Being the medic in command of an accident scene requires taking into account multiple factors: the stability of the car, local traffic patterns in the immediate vicinity, whether to wait for a helicopter, hazardous fluids spilling on the ground, bystanders and other responders. Most tenured medics can handle that kind of responsibility without a second's hesitation. Command usually ends up looking like a military leader shouting out orders to ensure the best outcome for the patient under short time tables. This isn't a job for the faint of heart or indecisive.
We make decisions based on current availabilities and best possible outcomes in the next minutes and set that plan into action. This concept of "Adapt and Overcome" is a crucial skill in any medic's arsenal, but one not often taught in the classroom. While immensely important on scene, it's a paradox for leading the organization. This is why individuals who are great clinicians may not be the best choice for leadership positions.
EMS is not military. On scene, people will take orders because they know that even if an ego is bruised in the short term, it's for the benefit of the patient. In leadership, however, it's unacceptable. The answer to questions can no longer be "Because I said so." It doesn't mean that the urgency is any less, but in strategic positions, it is very rarely important to make large decisions under short time tables.
Being a leader requires taking a more global view of not just what's going on in one sector, but throughout an entire organization. Going back to the above-mentioned car accident scenario, the commanding medic may request a helicopter that's a half hour away because it's in the patient's best interest. The director then has to consider the cost-to-benefit ratio for using the helicopter: distance involved, fuel costs to get to the LZ, time the unit is out of service waiting to turn over care, cleaning, and the very real possibility of not being reimbursed because his agency was not the transport unit to a hospital facility versus the crew's ability transport the patient to the closest facility and have the helicopter meet them there if the physician wishes to have the patient sent on. The leader must also consider ramifications if the helicopter is unnecessary or the best utilization of resources for the rest of the responding area. The ideas are the same, just more expanded, and usually are not intuitive to the field medic. They must be learned.
Field medics are great at assessment. Leadership requires the same skill used in a different way. Medics evaluate patients while leaders evaluate systems, but they are not the same. Leaders assess the political climate (especially if you are a government entity), budgetary climates, staffing issues, the legal minefield, physician relations and logistics. Just like a field medic, the leader has to continuously monitor his patients, but it's not as simple as taking a B/P every five minutes. It requires computer skills and an education based on business principles.
Everyone has a boss. Field medics report to a shift supervisor, medical control, or a training officer if something in their care needs adjusting. The leader reports to either a political appointee or a board. Along with reporting what the organization has been doing for the last quarter, the leader must also show a strategic plan for the future. For that plan to be successful, he has to convince his superiors to give him the funding, time and/or the logistics it requires. It's reminiscent of talking to a psych patient who is refusing treatment. Familiar skills expanded.
So how do you get from field medic to leader? While field experience is important, it is not a sole predictor of success as a leader. It requires a large base in education, and there are multiple avenues to achieve this. Fitch and Associates offers an Ambulance Service Manager's program, colleges offer degreed programs in business management and classes on grant-writing. Individuals may also join a professional group like the American College of Healthcare Executives (ACHE) or Healthcare Financial Management Association (HFMA) and attend their conferences and continuing education courses.