5 Ways EMS and Air Medical Go from Good to Great

— Teamwork, Communication, Common Sense, Leadership and Just Culture

As director of EMS Flight Safety Network, I get lots of questions about what makes air medical programs great.

I always answer the same way:

“All EMS and air medical programs do great things.”

Easy answer . . . and completely true.

Plain and simple, if you’re involved in saving a life, you’re involved in greatness.

Most people get this straight away. It makes sense to them. It’s easy to believe. And they want to believe it.

Here’s the catch —and a harsh reality:

There’s a big difference between doing great things and being great at what you do.

Reality is all air medical programs do great things, but very few are great at what they do. The last sentence may sting a little depending on your background.

Air medical crews (like most of us) are great at receiving high praise. They’re used to getting it. They believe it. And often they deserve it. The general public adores air medical. Ground medics and nurses want to be air medical.

All good.

Or is it?

Are you old enough to remember the “Lost in Space” episodes where the robot warns its family of signs of trouble by flailing its arms and shouting “Danger Will Robinson! Danger!”

Either way, you get the idea.

This is a danger moment for EMS and Air Medical.

Here’s why:

It’s really easy to start believing your own press when it’s all positive. It’s really easy to accept praise as an accurate assessment of your skills. It’s really easy to maintain the status quo when all you hear is how great of a job you do.

But it’s also very dangerous.

Think about it. Is your program really becoming better and safer if all you do is pat each other on the backs and remind each other the public thinks you’re great?

And what about you?

Does constant praise make you feel safer? Are you reaching Maslow’s self-fulfillment hierarchy quicker? Is the kool-aid working like it’s supposed to?

Or at some level do you just know better?

Is there a part of you that says “That was not smart. We need to do better. The end does not always justify the means.”

I’m guessing there is.

That’s the reason for this article. It’s about making you better . . . for real.

“The only people who are mad at you for speaking the truth are those people who are living a lie.” ~Anonymous

If you’re EMS or air medical, you already know how easy it is to fool the fans. You can get fan-boy or fan-girl praise any time you want it. You’re probably already getting more than you want. At some point, people need to leave you alone long enough to get your paperwork done, right?

This article is about understanding what gets results. Real results.

Put aside the world of political correctness, participation trophies and kid gloves. Let it all take a backseat for the next couple minutes.

This is about making you a better EMS and air medical operator. An EMS or air medical operator who does everything safer and better.

Below are tools to help you think critically about how to build a better you, and ultimately a better EMS and air medical organization.

An even harsher reality:

If you believe me when I say there’s a difference between “doing great things” and “being great at what you do”, you may be ready for the next step?

But be warned. You’ll have to open your mind even further.

Are you ready?

Here we go.

Do you think it’s possible some air medical programs intentionally try to confuse the two concepts?

Intentionally try to create the illusion that doing great things makes them great at what they do?

I do.

Because I think it’s a lot easier to hide behind “we do great things” then it is to admit “we didn’t do that so great.”

If you’re willing to consider this possibility, I can help you. I can help you go from good to great.

Improve any of the five areas below and you will see a marked difference in your program. Improve them all and you’ll truly be on the path to success, safety and greatness.

Go from Good to Great

Here are five areas of influence to take you and your EMS or air medical program from good to great:


This word gets lots of attention. It’s tossed around freely. The problem is attention doesn’t always equal results.

If you want results, start with you.

Reach out. Help. Follow-up.

Team players give more than they take. Team players ask more than they tell.


“Say what you mean, mean what you say.”

Sounds simple, right? The problem is that communication in EMS and air medical isn’t simple.

It’s critical. It’s time sensitive. It’s sometimes life or death.

It’s also a skill that deserves unlimited training and attention, but gets very little.

Again, start with you. Share your last batch of emails with a friend or your spouse. Let them read your emails and tell you what they think it means.

The results may surprise you.

Common Sense

I’ll spare you the cliches and quotes about common sense lacking.

Here’s the good news:

Nobody ever complains about something being too simple or too easy to do.

That’s your starting point. Look at how to make things easier or simpler. Common-sense is the natural by-product of both.


The lack of leadership in EMS and air medical is stunning.

I sometimes wonder if we could do any worse if we intentionally tried to do worse.

I know how harsh that sounds. Unfortunately, it’s still true. It’s past time to do better.

EMS and air medical crews deserve better.

Start here: Am I asking the people I lead to do anything I haven’t done? Or wouldn’t still do myself?

If your answer is yes, you owe it to your people and yourself to re-think it.

Just Culture

Sadly, aviation learned of and about “just culture” from the medical field.

Just culture is about creating a work environment where people can make mistakes, admit to their mistakes publicly, and do so without fear of retribution or job loss.

From a pilot perspective, this sounds almost surreal and fantasy-like. And herein lies the problem. It shouldn’t sound like fantasy. It should be believed and practiced. It’s real!

No joke: the first time I heard about just culture I thought it was a complete lie and nothing more than the latest and greatest setup to come out of the chief pilot’s office. It took no less than 14 months of hearing about it from pilot peers to believe it was real. To date, I don’t know of any pilots who have actually used it.

Clearly, there is still room for improvement.

Kudos to the medical professionals for trying to implement just culture.

Start by spreading the word about just culture internally. People need to understand it and believe it before than can practice it.

Where To Go From Here

If you feel like I barely scratched the surface on the topics above, you’re absolutely right.

I’ll write about each of the areas of influence over the coming weeks and months.

This article is to get your proverbial creative juices flowing; to help you start thinking critically about what works. Focus on teamwork, communication, common-sense, leadership & just culture to get moving in the right direction.

Do you care about EMS and Air Medical getting better? Leave a comment and tell us what you think.

Connect with Troy on LinkedIn here.


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Troy Shaffer
Troy Shaffer

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.

    5 replies to "5 Ways EMS & Air Medical Go from Good to Great"

    • Jeffrey Muller

      This article hits me square in the chest. I have been in professional EMS for 8 years and within the last 6 months took a new position at a larger hospital in a bigger system. When I was working in smaller systems I got frequent praise from providers and co-workers that lead me to believe “I do great things so I am great at what I do.” My eyes have been opended and now I am exploring ways to make myself better. I look forward to more articles similar to this!

      • Troy Shaffer


        Thanks for sharing your experience. And rest assured you’re not the only person to feel this way or fall into the “self-praise” trap. Kudos to you for having the humility to realize you can do better. Many folks never achieve the progress you’ve already made. Thanks again for your comments. It will definitely help others succeed.

        Clear Skies & Tailwinds

    • Jonathan Godfrey

      You are correct on all points, especially that this only scratches the surface and Just Culture. I am unsure if our community will ever be able to fully embrace a true culture of safety. Logically we could be one of the safest forms of transportation on the planet if our colleagues would change their mindset. This includes leadership as well as line crew.
      Dr. Ira Blumen studies which I have been very fortunate to be a part of found that 94% of crashes, incidents, accidents (with an NTSB number) have “human error” as a link in the error chain. Presumably a single link removed could have stopped the event from happening.

      What does this mean? We are a part of the problem as well as the silver bullet solution. Take a look in the mirror, increase your vigilance and professionalism and then start doing the right things for safety around you.

      • Troy Shaffer


        Your work at Survivor’s Network for the Air Medical Community and VisionZero precedes you. Thank you for commenting. It’s an honor to share your perspective and comments.

        I personally believe operators are doing their part to the extent they are empowered to do so. I do not believe air medical leadership is effective or even qualified in many cases. The FAA is somewhere between absent and severely lacking. The combination is deadly, and unfortunately the industry continues to prove this. Our air medical crews definitely deserve better.

        I agree vigilance and professionalism will always be needed. Thanks again for commenting. I sincerely appreciate you sharing your experience and perspective.

        Clear Skies & Tailwinds

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