Leadership in EMS

Image provided by Jeff Fishel, MSHA, NRP

The Circle of Care starts with providers.

There are many hot topic items in the realm of EMS these days. One of which is that of leadership, or the lack thereof, in our industry. While I would never even attempt to assume some sort of a title of “expert in leadership,” I feel in my career I have been extremely fortunate to learn from the best and to also learn from those who were not.

We’ve all seen it on social media with the mass sharing of the “leadership” meme. We’ve heard the leadership talks at conferences, read the articles and participated in the discussions. So, what makes this article any different? It is different because I think people fail to realize a very important issue that plagues our industry. EMS does not just need leaders, we need leaders of EMS. Now, let me explain. I have read every John C. Maxwell book, and believe me, John C. Maxwell has taught me a lot. However, there isn’t a book or a blueprint about our industry. I have succeeded, I have failed, and I have learned and listened. I am here to share my advice and more often, the advice passed down onto me.

Let me go back to my statement before of “we do not just need leaders, we need leaders of EMS.” People who work in EMS are typically well-educated in their craft and have Type A personalities. We are used to speed, we are used to fixing problems, and we are used to doing that with good communication, and in a timely manner. To lead this group of people takes more than just a regular leader. It takes a leader of EMS.

The challenge is daunting. We traditionally see a mentality in EMS of promoting the most tenured person, or the one who works the most overtime or takes on the most extracurricular projects. Equally at fault is the notion that we have a very large set of leaders in our industry who have been in the same exact organization or region for their entire career. That is completely fine given that you venture out, network, learn, and you keep an open minded. Too often than not, leaders and employees who are tenured in their systems or areas fall victim to the diagnosis of “They don’t even know what they don’t know” because they are so shielded to the outside world of EMS and blinded by what they do locally.

In no particular order, here are the five keys successfully lead an EMS organization:


1. Practice open, honest, and humble communication:

    a. Your employees must know and believe in an open communication culture within your department.

    b. You cannot lie to the. If you make a mistake own it. They will respect you for this and your credibility will reap the rewards.

    c. “Fake it till you make it.” This piece of advice from renowned author and speaker Amy Cuddy is great, but not in the EMS industry. Your employees will sniff you out as a fake in no time. If you do not know an answer to a question, then this should be your answer: “I do not know, but I will find out and when I do, you will be the first to know.” Do not give a fake answer that you think sounds good. You will inevitably back yourself into a corner that you will take a long time to earn your way out of with your crews and you employer because your credibility will have suffered.

    d. Be humble and allow yourself to receive honest feedback without becoming defensive. And if you in anyway attempt to seek some sort of retribution or retaliation for honest and open feedback, shame on you.

    e. Be good at EMS. In other words, be competent first. Otherwise, it’s hard to gain respect and your open and honest communication only shows you’re not very competent. Remember, you cannot “fake it till you make it!”


2. Have no fear:

    a. Do not fear change. Medicine changes daily. The why, how, delivery, and approach all changes. Embrace it, welcome it, and lead in it.

    b. Do not fear leading employees through change. Much like the above statement, change will occur, and it will occur often. Get used to leading employees through change. (That is an art form in itself; we will address this at another time in another writing). Your focus should be on positive change, and how change is positive.

    c. Do not fear having the backs of your employees. Employees of EMS have a lot of internal and external stressors. It is paramount that you as a leader have their backs and shield them from further stressors. Allowing them to focus on the mission of the department and themselves. Tell your employees what you want done, then get out of their way and let them do it. Back their decisions publicly and critique in private.

    d. Do not fear telling your employees no. Open and honest communication has very few drawbacks. As your employees begin to trust you, they will eventually bring ideas to you, and these are ideas you should welcome and cherish. However, you must learn how to say no. Saying no to an EMS-minded employee is not simple as they will not accept a simple no answer. Be prepared to explain your answer. People respond better to being told no when they understand the reason why.


3. Accountability:

    a. It is imperative to have an open and honest conversation with those you lead and those who you report to. You must explain to them exactly what you expect out of them, the level of service and professionalism that you will be holding them to, and what the process will be if they stray from this. That process should be fair and progressive discipline.

    b. It is equally as important that you give those you lead and those who you report to the opportunity to explain their expectations of you and the process that occurs if you stray. Accountability goes both ways, and you need to hold one another to high expectations.


4. Know the value of teamwork:

    a. Leadership is never about the “I” or “me.” Your employees have spent their entire careers learning how to work as a team. The achievements made are not any one person’s alone but that of a team. Recognize the team and do not take credit for it yourself. Your team performing well already reflects positively on you.

    b. The true mark of leadership is cultivating and growing those below you. If you left your position tomorrow, would the organization suffer? Or would it continue without missing a beat?


5. Be dynamic:

    a. Remember, leadership is not a position, it is a continual process. Adapt, be dynamic, and constantly improve. Your employees deserve it and so does your community. No one ever comes to work or applies to an agency thinking to themselves: “I hope my leader stays stagnant and our organization has zero progression or innovation during my time here.”

    b. As much as we say we hate change, we actually love change. Employees love being a part of something great. It is simply the process that scares them. Help them to build something you can all be proud of!


So, what is next? We’ve recognized the need, now we talk about it, define what a leader of EMS is, and create a pathway to learn it.

There are many opinions on how to lead and this article is simply my opinion of leadership in EMS. As always, I am more than open to the opinions of others and ways we can improve leadership within our industry.

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