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The Biggest EMS & Air Medical Leadership Mistake

When you first learn to fly

one of the very first things you’re taught (if you’re lucky)

is a simple, but profound checklist.

Aviate, Navigate, Communicate.

The checklist is critical for two reasons:

First, it teaches you what to do. And second, it teaches you when (the correct order) to do it.

Over time you learn the real value of the — aviate, navigate, communicate — checklist. Over time you watch the checklist save your own butt. Over time you fall in love with the simplicity and effectiveness of the checklist.

And if these experiences aren’t convincing enough to new pilots, well . . .

There’s always a steady flow of more experienced pilots killing themselves because they failed to follow the aviate, navigate, communicate checklist.

Student pilots are pummeled with real world examples of what happens when pilots fail to complete checklist steps in the correct order.

Examples include:

The pilot so concerned with making his missed approach radio call that he flies his aircraft into the ground. The commercial airliner crew so focused on a burned out light bulb, that they do the same.

And the list goes on and on. The list continues today. Unfortunately, the list is never ending.

The Biggest EMS & Air Medical Leadership Mistake

What is the biggest EMS and air medical leadership mistake? What do checklists and learning to fly have to do with it?

I’ll show you in this article.

I’ll also show you an easy way to catch yourself from making the biggest EMS and air medical leadership mistake.

Let me explain.

The biggest EMS and air medical leadership mistake is managing by crisis.

It’s ironic and unfair, but true.

The EMS Leadership Trap

Managing by crisis is something EMS and air medical leaders do ‘naturally’.

It’s also the reason so many otherwise talented EMS and air medical leaders fail.

Managing by crisis is a big trap for EMS leaders.

Why is it a trap?

Think about a typical EMS manager’s career before management. What were they doing?

In most cases, current EMS leaders were working in EMS or pre-hospital services. Current leaders were EMS operators transporting patients by ground or air, just like the folks they now supervise.

What did years of running EMS cases teach them?

You guessed it, right? How to manage crisis really well. Operators learn how to go from calm to chaos and back without flinching or changing their heart rate.

They did it for years and they got damn good at it.

They spent their time getting really good at managing crisis. And they took pride in doing it well.

After all, that’s what EMS and air medical operators do, right? So it just makes sense.

All good. Until . . .

The day they moved from EMS operator to EMS manager.

EMS Leadership is Brutally Unfair

Why is advancing from paramedic or line pilot to a supervisor position brutally unfair?

Because everything you know about managing crisis no longer helps you.

Managing crisis well as an operator doesn’t help you lead in EMS.

In fact, without a doubt, it hurts you.


Because leading by crisis is ineffective. Leading by crisis hurts you and your team.

Leading by crisis keeps you from getting any real work done. Leading by crisis creates stress for your team.

Why Leading By Crisis Fails

Why does leading by crisis fail? Why is leading by crisis so damaging to your team?

Easy answer.

If all you do all day long is run around putting out real or perceived ‘fires’ (workplace emergencies), you never get any real work done. You never get to the leadership part of your job.

Sure, you might feel like you did a lot. And you know you’re exhausted from running around like a chicken with its head cut off, right? Listening to one crew issue after another is exhausting.

The problem is you’re not making the difference you believe you’re making. You’re clearly not making the difference you wanted to make when you took the leadership reins.

This is the unfair part.

It would be nice if all the time you spent as an operator learning to manage chaos, helped you lead. Unfortunately, it does not.

But don’t worry. All is not lost.

Here’s Some Good News:

Now that you know the trap, you can avoid it. Now that you know the trap, you can start getting real work done. Now that you know the trap, you can start leading.

How do you do it?

In simplest terms, stop thinking like a crisis manager. Start thinking like a leader.

Remember the aviate, navigate, communicate checklist? The order of the steps is the most important part of the checklist.

If you want to keep from killing yourself as a new pilot, you absolutely must do the right things, in the right order. The same is true for EMS leadership.

How EMS Leaders Get It Right

How do EMS leaders start doing the right work in the right order?

How do EMS leaders keep from crashing and burning?

They follow a simple checklist. A checklist that does for them what the aviate, navigate, communicate checklist does for new (and experienced) pilots.

A checklist makes sure EMS and air medical managers do the right things in the right order.

What is the EMS leadership checklist?

Do important work before urgent work.

That’s it. Simple.

Simple, but not easy.

Choosing important tasks before urgent tasks requires discipline. Extreme discipline.

Choosing important tasks before urgent tasks is difficult for anyone to do. It’s a learned skill. A skill that’s especially difficult for people who come from a crisis management background. Choosing important before urgent requires you to fight your natural urge to manage by crisis.

Important Vs. Urgent: What’s the Difference?

Does prioritizing important tasks before urgent tasks really matter? Does choosing important before urgent make a difference?

In a word, yes.

Choosing important work before urgent work makes a huge difference. In many cases, it’s the difference between success or failure as an EMS leader.

What’s the difference between urgent and important?

Urgent activities demand immediate attention, and are usually associated with achieving someone else’s goals. They are often the ones we concentrate on and they demand attention because the consequences of not dealing with them are immediate.

Important activities activities have an outcome that leads to us achieving our goals, whether these are professional or personal.

The resistance I get to choosing important before urgent is always a variety of “I can’t just ignore the urgent stuff, it needs done too.” And I agree, to a certain point. Yes, urgent tasks still need completed. But urgent tasks rarely need completed right this second.

Choosing important before urgent is mission critical, and often leads to unforeseen benefits –like some of the ‘urgent’ tasks get completed without your personal intervention.

How to Put Important Before Urgent

How do you do it? How do you pick important tasks before urgent tasks, after a career of managing urgent tasks as an operator?

The same way new pilots do it.

Practice. Repetition. Willingness to learn from mistakes.

It really is unfair, but if you want to lead successfully in EMS or air medical, you need to do it. And you need to do it well.

My advice is to start small. Give yourself constant reminders to choose important tasks before urgent tasks. Then when the actual decision is at hand, pause and really give some thought to the decision.

Does it make sense to drive 50 miles to a satellite base for a personnel issue? Ask yourself: Is this the best use of my time? Is this an important or urgent task?

Over time, you’ll master the skill of choosing important before urgent; the same way you mastered the skills that made you an effective EMS or air medical operator.

Over time, you’ll learn to think important before urgent; just like pilots think about flying first, then fixing their position, then communicating.

The right order makes all the difference.


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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.

    2 replies to "The Biggest EMS & Air Medical Leadership Mistake —And How To Avoid It!"

    • Viren

      Thank-you so much for sharing, it’s really helpful & Informative .

      • Troy Shaffer


        Thanks for the feedback. I appreciate it. Improving EMS & air medical is up to us –All of us.

        Clear Skies & Tailwinds

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