“What you have is a foundational breakdown in EMS,” said Dr. Rayme Edler, EMS Medical Director in a meeting with the Escambia County (Florida) Board of Supervisors. “So, we need to redo the entire structure. Chief Nail and myself have been trying for months and months—and I can show you the emails—to try to do a reorganization with the management.” She continued, “Because what you have is very poor management with your emergency medical services. With that being said, your leaders are poor leaders, and that is trickling downhill.”

Poor EMS leadership is not an exclusive element of systems that are under federal or state investigation. Untrained EMS supervisors have been an issue in the dozen of EMS systems I have worked with or evaluated. It is the most consistently occurring element when looking at systems with staffing or performance problems.

Emergency Medicine – Public Health – Public Safety – Medical Transportation

The problem is partially caused by the overlapping roles that EMS provides in a community. The EMS supervisor’s role ranges from senior advanced skill caregiver providing rapid sequence intubation to commanding the EMS resources in a multiple jurisdiction mass-casualty event. Or, checking electronic Patient Care Reports for missing signatures and making sure the caregiver narrative matches the coding.

Success with large, single-role, public safety models

The organizations that tend to do well are the single-role agencies with more than 300 caregivers using the public safety model. They have the resources, and the need, to provide clear job descriptions and supervisory training.

This picture shows a Chicago Assistant Deputy Chief Paramedic running the Triage sector during a multiple alarm fire with an EMS Plan III activated for mass casualties. EMS Plan III brings 15 ambulances to the scene.

When The Agency Is Smaller – the expectations become more unclear and contradictory

There does not seem to be a trickle-down effect as the size of the organization shrinks. Since the EMS supervisor is not working on a transporting ambulance, the roles and expectations increase in direct relationship to the shrinkage of the agency size. EMS supervisors are starving for structure, tools, and training while being overwhelmed with responsibilities.

Many agencies provide a vague job description for an EMS supervisor. Often the nature of the must-do tasks have changed but the job specifications have not. In small and medium-sized organizations we are seeing the turnover of the founding members of an agency. They have not prepared their replacement for success.

Lacking structure and formal expectations, the supervisors find their own way within the organization. Some do a terrific job, establishing a new expectation for supervisors and subordinates.

Many become players in an agency-level Lord of the Flies survival, like the British schoolchildren that crash-landed onto an empty tropical island with no adult survivors during a raging war.

What to do

The agency, or the agency’s boss/owner, need to establish a realistic structure of roles and responsibilities for the supervisor. Doing a global “search and replace” of an existing fire officer, charge nurse or police supervisor job description will not accomplish much.

The National EMS Management Association (NEMSA) has provided a description of three levels of EMS officers – supervisors, managers, and executives. That can be a starting point in developing supervisor roles and responsibilities for your agency. The job description will be different for a hospital-based EMS versus a non-profit community-based EMS service. The nature of the structure, revenue, oversight, and overarching organizational goals are different.

The supervisor will need the authority, organizational access, and management tools to properly perform the tasks. In dual-role agencies, like firefighter/paramedic, there is a pattern for more tasks assigned to the EMS Supervisor than the equivalent fire supervisor. As vivid a difference of 4 hours of management work for the fire supervisor and 10 hours of work for the ems supervisor in the same workday.

The EMS supervisor needs training to perform the expected tasks. Being an excellent caregiver does not guarantee an excellent supervisor. These are different skill sets.

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Outzen, Rick (2019 May 08) EMS: “A Foundational Breakdown”. inweekly Pensacola, FL: Inweekly Media

Featured Picture: Aftermath of an EMS Supervisor vehicle fire.

Chicago ADCP picture used with permission from Dr. Paula Willoughby