By Matthew Panepento
EMS is at a crossroads. Staffing shortages and rising burnout are not just operational challenges; they are symptoms of a deeper issue: how we lead.
Across the country, agencies respond with more policies, more metrics and more emails, creating distance between leadership and the crews who hold the system together. Meanwhile, those crews keep showing up, working short, skipping meals, absorbing trauma and doing everything possible to keep the seams from splitting.
If EMS is going to survive and if its professionals are going to thrive, leadership must change. Not with more rules or memos, but with a shift from authority to advocacy and from office-based management to crew-centered engagement. The future of EMS depends on its leaders who understand that their greatest responsibility is not paperwork; it is people.
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Leadership is advocacy not authority
Leadership in EMS is not defined by rank or signature authority; it is defined by advocacy. Crews need leaders who will stand with them when budgets tighten, staffing thins or decisions are made far from the street. Effective leaders translate administrative realities to the field with honesty and respect, and they bring field realities back to administration with clarity and conviction.
Advocacy requires courage. It means stating difficult truths in difficult rooms, pushing back on unrealistic expectations and defending teams when things fail. Crews quickly differentiate between leaders who check boxes and leaders who improve working conditions. Influence comes from demonstrated commitment to people, not from position.
Advocacy sets the tone, but credibility depends on owning outcomes. The next step is accountability, because advocacy without accountability does not build trust.
Own the failures; especially the public ones
Nothing erodes trust faster than blame. When a call goes poorly, a process breaks or an error occurs, crews watch closely to see how leaders respond. Leaders who default to discipline or policy citations communicate self-preservation over improvement.
Accountable leadership begins at the top. Distinguish individual mistakes from systemic failures, and be willing to say, “This one is on me,” when appropriate. Establish transparent reviews that focus on learning and prevention. Model fair treatment and psychological safety so providers can discuss near-misses and errors without fear. Honest reporting prevents small issues from becoming major failures.
Ownership builds credibility; recognition sustains momentum. After we learn from what goes wrong, we must reinforce what goes right.
Celebrate the wins; not only the big ones
EMS is thorough in documenting what goes wrong. We must be equally intentional about recognizing what goes right. Not every victory is a cardiac save. Sometimes, the win is calm de-escalation, measured compassion or the disciplined choice to do less when less is clinically appropriate.
Recognition does not need to be elaborate. A thoughtful phone call, a handwritten note or a sincere public acknowledgment reinforces values and boosts morale. Consistent, meaningful recognition sustains engagement more effectively than annual ceremonies or generic praise. If you want a culture of excellence, acknowledge excellence when it happens.
Meaningful recognition requires proximity to the work. To see and celebrate everyday excellence, leaders must be present where the work happens.
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Lead from the field
You cannot lead EMS providers from behind a desk. Policies and spreadsheets do not capture the reality of the 3 a.m. call, the crowded emergency departments or the unit that has run nonstop for hours. Leaders who remain office-bound lose credibility, even with good intentions.
Be visible where the work happens. Ride the calls, visit stations and hold informal conversations in bays and at kitchen tables. Observe operations under stress and during routine. Presence builds trust and provides essential insight into barriers, workarounds and opportunities for improvement. Understanding precedes effective change.
Field presence reveals more than operations; it reveals people. Seeing the human realities of the job is what makes empathy non-negotiable.
Lead people, not just providers
“ EMS professionals are not call volumes, unit numbers, or staffing slots. They are people—with families, stressors, and limits. ”
Strong leaders invest time to know their crews beyond metrics. They recognize early signs of strain and intervene before issues escalate into disciplinary problems or burnout.
Empathy is a leadership requirement. Support your teams through critical incidents and personal hardship, not only clinically complex calls. Connect them to resources, peer support and recovery time. When people feel seen and supported, engagement and accountability rise, and commitment to the organization deepens.
Empathy creates the conditions for trust. With empathy established, leaders can build consistent, predictable trust that carries organizations through crisis and change.
Trust is built in small moments
Crisis reveals trust; it does not create it. Crews remember whether leaders follow through on promises, communicate honestly and explain the “why” behind decisions. Even unpopular decisions are more acceptable when communicated transparently and consistently.
Build trust by being predictable in your values and actions. Close the loop on commitments. Share context before you implement change, and invite questions. When leaders do not communicate, rumors fill the gap. When leaders communicate clearly, even difficult news is easier to absorb. You do not need perfection; you need credibility.
Trust is the cultural foundation, but culture should be measured and managed. To sustain trust and improve outcomes, we must track what matters beyond response times and outcomes.
Redefining what successful leadership looks like
Traditional measures of success — response times, budgets and compliance — are necessary but incomplete. Leadership success should also reflect retention, morale, professionalism and engagement. Supported teams deliver better patient care, adapt under pressure and remain with the organization longer.
Align performance indicators with culture. Track mentoring participation, recognition frequency, peer support utilization and leadership visibility. Gauge psychological safety and use feedback loops to guide improvements. Leadership legacy is not found in org charts or policy binders; it is found in the daily culture of the organization.
When metrics reflect culture and actions reflect values, momentum follows. That is the point at which your call to action becomes more than words, it becomes your organization’s practice.
The leadership EMS deserves
Leadership is not a promotion; it is a responsibility. Crews will tolerate long hours, difficult calls and imperfect systems. They will not tolerate indifference. They want leaders who show up, own mistakes, celebrate success and advocate relentlessly.
Start today. Visit a station. Listen before you decide. Share the “why” behind a change. Recognize a quiet win. Take ownership when something goes wrong. Lead from the field and keep people at the center of every decision. That is the leadership EMS deserves, and it is within reach.
ABOUT THE AUTHOR
Matthew Panepento is the EMS officer for Trussville (Alabama) Fire and Rescue. He also serves as a paramedic instructor at Jefferson State Community College and as a flight paramedic with Regional Air Medical Services (RAMS) in central Alabama.
Panepento’s professional interests include critical care transport, advanced cardiac care and EMS leadership development, with a focus on crew-centered leadership and high-reliability training.
He holds a bachelor’s degree from Columbia Southern University and is a licensed paramedic with experience in both ground and air medical operations.
