Resilience, Culture and the Role of EMS Leadership

The emergence and spread of COVID-19 profoundly affected emergency medical services—not just how you do your job but the nature of the work itself. But, according to the 2021 EMS1 Trend Report, COVID-19 ranks significantly below poor leadership in adversely impacting the profession (10% vs. 31%). Respondents noted a lack of providers and ambulances to keep up with demand, and 56% blamed leadership for deteriorating conditions. It’s sobering: Poor leadership, by this measure, is perceived a greater threat to EMS professionalism and morale than a novel global pandemic responsible for 4.5 million deaths.

Mistrust between the ranks in EMS isn’t new. Writing about EMS in the late 1970s, James O. Page noted, “Nearly everyone with a year or more of EMS experience has a story to tell about confrontations with other members of the ‘team.’” Page was referring to perspectives among various first responders as well as between ranks. His solution: “Cooperation can be increased if each side has an understanding of the others’ point of view.”

This is undoubtedly true. But it’s neither easy nor common.

Trust and Cooperation

Leaders who have lost the trust of their people are invariably seen as aloof to the concerns of those people. EMTs and paramedics in the Trends Report describe feeling like data points in a spreadsheet rather than fully formed human beings with valid input for the organization. One representative comment: “‘Historical’ call volumes are not an adequate reference when it comes to provider fatigue, unit/hour utilization and business models in this industry.”

The concept of resilience is of increasing interest among EMS professionals. Resilience literally means to “leap back,” as in to be knocked down and get back up. Many factors contribute to a person’s resilience but one of the most important is social connection. Research has shown that loneliness and isolation can lead to depression, cardiovascular disease, diminished immune response and general morbidity. The culture of an EMS agency where leaders aren’t trusted—where providers feel isolated and unsupported—is therefore less resilient.

Lesson, Relearned

To understand the perspective of the other side, to empathize, requires sustained time and effort, and it goes both ways. During challenging times—and the past 18 months would certainly qualify as such—being a leader requires making tough decisions and navigating uncharted waters. Asked to rank the top three most critical issues facing EMS today, respondents placed workforce retention in the top position for the second year in a row. But this year the second most critical issue identified was provider mental health (rather than funding and reimbursement), with personal safety replacing recruitment of qualified applicants in the third spot.

“Cooperation can be increased if each side has an understanding of the others’ point of view.”

The positive news is that many EMS leaders are stepping up to address provider mental health and safety, seeing these as the critically important issues they are.

EMS is the noble work of helping people who are often vulnerable and in their worst moments. As COVID-19 made evident, this is the definition of essential work. When we talk about the mental health of first responders, too often we speak of them in isolation, putting the burden of wellness on the individual. True leadership recognizes the essential role agency culture and trust play in fostering and supporting both wellbeing and professionalism. Sometimes it takes a fresh calamity to wake up old truths.

Crawford Coates

CRAWFORD COATES is the content marketing manager Lexipol. Prior to this role, he was publisher at Calibre Press, a publisher and trainer for law enforcement, and an editor at PennWell Public Safety, publisher of Law Officer, FireRescue and JEMS. He is a co-founder of Below 100 and author of the book Mindful Responder: The first responder's field guide to improved resilience, fulfillment, presence, & fitness--on and off the job. He holds a master's degree in public policy and administration.

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