What I Wish I Learned Before I Pinned On Rank

What I Wish I Learned Before I Pinned On Rank

A few years ago, I took a chance on a management-level position in EMS. At the time, I was happy with being an FTO and loved teaching, but wouldn’t ever get the chance to move the ranks beyond what I was doing. I wanted to do research, I wanted to influence things, I wanted to move a department in a clinical direction. I wanted to have my own ship; so to speak.

And so I did. I went from the truck to an office, I pinned on rank insignia on my collar, put a gold badge on, and moved into the world of chief-level administration. Seems easy, right? After all, I was coming from the street. I was one of them. Surely, they would love everything I wanted to do, and of course they would understand.

They would love that I spoke their language, that I was blunt and straight-forward. They would appreciate my candor. They’d love all the cutting-edge things I wanted to bring to the shop. They would greet me as a liberator.

I couldn’t have been more wrong. And worse, most of it was my fault.

The story does have a happy ending, though. I truly enjoy being at my place, and I really like the people I work with, and the staff members who go out every day and do the hard work. And after a time; I really do think that although I doubt I’ll ever have a ticker-tape parade at my shop, I have started to gain some respect.

The thing that sucks about moving into leadership positions in EMS is that unlike the other emergency/uniformed professions; there is absolutely no such thing as development of leaders for the profession. I’m not sure why. It’s as though we think it’s intuitive; and it is most certainly not. Most of the time, you get a badge, a radio and other accoutrements, and get cut loose to go do it. And that is a minefield that very few get through unscathed.

We somehow expect people to be leaders and take on leadership roles in our organizations, but we don’t groom or train them to actually DO it. We don’t mentor them so that when things happen, they have a resource to go to and ask honest questions. Especially in EMS, we sometimes use the wrong metrics to decide who should be the leaders, even if the metrics don’t tell the story. You may be a fantastic clinician, or know the policy manual backwards and forwards.

But those skills do not guarantee that you know what the heck you’re doing when you’re in charge.

What I thought I’d do is for the people out there who want to pin little leaves, birds, stars, bars, or whatever you use to show who’s in charge some of the lessons I learned so far, and hopefully you can avoid the mistakes that I made. You won’t be perfect; you’ll make your own mistakes. But, at least they’re yours.

First and foremost, listen. Listen, especially if you don’t like what you’re hearing. Look, in this profession, we’re all Type A’s and the initial response is to go back and debate. I’m going to tell you to try and do something different: Listen, acknowledge that you understand what they’re saying and think before you answer. Try to dig into what they are saying, and try to figure out WHY they’re saying it. There may something there that you can address and move forward on.

Don’t rush. You have time, even when you think you don’t. How many times have we said to students that “Slow is smooth, smooth is fast”?

Leadership is the same. Don’t feel like you must change the world overnight, even if it’s needed. You have more time than you think you do. Slow, smooth, and steady wins this race. Need a medication or piece of equipment on the street? Need to change a response area? Do the homework first, explain the reasoning behind it, and give your people room to adapt to it smoothly.

Stick to your principles, and keep those principles consistent. Nothing destroys confidence in a leader. On the positive side, if you do keep your standards consistent; they may not like it, but at least you’re not playing favorites. And communicate those principles. Tell people why this is important to you, and why it should be important to them.

Understand that you will have to deal with some form of bureaucracy in your new position, and don’t think that you can roll over it with force of will. The world of EMS leadership regardless where you work is not a ship that can be turned abruptly or fast. But it does turn. And you can make those turns, if you understand the system you’re in and what you can and can’t do…and just because it can’t happen now doesn’t mean it will never happen.

Network. Find people who will teach you about all aspects of your operation, and learn from them. You don’t know when you’ll need to know how something works, but it will happen. Learn about the jobs your subordinates do; and learn about the job your immediate superior does. The days of staying in one place for 30+ years exists in very few places; and you may be thrust into something on short notice. Better to know something about it.

This one is mine, but I think it matters. If you hold a license or certification, make sure that you are getting into the field, if not regularly than as much as you can. Jump on a rig for a transport, be willing to fill in, step up and staff a unit when you’re at level zero. Your people are watching, and they notice. Especially for those in clinical positions, you need to be able to do the same things that staff at your level can do. If you’re weak on something, get yourself trained up. There’s no shame in admitting you’re not sure about things, there is shame in not fixing it.

Last, and most important: Be honest. Own your shop and the responsibility. If something goes wrong, acknowledge it and have a way to fix it. If you don’t know something, say so. Credit your team with successes. After all, they’re the ones who did it.

So after all that, why would anyone take this on? It sounds ridiculously hard, unfair, and stressful.


But you will have the opportunity to guide your profession. You will get to help the next generation of clinicians move forward and gain their spurs. You’ll be able to make your people safer. You’ll get to serve. You’ll get to lead.

It’s worth it. More importantly, they’re worth it.

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