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Providers vs. Leaders: Trend report reveals divide on issues of safety, fatigue, mental health

An organization’s leadership culture may explain the stark difference in opinion between providers and leaders on issues of patient and provider safety

This feature is part of the 2018 EMS Trend Report, an in-depth look at EMS trends in the U.S. and an assessment of how the EMS profession is changing. To read all of the articles included in the 2018 report, click here.

By Art Hsieh

We often talk about family in EMS, and no wonder: the 800,000 EMS providers in the United States comprise a small community when compared to firefighters (1.2 million), law enforcement (1.1 million), or nurses (2.9 million). EMS folks are a special breed, often toiling under long working hours, for low or no wages, providing medical response to all segments of society, regardless of status or economics. Members of the EMS family spend precious time away from their other families, during nights, weekends and holidays. And they do this without fanfare and with little notice from the public.

Like any family, EMS folks have their disagreements. And when it comes to key issues affecting the day-to-day duties of field providers, the divide can be quite significant. In the 2018 EMS Trend Report, there is a stark difference between how line personnel and agency managers view efforts to improve both patient and provider safety, mental health and fatigue management.

Field providers were much less likely to agree that their agencies did a good job in these key areas, compared to managers and leaders.

To be fair, this report is based upon a convenience sampling of participants. In other words, only those who had the time and inclination to take the survey did so. It’s possible that folks who are generally content with their employment situation are less likely to answer a survey, compared to those individuals who are unhappy about their employer. Given the greater number of line personnel who responded compared to managers, this would tend to skew the results in a more negative direction vs. had the participants been randomly chosen.

Despite that limitation, the results do tend to align with general opinions and anecdotes from fellow colleagues across the country. There seems to be a disconnect between field providers and managers.

Top down leadership

I am interested in the organizational culture of agencies involved in the survey. In a company where the management hierarchy is flat, and policies are issued from the top down, I imagine that staff are less likely to be satisfied, due to a lack of transparency in the decision-making process.

Moreover, the individual who spends less time in the field providing direct patient care is more likely to become disconnected from the real needs of line personnel. As the gap worsens, it’s less likely that ideas that seem great on paper work in reality.

For example, most EMS agencies offer Employment Assistance Programs for their members which provide mental health assistance. EAPs are a great idea, but do they really help?

Most field providers I’ve spoken to over the years feel the pamphlet they receive as part of agency orientation was not the encouragement needed for someone in crisis to utilize the service. Others have been afraid to use the service due to reporting fears. Others have indicated that the short-term relationship with their EAP was more like debriefings and that assistance with long-term counseling and therapy was not available.

Participatory leadership

I suspect that in agencies where participatory leadership is the organizational norm, there is likely to be less of a difference between field personnel and management. Decisions that are made with both sides participating at the table are more likely to be satisfactory and be more beneficial to both staff and the organization.

Participatory leadership comes with its own challenges. Wages for field providers continue to be low, forcing many of them to work overtime and at multiple agencies to support themselves and a family. This leaves little time and energy for committee work, which too often is unpaid.

Patience is needed by all to allow participatory practices to work. Committee members need training on how to actively listen and engage productively in group process. And with retention and turnover being a major issue confronting our industry, it’s clear that there needs to be a certain level of organizational stability for this type of culture to succeed.

The financial pressures are also great in EMS. It’s clear by the results of this survey that reimbursement for EMS service remains abysmal. While strides are being made in evolving our mission from pure transport to more interconnected services to the house of medicine, without adequate funding our ability to ensure patient and provider safety, and well-being is dangerously hindered.

Despite the differences of opinion among staff and management, the need to improve alignment on key issues involving safety of our patients and providers exists. It’s incumbent upon us to find ways to improve how we protect the health of our communities and provide the right services to our patients, safely and effectively.

About the author

Art Hsieh, MA, NRP teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. Author of “EMT Exam for Dummies,” Art has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at

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