Emergency Medical Leadership

Prinicples of Managing a Medical Emergency

Rod Brouhard coordinating patient transportation during a weapons of mass destruction drill. (c) Melanie Martinez

Most medical emergencies involve a single victim. Professional rescuers respond in teams of 2-6 people, depending on whether a fire engine or other first response agency responds along with the ambulance. More than likely, one of the paramedics or emergency medical technicians from the ambulance agency will direct the scene.

The principles of leadership used by professional rescuers can be used by lay rescuers as well.

Planning for an emergency should include defining the roles of rescuers and designating leaders before they are needed. If no leader is defined one will probably emerge, but don't count on it.

The Importance of Delegation

Healthcare providers rarely handle medical emergencies alone. Instead, we're pack animals. We work in groups of at least two, often more. There are very few emergency medical conditions that can be assessed and treated by a single rescuer.

To effectively work in a team with a clear leader, there must be delegation. The leader of a rescue team must be willing to make decisions for the team and direct team members' actions. In many medical emergencies, the person with the highest level of training is the leader as well as the only person at the scene that has a certain skills set called a scope of practice. A leader must delegate lower trained rescuers to perform tasks they can do so the highest trained is available to perform the tasks others can't do.

Autocracy of Emergency Management

Consensus has no place during an emergency. To watch a large emergency incident in action, one would think there is no direction, that everyone on the scene is simply acting as trained and getting the job done. It looks like chaos.

On the contrary, someone is always leading.

The leader may not be designated to lead, he or she may have stepped into the role of leader because of a leadership vacuum. Usually, the leader has the rank and expectation of being in charge before there was ever an emergency. In other words, the leader is assigned.

In most formal emergency response systems, a medical emergency with a single victim is managed by the highest medically trained responder - usually a paramedic. Larger incidents are managed by the ranking official on the scene, which may or may not have medical training.

It's vital in an emergency that the leader not be afraid to take charge. Taking charge during a medical emergency is similar to being the coach of a basketball team or the captain of a ship. There is only one.

Communication at the Scene

Effective communication with team members at the scene is one of the most important aspects of emergency management.

Be clear to whom you are speaking.

  • Use Names
    Addressing a person by name will help him or her hear and understand you. No one at the scene is named somebody, so "Somebody call 911!" may not get results.
  • Use Physical Contact
    Place a hand on the shoulder or use some other light touch to get the attention of the person you are directing.
  • Use Eye Contact
    Look the person you are speaking to in the eye, it helps him or her understand your directions.

Tell, don't ask. "Please" is fine, but "Would you...?" leaves the impression that there is some debate about the action you need completed. No need to be rude, but no need to be timid, either.

Making Good Decisions

Managing a medical emergency is more art than science. There are many right ways to handle every situation and many wrong ways as well. Professional rescuers have established guidelines or protocols to help them make decisions at the scene of an emergency, but even protocols don't cover every situation.

Some people are naturally decisive, while others have trouble choosing paper or plastic at the supermarket. Regardless which end of the spectrum you come from, decisiveness comes with practice and with knowledge. Practicing for certain situations helps make decisions clearer. That's why CPR is practiced repeatedly during training.

Be flexible. Being decisive is not the same as being obstinate. If something isn't working, have the confidence and flexibility to change direction. There's a fine line between acting by committee and being a good leader. Listen to feedback from the rescue team, then make the call.

Safety is Always #1

Every member of the team should keep safety in mind, but making sure the whole scene is safe remains the responsibility of the leader. Remember, the safety of the rescuers is most important, followed by the safety of the victims.

Planning is the Key to Good Leadership

Planning and training for medical emergencies improves decisiveness and coordination. Proper CPR and first aid training should be a priority for everyone. Get the tools to respond in a medical emergency. Professional rescuers use the Incident Command System (ICS) to define command roles during emergencies.​

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