EMS Leadership Part 7: Team Building

This is the seventh in a series of columns on EMS leadership. Dr. Breaux will cover leadership applications such as behavioral, managerial, situational, path-goal, leader-member exchange, full-range transformational and transactional leadership. Other areas like conflict management, effective communications and organization structure will also be addressed.

Medics 1 and 2 respond to a major 10-50 two-vehicle accident with multiple casualties at the intersection of Bluebonnet and Maple. Susan, Jefferson County's EMS director, calls dispatch to let them know she is responding and asks them to tone out the local fire department for scene assistance and place a medical helicopter on flying standby. She also tells them she will be scene commander. Susan arrives at the scene with law enforcement and asks the fire department to assist the ambulance teams in identifying and securing patients for on-scene rapid stabilization and emergency treatment. Before she can request it, two paramedics offer to conduct a quick triage on the patients in each of the two vehicles and provide the results of their findings so she can call in additional resources as needed and keep the hospitals and medical helicopter updated on the number of patients and seriousness of injuries. Susan commends the paramedics on their initiative.

The paramedics report that there are two critical and two ambulatory patients and advises Susan of their injuries. Susan requests dispatch to have the fire department establish a landing zone and bring in the medical helicopter. The ambulance crews, with assistance from the fire department, establish c-spine stabilization and place the two critical patients in an ambulance for transport to the helicopter landing zone; the two ambulatory patients are placed in the other ambulance for transport to the local trauma hospital. Susan advises both the medical helicopter and the emergency room of individual patient injuries. Based on previous team training, the ambulance crews update the medical helicopter crew and emergency room staff regarding patient vitals and other important medical information.

The good news is that all of the patients recovered from their injuries, thanks to responsive and effective team work of the ambulance crews, fire department, law enforcement, medical helicopter crew and emergency room staff. Everyone worked together to assure scene safety and provided appropriate and responsive emergency medical care for all the patients involved in the accident. Susan not only assured smooth on-scene command, but had previously conducted consistent training courses and collaborative team coordination exercises and strategy meeting involving all local response organizations. Susan immediately thanked all who participated in the incident for their outstanding support.

Team-building is important not only in emergency care, but also in other important organizational initiatives. Under the Leader-Member Exchange (LMX) model of leadership, the best leaders are those who build effective relationships within teams, which may involve giving credit to the team in a way that teammates feel they did it all themselves.¹ Members in high-quality exchange relationships with their team leaders are given more freedom, better job assignments and increased opportunities to work with their leader. Members with low-quality exchange relationships are directed toward unpopular jobs with few opportunities to interact with their team leader. ² Graen³ says that followers who share leadership grow into leaders within the team and share equitably in the team's success. Also, traditional managing or controlling leadership techniques work well in business-as-usual settings; however, more team-oriented, high LMX leadership is needed when dealing with less favorable situations. ¹