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10 Signs Your EMS Base Is Toxic

10 Signs Your EMS Base Is Toxic

Be Warned

—This article is raw.

Hard to read. Hard to write. Hard to admit.

Why? Because EMS looking out for each other is a no-brainer.

Or at least something we all want as a no-brainer.

Who better to look out for you than one of your own?

Who better to take care of you than your own EMS family? Who better than an EMS brother or sister?

Caring for people is what we do.

When No-Brainers Fail

The simplest way to explain EMS workplace toxicity is:

Sometimes no-brainers fail.

Sometimes families let each other down.

Sometimes families treat each other worse than they would ever consider treating a stranger.

That’s how things get toxic in Emergency Medical Services (EMS). Air medical and EMS are the best jobs in the world when everything is going well. But when things go bad, they go really bad—really fast!

EMS toxicity is hard for me to write about. It’s a subject I don’t normally write or speak about publicly. A subject I normally save for seasoned coaching students and INSIDERS.

Why?

Because toxic workplaces suck.

Toxicity, by definition, makes people sick. It’s not a topic people want to read about. And it’s not what I want to spend my time writing about.

But . . .

I’ve watched toxic EMS and air medical workplaces chase away lots of bright, talented, motivated, good people. And once they’re gone, they’re gone! These folks never return to EMS or aviation.

We all lose when this happens.

So it’s time.

Time to share warning signs of a toxic EMS workplace and what to do if you’re infected.

10 Signs Your EMS Workplace Is Toxic

 

#1 Trauma Drama

High drama is the norm in toxic work environments.

You may feel anxious and paranoid that your colleagues are talking about you—and with good reason.

If your co-workers crucify other team members when they’re not around, why would you think you’re the exception?

Toxic, cliquey co-workers spend their EMS down time looking for ways to spread unhappiness. They level the playing field the only way they know how—by bringing others down to their level. They make what should be friendly workplace competition seem hostile and dog-eat-dog. There’s always rumors or gossip floating around the base; misunderstanding, favoritism, and infighting.

#2 The Never-ending “Lucky You Have A Job” Announcements

If you’ve ever heard the “you’re lucky to have a job” statement from your boss, Human Resources, or even other co-workers, it’s a major red flag.

This scare tactic is a means of threatening you and your co-workers into staying in a marginalized position, and is symptomatic of an organization that thrives on bullying behavior and control.

If you’ve done everything required to work as a flight nurse, flight medic, or EMS pilot; you’re the prize, not the commodity. Don’t let anyone make you feel differently.

You should absolutely consider being thankful you have a job, . . . but lucky? No. Read my wooden spoon article for more inspiration.

#3 Major Communication Problems

A sure sign of a dysfunctional, toxic workplace is significant communication problems.

Communication problems between crew. Communication problems between departments. Communication problems with the communication center. You get the idea.

EMS sometimes aggravates this situation with displaced geography. The main hospital is at one location, satellite bases are at different locations, helicopter maintenance and resources are at still other locations. But geography is secondary. It’s not the root cause of communication issues. Lack of leadership is the cause. Click here to read more about EMS Leadership.

What matters most is how you feel about communication channels within your organization.

Do you feel like you’re left out of the loop regarding important information? Do you get little to no feedback about your performance, and when you do, it’s negative and harsh — never constructive. Can you fit your bases’ annual atta-boy and atta-girl feedback on a dinner napkin?

Does your boss encourage open communication, or punish it?

#4 Narcissistic Leaders

This is one of those proverbial chicken or egg dilemmas.

It’s not clear whether toxic leaders create toxic workplaces or toxic workplaces are magnets for toxic leaders. In either case, the two go together.

What’s a narcissist and why should you care?

Put simply, a narcissist is a person who is all about themselves. Narcissistic leaders view themselves as categorically brighter and more talented than anyone else around and therefore more deserving of special treatment. The rules for everyone else are beneath them, they think.

Narcissistic leaders are condescending. They take credit for others’ successes and manipulate others (and information) to ensure that they look good. Others don’t really matter to them.

While these leaders may appear successful for a while, over the long haul their attitudes and actions catch up with them. Trust and teamwork plummet wherever they go. They are a source of high turnover rates and eventually destroy the health of the organization.

Toxic leaders might not be at the top of an organization; they often crop in mid level management and even in front-line supervisory roles.

#5 Work Harder, Not Smarter

When you are a motivated, dedicated, professional worker, an overly bureaucratic organization is toxic.

Generating paperwork only to appease supervisors or regulatory agencies is a waste of everyone’s time. If this is happening at your base or station, your leadership is failing you. Period.

This wasted time will eventually kill your motivation and your chances for success.

Leaders in good organizations work to remove obstacles to getting work done, and provide ongoing support and encouragement. Good leaders consider it part of their job—because it is their job.

#6 No Good Deed Goes Unpunished

The “no good deed goes unpunished” mentality is a sure sign of a toxic EMS workplace.

In this type of environment, everything is punitive.

Workers learn that if they stand out for any reason—make a mistake, criticize, or make a suggestion—they get attacked and/or punished. Every action ends in punishment. This shut-up-and-keep-working environment is guaranteed to stifle any sort of creativity or innovation, and leads to ever diminishing returns.

Eventually, employees in this environment lapse into what I call “vicious compliance” mode. A sort of “I’ll do exactly what the policy states, and not a single thing more” type of compliance.

Obviously, everybody loses in this type of toxicity.

#7 Nobody Wants To Lead

EMSers are smart.

EMSers have a sixth sense when it comes to health—especially their own health. In healthy workplaces, the best employees compete for the best positions. In toxic workplaces, nobody competes for anything. Open positions are handled one of two ways: nobody applies at all; or, the in-house favorite “competes” against a sudden surge of highly competitive out-of-state applicants. Please do read between the lines.

A red flag at air medical companies is when pilot management positions are staffed by pilots brand new to air medical. So you’re not qualified to fly IFR or goggles yet, but you are uniquely qualified to run the base? How does that work, exactly? Please note: this is not the fault of the newbie.

A jumbo-size toxicity flag is when pilot manager positions are staffed by non-pilots. So, you’re questioning why I turned down a flight for weather, but you’ve never actually flown (or started) an aircraft? Successful “missions” on Microsoft flight simulator do not count as Single Pilot Instrument Flight Rules (SPIFR) experience.

At the corporate level, if you see key positions like safety or operations open for long periods of time—don’t walk away, run! You do not want to work for a company that cares so little about its employees that it fails to staff key positions. This is another sure sign of toxicity.

#8 High Turnover

High turnover is a trademark of toxic workplaces.

If you’re consistently replacing operators and / or managers, you need to take a hard look at why this is happening. Sure, some people aren’t a good fit and there is a certain amount of normal turnover. But 10 times the industry average isn’t normal.

If your crews spend their downtime trying to remember all the names of past crew and pilots . . . here’s your sign. Your workplace is toxic. And don’t go thinking your barrel of toxic sludge is half full with some pending positive outcome. That’s not how toxicity works. You don’t get to pick who leaves on their own. In fact, your best and brightest are already gone, right?

Plus, the personnel challenges you were hoping would leave on their own, don’t. The socially awkward pilot who makes all your female crew members uncomfortable? Yeah, he didn’t leave. In a toxic environment, he’s your next chief pilot. See the problem?

#9 It Takes An Act of God, To Get Anything Done

Apply the reasonable person test to pending projects in your EMS organization. The results are telling.

Here’s what I mean:

Ask yourself how long it would take a reasonable person to complete any given task. For example, what is a reasonable time estimate for construction of new crew quarters? Be fair in your assessment, otherwise your results are tainted. Under normal circumstances, maybe six months to one year? Under challenging circumstances (legal barriers, zoning, special permits, etc) maybe one-year to one-and-a-half years? You get the idea. Here’s the point:

If your workplace is taking 8-15 times the reasonable person estimate, it’s toxic.

When you’re measuring event success in decades— instead of years, months, or weeks—your workplace is toxic.

#10 You Know It In Your Gut

This is the most difficult sign of all.

You already know things at your workplace are not as they should be. You watch signs of toxicity manifest and good people leave and move on.

You know you’ve “changed” certain things about yourself to “compete” in your current workplace.

It’s a shame, because you also know how hard you worked and how much you sacrificed to get here.

But you can’t seem to shake that uneasy feeling . . .

No matter how hard you try. No matter how many good cases you fly. You know it in your gut.

Moving Forward

What do you do after a reality check like the one you just read?

Only you can answer that question. Only you know what’s best for you.

From personal experience, I will confirm there is life after EMS and air medical. If you don’t remember anything else from this article, remember that no job is worth a career, and no career is worth your life.

Take a hard look at your current situation. Make a fair assessment. Then listen to your inner voice. It knows what to do next.

———

Have you ever experienced toxicity in a workplace? Share a learning experience in the comments section below.

About the Author: Troy is an Air Medical Career Expert passionate about a team approach to improving air medical safety from the ground up. Troy is a former Army medic, Army pilot, Coast Guard pilot and EMS pilot. Troy has taught hundreds of wannabe flight medics, flight nurses and EMS pilots the exact steps needed to launch air medical careers.

Comments

  1. Jeroen Straub check out this article and tell me what you think. Thanks!

  2. Ashley Spillman & Jenna Henderson can you relate to any of this? Almost hits a little too close to home.

  3. David Nahkala read this article please.

  4. Colin Pilarski you gotta read this guy’s stuff! It’s awesome!

  5. This article really hits home. I was a Communications Specialist for 8 years before being tossed out like a bag of trash, uh, I mean laid off from a great position at an Air Medical program.

    It also has great meaning and hits home in professions other than Air Medical, I would say in virtually all walks of life this exists and is quite often swept under the rug, too much work to correct.

    As with so many other aspects of our world today, pretty sad.

    • Bob,

      I’m sorry to hear it. I hope this article helps people avoid your situation. I sincerely appreciate you taking the time to comment and share your story. Thank you!

      Clear Skies & Tailwinds

  6. Ian you need to follow this guy! He’s the air medical guru I was telling Ryan about.

    • Andrew,

      Thanks for the kind words and for sharing my article with friends. I hope it helps Ian make smarter (or at least more informed) decisions. EMS and air medical looking out for its own is always the goal.

      Clear Skies & Tailwinds

  7. This exactly defines EMSA Oklahoma and Acadian as well.

  8. Hit the nail on the head with this article. 6 year in EMS wish I had read this article before I started. Any job can become toxic but I do believe EMS has the cards stacked against them to become toxic.

    • Nate,

      Thanks for the feedback. If things are difficult for you right now, I hope they improve quickly. And that’s really the point of the article –awareness.

      I think a lot of times EMSers truly don’t realize they’re treating each other badly. Sometimes awareness is enough to make noticeable improvements. Sometimes it’s not and it’s just time to move on to a different EMS workplace, or in some cases, a whole new career.

      Thanks again for taking time to comment.

      Clear Skies & Tailwinds

  9. I really enjoyed this article. Could you possibly do a follow up on how to address these issues in the work place and prevent them from developing?

    • Trey,

      Thanks for your feedback. I appreciate you taking time to comment.

      You are one of many to request additional information. In fact, the email response to this article was overwhelming.

      Here is a follow-up article that addresses your request. I can’t address every situation and circumstance, but this article does give a solid starting point for improving toxic work environments. Here is the link:

      http://flightsafetynet.com/a-quick-fix-for-toxic-ems-bases

      Thanks again for your question.

      Clear Skies & Tailwinds

  10. Wilmar Espadin you need to check this out! Lots a really good info on this guy’s blog for becoming a flight medic.

    • Ricardo,

      Thanks for recommending Wilmar. I hope he sticks with it. Flying air medical professionally is a great career.

      Thanks for taking time to comment.

      Clear Skies & Tailwinds

  11. I’m currently trying to figure out how to combat an EMS house like this. This article offers a lot of insight and I plan on sharing it with my crew.

    • Jack,

      Thanks for commenting. It’s absolutely possible to fix each and every toxic situation. Believe it or not, a lot of times it has a great deal to do with awareness. Once you sit somebody down and explain this (signs and symptoms) is how you’re making your co-workers feel, this is how your co-workers perceive your actions, etc, the person receiving the information (toxin creator) is so shocked they immediately start taking corrective actions. So why doesn’t everybody just take these actions? Because it’s a lot easier to do nothing than have difficult conversations with people.

      Anyway, I hope that makes sense. Good on you for taking action and trying to make improvements. Let us know how you make out.

      Clear Skies & Questions

      • “You’re against change. You’re not a team player. You have a bad attitude.” These are the words my husband was told when he sat down and to explain to his “toxic creator” how he felt about the toxic workplace he was in and about how other toxic idiots he worked with made it difficult, if not impossible, for the ones who knew what they were doing to keep the place responding to E-911 calls effectively. His best friend, a 30+ year professional quit the day the phones were melting down and their director walked in to announce, “Nobody answer the phone unless it’s an emergency.” He stood up, tore off his headset and said, “Every damned thing in here IS an emergency,” and walked out.

        I had worked for the same agency in a different division. The director had asked for representatives of each division to come to a meeting to discuss a way to improve the moral issues. He talked about the rumors he’d heard, which were barely affirmed by the people in the room, then asked what could be done to improve the problems. These people who had for over a year been bitching in the parking lots and bays were suddenly suggesting the silliest things, like getting an ice machine for the kitchen in the base, making sure the fridge was cleaned out once a week and people labeled their food containers, having a group picnic or holiday parties. He went around the table asking each person for ideas and that’s all they were coming up with. I declined to comment multiple times, telling him he didn’t want the truth. But when he insisted I told him that if you put icing on a cake made of poop, no matter how great the decorating, it was still a cake of poop when you cut into it. A month later I was out of a job due to “budget cuts.”

        If you are in a place with bad leadership, it’s because the person in charge isn’t a leader, they’re a manager. Managers “manage”, always looking over your shoulder and constantly criticizing your work while looking for ways to make you feel small and threatened; making rules for everyone to follow about every little thing based on things people do instead of correcting one person’s bad behavior; promoting those who are a problem and giving more work to those who do their job well. All they care about is getting to the top where they can make more money and have prestige.

        A leader leads. Seems like a simple concept, but it’s not. A leader sets the example they want everyone to follow. They will work harder, longer, better than anyone else in the organization so that everyone else is so inspired that they will do all they can to live up to the ideals that leader instills in them in order to gain the respect of the leader. The leader demands respect as equally as he gives respect, is fair, just, honest, kind, generous, open and allows people to solve problems using their brains and intuition. They give work assignments, resources, information, then allow people to do their jobs knowing that stuff will happen because the people who were hired are there because they were experts in their field. (Here’s where I slightly disagree with your article, in that as a leader I don’t have to be a pilot to know if my pilot comes to me and says the conditions are too dangerous to fly regardless of the AWAS info. then I’m going with what my PIC says and not the AWAS. Just saying. And I’m not a pilot.)

        The problem now is that we’ve had too much tv and movie time of the smart assed, tough, cocky arrogant emergency service people who push people around, and they get rewarded for being that way in the soap opera of entertainment. But, as Wanda says below, if you are in it for the right reasons, you had better be really mature and tough, knowing that if you are right you won’t get promoted, you won’t get the pay raises, you won’t be popular. What you will get is the satisfaction of doing an important job that impacts lives in ways most people never get a chance at, and only you and they will know it. If you’re cool with that, cool. The workplace of emergency services will always be toxic, because it’s loaded with adrenaline and big egos, something that’s really important for that kind of job, but at least talking about it may bring the level down to a less lethal dosage.

  12. Awesome article, spot on!!

  13. Great article! It really needed to be said. The lingering effects on those thrown out with the trash are endless. Unfortunately it is a career for strong willed and independent personalities. Adrenaline junkies! So drama becomes a way of life. When there is down time, drama is created and breeds a lack of trust and respect. Those being cut down, lose there confidence and self esteem. It becomes a dog eat dog work place. If you do not join in with the conspirators, you become a target. Pretty soon, the target is hit so often, there is no fight left. Standing up for yourself gets punished and nest thing you know, you are out the door. And you are right, never to return. It can be the most rewarding job in the world, when the focus is on those you help. But when too many people come along for the wrong reasons, the workplace becomes toxic!

    • Wanda,

      Thank for re-stating some of the concerns mentioned in the article. My hope is that if we create enough awareness, we can effect positive change. I also hope that’s what happens for you personally if you’re currently working in an environment similar to the one you described. Let me know how it works out for you.

      Thank you for taking time to comment and share your thoughts.

      Clear Skies & Tailwinds

  14. Excellent story! As Kevin stated…spot on!!!

    • Kelly,

      Thanks a bunch!

      I appreciate you taking time to comment and also your kind words. Sometimes being right sucks. This is one of those times. I’m hoping a little bit of awareness will go a long way. Toxic workplaces are fixable. But like anything else worthwhile, it takes a little bit of effort and work.

      Thanks again for commenting.

      Clear Skies & Tailwinds

  15. Great work!

  16. Mr. Shaffer, thank you very much for this article. I am glad to see that I am not alone when I look around at my paramedic job and co-workers and I see a systemic level of dysfunction.

    • James,

      Thanks for sharing your experience. Remember that awareness of the issue is the first step to fixing the issue. A lot of times people just don’t realize they’re treating each other badly, until somebody brings it to their attention. It’s ironic that professional caregivers treat each other badly, but sometimes they do.

      I hope that makes sense and helps you.

      Thanks again for commenting.

      Clear Skies & Tailwinds

  17. I know someone who’s an air medic over night shift, one pilot and a female nurse, when does it become toxic with opposite sexes? Do bad and good feelings happen when u work that many hours so closely together. Eventually u do get on your last nerve…to me it would feel like a bunch of chickens pecking at eachother when we are talking toxic work environments…

  18. Management…. Say no more.

  19. Yep

  20. Great and true article with ALL agencies in public safety!

  21. True. One problem is that toxic leaders hire followers. They push out leaders because they fear them.

    • Van,

      You make a good point. I have to think about that one, or at least think about the best way to approach solving the issue. Thanks for sharing your experience.

      Clear Skies & Tailwinds

  22. So we’ve identified a toxic work environment. How do we fix it and make it non-toxic?

  23. Fantastic article! As I read it, I thought maybe you had done an observation of the company that I used to work for. I was a pilot in an air ambulance outfit that fits nearly every point in your article to a “T”. I wish I had read your article back then, I may have gotten out sooner and saved myself some serious heartache. Loved the job and the people but the dynamics of the few malcontents made it practically unbearable.

    • Dennis,

      Thanks for the feedback. The scary part is just how many people feel as though this article was written about their specific circumstance. It’s a testament to how much improvement is needed. Thanks again for sharing your experience.

      Clear Skies & Tailwinds

  24. Moroni Breitbart

    Great article. Easy to fix many of the problems.
    One of the first is to mandate the FAA to step in and treat EMS exactly like any other regulated aviation organization. The pilot(s)…and ONLY the pilot(s) run the aircraft and make decisions. Unfortunately, the fact remains that a medic or nurse have no more say in a pilot’s decision making than a flight attendant has in the cockpit of an A-380. To any rational, thinking person, and from a technical/legal aspect, there is no grey area. Fix this and many of the problems you speak of will go away.

    Another giant step is to stop hiring bubble-gummers to fly the aircraft. Mandate 8000hrs (example) and stick with it. Anyone who’s been in the business in the past fifteen years knows that the low time pilot is not only hired to keep expenses down, the primary reason is to have a pilot that will take a flight request, check the WX, and carefully approach the Med Crew to ask…”what do you think?”. Unfortunately, it’s none of their business. Want to make LZ, WX, and departure decisions? Join the Military and fly for years, or pay out $100K+ and work your way up until you have the time to professionally and safely pilot a SPIFR twin helicopter while giving the Med Crew total confidence in your ability.

    • Moroni,

      Thanks for commenting. You’re obviously experienced in EMS and Air Medical.

      I appreciate you taking time to comment and share your perspective.

      Clear Skies & Tailwinds

  25. “Horizontal Violence” is common in the nursing profession, judging from my past experience and the numerous websites, articles, books and consultants addressing it. Do a simple google search and you will be kept busy for quite a long time. Naturally this bad culture has become a part of many EMS bases, where a just culture is nonexistent. After 20 years in EMS, I now fly in another part of the aviation industry and am much happier. It’s amazing how much happier my coworkers are and how well they work together and get along. I still have friends in the medical field, and whether you are talking about an EMS base or the hospital environment nothing has changed. The biggest problem seems to be the lack of leadership, which either doesn’t think there is a problem or they don’t know how to address it. Either way, it’s a failure of leadership.

  26. #7, #10..moving forward. Good read. Thank you.

  27. #10 was what made me think of you and conversations we’ve had.

  28. Yes..and that’s exactly how I feel. Looks like it’s happening enough to make an entire article out of it.

  29. I hate to say it, but all of these are why I left EMS. I loved the field itself, I just hated how it was ran. I will admit that I am was not the perfect EMT, and maybe I should have given it more time. I held 2 full time EMS jobs, plus some PRN third shift on the side ones. With one, the field supervisor was an EMT who thought he was a paragod, checks always threatened to be withheld, forced OT- where you didn’t have to pick up OT but if we didn’t they would find someone who would. Having FTOs with half the experience I did. Shitty rigs that would break down constantly. Management that had no idea how EMS worked, (literally didn’t think Narcan was worth the cost…). My second EMS job was a lot of the same, just this boss was an actual Paragod and wouldn’t hire extra paramedics because they didn’t like the way they were a paramedic. I just could’t stand it anymore, so I left the field. It was a drain on my relationships, life, and overall health. Egos got in the way, we were under appreciated, forced to do thing or risk being let go. I have seen all 10 of these at both of my jobs.

  30. Susan Sembach read this!

  31. Sounds pretty spot on!

  32. Great article!

  33. Your article was well-written and comprehensive and raised many good points for people to consider when dealing with co-workers, both when you feel you are not being treated properly and when making sure to treat others just as properly.

    I realize that your field has its own challenges and rewards…but frankly, where you work has nothing to do with this information. Everything you said is true of every office at every company where I ever worked. The title should be changed so that more people would read it. Right now it appears to be discussing only a section of the medical field, but I assure you, it is true of way too many places where people spend their days to support themselves, their families and who want a job where you help and support others. Whether you are solving a problem for an employee, soothing an angry customer, providing your employer with information needed for both of you to succeed, or just representing your company to the public, it is important to know these signals and signs and be able to steer your career and goals toward a satisfying end. Thank you for your article but it really needs to spread its wings. Dee Brandvig, 30 years experience as Administrative Assistant for several companies’ Presidents and Vice Presidents.

    • Dee,

      Thank you for sharing your perspective. I have no reason to doubt your expertise in areas outside EMS and Air Medical.

      Having said that, I deliberately write for EMS and Air Medical; and specifically for folks on the EMS Flight Safety Network team – air and ground.

      I appreciate you taking time to comment and share your perspective.

      Clear Skies & Tailwinds

  34. #6 really hits home for me. But the whole article is true in EMS.

  35. Ray Gulcynski you gotta read this article! It is spot on!

  36. A good read for Wichita Crews:-)

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