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We cannot afford to ignore the EMS elephant of an aging leadership

Planning for the future of EMS begins today, with tips on how to start succession planning and training the next-gen leader at the local and national level


Above all, do something to prep the next-gen EMS leader. We may be aging to the point where we will soon need their services.

AP Photo/Josh Edelson

In 2019, I presented the opening plenary session at the American Ambulance Association’s Annual Conference and Tradeshow, where I highlighted some of the EMS elephants in the room. The elephants in question ranged from some of the more obvious, like the increasing lack of volunteers, to the unrealistic expectations of municipalities issuing requests for proposals that have little basis in the financial realities of running an EMS system.

The one point that had great resonance in the auditorium was the elephant of our aging workforce. As we head toward the world envisioned in the EMS Agenda 2050 – which envisions people-centered innovative possibilities to advance EMS systems, I asked those attendees in the room who would still be working in 2050 to stand up. As AAA is a conference for leaders, not many people stood, which made my point elegantly. The onus is on us as leaders of yesteryear and today to select, train, mentor and lead our junior management and supervisors to take over the reins.

Getting older is a chronic condition and, in the next decade, those who signed up because of Johnny and Roy will most probably be signing off. In addition to all the other “to-dos” on the EMS survival list, training our replacements, developing future leaders and getting ready to pass the baton must be a key activity. Institutional knowledge is power, but if it is not bequeathed, it disappears the first day of an employee’s retirement.

Where do we begin? The answer is to start the journey with a small step. By way of example, an organization’s budgeting process always seem to be a closely guarded secret, yet it sits at the heart of the organization and lubricates the flow of the business. In the words of an influencer in my managemental life, an EMS budget is like a “Bucket of Money” – if we do our jobs properly and responsibly, the bucket will fill, we can make payroll and support the good things like bonuses, pay rises, new equipment and advanced training. If we are poor stewards of the said bucket, it hemorrhages cash and all, including patient care, suffers. The solution is to ensure those in charge at every level understand how the budget works and regularly monitor and adjust going forward.

At the Richmond Ambulance Authority, I instigated a monthly financial review with all my direct reports and other guests (field supervisors all got the chance to attend as well). The team all became accustomed to attending with their ruler to follow the budget line as we discussed in detail the items that were of concern. We discussed budgeting, expense tempo, timing and drilled down into both under and overspends. All bred understanding and ensured focus. Small steps lead to giant leaps! Training or mentoring breeds knowledge, understanding and education, which in turn leads to the confidence to do the job and make decisions or at least create a course of action to drive to success.

Opportunities to prep the next-gen EMS leader

At the local level, open your business practices to your junior management. Let them take part in (or at least as described above, gain insight into) the budgeting process. Develop local leadership events or academies to introduce up and coming staff to the business of EMS. Make use of leadership and management classes offered by neighboring agencies and organizations to benefit your organization. Local initiatives, such as participation in regional citizens academies, leadership programs or even the retail merchants’ associations and chambers of commerce may all provide leadership training as well as all important local networking opportunities.

At the national level, identify, highlight and celebrate your future leaders. This is an opportunity to recognize exceptional rising leaders as the future of EMS.

Look out for a number of leadership development classes and boot camps being offered around the country from respected organizations that offer a combination of online and residential classes.

For public sector organizations, make use of the free resource offered by the Emergency Management Institute. Federally funded, minus the weekly food check, all is free including travel, and classes provide leadership and management related programs, as well as PIO training.

Above all, do something to prep the next-gen EMS leader. We may be aging to the point where we will soon need their services.

This article, originally published in January 2020, has been updated.

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.

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