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What’s A Leader to Do?


Significant discussions have been going on in Washington, DC, and around the country calling once again for the establishment of a lead federal agency for EMS. There is passionate debate advocating for the Department of Transportation, Department of Health and Human Services or the Department of Homeland Security to be the “leader.” These arguments typically align with personal philosophies of historical perspective or whether EMS is healthcare, public safety or public health. The Federal Interagency Committee on EMS (FICEMS) has been tasked with developing recommendations for the government to consider. Having the federal government asking the questions is a significant stride forward. It appears there is interest and the government recognizes the value of an effective and efficient EMS system across the nation.

While most of the debate centers around who should be the lead federal agency, the better question is what should a lead agency do? FICEMS is soliciting stakeholder input to determine what the role of the federal government in EMS should or should not be. Questions that are more difficult to answer but certainly more important are: Does the EMS profession know what it wants from its leaders? Do leaders know how to deliver?

This argument is not limited to the lead federal agency debate, but holds true in every EMS organization. What do we expect from our leaders? What do we want them to do? We know we want our leaders to be worthy of our trust. We addressed the 13 behaviors that instill trust in “The Making of a Leader” in the March edition of EMSWorld. For us to follow, we also want our leaders to be ethical, openly displaying honesty and integrity. But this is more how we want our leaders to act, not what we want them to do.

Being a Good Leader

How to be a good leader is more conceptual that actually delivering the goods. To get results and achieve success using your leadership behaviors, you must do the work. Successful leadership actions must include:

1. Great communications. Leaders must have great communications skills, both oral and written. This will help ensure ideas and expectations are clearly articulated and questions clearly clarified.

2. Expertise in their field. Knowledge of EMS systems and clinical medicine builds credibility with EMS providers. Followers want to know their leaders understand what they are experiencing in the field.

3. Business acumen. EMS is a business. Without basic budgeting and financial skills, the leaders may not be able to sustain operations on a long-term basis. Financial stability provides security for employees, eliminating a primary stressor for both their professional and personal lives.

4. Innovation. The only constant is change. If an organization is not moving forward, it is falling behind. Leaders must continually assess the environment and change to meet the needs of the community today and tomorrow.

5. Improvement. Leaders must continually strive to improve. Instill a learning culture within the organization to never rest on its laurels and to pursue excellence.

6. Advocacy. Leaders must be the champion for their organization. This includes many different facets: ensuring EMS priorities are at the forefront of policy and financial discussions; defending the organizations from invalid, negative attacks; and taking responsibility when something goes wrong and sincerely working to fix the problem.

7. Servitude. Effective leaders serve the needs of the organization before their own.

The term servant leadership was coined by Robert Greenleaf in 1970 and is defined as “The servant-leader is servant first… It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead.”1

Servant leadership is a combination of 11 characteristics: a calling, listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, growth and building communities.2 To ascertain whether you are a servant leader, answer the questions posed by Barbuto and Wheeler: Do others believe you are preparing the organization to make a positive difference in the world? Do people believe that you are committed to helping them develop and grow? If you answered “yes,” you may have servant leadership characteristics.

The bottom line is that we want our leaders to take good care of us and move our organizations forward, so we should want the same things from a lead federal agency. We want federal leadership that will take good care of EMS and move the profession forward. If effectively led, EMS will meet the needs of the greater good and make a positive difference in America. We want servant leaders. We also know we do not want a lead federal agency to micromanage or standardize to the point where innovation and community expectations cannot be delivered. We do not want the federal government to take over EMS and become the TSA (Transportation Security Administration) of health care.

Proper federal leadership will exercise the 13 behaviors that develop high-trust leaders discussed in the March issue and the seven actions described above. They will be the champion on Capitol Hill that we can all aspire to follow. The “who” is not as important as “what they will do.” The department that is most suited to achieve these goals should be the lead federal agency.

The National EMS Management Association (NEMSMA) provided stakeholder input for the federal government lead agency discussion. You can view its position at

1. The Greenleaf Center for Servant Leadership. Retrieved March 30, 2011, from
2. Barbuto JE, Wheeler DW. Becoming A Servant Leader: Do You Have What It Takes? Oct 2, 2007. Retrieved March 30, 2011, from NebGuide:

Troy M. Hagen, MBA, EMT-P, is director of Ada County Paramedics in Boise, ID. He has more than 22 years of EMS experience and is president-elect of the National EMS Management Association.



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