Teamwork and Leadership in EMS

Being a team leader can be both effective and ineffective. In think, a leader is someone who takes control and/or manages a stressful situation appropriately and most importantly, with confidence. With that comes experience and situational awareness. In emergency medical services (EMS), leadership skills are very important skills that paramedics should demonstrate effectively. If an effective leader is not present at the scene of a call, situations could become more stressful for others and sometimes even the patient you're caring for. A team always consists of a leader and the other teammates. Without a leader, there is no team and without a team, there is no leader. Teamwork and communication are key to have an effective team dynamic.

An effective leader is someone who can communicate and manage a scene accordingly. An effective leader should be able to keep their emotions to themselves during a stressful situation, know how to delegate the appropriate tasks, continue to learn and teach other personnel, be readily available for their teammates, be able to make appropriate decisions and know how to justify any decision that is being made. An effective leader is passionate and committed to what they do, can take accountability for their actions and have integrity. It is important that a leader is always open to suggestions from their teammates and listen to their ideas, as some people may have additional knowledge that some leaders may not have. They also must know how to fairly solve conflicts and disagreements. There may be times when teammates disagree with their leader, so it is essential for a leader to be open-minded to what others have to say without getting defensive or mean at all. A leader must show their team that they care about the input and suggestions others may have. This will build not only trust, but commitment as well.

Throughout your careers, you will at some points run into ineffective leaders. Ineffective leaders can sometimes have a habit of wanting to run things their own way and feeling like they need to work independently. They show no effort in collaborating with their peers or showing positive remarks as in good teamwork and/or communication. They are so focused on their own turf and wanting to build solely, that they fail to realise that the most important aspect is the organization that they work for and the people they are surrounded by. They resist goals and improvements, lack skills and competencies, may damage a company’s reputation, may also lead their peers the wrong path due to their lack of leadership skills. For instance; “

In my opinion, ineffective leaders were either taught the incorrect way or they simply are too stubborn and focused solely are there selfs.

An effective team should be able to perform well under pressure, especially in times when they are needed most, they should comparatively have the same goals while working together to achieve those goals, are honest with one and another, and are all leaders in their own way. For instance; “

A team takes a lot of time management and practice to be successful. When working with a team, one has to get a feel for the people they are working with and see the different things that people can bring to the table. A team could fail repeatedly before getting on their feet and becoming successful. One of the most important aspects of becoming a successful, effective team is to build trust with one another. I think a “team dynamic” is a team that shows loyalty, have the determination to continue to do better, teamwork and communications are their priority. Some examples of team dynamics are team effectiveness, efficiency, motivation, and performance. Without team efficiency, it is likely that the performance will suffer. Team effectiveness is the ability to perform with team members in the appropriate manor, and the ability to effectively accomplish the same goal. Motivation is when one oversees the positive performance of your team members, therefore making you want to perform well. Efficiency can be defined as practicing and working together to improve their skills, so when put into stressful situations, everyone can perform well under pressure. All of these team dynamics tie into each other to create a well performed team.

These attributes relate to a paramedic simply because a paramedic should be a leader, especially during a stressful situation. When working with an emergency medical technician (EMT) partner, they are always looking to you for the next step to help the patient or manage the scene. Paramedics have many skills, one specifically being a leader. It is key that a paramedic knows how to calm a patient and/or their family down in what may be the worst day of their lives. When on scene, paramedics work with a variety of people, such as police officers, volunteer firefighters or EMTs, nurses and sometimes even a patient's family member. A paramedic can be defined as someone who is a leader, team member, and a skilled medical professional. In addition, paramedics are both heroic and brave. A hero is courageous and is able to help during a stressful situation, especially when someone is in need.

There are times when emergency medical service (EMS) providers deal with an ineffective leader and/or poor team dynamics. It’s not always realized, but sometimes the situation could be on your hands. It can be difficult to manage a scene smoothly or delegate simple tasks to your teammates. I have had firsthand experienced with someone that was an ineffective leader. During one of my clinical rotations in the emergency department, a cardiac arrest patient was brought in by EMS. EMS appropriately performed cardiopulmonary resuscitations (CPR). The paramedic provided a full report with all necessary treatments used to accommodate the patient’s needs. Once the full report was received, patient care was turned over to the medical director, who seemed flustered. CPR was continued by hospital staff, however, the medical director failed to assign tasks to each of his teammates. As a result, the team was unorganized and stepping on each other’s toes. There was a period of time before the patient was placed on the cardiac monitor to identify their current rhythm. The medical director seemed to be more concerned on the reasoning the paramedic brought the patient in to the ED. Although good CPR was being performed, the appropriate manual ventilations were not. The team seemed very discombobulated, no documentation was being done, there was minimal communication, no team dynamics, and most importantly, there was no leader taking control of the situation. Medical directors soon after became more focused on the patient's airway. They repeatedly attempted to intubate the patient with an endotracheal tube (ETT) and when they couldn’t, they continued to try instead of using a basic airway to manage the patient's airway appropriately. The doctors could have provided rescue breaths, proper manual ventilations with an airway adjunct, and/or preoxygenation prior to another attempt at intubation. Providers sometimes forget the term “basic life support (BLS) before advanced life support (ALS).” Eventually, an experienced nurse took the lead and organized all the teammates in a mannerly fashion. They had multiple personnel rotating the compressions every two minutes, one nurse had the next medications ready that needed to be administered, and another nurse documented all the medications administered and other events that were performed. There, I saw a nurse with more experience than the medical director, take the lead. In return, I learned that the most knowledgeable person on scene won't always be the best person to take charge. Although a paramedic or a doctor are supposed to be more educated than some of the nurses or EMTs and take the lead, both in pre-hospital or in the emergency department, there are times when the other medical personnel are forced to take charge for the sake of the patient. During calls, paramedics can be put under a tremendous amount of stress and it is important that their partner assists them with whatever they need done. This can help relieve some of the pressure put on the paramedic and make the call run smoother.

In my career in EMS, I've been fortunate enough to be influenced by great leaders and see many organized team dynamics being performed. Transitioning from an EMT to a paramedic is by far one of the toughest tasks I have had to face in my career. During lab groups at school, I’ve learned the most from my classmates and instructors. Lab has taught me that with failure comes success. You must learn how to fail in order to push yourself to succeed. When I first started paramedic school, I had to try a variety of new things for the first time. With trying all these new things, I failed many times. I failed while running scenarios, overseeing a team, delegating tasks, managing a scene, administering all the correct medications with the correct dosages. All these tasks were hard for me until I could grasp the concept and succeed. Failing and picking myself back up gave me the opportunity to learn something new about myself, my classmates, and my instructors. With paramedic school almost over, I can proudly and confidently say I have improved greatly as a leader. A time where I have found myself being an effective leader while using team dynamics was during my internship. During internship my preceptor and I were dispatched on a call for “an unresponsive person.” Upon our arrival, we found a patient who was in cardiac arrest in care of other first responders. Those first responders initiated the CPR until we arrived. I was able to give the other responders tasks to be involved with the patient care. I ensured that CPR was being performed correctly and that there were minimal interruptions. Although I was being overseen by my precepting paramedic, I always confirmed with him what I thought needed to happen next, whether it was to administer a medication or just identifying the rhythm on the cardiac monitor. There was great communication between all the first responders, and everyone was able to successfully work together as a team. After ten minutes on scene with continuous CPR and manual ventilations being performed, we were able to get return of spontaneous circulation (ROSC). I attempted to intubate the patient, however, I was unsuccessful as the patient had a difficult airway anatomy. I had asked my precepting paramedic to look at what was going on. When the call was completed, my precepting paramedic gave me a compliment that I will never forget. He said “you impressed me by your maturity on that call. You failed at something but didn’t allow that to interrupt your concentration and instead decided to just pass it along to another paramedic. You will be a great paramedic one day.” One tip that I took from this call was that you are never alone and there is always help if needed. This internship has helped excel my paramedic skills and ensure that I will manage the scene appropriately and effectively.

These examples can be applied to future self-improvement by allowing providers to trust each other and continue to follow the education on leadership and team dynamics. Any EMS provider should always be learning something new. There is always something new to learn about in this field of work. It could be about learning the different medications and treatments or something as little as learning how to become a better leader while directing others in the right path. Having leadership skills and team dynamics benefits you in many ways. These skills will provide you with the knowledge needed to oversee a stressful situation knowing you are the paramedic, and you must come up with treatments in attempt to stabilize your patient. In my experiences, whether it was during my clinicals, lab group scenarios or my internship, I have learned that becoming a great leader and establishing good team dynamics comes with practice. It won’t come easy, and you won’t always excel on it. As a new paramedic, I will always take into consideration the things I have learned from my internship, clinical, lab and my instructors. Although you will be seen as the leader on scene and the one that everyone is expecting an answer from, you can never forget that you were once an EMT. Being a paramedic is a big step, but keeping your ego is key. Always teach anyone who is willing to learn the different aspects of this career and most importantly, listen and take feedback from the other first responders working on your team. Never forget that it takes a team to save a life!

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