In EMS, resilience has long been viewed as the defining trait of strong leadership — the ability to bounce back from adversity, recover from crisis and carry on despite the odds. However, the landscape in which EMS leaders now operate is fundamentally different from the one that shaped the traditional resilience narrative.
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Today’s leaders face a volatile, uncertain, complex and ambiguous (VUCA) environment marked by persistent workforce shortages, rapid technological change, mental health challenges, reimbursement instability and societal transformation.
Within this reality, “bouncing back” is no longer enough. Resilience enables recover, but presilience — the proactive anticipation for future disruptions — enables endurance, growth and evolution.
Resilience and presilience: What’s the difference?
Resilience has a strong foundation in leadership and organizational science. It is marked by the capacity to endure adversity, recover equilibrium, adapt and persist. Research defines resilience as “the ability to regain balance following exposure to an adverse event or events” [1]. Resilient leaders demonstrate adaptability, emotional intelligence and calm decision-making under pressure [2]. Within EMS, resilience is linked to reduced burnout, improved mental health and stronger team cohesion [3].
“ Presilience is proactive and anticipatory. It represents a leadership approach that does not simply weather storms, but anticipates, plans for and grows through them. ”
However, resilience is primarily reactive. It begins after a stressor occurs and focuses on responding, recovering and returning to a previous or slightly improved state. This is extremely valuable, but it assumes that there is a “normal” state to return to. In EMS, the new normal is abnormal, diverse and constantly evolving.
Presilience, on the other hand, is proactive and anticipatory. It represents a leadership approach that does not simply weather storms, but anticipates, plans for and grows through them. It incorporates adaptation, and opportunity orientation. Presilience asks leaders to build the capacity to evolve before disruption demands it. In the simplest of terms, resilience means bouncing back while Presilience means bouncing forward or, better yet, not being knocked down in the first place [4].
For EMS leaders, resilience means surviving a surge, recovering from a major incident and sustaining the workforce after trauma. Presilience means designing systems that anticipate surges, creating workforce models that adjust before collapse and cultivating innovation so that disruption becomes an advantage, rather than a setback [3].
Why resilience remains critical but alone is not enough
Resilience remains an essential leadership capability. Research shows that resilient leaders foster psychologically healthy workplaces, reduce burnout and improve retention. A recent study of EMS personnel found that optimism, emotional stability and social connection correlated with resilience and reduced psychological distress [3].
Similarly, wellness programs and peer-support initiatives are increasingly used to enhance resilience among EMS professionals. Yet, resilience by itself falls short in several ways:
- It reacts after disruption rather than anticipating it
- It assumes a return to a steady state, even when that state no longer fits the current reality
- It can overlook innovation and growth in favor or restoration
An EMS service built solely on resilience may survive repeated crises, but will struggle to thrive amid the constant evolution of clinical practice, reimbursement models, technology and community expectation.
Implementing presilience in EMS leadership
To operationalize presilience, EMS leaders can take several strategic actions:
1. Scenario and contingency planning
Presilient leaders are constantly asking “what if?”
What if a cyberattack shuts down our CAD system?
What if hospital diversions triple overnight?
What if our next pandemic is more aggressive?
These questions, often fueled by a leader’s natural worry or hyper-vigilance, can become powerful tools for foresight and readiness. The key is to transform anxiety into structured curiosity. Rather than being consumed by “what might go wrong,” presilient leaders use those questions to design flexible staffing models, diversified supply chains and backup systems that make their organizations more adaptive [1].
2. Adaptive culture
Encourage experimentation, rapid learning and iterative improvement. Leaders should model curiosity, humility and openness to change while fostering psychological safety within their teams. When teams see their leaders openly asking, “what if” and exploring multiple features, they learn that anticipation is a shared responsibility that than an individual burden [1].
3. Workforce readiness
Strengthen the human infrastructure before crises occur. This includes investments in wellness, peer support and training that builds readiness in addition to recovery. Encouraging staff to think about “what if” scenarios builds a sense of control and confidence instead of fear, empowering teams to act decisively when uncertainty does strike [5].
4. Learning and growth from disruption
Treat each disruption as a learning opportunity. Conduct after-action reviews, document lessons learned, and integrate improvements into policy and practice so that the organization continually advances. Presilient leaders ask, “What happens if this happens again?” — not with dread, but with the intent to ensure that next time they are stronger and faster.
5. Innovative systems
Develop agile operations that can reconfigure quickly, such as modular resource models and decentralized decision-making. Workforce adaptability is one of the strongest predictors of success in uncertain environments [5].
6. Risk and opportunity mindset
Redefine how risk is viewed. Rather than seeing it only as a threat, presilient leaders see risk as a potential driver of innovation (risk = opportunity) [4].
For decades, EMS leadership has celebrated resilience as the key to survival in a demanding and unpredictable profession, yet survival alone no longer defines success. The EMS systems of today require leaders who are not only strong in the face of adversity, but also strategic in anticipation of it.
Presilience transforms leadership from reactive endurance to proactive evolution. It invites leaders to channel their anxiety into insight, to use “what if” as a compass for growth, and to build organizations that thrive amid our increasingly VUCA environment.
REFERENCES
- Southwick FS, Martini BL, Charney DS, Southwick SM. (2017). Leadership and resilience. “Springer texts in business and economics” (p. 315–333). Springer International Publishing. https://doi.org/10.1007/978-3-319-31036-7_18
- Coates C. (2021, August 26). Resilience, culture, and the role of EMS leadership. Available at: www.lexipol.com/resources/blog/resilience-culture-and-the-role-of-ems-leadership/
- Hebel K, Jałtuszewska S, Steliga A, Kłosiewicz T, et al. (2025). Resilience as a personality trait and stress coping styles: A cross-sectional analysis of a paramedic student cohort. “Journal of Clinical Medicine,” 14(6), 1878. https://doi.org/10.3390/jcm14061878
- Schneider G. (2024). “Presilience: How to navigate risk, embrace opportunity, and build resilience.” Amplify Publishing.
- National Association of Emergency Medical Technicians. (2024). “EMS health, wellness and resilience.” Available at: www.naemt.org/resources/wellness
- Brassey J, DeSmet A, Maor D. (2024, December 6). “Developing a resilient, adaptable workforce for an uncertain future.” Mckinsey.com. Available at: www.mckinsey.com/capabilities/people-and-organizational-performance/our-insights/developing-a-resilient-adaptable-workforce-for-an-uncertain-future
