EMS Leadership
Companion Guide
Your quick-reference study resource for modern EMS leadership — from conference bootcamps to daily practice.
How to Use This Companion Guide
This companion guide is designed for EMS leaders attending one of my leadership bootcamps or conference sessions. I offer 1-hour, 4-hour, 8-hour, and 16-hour leadership courses that build on these concepts and apply them to real-world EMS challenges.
Each section offers quick-reference summaries, key terms, practical applications, and real-world examples from my "Leading Forward: Strategies for EMS Visionaries" courses.
Interested in bringing a course to your agency, region, or conference? Connect with me on LinkedIn.
Case Study: Building EMS in Sri Lanka
From Impossible to Inevitable
"We recognized impossible odds and said, 'Let's begin anyway.'"
The Starting Point: Nothing Existed
Critical Gaps
- No national framework for EMS system
- EMTs and Paramedics did not exist as professions
- Only physicians could use stethoscopes
- Only cardiologists could perform ACLS
Infrastructure Barriers
- No national emergency number
- Government ambulances only transported between hospitals
- No education materials in local languages (Sinhala, Tamil)
- Deep cultural resistance to non-physicians touching patients
The Bold Decision
We made bold and collaborative decisions. We recognized impossible odds and said, "Let's begin anyway."
Imagined a modern EMS system where none existed — starting with what could be, not what was
Took action despite constraints — building education, protocols, and systems from the ground up
Key Lessons from Sri Lanka
- Change is not immediate: Visionary leadership is about laying foundations that endure.
- Vision + Execution: Dreams without action remain fantasies. Action without vision wastes effort. Both are essential.
- Build anyway: Visionaries don't wait for systems to be ready. They build despite the odds.
- Cultural adaptation matters: Solutions must fit local context — translated materials, culturally appropriate protocols, local champions.
💭 Reflection Questions
- What seems "impossible" in your agency right now?
- What inspired you about the Sri Lanka story?
- How can you anchor bold ideas in current realities and resources?
- What's one step you can take to create a foundation for future possibilities?
Visionary Leadership & Role Distinctions
Designing the Future of EMS
Core Definition
Visionary leadership is the practice of imagining and building what doesn't yet exist while staying grounded in today's realities. Visionaries design the future rather than simply predicting it — they challenge the status quo, inspire others, and mobilize communities around a shared purpose.
Manager vs. Leader vs. Visionary▼
Critical Self-Assessment Questions
- How much time do you spend as a Manager, Leader, and Visionary? Track your time honestly for one week.
- If you're a senior leader, your community needs you to be the visionary. If not you, then who?
- Why are you not spending time as a visionary? What operational tasks are consuming your strategic thinking time?
- Practice radical delegation. Start identifying tasks that others can own.
Mastering Delegation: From Manager to Visionary▼
The Hard Truth About Delegation
Delegation is more than assigning tasks — it's a critical leadership skill. When delegation fails, it's a failure of the leader, not the team member.
Leaders must delegate to free up time and mental bandwidth to move from Manager → Leader → Visionary.
Why EMS Leaders Struggle with Delegation
- "I can do it faster myself" — Short-term true, long-term disaster
- Perfectionism — "Only I can do it right"
- Operational background — Promoted without leadership training
- Fear of losing control — "What if they mess it up?"
- Hero mentality — "I need to be involved in everything"
- Guilt — "I should be doing this myself"
✅ What to Delegate
- Schedule management
- Supply inventory
- Training coordination
- Data entry and reporting
- Routine QA reviews
- Community event coordination
❌ What NOT to Delegate
- Strategic vision and direction-setting
- Personnel decisions (hiring, firing, discipline)
- Crisis communication during major incidents
- Relationship-building with key stakeholders
- Medical director and governance relationships
- Organizational culture and values
🔑 Nine Keys to Effective Delegation in EMS
- Play to Strengths and Development Goals: Know your team's capabilities and career aspirations. A paramedic interested in critical care could lead your agency's ventilator protocol development.
- Define the Desired Outcome Clearly: Provide context — what needs to be accomplished, by when, what does success look like, how will you measure it?
- Provide Resources and Authority: If you assign a task but don't give the authority or resources to complete it, you've set them up to fail.
- Avoid Micromanaging: Focus on what needs to be accomplished and why — not step-by-step how. If their method works, it's the right method.
- Establish Clear Communication Channels: Set regular check-ins so they can report progress without feeling monitored. "Let's touch base weekly on Tuesdays" gives structure without micromanaging.
- Allow for Failure and Experimentation: Accept that others may approach tasks differently — and that's okay. Their "different" method might be better than yours.
- Be Patient with the Learning Curve: A task you complete in 30 minutes might take them an hour the first time. That's investment, not inefficiency.
- Deliver Feedback (Positive and Constructive): After delegated tasks are complete, provide clear feedback. Also ask: "What could I have clarified better for you?"
- Give Credit Where It's Due: When delegated work succeeds, publicly credit the team member. Not claiming credit for yourself leads to more wins for everyone.
⚠️ Common EMS Delegation Failures
- "I delegated but they didn't do it right." — You didn't define success clearly enough. Delegation failure = leader failure.
- "They kept coming back with questions." — Initial questions are normal. Answer them now; future iterations won't require your input.
- "I delegated but kept checking in constantly." — That's micromanaging, not delegating. Set expectations, provide resources, then step back.
- "I only delegate tasks I don't want to do." — Delegation should be developmental. Delegate meaningful projects that build skills.
🧠 The Delegation Mindset
- Am I the only person who can do this task? If no, delegate it.
- Is someone else better equipped or positioned? Then why am I doing it?
- Could this be a growth opportunity for someone? Delegation develops future leaders.
- What strategic work am I NOT doing because I'm stuck in operations? That's the cost of not delegating.
EMS Pioneers: Collaboration Over Silos▼
The Critical Lesson: Power + Collaboration
The early EMS leaders of the 1960s–70s each had significant power, influence, and credibility. They could have developed systems in silos, creating competing local models. But they chose differently. They built coalitions and developed a national EMS system that serves the nation rather than individual fiefdoms.
This collaborative spirit — putting national good above personal power — is the foundation we must reclaim today. EMS leadership isn't about building your kingdom; it's about building OUR system.
View the Full EMS Pioneers Timeline🌟 Dr. Peter Safar: The Father of CPR and Modern EMS
Dr. Safar saw what didn't exist, ignored what couldn't be done, and built what others hadn't dared to imagine. Visionaries don't wait for systems to be ready — they build anyway.
"Ambulance report forms should become uniform on a nationwide basis to permit evaluation of the public health aspects of emergency medical services…" — Dr. Peter Safar, 1969 Airlie House Conference
Without Collaboration:
- 50 separate EMS systems with incompatible standards
- No cross-border clinical coordination during crises
- Fragmented data systems, incomplete patient histories
- Inconsistent training and competency expectations
- Workforce shortages no state can solve alone
With Collaboration:
- A unified, recognized EMS profession with shared identity
- National Registry enabling consistent entry-level competency
- Evidence-based protocols across states and regions
- EMS Compact & EMAC enabling rapid interstate deployment
- Coordinated disaster response and mutual aid systems
Advanced Traits of Visionary EMS Leaders▼
Protocols, checklists, and accreditation are treated as a floor, not a ceiling, for patient safety.
AI, eVTOL, and autonomous vehicles evaluated as instruments that extend clinician capability, not threats to identity.
Surface hidden assumptions, name cognitive bias, and use data to show when the status quo is no longer acceptable.
Use structured approaches like STEP and Kotter to move systems from pilot projects to reliable daily practice.
Study aviation, logistics, telehealth, and other industries to borrow proven ideas and accelerate progress.
Visionary work is on the calendar, not in the leftover minutes. Reserve time for strategy and scenario planning.
✓ Quick Leadership Tips
- Start with reality: Vision must be anchored in honest assessment of current resources and constraints
- Design, don't predict: Actively shape the future rather than passively forecasting trends
- Balance aspiration with practicality: Dream big but build achievable milestones
Adaptive Leadership Styles
Goleman's Six Leadership Approaches
Daniel Goleman's research identified six distinct leadership styles. Effective leaders master all six and shift between them based on the situation, the people, and the goal.
Visionary
"Come with me"
Mobilizes people toward a shared vision. Most effective when a new direction is needed.
EMS: Launching a community paramedicine program; rallying staff around a new strategic plan.
Coaching
"Try this"
Develops people for the future. Connects daily work to long-term career goals.
EMS: Mentoring a new field training officer; helping a paramedic build leadership skills.
Affiliative
"People come first"
Creates emotional bonds and harmony. Builds trust and heals rifts.
EMS: Supporting crews after a line-of-duty death; rebuilding morale after organizational conflict.
Democratic
"What do you think?"
Forges consensus through participation. Builds buy-in and generates fresh ideas.
EMS: Protocol committee decisions; station design input; SOG development.
Pacesetting
"Do as I do, now"
Sets high standards and models them. Use sparingly — burns out teams if overused.
EMS: Accreditation preparation; clinical quality improvement sprints.
Commanding
"Do what I tell you"
Demands immediate compliance. Critical for crises and imminent safety threats.
EMS: Active MCI scene; immediate safety threat; ICS activation.
Key Insight: Adaptive Leadership Is the Goal
- Master all six styles — don't default to one
- Read the room: what does the situation, people, and outcome require?
- Overusing commanding or pacesetting damages culture over time
- Balance aspiration with practicality — dream big but build achievable milestones
Crisis Leadership & Communication
Leading When It Matters Most
Everyone should hear the same core message regardless of role or shift. Consistency reduces confusion and keeps rumors from taking root.
Words without visible action damage credibility. Tell people what is being done, who is doing it, and what will happen next.
Don't wait for perfect information. Say what you know now, what you don't know yet, and what you're doing to find out.
Acknowledge the emotional impact, recognize increased workload or risk, and express genuine gratitude. Empathy does not mean loss of accountability.
EMS-Specific Crisis Communication
- Notify crews about critical incidents involving co-workers — before social media or rumor
- Provide real-time updates during hospital diversion, system status zero, or major weather events
- Coordinate messaging between administration, medical director, and communications center
- Use multiple platforms: email, text alerts, supervisor briefings, station huddles, video messages
- End each message with "here is what you can do next" and "here is who to contact"
Leadership Structure: Horizontal & Vertical
Using the Right Structure for the Situation
Effective EMS leaders do not use one structure for every situation. Incident scenes require vertical control through ICS. Organizational growth and innovation require horizontal teamwork. The skill is knowing when to pivot.
🔄 Horizontal Leadership
Collaborative, flatter structures emphasizing teamwork and shared ownership.
Strengths:
- Encourages innovation and creative problem-solving
- Increases engagement and ownership
- Develops leadership capacity across the organization
Best for:
- Strategic planning and innovation projects
- Team development and succession planning
- Organizational culture work
⬇️ Vertical Leadership
Clear chain of command enabling rapid decisions and unity of command.
Strengths:
- Clarity of authority and responsibility
- Speed in decision-making during crises
- Discipline and standardization of response
Best for:
- Acute incident response and MCIs
- ICS operations and tactical scenes
- Safety-critical situations where delay increases risk
Bridging the Gap: Best Practices
- Recognize which mode you are in: Don't run the entire organization like an endless disaster scene
- Build horizontal culture by default: Use teams, working groups, and shared decision-making
- Practice the pivot: Drill the transition from routine operations to ICS and back
- Return to collaboration after the incident: Use debriefs and after-action reviews to learn
🔗 Hybrid Leadership: The "Team of Teams" Concept
Modern EMS systems benefit from a hybrid approach — a clear chain of command for emergencies combined with networks of empowered teams for daily operations. This mirrors the military "team of teams" model: disciplined execution with distributed thinking.
Four Keys for EMS Leaders:
- Create a unifying narrative: Make sure everyone understands the mission and how their role connects to it.
- Foster interconnection: Break down silos between operations, communications, hospitals, and support services.
- Shape an operating rhythm: Use regular huddles, reviews, and planning cycles to alternate between learning and execution.
- Define decision spaces: Clarify what decisions can be made at the frontline, what requires supervisor input, and what stays at the executive level.
The Core Principle
Effective EMS leaders do not cling to one style. They consciously choose whether the moment calls for command, collaboration, or a blend of both — and they explain that choice to their teams. The more comfortable you become toggling between vertical and horizontal structures, the more resilient and adaptive your organization will be.
Building Teams & Emotional Intelligence
The Foundation of High-Performance EMS Teams
Five Components of Emotional Intelligence▼
Recognize your emotions, strengths, and triggers as they occur
Control impulses, manage emotions, adapt to change
Intrinsic drive to achieve beyond external rewards
Understand others' emotions and perspectives
Build relationships, communicate, resolve conflict
Five Dysfunctions That Derail Teams▼
- Absence of Trust: Team members unwilling to be vulnerable or admit weaknesses
- Fear of Conflict: Artificial harmony; avoiding necessary debate
- Lack of Commitment: Ambiguity and second-guessing decisions
- Avoidance of Accountability: Low standards; no peer pressure to perform
- Inattention to Results: Focus on individual goals instead of team outcomes
Designing Teams with Personality Understanding▼
- Identify personality traits such as introversion vs. extroversion or thinking vs. feeling
- Decode communication preferences to understand how team members process information
- Reduce misunderstandings — different approaches aren't wrong, they're different
- Build balanced teams: analytical thinkers with creative innovators, planners with visionaries
Clinician-Centric Leadership in EMS
In healthcare and EMS settings, effective leadership centers on:
Understanding Generational Differences
Leading Gen Z and Gen Alpha in EMS
📱 Generation Z (Born ~1997–2012)
- Digital natives — technology is instinctive, not learned
- Value purpose, meaning, and social impact in work
- Expect transparent communication and rapid feedback
- Entrepreneurial and independent; may challenge hierarchy
- Mental health-aware; expect leadership to support wellbeing
How to Engage:
- Explain the "why" behind decisions and policies
- Provide regular feedback, not just annual reviews
- Offer career paths, not just jobs
- Leverage their technology skills
🧒 Generation Alpha (Born ~2013–2025)
- Raised entirely within the AI era
- Will expect technology-augmented everything
- Greatest diversity in American history
- Little patience for systems built on paper or tradition
Preparing for Alpha:
- Build technology into every aspect of training and operations
- Design systems that are intuitive and app-like
- Embrace their expectation for instant, transparent information
Bridging the Generational Gap
- Don't stereotype — use generational understanding as a starting point, not a box
- Adapt mentoring style — younger generations often prefer coaching over commanding
- Leverage technology comfort — Gen Z and Alpha can accelerate your technology adoption
- Create purpose-driven culture — every generation wants to know their work matters
- Meet people where they are — communication channel preferences vary by generation
Technology & Innovation in EMS
Designing Tomorrow's Emergency Services
The current EMS system is expensive, fragile, and often misaligned with what patients and communities need. Traditional models struggle with sustainability, ambulance deserts, access gaps, and a reimbursement structure still linked to transport — not outcomes or value. EMS must embrace technology, not resist it. Emerging tools are the leverage we need to solve generational problems: cost, workforce shortages, geography, safety, and fragmented information.
AI & Machine Learning
- Triage assistance: AI helps prioritize patients by acuity and risk
- Resource allocation: Predictive models forecast demand and staffing
- Pattern identification: ML detects trends invisible to manual review
- Assistive documentation: AI-drafted charts from voice and monitor data
- Whole-record review: LLMs analyzing HIE data for real-time insights
Telehealth & Remote Monitoring
- Virtual care: Connects patients, field clinicians, and physicians in real time
- Treat-in-place: Protocol-driven alternatives to transport
- Expanded access: Closes gaps in rural and underserved communities
Autonomous Ambulances
- Safety gains: Self-driving systems may reduce ambulance crashes
- Clinician focus: Free EMS clinicians from the driver's seat
- Operational efficiency: Optimized routing and real-time fleet coordination
Predictive Analytics
- Demand forecasting: Anticipate call volume by zone, time, and acuity
- Post-scheduling: Position units based on data, not tradition
- Quality metrics: Continuous tracking to drive improvement
Drones & eVTOL Aircraft
- Rapid delivery: Blood, medications, and equipment to remote areas
- Scene assessment: Aerial view before crews arrive
- Access gaps: Redesign rural/regional response beyond helicopter limits
Documentation & SDOH
- Scene context: EMS sees the patient's real-world environment
- Social determinants: Food insecurity, fall risks, caregiver stress
- Transparency: EMS reports should be accessible to patients and care teams
Building Cross-Functional Innovation Teams
Recognizing & Overcoming Bias
20+ Cognitive Biases Every EMS Leader Must Know
Cognitive biases are systematic patterns of deviation from rational judgment. They affect clinical decisions, organizational strategy, hiring, and interpersonal dynamics. Awareness is the first step to mitigation.
Decision-Making Biases▼
Seeking information that confirms what you already believe while ignoring contradictory evidence
Over-relying on the first piece of information encountered when making decisions
Overweighting information that comes to mind easily — often dramatic or recent events
Continuing to invest in something because of prior investment rather than future value
Being influenced by how information is presented rather than the information itself
Overestimating competence in areas of low experience; underestimating it where skilled
Social & Group Biases▼
Conformity pressure in cohesive groups that suppresses dissent and alternative viewpoints
Letting one positive trait influence overall assessment of a person or idea
Attributing others' failures to character while attributing your own to circumstances
Favoring those who are part of your group — your shift, your agency, your certification level
Accepting information from authority figures without critical evaluation
Adopting beliefs or practices because "everyone else is doing it"
Change & Status Quo Biases▼
Preference for the current state; resistance to change even when clearly beneficial
Pushing back against a directive simply because it feels like a loss of freedom
Feeling the pain of loss more intensely than the pleasure of equivalent gain
Underestimating the likelihood and impact of disruptions — assuming things will stay "normal"
"I knew it all along" — rewriting memory after an outcome is known
When correcting a misconception actually strengthens the original belief
💡 Bias Mitigation Strategies
- Assign a "devil's advocate" role in planning meetings to surface blind spots
- Use structured decision frameworks (checklists, scoring rubrics) to reduce intuition-only decisions
- Actively seek disconfirming evidence before committing to a course of action
- Create psychological safety so team members can challenge assumptions without fear
- Conduct pre-mortems: "Assume this failed — why?"
Change Management in EMS
STEP Framework & Kotter's 8 Steps
Most change initiatives fail not because of bad ideas, but because of poor execution. The STEP Framework gives EMS leaders a practical approach, while Kotter's 8 Steps provide a proven roadmap for large-scale change.
Stakeholders
Identify all stakeholders — internal and external. Map influence and impact. Build trust before you need it. Create champions at every level and shift.
Technology
Don't let technology drive the change — it's a tool, not the strategy. Ensure it solves real, lived problems. Involve end-users early. Train thoroughly, then train again.
Engagement
Involve frontline staff from the start. Change that is done to people will be resisted. Change built with people will be sustained. Acknowledge fear and uncertainty openly.
Process
Build workflows and SOGs before launch. Define success metrics before you start, not after. Debrief, adjust, repeat. Embed the change in policy, training, and culture. Align incentives and accountability — what gets rewarded gets repeated.
Kotter's 8 Steps: Engineering Change▼
- Create a Sense of Urgency: Make the case that the status quo is unsafe, unsustainable, or unfair
- Build a Guiding Coalition: Assemble a diverse, credible team of influencers across shifts and departments
- Form a Strategic Vision: Clarify what the future looks like if the change succeeds
- Communicate the Vision: Repeat the message until people can explain it back in their own words
- Remove Obstacles: Identify policies, habits, and people that block progress; fix systems, not blame individuals
- Generate Short-Term Wins: Plan visible early successes, measure them, and celebrate them
- Sustain Acceleration: Don't declare victory too early — use early wins to tackle harder problems
- Anchor in Culture: Make the new way part of evaluations, stories, traditions, and training
Many EMS projects fail at Steps 7–8: leaders stop communicating, stop measuring, and assume the change will sustain itself. It rarely does without deliberate reinforcement.
Integrity, Reputation & Professionalism
Your Most Valuable Leadership Asset
Your reputation is your most valuable asset. Consistent ethical behavior and transparent communication build trust with colleagues, patients, and the public. In today's digital age, everything you say and do can be recorded and shared — act accordingly.
Treat everyone with kindness, even during conflict. Professional demeanor fosters psychological safety.
Audio and video devices are everywhere. Speak and act as if your behavior will be broadcast.
Stay calm, listen actively, respond thoughtfully. Be nice, be professional, and talk as if you're being recorded — because you are.
Use social media responsibly. Online actions reflect your character and organization.
Earning Trust Through Accountability
- Admit mistakes: Own your errors publicly and quickly — transparency builds credibility
- Follow through: Do what you say you'll do, every time
- Protect your people: Stand between your team and political pressure when they've done the right thing
- Be consistent: Inconsistency breeds distrust faster than any single failure
EMS Advocacy & Policy Engagement
If You're Not at the Table, You're on the Menu
EMS leaders must engage in policy, regulatory processes, and advocacy. The rules that govern your agency, your practice, and your patients' care are being written — with or without your input.
Understanding the EMS Regulatory Landscape▼
EMS is primarily regulated at the state level — licensure, scope, protocols. Federal (NHTSA) provides guidance and national frameworks.
Statute (hardest to change) → Regulation (requires public comment) → Policy (agency-level, most flexible).
Oversee statewide systems, implement regulations, convene advisory councils. Join these!
Interstate recognition enabling cross-state practice for qualified EMS clinicians. emscompact.gov
How to Talk to Legislators▼
✅ DO These Things
- Be brief and clear: 3–5 minutes maximum, one clear ask
- Lead with impact: How does this affect their constituents?
- Bring solutions, not just problems
- Use local examples: Stories from their district resonate
- Follow up in writing: Leave a one-page summary
- Say thank you
❌ DON'T Do These Things
- Don't lecture or talk down
- Don't use jargon: Avoid EMS acronyms and insider language
- Don't be vague: "We need more funding" isn't specific enough
- Don't make it partisan: EMS transcends party lines
- Don't exaggerate or mislead: Credibility is everything
- Don't show up only when you need something
Three Sentences Every EMS Leader Should Master
- The Problem (one sentence): What specific issue affects their constituents?
- The Solution (one sentence): What specific action do you want them to take?
- The Impact (one sentence): What will change if they act?
🔊 Unified Message, Single Ask
When multiple EMS stakeholders approach legislators, the message must be aligned. If ten EMS organizations ask for ten different things, it becomes noise, not action. Work together before you walk into the room so legislators hear one consistent request from EMS, not competing agendas.
How to Actually Change the Rules▼
- Understand your state's formal rulemaking process: Know the steps from bill introduction to law, or from proposed regulation to final rule
- Participate in public comment periods: Written comments become part of the official record — submit detailed, data-backed input
- Testify effectively: Keep oral testimony concise (3–5 minutes), impactful, and focused
- Build legislative champions: Identify sympathetic legislators and educate them — they'll carry your message
- Balance long-term strategy with urgent needs: Some changes take years — start now
🌐 Build Coalitions Beyond EMS
Strength in numbers. Partner with stakeholders who share your goals:
Key Relationships to Cultivate
Build these relationships BEFORE you need them. Don't only reach out when you want something.
✓ Your Next Steps in Policy Engagement
Choose ONE action you can take in the next 60 days:
Regulatory Investigations & Preparedness
Document Like You Know It Will Be Reviewed
Why This Matters
Regulatory investigations can happen to any agency, even high-performing ones. Your goal is not to fear investigations, but to be prepared for them and to build systems that demonstrate professionalism, transparency, and continuous improvement.
Investigation Triggers, Rights & Documentation▼
What Triggers Investigations:
- Complaints from patients, families, staff, or partner agencies
- Adverse events, sentinel incidents, or unexpected deaths
- Routine compliance audits and site visits
- Media reports, social media incidents, or public attention
Your Rights and Responsibilities:
- Cooperate professionally, not defensively
- Understand the scope and basis of the investigation
- Know when to engage legal counsel (earlier is better)
- Designate a single point of contact for investigators
Assume You Are Being Recorded
EMS clinicians should assume they are being audio and video recorded on every call. Over-verbalize your assessment, differential, and decision-making. Use professional, calm language. Silent good care looks bad on video; narrated good care is understandable and defensible.
Why States License EMS: Competency vs. Morality▼
EMS licensure exists under the state's police powers for one core purpose: to protect the public from unqualified or unsafe practitioners. Courts have long recognized this authority — classic cases such as Dent v. West Virginia and Hawker v. New York frame professional licensure around two concepts. Most complaints fit one of two buckets:
Competency Issues
Clinical errors, poor documentation, protocol deviations, unsafe decision-making. Regulators have many tools: education, remediation, mentorship, targeted training, monitored improvement plans.
Morality / Character Issues
Fraud, diversion, abuse, discrimination, harassment, criminal conduct, dishonesty. Regulators have very few tools: often only suspension, revocation, or permanent restrictions.
🔥 Key Leadership Principle
Do not turn a competency issue into a morality issue. A clinician who needs education should not be treated as unethical. The fastest way to turn a competency issue into a morality issue is by hiding it: falsifying documentation, changing narratives, omitting information, or being deceptive with investigators.
Essential Leadership Frameworks
Practical Tools for Everyday Leadership Challenges
Building Psychological Safety▼
Psychological safety is the belief that you can speak up, take risks, and make mistakes without fear of punishment. It's the #1 predictor of high-performing teams.
✓ Leaders Create Safety By:
- Inviting input: "What am I missing?"
- Acknowledging uncertainty: "I don't have all the answers"
- Responding productively to bad news
- Admitting mistakes openly — modeling vulnerability
- Framing work as learning, not perfection
✗ Safety Killers to Avoid:
- Shooting the messenger
- Punishing honest mistakes harshly
- Dominating conversations without listening
- Allowing star performers to bully others
- Making decisions behind closed doors
The 5-Level Delegation Framework▼
- Gather Info, Report Back — Lowest autonomy. "Research this and tell me what you find."
- Recommend, Then Decide Together — Building judgment. "Bring me your recommendation."
- Decide, Wait for My Approval — Increasing trust. "Make the decision but check with me first."
- Decide and Act, Inform Me — High autonomy. "Handle this and let me know what you decided."
- Full Authority — Complete ownership. "This is your domain." Report only by exception.
Pro Tip: Be explicit about which level you're using — "I'm delegating this at Level 3."
Conflict Resolution: The Interest-Based Approach▼
Most conflicts arise from competing solutions, not incompatible interests. Focus on underlying needs rather than positions.
The 5-Step Process:
- Separate people from problem: "We both want what's best for patients"
- Focus on interests, not positions: Ask "Why?" to uncover real needs
- Generate options together: Brainstorm without committing
- Use objective criteria: What does the data / policy / best practice say?
- Create win-win solutions: Find options that meet both parties' core needs
EMS Example
Position Conflict: "I want to hire two more medics" vs. "I want to buy new equipment"
Underlying Interests: Both want to reduce response times, improve patient care, prevent burnout
Win-Win Solution: Hire one medic AND upgrade critical equipment; phase remaining purchases over two years
The SBI Feedback Model▼
Describe the specific context. "During yesterday's cardiac arrest call…"
Describe what you observed — actions, not interpretations. "You initiated compressions within 15 seconds of arrival…"
Explain the effect of the behavior. "…which set the tone for the entire team and contributed to ROSC."
✓ Good: "In yesterday's staff meeting (S), you checked your phone repeatedly while others were speaking (B). This sent the message you weren't interested in their input, and people stopped sharing ideas (I)."
✗ Poor: "You're disrespectful and don't care about the team." (Vague, judgmental, no specific behavior or context)
Leading Difficult Conversations▼
- Prepare Your Mindset: Enter curious, not furious. Separate intent from impact.
- State Your Intent: "I want to talk about X to find a solution that works for both of us."
- Share Your Perspective (SBI): Use Situation-Behavior-Impact to be specific.
- Listen to Their Perspective: Ask open questions; truly hear their view.
- Problem-Solve Together: "What can we do differently going forward?"
- Agree on Next Steps: Document who will do what by when; follow up.
Leadership Lessons to Remember
Essential Takeaways for Your Leadership Journey
Self-awareness is the foundation of growth. Reflect on strengths, blind spots, and motivations. Seek feedback and remain open to learning.
Surround yourself with competent, diverse people. Mentor them, delegate authority, empower innovation. Your success depends on their growth.
Build scalable systems and processes rather than relying on occasional heroic efforts. Sustainable performance yields lasting results.
Your attitude influences team morale. Demonstrate positivity, fairness, and ethical behavior — especially under pressure.
Find trusted mentors and peers. Give back by mentoring others. Leadership is a shared journey — no one succeeds alone.
Keep learning, experimenting, and asking questions. Curiosity fuels resilience, innovation, and adaptability.
Develop future leaders by sharing knowledge and opportunities. Your legacy is measured by how many people you help succeed.
Innovation requires adaptation. Stay open to new ideas, challenge assumptions, and design the future rather than defending the past.
Action Planning Framework
What Will You Do Monday Morning?
"Modern EMS was built by visionaries who didn't have the tools, money, or technology. But they had courage. They looked at what was missing and built it anyway. Now, it's your turn."
The Vision → Execution Path
Clarity
Define what you want to achieve and why it matters
Communication
Share your vision and build understanding and support
Collaboration
Engage stakeholders and create shared ownership
Your Leadership Commitments▼
Reflect on each area covered in this guide and identify specific actions:
Which style do you overuse? Which should you develop?
How will you engage and develop Gen Z and Gen Alpha?
What innovation should your agency explore?
Which bias do you struggle with? What checks will you build?
Apply the STEP framework to one change initiative
What relationship will you build? What issue will you advocate for?
📅 The 30/60/90 Day Action Framework
📋 Sample Action Plan Template▼
Focus Area: Adaptive Leadership Development
30 Days:
- Complete self-assessment of leadership styles (which I overuse/underuse)
- Seek feedback from 3 trusted colleagues on my leadership approach
- Identify one upcoming situation to practice democratic style
60 Days:
- Implement monthly leadership style check-ins with my team
- Coach two supervisors on matching their style to team needs
- Document situations where I successfully adapted my approach
90 Days:
- Conduct team debrief on leadership effectiveness
- Measure: 75% of team reports I use appropriate styles for situations
- Create leadership development plan for next quarter
Stakeholders & Metrics:
- Direct reports, peer leaders, executive director (for mentorship)
- Team engagement +15%, peer feedback shows style variety, documented examples of adaptive leadership in action
🎯 Your "Impossible" Challenge
What seems impossible in your agency right now? What would you build if you knew you couldn't fail?
- What is the "impossible" challenge facing your agency?
- If you applied the Pioneer Model (Clarity, Communication, Collaboration), what would the first step be?
- Who are your allies in this vision?
- What foundation can you lay in the next 90 days?
- What did the Sri Lanka story teach you about starting anyway?
💡 The Courage to Begin Anyway
- Visionary leadership lays foundations that endure — change is not immediate, but it compounds
- Adaptive leadership expands effectiveness beyond your comfort zone
- Technology disruption is here — will you lead or lag behind it?
- Bias is the invisible anchor — name it to tame it
- Change management is disciplined — use the STEP framework
- EMS leaders must engage in policy and advocacy
"You are the next generation of EMS visionaries. What seemed impossible when you started should now seem like a roadmap. Go build the future."
The EMS Leadership Blueprint
Ten Practices of High-Impact EMS Leaders
This blueprint pulls together the core lessons into one quick reference. You don't need to be perfect in all ten areas. The goal is to be honest about where you are strong, where you are growing, and what support you need.
Paint a clear picture of where EMS is heading and connect daily decisions to that future.
Set clear expectations and follow through. Accountability protects patients and culture, not punishment.
Invest in recruitment, retention, and growth as core leadership responsibilities.
Communicate with clarity, consistency, and honesty. Close the loop on feedback.
Think in systems. Ask "What system allowed this to happen" before blaming individuals.
QA/QI is used to learn and improve. Near misses are discussed so they don't become tragedies.
Treat change as a discipline. Use STEP and Kotter to design transitions, not just announce policies.
Embrace technology as a tool to fix structural problems. Use data to drive decisions.
Model professional conduct. Take complaints seriously and follow due process.
Lead yourself first. Have a plan for rest, reflection, growth, and know when to ask for help.
Quick Self Assessment
Score yourself 1–5 in each area. Circle two areas to protect and two to intentionally improve over the next 6–12 months.
Glossary & Quick Reference
Key Terms, Acronyms & Leadership Tools
Adaptive Leadership
The ability to adjust leadership style based on situational demands, team needs, and organizational context.
Cognitive Bias
Systematic patterns of deviation from rational judgment that affect decision-making under pressure.
Emotional Intelligence (EI/EQ)
The capacity to recognize, understand, and manage your own emotions and those of others.
EMS Compact
Interstate agreement enabling EMS providers to practice across state lines, facilitating disaster response and workforce mobility.
Horizontal Leadership
Collaborative, flat structure emphasizing teamwork and shared decision-making. Best for daily operations and innovation.
ICS (Incident Command System)
Standardized emergency management system using vertical command structure for coordinating response to incidents.
Psychological Safety
A climate where team members feel safe to take risks, speak up, and make mistakes without fear of punishment.
STEP Framework
Stakeholders → Technology → Engagement → Process. A structured change management approach for EMS.
Vertical Leadership
Clear chain of command with top-down decision-making. Essential for incident scenes and crisis response.
Visionary Leadership
The practice of imagining and building what doesn't yet exist while staying grounded in current realities.
🔤 Common EMS Leadership Acronyms
⚡ Quick Reference Cards
Goleman's 6 Styles
- ✅ Visionary: "Come with me" → When change needed
- ✅ Coaching: "Try this" → Long-term development
- ✅ Democratic: "What do you think?" → Need buy-in
- ✅ Affiliative: "People first" → After conflict
- ⚠️ Pacesetting: "Do as I do" → Use sparingly
- ⚠️ Commanding: "Do what I say" → Crises only
5 Components of EI
- 🪞 Self-Awareness: Know your emotions & triggers
- ⚖️ Self-Regulation: Manage impulses & adapt
- 🔥 Motivation: Intrinsic drive beyond rewards
- 💗 Empathy: Understand others' perspectives
- 🤝 Social Skills: Communicate & build relationships
5 High-Performance Team Behaviors
- 1. Trust One Another (vulnerability-based)
- 2. Engage in Healthy Conflict
- 3. Commit to Decisions
- 4. Hold Each Other Accountable
- 5. Focus on Collective Results
Delegation Checklist
- ☐ Define desired outcome clearly
- ☐ Match task to person's strengths/goals
- ☐ Provide necessary authority & resources
- ☐ Set clear success metrics & timeline
- ☐ Establish communication check-ins
- ☐ Allow for different approaches
- ☐ Provide feedback after completion
- ☐ Give credit publicly for success
📚 Essential EMS Leadership Resources
📖 Books by Donnie Woodyard Jr.
📖 Recommended Reading
- "Leaders Eat Last" — Simon Sinek: Building cultures of trust and safety
- "The Five Dysfunctions of a Team" — Patrick Lencioni: Team dynamics and performance
- "Primal Leadership" — Daniel Goleman: Emotional intelligence in leadership
- "Team of Teams" — Gen. Stanley McChrystal: Adapting organizations for complexity
- "Thinking, Fast and Slow" — Daniel Kahneman: Cognitive biases and decision-making
- "Crucial Conversations" — Kerry Patterson et al.: High-stakes communication skills
🌐 Organizations & Websites
- NAEMT.org — National EMS organization, conferences, advocacy
- NHTSA.gov/ems — Federal EMS resources and guidance
- EMS1.com — EMS news, training, and leadership content
- Harvard Business Review (HBR.org) — Leadership research and insights
- Center for Creative Leadership (CCL) — Leadership development programs
- NAEMT EMS Leadership Certificate — Professional leadership credential
- Harvard Business School Online — Leadership and management courses
🎙️ Leadership Podcasts
- "The EMS Leadership Summit Podcast" — EMS-specific leadership topics
- "WorkLife with Adam Grant" — Organizational psychology and leadership
- "HBR IdeaCast" — Business and management thought leadership
- "Leaders Eat Last Podcast" — Simon Sinek on trust and culture
📋 The One-Page EMS Leadership Cheat Sheet
Before Every Decision
- ☐ What biases might I have?
- ☐ Who else should weigh in?
- ☐ What's the long-term impact?
- ☐ Am I being patient enough?
In Every Interaction
- ☐ Listen more than I speak
- ☐ Assume positive intent
- ☐ Ask "What do you think?"
- ☐ Give credit generously
For Team Success
- ☐ Build psychological safety
- ☐ Delegate meaningful work
- ☐ Provide clear expectations
- ☐ Celebrate small wins
Sources & Further Reading
Foundational Research and Recommended Resources
Additional Resources
About This Guide
Developed from the 8-hour "Leading Forward" leadership workshop presented at EMS conferences nationwide. Content covers visionary leadership, adaptive styles, technology integration, change management, and policy advocacy.
Workshop Topics
- Visionary Leadership & Pioneer Model
- Adaptive Leadership Styles (Goleman)
- Crisis Leadership (Horizontal vs. Vertical)
- Team Building & Emotional Intelligence
- Technology & Innovation in EMS
- 20+ Cognitive Biases & Decision-Making
- STEP Framework for Change
- Essential Leadership Frameworks
- EMS Advocacy & Policy Engagement
Take This Guide With You
Save or print this companion guide for future reference. Share it with colleagues in EMS leadership.
© 2025 Donnie Woodyard, Jr. — Companion to the "Leading Forward" leadership workshop presented at EMS conferences nationwide.