EMS Leadership 101: How to Not Be That Supervisor Everyone Hates

New Guy to 'Been There'

I’ve been there, done that, and wore the T-Shirt (most of them are gun rags now). I’ve started over more times than I can count as the “new guy,” worked my way up through promotions, and along the way, I’ve witnessed a buffet of leadership styles. Some were spot-on, inspiring teams to perform like a well-oiled machine. Others . . . well, just call it like it is: shit. I watched firsthand how poor leadership can quietly—or sometimes explosively—wreck a system.

I’ve learned that good leadership can turn a team into something unstoppable, while bad leadership can make even the most dedicated people question why they showed up that day. The lessons I’ve picked up along the way are real, hard-earned, and exactly why I believe leadership in first responder roles isn’t just about giving orders. It’s about building people, building trust, and building systems that survive the highs, the lows, and the occasional “what the hell just happened?” moments.

Leadership in EMS

Leadership in EMS is a lot like running a code: somebody has to step up, make decisions, delegate, and keep the team moving forward when chaos is knocking on the door. But the difference between a good leader and a bad leader? It’s night and day.

Leading from the Front

The best leaders I’ve had weren’t the ones barking orders from the sidelines. They were the ones shoulder-to-shoulder with the crew, loading the 300-pound patient down three flights of stairs at 0300, folding the stairchair up before we take off (even if they look stupid trying to remember which red thing to pull and when), or even just making sure we are solid before shutting the back doors. They led from the front, not from an ergonomic rolling chair.

True leadership in this line of work is about setting the tone. If the boss is calm, squared away, and in it with us, the crew follows suit. If the boss is MIA until it’s time to take credit, morale goes down faster than a septic NH patient who decided walkers are for chumps.

“If you’re not willing to carry the monitor, don’t carry the title.”

Leaders Should Eat Last

There’s a reason the phrase “leaders eat last” resonates. In EMS, this doesn’t always mean skipping chow, it’s making sure your people have what they need before you worry about yourself. It’s grabbing the rookie a meal when they’ve been staring at ESO all day. It’s running that late call with the crew. It’s showing the team that their well-being is your priority, not your ego.

Shitty Leadership

I’ve also had plenty of “leaders” (and I use that term loosely) who couldn’t lead a one-car MVA with no patients. The lazy, incompetent, finger-pointing types who love the perks of the position but dodge the responsibility. The ones who know the mission statement but don’t embody it.

Bad leadership is like trying to DSI a shocky patient without working on that pressure: it looks fine for a second, but the crash is inevitable. And it’s always the crew left cleaning up the mess.

“Don’t confuse authority with leadership. One’s a patch on your shirt, and the other’s sweat on your back.”

Rogerian Communication: The Unsung Skill

One trait of great leaders that doesn’t get talked about enough? Communication. I know, ironic. Not just barking orders, not just “do as I say," but true Rogerian communication.

That means listening first, finding common ground solutions, and showing your crew that you actually understand where they’re coming from before you push your own perspective. In EMS, that could be as simple as:

• Letting your subordinate vent after a brutal call before you start critiquing.

• Acknowledging why a policy feels unfair before explaining why it exists.

• Actually hearing the rookie’s idea for improving inventory instead of just shutting it down with “that’s how we’ve always done it.” <-- By the way, it probably hasn't really worked this whole time huh?

  
  

Leaders who use Rogerian communication don’t just talk at people, they talk with people. And that makes crews more likely to buy in, trust decisions, and follow through when the pressure is on.

“If you want people to hear you during the call, prove you heard them before the call.”

Building People Up

Another cornerstone of leadership is knowing that mistakes are not the end of the world, they’re an opportunity. Stop taking everything so damn personally. In EMS, everybody screws up at some point. Incorrect med math, wrong turn, IV blown, forgetting to restock XS gloves for that one medic who doesn't hit their head on the ambulance ceiling like everyone else. A bad leader turns that into a public shaming. A good leader turns it into a training moment.

Correcting someone isn’t negative or punitive, it’s how we grow stronger as providers and as a team. Training should build people up, not beat them down. If your crew is afraid to admit mistakes, you don’t have a team.

Great leaders create an environment where:

• Screwing up is met with education, not humiliation.

• Training is ongoing, not a checkbox once a year.

• Feedback is constructive and private, not a chance to flex authority.

• Successes are celebrated just as loudly as failures are corrected.

  
  

“Correct in private, praise in public, and never confuse coaching with punishment.”

The Takeaway

I’ve been lucky to have some phenomenal leaders who reminded me what leadership is supposed to look like: humble, competent, and invested. But I’ve also had plenty who taught me exactly how not to lead. Both sides have shaped my perspective, and probably yours too.

So here’s my question to you:

What do you think are the top traits of a good EMS leader, and how do we make sure we’re all on track to becoming the optimal leaders for our people?