Does your agency have a toxic leader?

4 ways to weed toxic leaders out of your EMS agency and how to cope if your boss is one of them

By Jay Fitch

Toxic EMS leaders often cause caregiver dissatisfaction, low productivity, conflict, stagnant innovation and a higher than normal turnover rate. Unfortunately, in many EMS organizations, toxic leaders are a painful but undeniable reality. With their destructive behavior patterns and dysfunctional interactions, they create a disillusioned and demotivated workforce. Let’s examine how toxic leadership creates stress, how it develops, some common characteristics and what to do about it.

One of the biggest yet perhaps underrated factors in EMS provider emotional health and wellbeing is the workplace environment. We deal with an undeniable level of stress while caring for the critically ill, injured and those who may be sub-acute but believe they are in crisis. To cope with that level of rescuer stress, the EMS workplace has become essentially a second home, even the main home for many people. When relationships in the workplace become a source of additional tension for caregivers, that stress can take a larger toll than we initially realize.

Toxic EMS leaders are typically frightened individuals who have developed ineffective behaviors to cover their irrational fears.
Toxic EMS leaders are typically frightened individuals who have developed ineffective behaviors to cover their irrational fears. (Photo/Getty Images)

Accordingly, an EMS workplace structure that emphasizes positive mental health practices and emotional support is crucial. Sadly, though, the EMS workplace culture is lagging in terms of awareness or prioritization of these wellness issues. Often, leadership is one of the most important factors in setting the tone for a workplace’s emotional culture. Unfortunately, leadership can also be one of the major causes of stress in the workplace when an EMS leader displays certain behaviors and characteristics that contribute to a negative, even hostile working environment.

How toxic leadership develops

Toxic EMS leaders weren’t born that way. They develop or devolve over time. Like rust on an ambulance or cholesterol in your arteries, it develops in small deposits and then becomes a larger problem. However, there are usually some precipitating incidents that set the toxic ball rolling early in life. Values and the sense of right and wrong are usually imprinted by age 7, according to management guru Morris Massey, PhD.

For most people, a fearful incident or series of them in childhood threatens the need we each have to be loved and accepted, valued and significant, and safe from harm. In those moments of fear, we generate theories of how to protect ourselves later in life. Because we usually produce these beliefs before age 7, when we first have the ability to think logically, they are automatically irrational. These theories include ones like: “I need to be shy and pull back to make sure I’m not rejected;” “To be seen as competent, I must prove that I am smart and make sure I get all the credit;” or “I must make sure people around me are not seen as more competent than me or I may be replaced.” Over time and at a deep level, a leader can feel like a fraud in the role and work hard to compensate for their perceived inadequacies. Inappropriate compensation can lead to undesirable leader behaviors.

10 Characteristics of toxic leaders

One of the most definitive descriptions of toxic leaders was developed by Colonel Denise Williams in her landmark paper about military leaders, originally published in 2005, including these 10 characteristics:

  1. Bully Leaders: those who inflict emotional pain, threats, insults, and invalidate the opinion of others.
  2. Self-Absorbed Leaders: those who are arrogant, self-congratulatory, heavy-handed, and overbearing.
  3. Divisive Leaders: those who are like the narcissistic leader but channel their arrogance toward one person or group of persons.
  4. Insular Leaders: those that form cliques and that ensure their friends enjoy special privileges.
  5. Hypocritical Leaders: those who rarely practice what they preach.
  6. Enforcement Leaders: those only interested in pleasing their superiors; so anything goes to accomplish that task.
  7. Callous Leaders: has a blatant disregard for his subordinates’ welfare or desires.
  8. Senior Preference Leaders: gives preferential treatment to those who served the longest.
  9. Credit-hog Leaders: takes credit for the success or contribution of others.
  10. Blame-shifting Leaders: these are quick to point the finger for anything that goes wrong.

Understanding these 10 common characteristics are necessary to spot a toxic EMS leader and develop strategies to deal with them as an individual and as an organization.

Dealing with toxic leaders

As an individual caregiver, recognize that a supervisor or leader’s toxic behaviors are not the result of anything you have said or done. The foundation for the toxicity was laid long before they met you. Toxic EMS leaders are typically frightened individuals who have developed ineffective behaviors to cover their irrational fears. Try not to let your own fears and faulty beliefs cause you to overreact to these people, but, rather, take a breath and respond to them as calmly and rationally as you can. 

Here are six specific strategies EMS providers can use when dealing with a toxic boss:

  1. Accept the fact that you cannot change the boss. Adopt new methods of interacting to accommodate the shortcomings and toxic boss tendencies.
  2. Work hard to know and understand your boss’s strengths and weaknesses. This information should put caregivers in a better position to use their own emotional intelligence to find more effective ways to communicate and interact daily with their bosses.
  3. Demonstrate your value. The objective is to be the person who is given the hard tasks, time-critical missions, and highly visible requirements, even if the boss displays leadership characteristics that might be considered toxic.
  4. Communicate on their terms. Most bosses have a preferred style of communication. Figure out how to best approach the boss and create an environment and communication approach that facilitates useful, positive discussion, rather than triggering the boss to respond in the opposite manner.
  5. Always show respect for your boss, even if it is undeserved. It’s a simple rule: if you do not have something good to say about your boss, then it’s probably best to keep your mouth closed.
  6. Know when it’s time to go. If your boss is dragging the entire department down because of bad behavior and an ineffective leadership style, it might be time to dust off the old resume as bad things might be coming.

As an organization: Work diligently to address underlying cultural issues. Here are four factors that should be considered:

  1. Don’t hire toxic leaders. A leadership assessment should be conducted for internal hires. For external hires, the assessment should be paired with an in-depth structured interview. For executive-level leadership roles, use a battery of assessments that identify strengths, styles, and warning signs along with an in-depth interview that identifies motivational fit.
  2. Regularly use 360 feedback instruments. We recommend bi-annually administering a recognized 360-degree feedback instrument that can be used to benchmark behaviors. Using an independent agency to conduct the survey helps reassure raters that their specific responses are confidential. Provide in-depth feedback on the instrument and use it to create a development plan. 
  3. Appropriately use coaches and consultants. Hire an executive coach or consultant who is competent and confident enough to dig into the underlying dynamics of the toxic behavior to ensure that the individual will gain insight about the irrational fears and faulty beliefs, as well as develop new leadership strategies. 
  4. Require accountability. Make certain the individual supervisor or leader is held accountable for the behavior changes identified. This includes making the successful behavioral change a part of the leader’s performance appraisal and a significant factor in the leader’s continued involvement with the organization.

In summary, toxic leaders impact multiple facets of the organization’s culture, productivity and success. Recognize undesirable leadership characteristics early and work to address them for the benefit of caregivers and the community the EMS organization serves.

Read next: Toxic management: How a rotten culture can infect all levels of EMS

Additional reading on toxic leadership

Learn more about toxic leadership with these resources:

About the Author

Jay Fitch, PhD, is the founding partner of the EMS/public safety consulting firm Fitch & Associates. He has been an instrument-rated pilot for over 15 years. He serves as the co-chair of the Pinnacle EMS leadership conference and is a founding commissioner of the American College of Paramedic Executives. Contact him at

Recommended for you

Join the discussion

Copyright © 2022 EMS1. All rights reserved.