn how to lead based on how they were treated. They move up, and treat others the same way, and it becomes a perpetual cycle of poor managers–and anyone who tries to call out their “tradition” is immediately driven out.

There’s nothing wrong with spending a career in one place. Rather, there’s an issue with failing to develop both personally and professionally as an individual–and especially as a leader.

Leaders must be aware of their strengths and weaknesses and should diligently seek to improve all aspects of their leadership. Whether it’s books, courses, or professional coaching, become the leader you want to be and never forget where you came from.

Talent Management Utilization

Though paramedics are often underrated and the general population doesn’t know the difference between an EMT and paramedic, the skills and experience many paramedics have go far beyond their job title.

I was once told that, because I didn’t work in one organization for “x” number of years, my experience and leadership didn’t mean anything. Initially I wrote it off, but the more I became the firefighter-paramedic that went from one organization to another, the more I experienced the lack of talent management utsed in organizations. It was actually nonexistent.

In many organizations, all levels of management fail to empower their employees to become better and do more. It’s as if they’ve reached the pinnacle of their careers and don’t want anyone to encroach on their laziness.

There are always individuals that want to learn more, and a true leader will capitalize on that and empower them. An employee who takes pride in an organization and its leadership will carry that leader further than imaginable, and choose to grow with the organization.


There’s very little vertical growth in EMS. Though some of this may be because of leadership, it’s often a result of the industry and a lack of innovation.

All businesses require innovation to grow, and leaders should do whatever they can to capitalize on the talent management, innovate, and create opportunities to grow laterally. What do I mean by this?

We already know that employees are leaving for similar positions in other organizations, so why not innovate to prevent the inevitable? Paramedics understand that vertical growth isn’t always feasible, and many don’t focus on promotions.

However, those who do could benefit the department in greater ways. For example, an agency can budget for internal opportunities such as bike medic, tactical medical, community outreach, regional/area task forces (if the area supports it)–the list is only as short as your imagination allows.

This approach benefits the employee, and it also benefits the organization and the community. When people volunteer for tasks, they’re more likely to take pride and ownership in them.

Tradition vs. Change

If I got paid for every time I heard “Because we’ve always done it this way; it’s tradition,” I’d be a millionaire. This toxic mentality is plaguing public service organizations and is a significant source of many problems.

Poor managers hide behind the façade of tradition and the phrase “change takes time” to prevent any shift in the status quo–even if the change would benefit them or the department.

Yes, change takes time, but it also takes influence, and that’s the key leadership concept that these managers lack.

Putting it All Together

Leadership in many EMS departments is antiquated and outdated and in desperate need of overhaul, but who’s going to do it?

There should be few reasons why most EMS departments can’t retain the employees they have, especially the ones who’ve been doing it for decades. They clearly love the job and don’t want to do anything else. They’re looking for a home, so give it to them.

Use their talents and experiences, create lateral opportunities for growth, develop your leadership skills and theirs, and don’t be afraid to change. Invest in your team, give them opportunities and make them qualified to go anywhere–and then create a culture that they won’t want to leave.

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