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Ludwig on Leadership: Do You Work for a Dysfunctional EMS Organization?


This issue introduces a new column by veteran EMS chief and author Gary Ludwig, which will focus on leadership and management issues. Gary is a featured speaker at EMS World Expo, Sept. 15–19 in Las Vegas, NV. Register at

It seems like the only way we measure the performance of EMS systems is by things we can measure. We can measure response times. We can measure cardiac saves. We can measure STEMI times. But can you measure the dysfunction of an EMS organization?

Do you measure how many times an ambulance breaks down? How many times personnel are held over and forced to work another shift because there are no other personnel available? Does your service frequently hold calls because there are no ambulances free to respond? Do you measure how many times you have to cannibalize an ambulance for parts or medical supplies just to keep another ambulance functional? We seem to want to measure things that may promote us as a good EMS system, but we seem to stick our head in the sand when it comes to looking at things that might confirm how dysfunctional an EMS system is.

You might work for a dysfunctional EMS organization if your organization constantly finds itself in the news for negative things that have occurred. How about running out of medical supplies or critical equipment that is broken with no replacement? Is duct tape a common remedy for fixing things like torn jump kits, broken handles on monitor-defibrillators or things on ambulances? Hopefully you’re not using the duct tape to hold IVs down because there is no other surgical tape.

Leaders Who Won’t Lead

One of the biggest causes of dysfunctional EMS organizations is leaders who refuse to lead. They have not learned the difference between management and leadership. They fail to realize that you manage things (budgets, fleets, inventory, payroll) and lead people. The other cause of dysfunctional organizations is the failure of leadership to address minor issues. If no one is paying attention to the small details, such as torn jump kits and broken handles on monitor-defibrillators, then what does that say for other issues that have to be tackled?

One of the best ways to tell if you work in a dysfunctional organization is look at the turnover rate. Does it look like a revolving door, with people coming and going before you even have a chance to find out who they are? If you have a turnover rate of more than 20% in a year, dysfunction may be a chief reason. No one wants to work in an organization where they’re unhappy. Low pay, lack of benefits, administration that has no clue how to run an organization, and many other things listed in this article are reasons why people leave. High usage of sick leave is usually another indicator of a dysfunctional organization. High sick leave usage and turnover rates are usually barometers of employee morale.

What to Do?

What can you do if you are a leader of a dysfunctional organization? First, you may be the problem. You really need to take a good look in the mirror and ask what you can do differently. Unfortunately, many terrible leaders I have met, known and, in some cases, worked for over the years left a trail of ruined organizations and had no clue they were the problem. Sometimes they were just in denial. When a leader like this leaves an organization, it takes years to get things heading back in the right direction and return to a semblance of functionality.

No one wants to work for a dysfunctional EMS organization, and certainly, if you are a leader who makes an EMS organization inept, you either need to change your leadership style or move to another career. If you don’t want to move to another career, you need to start developing yourself as a leader and determine what makes other leaders and organizations successful.

Study other successful leaders in and out of the EMS profession. Read the many leadership books out there. If you don’t like reading, watch YouTube videos on leadership—you can find plenty of training there. Don’t hesitate to attend conferences such as EMS World Expo to learn leadership and network with others and learn how they deal with problems in their organizations.

You have two choices: Stay dysfunctional and fail, or change and succeed.

Gary Ludwig, MS, EMT-P, is chief of the Champaign (IL) Fire Department. He is a well-known author and lecturer who has successfully managed large, award-winning metropolitan fire-based EMS systems in St. Louis and Memphis. He has a total of 37 years of fire, rescue and EMS experience and has been a paramedic for over 35 years.

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