An EMS Organization Self-Assessment

I worked for some great EMS organizations through the years. I’ve worked for some really awful ones along the way as well. Finding the right EMS organization and contributing to them in a positive way can be tricky. Sometimes, the struggle can be deciding whether to stay and help make things better or move on and plant your awesomeness elsewhere.

If your current EMS employer doesn’t value and respect you, there are plenty of organizations out there that will. If you are in a toxic work environment, it may be hard to imagine that there are places out there where respect, dignity and good patient care are the norm. Good organizations are out there and, as you might imagine, there are many common elements to their success.

Are you wondering if your being treated the way you should be? Let me help you answer the question of whether you’re working in a top-notch company or scraping the bottom of the EMS-service barrel. Here’s a list of some of the positive attributes of well run EMS organizations.

Best in class EMS organizations:

1. Value 2-way performance evaluation and are open to employee feedback.

Some EMS organizations prefer to give no feedback what-so-ever to their employees. (Unless someone screws up.) There are no scheduled performance reviews and supervisors say very little about job performance on a day-to-day basis. Most companies provide some sort of formalized performance review, though they may do it out of the misguided perception that it protects them from liability. (It doesn’t.)

The very best EMS organizations give generous real-time feedback to their workforce, both good and bad. Feedback is received in a timely manner, when it is most relevant and appropriate. But they don’t stop there. They also seek out feedback and create channels for employees to evaluate their leaders and their workplace. They encourage feedback and then they do something amazing with it, they listen and respond.

2. Hold personal respect as an essential ingredient in all human interaction.

It should have been made clear at some point in your employee orientation that disrespect is not tolerated in the workplace. High performance workplaces understand that when employees are given the latitude to express themselves and give honest feedback, there will be conflict. It’s OK to disagree with each other in the workplace and have honest discussions about what’s working and what isn’t. The only way this can happen consistently is if all communication is based mutual respect. It’s essential. It makes all the other good stuff possible. That’s why good employers value it so much.

3. Support their employees personal and professional goals.

Sure, the company has a mission statement and they may even have some goals that they came up with at a leadership retreat somewhere, but what about your goals? If you want to know if your employer really values your personal goals, watch how they respond when an employee announces that they have a personal goal that may not fit with the organizations agenda. (i.e. I want to become a nurse, or a PA or be a firefighter or go to medical school.)

Notice if those employees are supported in their personal goals or ignored…or worse, hindered and discouraged. If an organization doesn’t value their employees personal goals, they don’t value their employees. And that means, beyond the hours of labor that you provide, they don’t value you either.

4. Provide clearly defined expectations.

Expectations don’t need to be complicated. They don’t need to come in a 400 page employee manual with chapter after chapter of rules and minutia. Expectations can be simple. (The best ones usually are.) Provide competent, compassionate care to our customers. Treat people with dignity and respect. Work hard.

The very best EMS shops out there have clearly defined, simple expectations and they make them well known. When expectations are simple and clear you don’t need to spend hours wading through employee manuals to figure out what you need to wear to work or how you are expected to act or what you are expected to do. It should be obvious when you walk around. that everyone is on the same page and everyone knows what is and is not allowed.

5. Value learning and maintain an opportunity focus.

The best in class workplaces are future oriented and are willing to try new things and innovate. Regardless of whether or not the organization is growing in size (Bigger isn’t always better.) they are always growing in performance. Management is open to new ideas and advancements in prehospital care that might be implemented to better serve the end customer. There is an expectation that employees will attend continuing education to keep on top of the most current information.

Working in a high performance EMS system can be exhausting because of the pace of change and the expectation that employees will keep abreast of current research. The pace of change can be stressful for some folks. The leadership team may decide to try something new this week and then decide to change it back the next week. New equipment and protocols seem to appear monthly. Some last, some don’t, but just about everything that looks useful is given a try.

6. Pay attention to breaks and down time.

As a rule, EMS employees will work themselves to death if you let them. It’s considered a badge of honor to run the most calls, put the most miles on the rig or work the longest shift. The best EMS organizations value down time and rest as an essential component of a long term, healthy workforce.

It’s easy (and tempting) for some EMS workplaces to take advantage of the work ethic of the average EMT. Some design “system status response” deployment models to strip the workforce to its bare minimum and keep every rig running nonstop for 12, 16 and 24 hours at a go. They run their people into the ground and call their system efficient. Morning checkout times, mid-day breaks, meals and off times become lesser priorities to running the most possible calls with the fewest possible resources.

Once an organization has given in to the temptation and bitten into this type of profit model, it’s very difficult to get them to turn back. You may be better off starting over somewhere else.

7. Practice fair compensation and provide a living wage.

The EMS workforce doesn’t expect to get rich running EMS calls. They know about the modest pay when they sign on to do their job. That’s OK. In fact, once peoples basic life needs are met, more money doesn’t really motivate them anyway. But people do need to be paid fairly. Great EMS organizations strive to compensate their people fairly and provide the highest standard of living that is reasonably possible.

8. Give employees a stake in organizational goals and celebrate combined success.

Great EMS employers also work to create profit sharing systems and mutual goals, tying increased compensation to reducing workplace injuries, eliminating avoidable accidents and increasing call volume.

One of my favorite EMS bosses used to take a big chunk of money and offer it to the employees at the beginning of the year. “This is your money.” he’d tell us. At the end of the year we’d all be able to split it. Here was the catch. Every avoidable workplace accident or injury was paid for out of the fund throughout the year. If an employee got an exposure, the pot was reduced. If a vehicle backed into a pole, the pot was reduced. Suddenly, management wasn’t spending company money on these avoidable expenses, they were spending OUR money! Once it was our money, it was amazing how hard we all tried to stay safe and not be responsible for pulling money from the pot. The peer pressure was very effective. The idea was brilliant.

9. Demand competence and quality care.

Employees want to know that they are doing good work. The best EMS organizations aren’t afraid to demand competence. Demanding competence doesn’t reduce morale, it increases it. People want to feel like they are part of a high performance team. Allow team members to demonstrate sub-standard performance and you demoralize the rest of the team. People will work extraordinarily hard to become and remain a membere of a highly respected team. If they weren’t, special operations groups like the Navy SEAL’s wouldn’t be able to exist. Great employers aren’t afraid to set the bar high and they have confidence that their people will rise to the challenge.

10. Give employees the opportunity to practice meaningful service.

Service doesn’t end at the ambulance emergency room door and it doesn’t stop with the folks who call 911 in our district. The best EMS workplaces understand that and they value service in all of its forms everywhere. That means they support the mission of caring for the sick and injured everywhere.

Once an employer truly embraces the mission of emergency service they seek out opportunities to servie the community and the world. They support employees in fund raising efforts and community wellness initiatives. They might participate in local health fare clinics, not for the promotional aspect, but because it’s part of their mission. They encourage employees to travel and perform medical missionary work and participate in disaster relief and clean water initatives.

The good organizations don’t do it for the good press and they don’t need the public information officer to explain why it might be a good return on investment. They do it because that’s what we do. We are a service industry. That means we are of service to all communities, everywhere. Best-in-class EMS companies understand that the people who want to do those things are the people they want running calls for their company and caring for their patients. Those are the people that embrace the mission because it’s part of who they are.

Now it’s your turn: What do you think? Do you work for a best-in-class EMS organization? What does your workplace do well and what could it do better? Leave a comment below and let us know.


  1. That made my eyes tear up… I wanna work there -I really really wanna work there.

    In a word NO my system doesn’t operate that way and they are locked into the profit model you described above – I often run from 0800 to 2000 with no break at all… and our out time at the hospital is “capped” at 20 minutes.

  2. I think you might have a lot of readers checking the wants ads for a new job. Although best in Class EMS Organizations don’t need to advertise for employees because retention is high, turn-over is low, and preceptors purposefully recruit the best students that come through the system. Those preceptors are partly looking for students with good skills, but more importantly they are looking for students that will be a good match to the culture.

  3. Art Hsieh says:

    I especially like your concept of meaningful service. I’m not sure if a lot of newer professionals understand what that means as applied to EMS. It’s a bit ironic, since the Millennial generation is supposed to be about meaning in a job. We can do better with that motivation by providing opportunities for voluntary service beyond the paid part of the job. It helps to foster community within the organization and improve relations between the service and its community.

    I’d like to throw in the philosophy of medicine as a basic tenet or core belief. A highly engaged physician that promotes evidence-based practices and compassion can increase the caring capacity of the organization, resulting in greater ROI.

  4. This was great to read! I recently got my cert 2-3 weeks ago. (still looking for something part time or perdium) no luck yet… But still praying for the best. Great article thought!

  5. Wow, I really enjoyed you insight and knowledge in this read. I would submitted to add; “Maintains, Re-evauates, and Changes practice as needed to continue its best of class service”.

  6. No I don’t work there but I would love to be in a system that had those 10 qualities.