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Another Angle: Making Managers

If you’re a rank-and-file paramedic or EMT who’s thinking of getting into management, these aren’t the best reasons to do so:

  • You have decades of street experience;
  • You’re a psych major;
  • Everyone says you’re much nicer than the boss;
  • You like telling people what to do.

I mention those fallacies because management skills are often undervalued or misunderstood. You don’t have to take my word for it; here’s what author and former Avis CEO Robert Townsend says in Up the Organization about employers taking care of employees:

The best managers think of themselves as playing coaches. They should be the first on the field in the morning and the last to leave it at night… No job is too menial for [them] if it helps one player advance toward [the] objective.

Take another look at that quote, then start counting the number of bosses you’ve had who’ve met Townsend’s criteria. I’m stuck at either one or zero, depending on how charitable I’m feeling.

Dedication, loyalty, unselfishness—those aren’t traits that develop naturally over time like liver spots. That’s why the most admired street medics don’t necessarily make the best managers. We’re talking different skill sets. Essayist Robert K. Greenleaf offers an example he calls servant leadership: seeing oneself as subordinate not only to goals but to staff working toward those goals. Here’s how that might play out in everyday EMS:

As supervisor of the midtown night shift, you arrive at a cardiac arrest a few minutes after the ambulance. Technically you’re in charge; plus you have twice as much field experience as the next-most-senior paramedic. Your initial impression of what’s being done is favorable, but after having run a few hundred arrests, you’re not shy about telling others how to treat the nearly dead. And yet the first thing you do is ask your crew, “Does anyone need anything?”

A young EMT, surprised you didn’t just take over the scene like her last boss would have, says she could use fresh gloves. You fetch her two pairs. Then you notice an IV hasn’t been started, so you tell the crew you’ll take care of it. You’re happy to help because at that moment, on that call, you know it’s most important for you to demonstrate teamwork in pursuit of a desired outcome.

Other Tools

Servant leadership can be hard for take-charge veterans of high-volume 9-1-1, but it’s only one tool successful managers use. Consider these equally important practices:

  • Setting ambitious standards. Make your own behavior the very best example of what you want from others.
  • Delivering appropriate reinforcement. Not everyone’s a star. Not everyone’s a jerk.
  • Keeping commitments. Missed promises are much worse than no promises.
  • Encouraging professional development. Successful subordinates should be a source of great pride to those who guide them.

Do we hire potential supervisors who are capable of such excellence? Yes. Do we cultivate those qualities? Not often enough. I’m not sure how many of today’s EMS managers even know what to look for.

Maybe start with people you’d want managing you.

Mike Rubin is a paramedic in Nashville and a member of EMS World’s editorial advisory board. Contact him at

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