Knee Jerk Management

Your department has a policy that they send two ambulances to reported cardiac arrests.  On one particular busy night two of your trucks are dispatched to a person reportedly not breathing.  The first truck gets on scene and finds a patient beyond help.  Before they can cancel the second ambulance, they are involved in an intersection accident.  In response to this incident the next morning your director releases a memo stating that second ambulances will no longer be dispatched to cardiac arrests.

In a labor management meeting, an employee suggests development of an “emergency code” for field personnel to report to dispatch that they are in trouble to help activate a large law enforcement response to assist them at their location.  Your boss says that this will not happen because they think field crews will abuse it.  A week later, a paramedic is seriously assaulted by a psychiatric patient.  The dispatcher on the other side of the radio was unable to make out their calls for help.  Your boss then revisits the policy.

Your division uses a non-disposable laryngoscope blades.  A supervisor goes to your boss and suggests following the industry trend and shifting to disposable ones to reduce the risk of infection for patients.  Your boss decides against this since your company has never been sued by someone receiving an infection from this means of transmission.  You are convinced that the only way this policy will change is through some sort of tragedy.

All three of these incidents are loosely based on actual events that I have either been part of or have heard about from friends of mine working in different systems throughout the United States.  They are all evidence of the same though, change driven by catastrophe.  We have all experienced it at some point in our career.  We have all been sitting around in a conversation with our friends and coworkers and had somebody utter the words, “Nothing is going to change until somebody gets hurt.”  Some of this attitude from leadership is because of a generalized disconnect from the field.  Some of it is because of the kneejerk, reactive nature of EMS that seems to carry on with people when they get promoted.  And some of it, sadly, is just due to plain ignorance and an inability to listen to those around them.

The culture of EMS is to sit and wait.  It’s like fishing.  You put your hook in the water, and you sit.  Sometimes a call comes in, and sometimes it doesn’t but typically, you do not do anything until somebody pushes the button and it is your time to act.  We are reactive by nature and therefore, the leadership techniques that some adopt are reactive as well.  The big question though is how do we change this sort of attitude?  How do we prevent tragedy before it happens?  The first step is to admit that we might not have all the answers in our own knowledge base.  Everybody has their area of expertise and as leaders we need to reach out to those people and admit to ourselves that somebody else might know more about a situation than we do.

Good leadership is not having all of the answers.  Part of being a leader is knowing your limitations and knowing who else can contribute to your organization.  Good leadership means actually listening to what a person has to day, and taking in the pros and cons of changes that their ideas might have for your department.  It is not expecting all of the final decisions to come from your mouth, or your office.  It is not staring a computer screen and nodding while somebody talks to you, or allowing phone call after phone call to interrupt your conversation.

Most of all, being a good leader is not letting one isolated incident outweigh all of the positives that happen as the result of a policy.  It is not ignoring legitimate concerns from your staff, especially when it comes to their safety.  It is not ignoring industry best practices and instead caring about those couple of dollars that your department might save.  And it is not making kneejerk decisions with little information.  All of these are characteristics of a boss, not a leader, and I know which one of those I want to work for.