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A formal training schedule for first-line EMS supervisors

Limit turnover and improve a toxic culture by investing in leadership development


EMS agencies have a long history of promoting good clinicians to supervisory positions, and then wondering why those clinicians are not successful as supervisors.

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EMS graduates can climb the career ladder quickly, arriving in leadership positions with minimal life or professional experience, and even less management training. Supervision is as different from clinical medicine as auto repair is from plumbing. Even a smart, motivated individual will need additional skill sets to succeed in the new role.

In this special coverage series, learn how to equip field supervisors with the skills they need to be effective in their roles.

By Skip Kirkwood

Across our nation’s EMS community, the concerns are common. “Turnover is too high!” “As soon as we get somebody trained, they move on!” “Turnover costs a lot of money!” At the same time, HR research is pretty clear – employees often don’t quit their profession or their company – they quit their boss because they aren’t treated to their liking.

We do have some industry-wide detractors, too – low salaries, 24-7 schedules, working holidays, etc. And the last year of COVID-19-related stress hasn’t helped, either. But let’s focus on the big one – employees quit because of poor supervision.

At the bottom of this article, print out a sample EMS promotion training program

EMS agencies have a long history of promoting good clinicians to supervisory positions, and then wondering why those clinicians are not successful as supervisors. There’s a logical gap there – we’d think it was silly to take someone who is a good auto mechanic and promote that person to plumber, without any additional training, and expect them to succeed. Yet, supervision is as different from clinical medicine as auto repair is from plumbing. Even a smart, motivated individual will need additional skill sets to succeed in the new role. Learning by osmosis is extremely inefficient and learning by doing is like meandering through a minefield – where the inevitable explosions cost the organization its most important capital.

Historically the EMS community has never established standards for training first-line supervisors. The reasons for that are unclear, but they include both a generalized unwillingness to invest in staff development, along with roots in an era where hierarchical supervisory structures were generally not favored. Yet our public safety colleagues in law enforcement and the fire service have well established programs and curricula for promoted individuals and individuals seeking promotion, as do many of our more progressive hospitals and healthcare systems.

Why not then in EMS?

Most of the agencies I spoke with in preparation for this article utilize only observation or learn by doing to develop their first-line supervisors. A newly selected supervisor may ride along with an established supervisor for a few shifts, or a senior medic may be allowed to fill in for an absent supervisor for periods when learning may or may not take place. These techniques run a high risk of missing critical knowledge and skills.

As I moved to various organizations in my career, I attempted to bridge some of these gaps with formal programs. At one agency, the operations chief and I, assisted by some experienced supervisors, designed an orientation program for those who aspired to work as relief field supervisors, and for those selected for promotion who had not already served in the relief role.

This consisted of a week of classroom learning, as well as a task book of skills and procedures that field supervisors were required to handle that were not in the domain of a field paramedic (e.g., investigating and reporting an employee injury, a vehicle collision, a patient complaint or a clinical misadventure).

There was also some external training, including a course on making death notifications and completion of crisis intervention team training. Most importantly, these individuals got specialized incident management training (not ICS 100-200), that involved role playing the parts EMS supervisors are expected to play at various types of incidents in our system.

A sample training program for promotions

At another agency, we were asked to develop a formal schedule of training to be made available to individuals who wished to promote through the ranks. When implemented, it looked something like this:

Staff paramedic wishing to promote to Field Training Officer (FTO)/Corporal):

  • NEMSMA Basic FTO course
  • In-house HR training – investigations, Just Culture, etc.
  • North Carolina EMS Instructor Level I

FTO wishing to promote to District Supervisor/Lieutenant:

District Supervisor wishing to promote to Shift Commander/Captain:

Captains wishing to pursue further promotions undertake function-specific education, as well as external leadership development programs such as the West Point Leadership Institute, the Disney University or similar managerial or executive-level programs. All had the option of attending the Fitch & Associates Ambulance Service Manager program. Accreditation by ACPE as a Managing Paramedic Officer is encouraged.

Individuals who have previously completed similar leadership development programs (e.g., hospital-offered programs or military officer/NCO development schools) may be excused from particular courses on a case-by-case basis. All coursework is sponsored and supported by the organization and is completed on the clock. If the course is not offered locally, the agency pays for participants’ travel, lodging and meals.

Have a transparent plan to develop supervisors

There is some discussion between EMS agencies whether or not the FTO role should be part of the promotional ladder or something different. There is a concern that individuals will become FTOs not because they wish to train newly hired personnel, but only because they must do so to promote. We find this concern to be manageable, if the agency is willing, because being an effective first line supervisor requires much coaching, teaching, documenting and providing feedback – all of which are developed while serving as an FTO.

There is no single right answer to this complex problem, and the many small agencies nature of EMS in the U.S., combined with the lack of graduate-level research into management issues, does not lend itself to evidence-based solutions. It would be interesting, for example, to study the results if a large EMS organization (like AMR/GMR or Falck) were to develop, implement and study a uniform supervisor development program across their broad HR and geographic base.

Absent a single right answer, EMS agencies should at least have a plan. A well-documented, transparent plan will go a long way toward eliminating perceptions of favoritism and the “good old boy” network, that plague many EMS agencies’ HR efforts. And, with a bit of effort, these investments in leadership development will help to remedy the excessive turnover rates and toxic culture that plagues so many EMS agencies.

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About the author

Skip Kirkwood retired after a 44-year EMS career, of which 27 years were as a chief officer. He is an attorney, consultant, educator and advocate for a number of EMS causes. He currently serves on the Board of Directors of the National EMS Management Association (NEMSMA), and as a Commissioner of the American College of Paramedic Executives (ACPE).

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For more than three decades, the Fitch & Associates team of consultants has provided customized solutions to the complex challenges faced by public safety organizations of all types and sizes. From system design and competitive procurements to technology upgrades and comprehensive consulting services, Fitch & Associates helps communities ensure their emergency services are both effective and sustainable. For ideas to help your agency improve performance in the face of rising costs, call 888-431-2600 or visit