How To Lead From The Back of The Bus (Ambulance)

And How To Lead From The Back of The Bus, Helicopter, Station or Base…

“Do you want to talk to the doctor in charge or the nurse who knows what’s going on?” ~Unknown

There’s truth in this quote.

And it’s no disrespect to doctors.

Have you ever noticed how every EMS station, dispatch center, and air medical base has two sets of leaders?

A person with the title “boss,” and the guy or gal everybody goes to for advice?

If you’re lucky, there’s some overlap. If you’re really lucky, one person wears both hats.

Luck is Not a Plan

But what if you’re not lucky? What if your supervisor is a nice person, means well, and just can’t lead? I know it’s hard to imagine, but try, just in case you ever find yourself in this position.

What if the boss only thinks of himself and rarely does the best thing for the team? What then?

Reality is you worked hard for your position. Your family is counting on your next paycheck. And your own safety depends on how well you and your co-workers function as a team. It’s not as simple as just walking away.

It’s up to you to make your situation better.

Why Leadership Matters

Have you ever wondered why leadership matters in EMS and air medical?

It’s a fair question.

After all, EMS is not the armed forces. Your communications center will never be asked to defend America’s shorelines, right?

But make no mistake, leadership matters –everywhere. And leadership absolutely matters in EMS and air medical. Here’s why:

New crews learn through example. New crews copy what they see. New crews are the future of EMS and air medical.

Leadership sets the tone for success or failure of new and experienced crews. Leadership directly influences your personal safety, as well as the safety of your co-workers and patients.  

To be blunt, the safety fairy isn’t coming.

There’s no magic pill to immunize yourself from accidents. The closest thing you have to safety “magic” is leadership.

That’s why leadership matters.

But how do you do it?

How To Lead

Can you lead if you’re not the boss?

Can you lead without a title or position authority?

Can you lead from the back of the bus? Or helicopter? Or emergency department?

The answer is yes.


If there’s a ‘secret’ to leadership, this is it.

Leadership starts with trust. No trust equals no leadership.

That’s the reason you see so many workplaces with both formal and informal leadership structures. When crews don’t trust the formal leadership, they keep looking until they find someone they do trust.

Here are four ways to establish yourself as a trusted authority and leader. Four ways to keep yourself and your crews as safe as possible.

1. Be consistent

Consistency matters. Consistency beats perfection.

Your coworkers can handle you making mistakes. What they can’t handle is you being inconsistent.

Here’s what I mean: it’s really important you explain the details of cases, calls and flights consistently.

It’s not okay to tell one version of your story to flight medics, another version to flight nurses, and yet another version to ground crews and the communication center. You absolutely, positively, must be consistent.

And be careful —before you default to “I already am consistent” –stop and really think about your explanation of past cases. Do you really tell the exact same story to your peers? Your supervisor? And other coworkers and observers?

Trusted professionals (and leaders) are consistent. You may think you’re consistent and not really be there. That’s okay. Awareness is about 90% of the battle. Now you know. Now you can do better.

You can literally start improving today.

2. Show, Don’t Tell

“Your actions speak so loudly I cannot hear what you say.”-Ralph Waldo Emerson

Leaders show, not tell.

Everybody has a “war story” in their past. A memorable case, call, or flight that highlights their experience and expertise perfectly. And stories are great in the right context, time, and place.

But don’t limit yourself to just stories. Be willing to roll up your sleeves and do the work.

Leadership is as much about doing the work as anything else. Many seasoned leaders forget this. They convince themselves they’re “managers,” not “worker bees.” Truth is, leaders do both –manage and work.

Gain trust by doing the work.

It goes without saying, but I’ll say it anyway -If you want people to trust you, follow the rules. If the rules dictate a certain methodology or performance standard, you absolutely must meet this standard every time. No exceptions.

Remember that nobody respects the manager (or worker bee) who says one thing and does another. It’s glaringly obvious whenever this happens, and it’s devastating to the manager in terms of building and keeping trust.

Build trust by never asking other team members to do something you haven’t done (or wouldn’t do) yourself.

Pause the next time you have a choice between doing the work or delegating a task. Is this a chance to lead? When coworkers see you do, instead of delegate, it sends a powerful message. It builds trust.

3.) Make the Tough Calls

Leaders make tough calls. Leaders take ownership of their decisions, right or wrong.

It’s okay to be wrong. It’s not okay to take less than 100% ownership of your decisions.

Your coworkers respect honest mistakes followed by honest explanations. Nobody respects lack of responsibility or unwillingness to make difficult or unpopular decisions.

Sooner or later, you will make a tough call that goes badly. Take full responsibility immediately.

Don’t fall to pieces. Take responsibility and move on. Your coworkers will respect you for it.

Over time, nobody remembers the details of cases, calls, or flights. What people remember is how you treated them and how you made them feel. When you build trust through action, people feel good about time spent with you. They want to follow you.

4.) Stay Positive

Do you know someone who’s usually right, but always negative? Remember how you just thought of this person. Is this how you want others to think of you? Enough said.

Leaders stay positive.

Leaders expect the EMS plan to continually change. Leaders make adjustments, move forward, and stay positive no matter what.

Don’t be the guy or gal that brings the whole mood down. It’s okay to have a bad case, call, week, or even month. It’s not okay to bring everybody around you down. And it’s not okay to be terminally negative.

Your attitude influences others. Your attitude influences safety. It matters.

Stay positive.

When To Start

How do you get started? Is there a best time to start building trust and using the leadership principles above?

Yes. Right now.

If you work EMS or air medical, you already know improvements can (and should) be made. Don’t waste time pointing fingers or placing blame.

Take control of your own future. Do your best for your coworkers — and for yourself.

Be consistent, show (not tell), make tough calls, and stay positive. Follow these simple but powerful principles and you’ll quickly see results.

You’ll also find yourself becoming the “go to” guy or gal who leads by example –regardless of your title or formal position within Flight Safety Network.


Interested in learning more about how to get started as a Flight Medic, Flight Nurse or EMS Pilot?

Join our Future Flight Crew Private Facebook Group. Answer 3 simple questions to join, takes less than a minute.





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.

    14 replies to "The Great EMS Leadership Hoax"

    • Chris Starkey

      I would like to see this author do a EMS leadership seminar.

    • Chris Starkey

      THIS IS A GOOD READ!!!!!!!!!!!!! I LIKE THE FACT THEY POINT OUT REGARDLESS OF TITLE YOU CAN BE A LEADER. A lot of people expect leadership form only the rank and title. Real leadership steps up from any position,and does the work.

      • Troy Shaffer


        You can absolutely lead without a title or position authority. Thanks for the kind words.

        Clear Skies & Tailwinds

    • Scott Nied

      I totally agree with you and wish you were available for speaking engagements . I would enjoy having you speak at a seminar in our region.

      • Troy Shaffer


        Thanks for your feedback and kind words.

        Clear Skies & Tailwinds

    • Bradley Williams

      The back of the bus is full of much better talent. Leaders in my mind when it comes to EMS, are the resume builders and the people that should not be working on people.

      • Troy Shaffer


        I agree. The back of the bus is full of EMS talent. And there really is no requirement for managers to perform as operators, before moving on to management. I hear what you’re saying. Thanks for commenting.

        Clear Skies & Tailwinds

      • Amy Eisenhauer

        Hi Bradley and Troy,

        I enjoyed the article and agree with the suggestions on how to lead and that there can be leaders in the field AND within management- indeed, both are needed.

        My comment is in response to the comments above: yes there is a vast amount of talent and leaders in the back of the bus, but those individuals are not always viable leaders in management and management leaders aren’t always great operators and they don’t need to be. Each environment has its own atmosphere and requirements, some are innate and some are obtained via education. My point is, one is not better than the other, they are both necessary for the whole to function well.

        • Troy Shaffer


          Thanks for sharing your perspective. I agree with you.

          Unfortunately, what you often see in EMS and air medical is a propensity to promote people based on friendships or cronyism. This almost without exception hurts the team and lowers morale. It also leads to a lot of dissatisfaction and animosity between employers and employees. And once this happens, it’s very difficult to rebuild trust with employees. Avoiding all this hassle was one of the reasons for this article.

          Clear Skies & Tailwinds

    • Dan Gerard

      Solid piece of writing.

      • Troy Shaffer


        Thanks for the feedback. I hope the article helps you help others.

        Clear Skies & Tailwinds

    • Stephen

      There are formal and informal leaders in every agency. Thanks so much for challenging us to lead where we are…

      • Troy Shaffer


        You’re right! Good on you for stepping up and accepting the leadership challenge.

        Thanks for the feedback. I sincerely appreciate it.

        Clear Skies & Tailwinds

Leave a Reply

Your email address will not be published.