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

Beleaguered EMTs can use self-reflection and distance to escape bad partners or agencies


What do we do when we’re saddled with a toxic partner we can’t escape and management seems just as bad?

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After my column on toxic partners, I received a number of comments from EMTs who are stuck with a toxic partner, asking, “How do I get away from this guy, or make him understand what a jerk he is?”

A few comments displayed a staggering lack of introspection, enough so that it makes me wonder if they read the Raylan Givens quote at the beginning of the article.

Ultimately, the only common denominator in all your dissatisfying relationships is you. If you can’t get along with anyone you work with, the problem is you.

Paramedic, heal thyself

Even more distressing, but unsurprising, is the number of off-line emails I got from people afraid to comment publicly about the toxic culture in their agency. The rot permeated the entire agency, from management to ambulance crews; and anyone who felt uncomfortable in such an environment was ridiculed and ostracized as being “too sensitive” or told, “You just don’t fit in here.” Supervisors were deaf to complaints or complicit in the toxic behavior.

The sad fact is, being a jerk doesn’t disqualify you from most EMS jobs.

As long as you show up to work on time, turn in billable PCRs, don’t get any complaints from patients, don’t violate protocol in any way that places the agency at legal risk or angers the medical director, and aren’t insubordinate to your superiors, you can be a four-star jerk to everyone else, including your partners.

Absent any complaint from coworkers that falls into the sexual harassment or racial discrimination categories, these folks are unlikely to be fired. When their behavior renders them unemployable because the rest of the crews refuse to work with them, they’ll be terminated. However, many managers are leery (often unjustifiably so) of saying anything derogatory about employees when a prospective employer checks their references.

Unfortunately, saying, “The guy’s an absolute idiot, a cancer on EMS, barely competent on his best days, disagreeable and unpleasant, and we’re embarrassed that we ever hired him,” is still legally actionable, even when it’s true. Most managers won’t take the risk and will instead offer a bland but safe, “Paramedic Jones is not eligible for rehire.” And thus, Paramedic Jones is free to take his bad attitude and his meager skills to another agency with staffing shortages, so desperate to put meat in the seat that they ignore the fact that the meat is rancid.

Lather, rinse, repeat

Respected EMS chief and consultant Jon Politis refers to this phenomenon as the “cross-pollination of a**holes,” and he’s right. These people will spend their careers bouncing around from agency to agency, tainting everything they touch. They’ll always have jobs, even when what’s needed is an angry mob of former partners and supervisors with torches and pitchforks to run them out of the profession.

The same is true of management. One major failing of EMS is that we have far too many managers, and far too few leaders. The profession is full of people who bludgeon crews into submission with a policy and procedure manual, rather than inspire high performance through mentoring and servant leadership. They don’t practice responsibility upward, and they’re often the living embodiment of the Peter Principle.

They rose through the ranks because they were good employees but not necessarily good medics, and the skills they employed on the street don’t necessarily translate to a supervisory role. Without mentoring and training from their superiors, their career ladder ends in a position they are wholly unsuited for, and ultimately, to a top tier of the organizational hierarchy composed of people who are bad at their jobs.

So what do we do when we’re saddled with a toxic partner we can’t escape and management seems just as bad?

First, you take another lesson from Jon Politis: “You can’t un-jerk a jerk.” If you’ve honestly evaluated your own behavior and concluded that it’s not you, it’s them, then the only thing you can do is vote with your feet.

How to escape a toxic culture

I know that leaving isn’t an option for many of us, but that’s the only way the culture will change at many of these agencies. Eventually, the agency runs out of people willing to work for it, or the people who are willing to work there are so mediocre that the agency develops a bad enough reputation that taxpayers, municipal leaders or shareholders demand change.

“But, Kelly, I can’t vote with my feet,” you’re probably saying. “I have bills to pay, and I have roots here. There are no other available jobs.”

The fact is, there are jobs – plenty of them, with companies that value you, and treat and pay you accordingly. If you’re unable to uproot now, then bide your time until you can, and put down new roots in a community and a career where you can be happy.

Until then, practice a favorite philosophy of my Inside EMS co-host, Chris Cebollero: Don’t let someone else’s attitude determine your own.” Ultimately, you are responsible for how you treat others. Failure to acknowledge that might be the very reason your toxic partner spreads his discontent to everyone else; in his mind, he’s justifiably cranky.

Don’t fall into that trap. Focus on the good things you can, try to be kind and civil to others, and maybe your attitude will be the one that rubs off on others.

Read next: Toxic Partners: The damage they do in EMS columnist Kelly Grayson, is a paramedic ER tech in Louisiana. He has spent the past 14 years as a field paramedic, critical care transport paramedic, field supervisor and educator. Kelly is the author of the book Life, Death and Everything In Between, and the popular blog A Day in the Life of An Ambulance Driver.