Never has running an EMS organization been more complex. Today's bosses face challenges of patient care, system operations, technology, finance, quality assurance and more. But the problem is, EMS has never really set out to train its leaders right. We've never really tried, in any sort of formal, systemized way, to define and instill the knowledge and skills essential to those in EMS leadership positions—certainly not the way fire and law enforcement have.
With the publication of a new white paper, the National EMS Management Association (NEMSMA) offers a blueprint for changing that. Emergency Medical Services Management and Leadership Development in America: An Agenda for the Future envisions standardized levels and competencies for EMS officers, a supporting educational system that produces qualified candidates, and credentialing that vouches for their fitness.
"In EMS, we have a 30-year history of promoting our best and brightest clinicians, and putting them in new positions in sort of a sink-or-swim mode," says project chair Skip Kirkwood, MS, JD, EMT-P, chief of Wake County EMS in North Carolina. "We set a significant percentage of those people up for failure. They are promoted but never taught or trained, and they don't have the competencies to be effective supervisors."
Step No. 1 is defining those competencies, which means defining standard officer levels and roles across the EMS world. NEMSMA's team didn't attempt that, which would obviously require a broad consensus process. But it presents a significant body of work from which to begin: From 2004–08, members of NEMSMA and the NAEMT's former National EMS Chiefs, Officers and Administrators Division worked on a draft document that defined four levels of EMS officers (unit leaders, supervising officers, managing officers and executive officers) and their competencies in various areas. It is included as an appendix to the white paper.
EMS folks will no doubt have a lot to say about these kinds of specifics, which is the point of the paper's recommended consensus process. "Before we can move ahead with the rest of this stuff," Kirkwood says, "the first step is getting all the groups to fold, spindle, mutilate and otherwise participate in the development of some sort of consensus document everybody can own part of."
Once that's accomplished, aspiring officers will need specific education, training and experience to serve. Supporting infrastructure must be developed. There's been work done here too: A National Fire Academy committee created in 2006 to help EMS management degree programs develop courses has been working toward an undergraduate EMS management curriculum template for colleges and universities. Members have worked to identify levels and competencies and courses that support them. Once that work is fleshed out and consensus-validated and aligned with the results of the first step, a national network of academic institutions, training programs and a centralized EMS officer development center can begin generating qualified graduates.
The third component is credentialing. NEMSMA's team imagines a national process based on its defined levels and competencies by which organizations can ensure their officers pass muster.
A final section of the paper looks at the officer-development experiences of other disciplines. What, if anything, can EMS take from the efforts of the fire service, law enforcement, the military and other parts of healthcare?
"The basic thing is that all of those folks, in one way or another, invest a lot of energy in leadership development," Kirkwood notes. "We don't, and that's a big red flag. For them it's ubiquitous. We need to put just as much into it. That message itself is as important as the specifics of any one approach."