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Saving the Dying Agency: The Value of Transformational Leadership in EMS


By Dr. Shana Nicholson and Scott Crouch

Maintaining strong leadership within Emergency Medical Services (EMS) has always been a challenge, particularly for agencies in rural areas that depended heavily on volunteers. Today those leadership challenges have shifted, as the need for continual care coverage rises and paid crews are increasingly necessary. As these paid EMS agencies have taken root around the country, volunteers have dramatically faded.

When an organization transitions to an all-paid staff, the financial burden is immense and, without strong leadership, an agency can bleed money like a patient in hemorrhagic shock. In addition, morale often plummets and the organizational structure can buckle.

Shifting to a Transformational Leadership Style
So how do you turn an agency around when it’s circling the financial drain? The answer is transformational leadership. When a new administrator takes over a financially challenged organization, an initial assessment of the agency’s personnel, apparatus, equipment, finances, and care protocols should take place.

It is important for a leader to reach out to employees to get their evaluation of the previous system as well as establish their personal aspirations for the future of the organization. The leader can then challenge his/her employees to think outside of their previous experiences. They key question is, “How can we as a team establish a brighter future?”

As the vision for the future is established, leadership can then begin to communicate that vision to the organization, its employees, and the community. The newly established leader will certainly face challenging attitudes, but gathering the support and knowledge of staff members in the face of adversity helps establish the foundation for success. There will always be negativity, but if the majority of the staff knows the goals of the agency, a sense of camaraderie and direction will emerge.

With an improved sense of direction, revenue can be increased through cohesive billing, solid response times, and efforts to acquire funding via grants, events, and community involvement. As an agency’s financial security improves, there is often a renewed sense of purpose within a department as newer apparatus, enhanced training, new uniforms, and other equipment are able to be procured. While leadership should never try to buy the affections of employees, such equipment speaks volumes about the confidence leadership and the community have in the agency and its staff.

Leaders must maintain agency progress through continual reassessment and evaluation. Maintaining clear lines of communication and ongoing support from staff members will continue to build a trust system to restore the agency’s success, despite the challenges of past growing pains.

About the Authors:

Shana Nicholson headshot_v2Dr. Shana Nicholson has more than 20 years of emergency medical and fire science service experience. Her professional background also includes government, social services, and nonprofit administration. She is currently a faculty member in emergency and disaster management at American Military University. She received a bachelor’s in criminal justice from Fairmont State University, a master’s of science in Human Services with a specialization in criminal justice from Capella University and a PhD in human services with a counseling specialization also from Capella University.

Scott CrouchScott Crouch is a retired West Virginia State Trooper. He is currently the executive director of Monongalia Emergency Medical Services through MonHealth Systems. He has been in EMS since 1983 and was a paramedic from 1991-2011. Scott holds an associate’s degree from Marshall University in Police Science and is United States Air Force veteran.



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