Ethical EMS Leadership: Leading Through Crisis

by | October 16, 2023

It’s often noted that when disaster strikes, first responders run toward what everyone else is running from. “First responders thrive during times of crisis. We love to step into the crisis as the cool, calm, and collected individuals that we are, and provide some guidance, some care and hopefully take folks out of crisis,” says Deputy Chief (Ret.) Kevin Brame, EFO.

But what happens when we don’t know what to do?

In a recent session from Lexipol’s Connect 2023 virtual conference, Brame explored this scenario with a specific focus on ethical EMS leadership. During times of crisis, EMS providers and leaders must act ethically. But when the unknowns outnumber the knowns, our typical ways of making decisions can break down, creating the risk that we will act unethically.

When Community Crisis Becomes Personal

It’s challenging enough for EMS providers to respond to someone else’s crisis. When the community crisis becomes personal, decision making gets ever more complex. Perhaps the best recent example of this phenomenon is COVID-19. At the beginning of the crisis, EMS providers were on the front lines, operating with very little information about the risks involved. But COVID-19 wasn’t just someone else’s emergency – it very quickly became a personal crisis for every EMS provider. How could they keep their family safe? Were they willing to continue to risk their lives as the crisis stretched on and essential PPE and supplies were often lacking?

There are more recent examples, too. Hurricane Idalia in Florida. The wildfires in Lahaina. But it doesn’t have to be a big disaster. Brame describes the “Yikes, what just happened?” moment –when there’s a rapid change in the tempo of the event. “With that tempo change comes a rapid change in the need of the event; the intent and the action of those involved have to change,” he says.

Think of a law enforcement officer stopping a speeding vehicle only to realize there is a panicked mother driving and her baby has stopped breathing. The officer must perceive what’s going on and immediately change their actions to respond appropriately. While this specific situation is unlikely to create an ethical dilemma, more complex “Yikes!” situations certainly can. “Think about the situations when you are thrust into a crisis, and you’re saying, what about me? You’re looking for answers as well,” Brame says.

Leadership Is a Shared Responsibility

A key takeaway from Brame’s session: During times of crisis, leadership must become a shared responsibility. All the usual guidelines apply – leaders must be truthful, honest, empathetic, transparent. They should provide whatever direction they can. But when the answers are truly lacking, ethical EMS leadership does not come from pretending to have the answer.

It comes, Brame says, first from self-leadership. He lays out four key questions EMS providers should ask themselves in crisis situations:

  1. What are my expectations?
  2. What am I willing to do?
  3. What am I willing to risk?
  4. What is my bandwidth?

These considerations are critical, Brame says, because “when you go to exercise leadership in a crisis, there will be dangers associated with it. And I’m not necessarily talking about the physical dangers. What I’m talking about are the dangers to your career, the dangers to your reputation.” He notes that following many catastrophic events, people look for someone to blame.

The four questions help EMS personnel define the parameters of their response, creating a framework against which other decisions can be made. Even more crucially, these questions underscore that in times of crisis, one individual can’t do it all. By understanding our limitations, we can begin to make leadership a shared responsibility. And that’s critical when no one has the answers.

Much of what EMS providers do is by protocol. The answers are there, the operating guidelines are firmly in place. When those answers and guidelines are replaced by uncertainty, provider decision making is challenged. This is when we must open the decision-making process to others. “When the unknowns are greater than the knowns, you must think community,” Brame says.

Watch the full session to learn more or catch the complete Lexipol Connect 2023 on-demand lineup.

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