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Ludwig on Leadership: Is a HiPPO Running Your EMS Agency?


Have you peeked in the biggest office in your EMS agency and found a HiPPO sitting in the chair? No, I do not mean the type of animal you see at the zoo. When I use the word HiPPO, I am using an acronym for the Highest Paid Person’s Opinion.

EMS and fire agencies are notorious for having HiPPOs. We’re usually paramilitary organizations where the highest ranked person—who is usually the highest paid person—has the final say on how matters are to be resolved.

The highest paid person mimics a hippopotamus in many ways. They have the rank and the pay, so therefore they have the bulk of weight behind them whenever they offer their views on how something should be done. The HiPPO can have powerful jaws. If you challenge them, they will put you back in your place by—either directly or indirectly—letting you know that things are going to be done their way.

They are not open to suggestions, opinions or other ideas. If you are not civil service or lack union representation, they have the power to fire you without recourse. Your career and job are always at their mercy.

Usually HiPPOs do not think they have to ask insubordinates any questions or opinions as they think they know it all. They may not think they have to look at data regarding how an EMS organization is functioning. They have all the answers about billing issues, quality improvement, response times and any other critical area you can imagine. They may not even listen to a patient who complains about the service they received. They may just chalk up a negative review to just one person, not stopping to think how it reflects on the EMS agency as a whole.

The bottom line is that HiPPOs are autocratic leaders. As an autocratic leader, they have complete control and authority for decision making in the EMS agency. Unfortunately this type of leadership style leads to resentment among staff and impacts morale.

How Do You Deal With a HiPPO?

The best way to deal with a HiPPO is to be armed with data. In the absence of data, everyone has an opinion about how operations should be conducted. You will always lose this debate since the highest ranked and paid person’s opinion wins the day.

If your HiPPO does not readily accept being proved wrong in front of staff, do not confront them with the data in a staff meeting with a room of peers. Show them the data privately before the meeting and let them offer the direction to the staff armed with good information.

I have sat in meetings where the HiPPO pontificates and junior staff are reluctant to speak up. You can feel the tension as each subordinate to the HiPPO squirms in their seat, wanting to say something, but knowing it is better to stay quiet.

Data is your friend. EMS organizations should be able to produce all kinds of data to measure the performance of the organization. Most of this data comes from the CAD system, electronic patient care records, payroll, fleet operations and logistical management. Don’t overlook any of this data to support your opinions when dealing with a HiPPO.

I can think of hundreds of data points for measuring your EMS agency’s performance. All of them should be analyzed and validated before presenting the HiPPO with data to make a sound decision.
I have worked for excellent bosses in my time, and I have worked for some very challenging chiefs. The challenging chiefs helped me grow in my profession, but truthfully I would have preferred to develop other ways. They were definitely HiPPOs. They had no business being in leadership positions and usually left the organization far worse than they found it.

With a careful and strategic approach to dealing with your HiPPO, you can be successful dealing with an autocratic and domineering leadership style.

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

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