Leadership in Pre-Hospital Medicine. Why Does it Suck and What Can We do to Fix it?

Leadership in EMS is a touchy subject. We all have opinions on what makes a good leader and even more opinions on what makes a lousy leader. What I think we all can agree on, is that EMS is full of God-awful leaders. Every provider I have ever worked with has a story of being screwed over by management. Oftentimes, this screwing over involves supervisors not having providers' backs. While we can't all have Jocko Wilink as our shift supervisor, we shouldn't have to settle for Greg, the 26-year-old once captain of a kickball team in 6th grade, recent paramedic school graduate shift supervisor. So why do EMS agencies end up with more Gregs than Jocko's and what can we do about it?

Education

I'd like you to close your eyes and remember your EMT class. Smell the sweat, angst, and pizza(?) of your local community college. Listen to the sounds of anatomy and physiology lectures, the hardcore conservative who sat in the back seat discussing his expert view on why .45 caliber is superior to 9mm, and of course that dumbass in the front of the room who somehow asked the stupidest questions in existence. Can you picture it? Good. Now, think about what you learned about leadership. Personally, my mind wanders to chapter 2(ish) of the class textbook. I remember traces of a paragraph on leadership and how you should try your best at it. That is all.

My point is that we aren't taught leadership skills in our EMS education. We may have a cool quest lecturer discuss some leadership stuff or share some horror stories from ride time but that's really it. As EMS professionals we need to become better at teaching the skill of leadership. When we debrief mock calls in class we must discuss what worked and didn't work in terms of leadership. Did the PIC announce themselves at the beginning of the call? Was closed loop communication utilized? These are all just as important as the life-saving procedures done for our patients.

Empathy

Without a doubt, empathy is an essential skill for anyone working in medicine. It's important that we empathize with our patients and try to make their day a little bit better. I think most providers do a great job of this. Sure, we can all think of that grouchy, salty provider who seems to hate everyone. But this is usually the exception to the rule. For the most part, we all care about those we treat.

Now, let's think about the empathy we give our co-workers or fellow providers. A bit of a different view huh? Unfortunately, as providers, we struggle to see our co-workers as human beings. Supervisors seem to be at the center of this problem. To be clear, I've had supervisors who were good, and supervisors who were bad. There are some who value their employees, and others who view us as expendable. Ultimately, the lack of empathy shown by a majority of supervisors is not only concerning but potentially harmful to provider mental health.

Being treated as expendable makes us feel expendable. It's not a great feeling. I've seen great providers get beaten down by supervisors and turn into uncaring, salty senior members. This process needs to be reversed, and enthusiasm should be encouraged.

So What Can I Do?

Educate. Both yourself and others. Questions of leadership have existed since the beginning of mankind. We have always asked the question "Why them?" when someone takes a leadership role. There is an incredible amount of info out there on what it means to lead and how to do it successfully. Personally, I am a huge fan of Jocko. While I will admit he can be a bit over top at times, he really hits the nail on the head when it comes to being an effective leader. De-centralized command should be how all EMS agencies are run. Set a goal for the agency, and support members who wish to pursue smaller, more obtainable goals that support the overall mission.

Don't be an asshole. Seriously. Think about the things you say and how you treat others. Really analyze how your actions affect other people. As EMS professionals we complain that pay is too low and standards aren't being met yet we put down members of the community who try and initiate change. The trope of treating new people like garbage has significantly damaged the EMS profession. We treat new people poorly, have terrible pay, and are shocked that turnover is high with a diminishing number of newly certified providers each year. This is obviously not sustainable.

Be A Mentor

Be a mentor. We all can be leaders within our sphere of influence. Help one another. Mentor the new guy. Be a positive member of your agency.