EMS Words of Wisdom - Good Leadership Begets Good Leadership

 

EMS Discussion - When Scope Meets Survival

Lessons from Kentucky’s Antivenom Case

When the call comes in, seconds matter. EMS Providers are trained to act decisively, but also within the limits of their medical scope.

What happens when those two imperatives collide—when a patient’s survival depends on a treatment that regulations forbid?

That question faced a Kentucky EMS crew this spring, and the outcome has sparked national discussion about scope of practice, ethics, and the realities of prehospital medicine.

The Case: A Mamba Bite and a Tough Decision

In May 2025, Powell County EMS responded to a call involving James Harrison, director of the Kentucky Reptile Zoo, who had been bitten by a Jameson’s Mamba - one of the world’s most venomous snakes.

As paramedics worked the scene, Harrison reportedly told them, “You have to give it, or I die.” The crew had access to antivenom - normally reserved for hospital or wilderness medicine use - and, after consulting with a physician, decided to administer it while awaiting helicopter transport.

That decision likely saved a life. But it also triggered an investigation.

Under Kentucky EMS regulations, only certified wilderness paramedics are authorized to administer antivenom. The Powell County crew did not hold that certification.

Despite acting under medical consultation and in good faith, they were reported to the Kentucky Board of EMS (KBEMS) for operating outside their scope of practice.

Importantly, the EMS providers self-reported their actions - a key factor later cited in their defense.

The Outcome: Case Dismissed, Questions Remain

In late September, the KBEMS Preliminary Inquiry Board reviewed the case and dismissed it, concluding that while the paramedics acted beyond their formal scope, their actions were justified by the unique circumstances and their immediate self-reporting.

Powell County Judge-Executive Eddie Barnes, who also serves as a paramedic and was part of the crew, expressed no regret, saying he take the same action again if faced with a patient in similar distress.

Kentucky State Senator Brandon Smith publicly supported the EMS team, calling for revisions to EMS regulations so that first responders are not punished for taking life-saving action in good faith. 

Understanding the Regulatory Context

Scope of Practice exists to protect patients and providers alike. It defines what interventions each level of EMS certification can safely and legally perform. But scope is not static - it evolves with medical evidence, training, and policy.

In Kentucky, antivenom administration falls outside the standard paramedic scope because it requires specialized training and monitoring, typically found in wilderness EMS or toxicology units. 

Risks include allergic reactions and the need for prolonged observation - conditions not always manageable in the field.

Still, real-world medicine is messy. In rare, life-threatening situations, rigid adherence to scope can feel incompatible with the provider’s duty to act.

This case underscores the challenge: how can systems preserve safety and standardization without punishing good clinical judgment? 

Ethical and Operational Takeaways for EMS Providers

This incident resonates with every provider who’s ever faced a “gray zone” decision. It highlights several practical lessons:

1. Consult Medical Control Early

When possible, contact online medical control before performing an off-protocol intervention. In this case, consultation reportedly occurred with an emergency physician - a critical step that strengthened the crew’s defense.

2. Document Everything

Thoroughly record your assessment, communications, rationale, and the patient’s condition. Accurate documentation can be your strongest protection in post-incident review.

3. Self-Report and Debrief

Transparency matters. The Kentucky team’s decision to self-report demonstrated integrity and professionalism - and likely influenced the case dismissal.

4. Know Your State’s Regulations

EMS scope and authority differ across states. Understand your protocols, but also be aware of how to escalate unusual situations through medical direction or administrative channels.

5. Advocate for Realistic Policy

This case may prompt states to consider “emergency exception” provisions - protocols that recognize provider discretion in extreme, time-sensitive cases where a patient’s life is at stake. 

A Call for Systemic Reflection

For EMS Leaders, Educators, and Policymakers, the Powell County case is not about right or wrong—it’s about readiness.

Do our systems empower providers to save lives when the textbook no longer fits? Are our regulations flexible enough to adapt to low-frequency, high-acuity calls? Do we support providers after they make those tough calls in good faith?

As medicine advances, so must the frameworks that govern it. No protocol can anticipate every scenario—but policies can be written to support critical thinking, consultation, and accountability without punishing courage. 

Conclusion

The dismissal of the Kentucky antivenom case is more than a regulatory footnote—it’s a reflection of what makes EMS unique.

Prehospital medicine operates in uncertainty, in chaos, and often in the seconds between life and death. This case reminds us that clinical judgment, ethical courage, and transparency remain as vital to patient outcomes as any drug or protocol.

Let it also be a reminder that systems must evolve - to ensure that doing the right thing never becomes a career risk.

Sources & References

Kentucky Board of Emergency Medical Services (2024) Scope of Practice Guidelines

LEX18 News. (2025, September 27) Kentucky paramedics cleared of disciplinary action after antivenom administration. Retrieved from https://www.lex18.com

U.S. Department of Health and Human Services, Office of EMS (2023) National EMS Scope of Practice Model

WBKO News. (2025, September 25) EMS team under fire for treating man with antivenom after mamba bite. Retrieved from https://www.wbko.com

WKYT News. (2025, September 30) Case dismissed against KY EMS team that gave antivenom. Retrieved from https://www.wkyt.com

EMS Discussion - EMS Leadership During A Time Of Outrage

The Challenge

Today’s EMS Leaders face more than operational demands - they must also navigate a world shaped by public outrage, political division, and social media amplification.

Every statement, policy, or silence can be scrutinized, criticized, or misinterpreted. Balancing staff expectations, public trust, and professional neutrality is harder than ever.

Why It Matters

Outrage culture can fracture teams, erode trust, and distract from the mission. In EMS, where teamwork and composure are essential, strong leadership in emotionally charged times is critical for morale, credibility, and community confidence.

Core Leadership Strategies

1. Anchor in Mission and Human Impact

• Ground decisions in your agency’s purpose: serving patients and protecting the public.
• Ask: Does this issue directly affect our people, patients, or mission?
• Avoid performative responses that distract from care delivery or operational priorities.

2. Foster Respectful Dialogue

• Create safe spaces for staff to share views without fear of retaliation.
• Set clear boundaries (no hate speech, no harassment) but allow for conversation.
• Model Civility - leaders must demonstrate what respectful disagreement looks like.

3. Engage Employees in Decision-Making

• Don’t respond impulsively to every trending issue.
• Use consistent criteria to decide which issues merit an organizational response.
• Let your workforce have a voice in shaping those priorities.

4. Lead with Consistency and Integrity

• Match public words with internal actions.
• Empty statements damage credibility — authenticity builds trust.
• Ensure policies, behaviors, and culture reflect your stated values.

5. Build New Leadership Skills

• Today’s leaders need emotional intelligence, ethical clarity, and communication literacy.
• Equip your leadership teams with training in empathy, listening, and conflict navigation.
• Recognize that leadership in a polarized era requires as much heart as it does strategy.

6. Protect Leader Well-Being

• The emotional toll of constant outrage is real.
• Develop personal coping tools, peer support, and boundaries.
• “Presilience” - preparing emotionally before the crisis - is as vital as resilience afterward.

In Summary

For EMS leaders and providers, the path forward lies in focusing on purpose, consistency, and humanity. Not every social or political issue requires a public stance; instead, leaders should filter decisions through the organization’s mission and its direct impact on patients and personnel. 

Credibility comes from alignment — when an agency’s actions match its stated values, it builds trust both internally and externally.

Leading through outrage demands emotional intelligence, humility, and courage. It means fostering open, respectful dialogue rather than silencing dissent, and recognizing that empathy and transparency often carry more influence than public declarations. 

Ultimately, in an era of polarization, EMS can stand as a model of professionalism and composure — reminding communities that compassion and service remain the foundation of effective leadership.

This discussion piece is based on “Leading Through Outrage” by Shannon Gollnick, JEMS (Oct 2025).

Source:

Gollnick, S. (2025) Leading Through Outrage: EMS Leadership in an Age of Polarization. Journal of Emergency Medical Services (JEMS).

https://www.jems.com/exclusives/leading-through-outrage/

EMS Essentials - Effective Leadership Skills

EMS providers are critical in prehospital care, and strong leadership skills are essential for delivering high-quality, efficient service. 

Here’s a breakdown of key leadership principles:

1. Communication

Clear and Concise Communication: This is vital in ensuring effective teamwork, especially in high-pressure situations. EMS providers must develop the ability to deliver clear instructions and ensure information flows seamlessly between team members and other healthcare professionals.

Active Listening: Effective leaders listen attentively to their team and patients, ensuring concerns are addressed and relevant information is gathered.

Nonverbal Communication: Body language, eye contact, and tone of voice also play a big role, particularly when team members are dealing with chaotic environments or emotional patients.

2. Decision-Making

Critical Decisions Under Pressure: EMS providers often face time-sensitive situations where quick, sound judgment is required. Leadership involves the ability to gather information swiftly, analyze it, and make informed decisions that prioritize patient safety and care.

Calm Under Stress: Remaining calm in high-stress environments helps to foster trust and confidence within the team, promoting clear-headed decision-making.

Risk Assessment: Leaders must weigh risks and benefits in real-time, making adjustments as new information becomes available or as a patient's condition changes.

3. Adaptability

Flexibility: Emergency situations are dynamic, and leadership means being ready to adjust your approach based on changing circumstances. This can include reevaluating a treatment plan, reassessing team assignments, or modifying transport strategies as new challenges arise.

Problem-Solving: Leaders must think on their feet and be resourceful, often working with limited information or resources. Being adaptable also involves having contingency plans and being ready to pivot quickly.

Emotional Adaptability: EMS providers often deal with patients in distress, and leaders must remain emotionally adaptable, balancing compassion with professionalism.

4. Team Management

Fostering Collaboration: As leaders, EMS providers must create an environment where all team members work together effectively. This means encouraging input, maintaining open lines of communication, and resolving conflicts quickly.

Delegation: Effective leadership involves delegating tasks based on each team member’s strengths and capabilities. Trusting others to handle their responsibilities allows for a more coordinated and efficient response.

Motivating & Supporting The Team: A good leader promotes a positive, inclusive work environment by recognizing the contributions of others, providing constructive feedback, and encouraging team members to grow professionally.

5. Continuous Learning

Staying Updated: The medical field is always evolving, and leaders must stay informed about the latest treatments, protocols, and technology. Regularly attending training sessions, workshops, and conferences is key.

Reflective Practice: Taking time to reflect on past experiences allows EMS providers to identify areas for improvement. Leadership involves recognizing mistakes, learning from them, and sharing those lessons with the team.

Professional Development: Leaders encourage both their own growth and that of their team members. They mentor less experienced personnel, fostering a culture of continuous improvement.

Key Leadership Takeaway:

EMS leadership is about more than just making decisions. It’s about ensuring patient safety, fostering a strong, cohesive team, and continuously adapting to both the unpredictable nature of emergencies and the evolving healthcare landscape. 

By focusing on communication, decision-making, adaptability, team management, and lifelong learning, EMS providers can enhance their leadership skills and, in turn, improve patient care outcomes.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Crowe, R. P., Wagoner, R. L., Rodriguez, S. A., Bentley, M. A., & Page, D. (2017) Defining Components of Team Leadership and Membership in Prehospital Emergency Medical Services. Prehospital Emergency Care, 21(5), 645–651 Accessed September 14, 2024

Fernandez, W. G., Benzer, J. K., Charns, M. P., & Burgess, J. F. (2020). Applying a Model of Teamwork Processes to Emergency Medical Services. Western Journal of Emergency Medicine 21(6): 264-271 Accessed September 12, 2024

Fitch & Associates (2019) 6 Common Competencies of Highly Effective EMS Leaders. EMS1. Accessed September 14, 2024

Foster, D. T., Goertzen, B. J., Nollette, C., & Nollette, F, P. (2013) Emergency Services Leadership - A Contemporary Approach. Burlington, Massachusetts: Jones & Bartlett Learning

Knox, A. G. S. (2018) Conflict Resolution & The Importance of Teamwork in EMS. EMS1. Accessed September 12, 2024

Lundy, D (2014) Preparing for Leadership in EMS. NAEMT News: 4 & 9 Accessed September 14, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

EMS Essentials - Effective Teamwork Skills

In the prehospital setting, effective teamwork is critical for the success of emergency medical services (EMS) operations. 

EMS Providers must be able to work seamlessly together under high-pressure, time-sensitive conditions. 

Here are some key elements of effective teamwork:

1. Clear Communication

Closed-Loop Communication: When one team member gives a direction or request, the recipient should repeat it back to confirm understanding, and the sender should confirm that the message was understood correctly.

Concise & Timely: Communication should be clear, concise, and delivered in a timely manner, especially when sharing critical patient information (e.g., vital signs, treatment decisions).

Non-Verbal Cues: Body language and other nonverbal signals are essential, especially in noisy or chaotic environments where verbal communication might be difficult.

2. Role Clarity and Task Delegation

Defined Roles: Each team member should know their role and responsibilities. This reduces confusion and redundancy during an emergency situation.

Task Delegation: Leaders should effectively delegate tasks based on team members’ skills and experience to maximize efficiency and reduce errors.

Leadership In Critical Moments: During high-stress situations, a clear leader should emerge or be designated to direct operations and make final decisions.

3. Interdisciplinary Collaboration

Coordination With Other Responders: EMS providers often work alongside law enforcement, firefighters, or other healthcare professionals, and it’s important to understand their roles to ensure smooth collaboration.

Unified Command Structure: Especially in large incidents, integrating into a unified command or Incident Command System (ICS) ensures all responders are working toward a common goal with shared information.

4. Trust and Mutual Respect

Trust: Team members must trust each other’s skills, decisions, and judgment. This fosters a supportive environment and allows quicker execution of tasks.

Respect: Mutual respect is key to maintaining a positive team dynamic, even during disagreements or high-pressure moments. Every member should value the contribution of others.

5. Situational Awareness

Shared Mental Model: Every team member should maintain an awareness of the overall situation, patient condition, and potential risks. This allows for quick decision-making and adaptability.

Continuous Reassessment: Teams must continually reassess the situation, making adjustments to treatment plans as needed based on new information.

6. Conflict Management

Quick Resolution: Conflicts should be addressed quickly and professionally to maintain the focus on patient care.

De-Escalation: Leaders and team members should know how to manage and de-escalate interpersonal tensions, as conflict can reduce team effectiveness.

7. Debriefing and Feedback

Post-Call Debriefs: After every major incident, teams should debrief to discuss what went well and what could be improved, allowing for continuous learning and improvement.

Constructive Feedback: Providing and receiving constructive feedback helps team members grow and better prepare for future emergencies.

8. Adaptability and Flexibility

Adapt To Changing Conditions: EMS teams must remain flexible to changing circumstances, such as evolving patient conditions or unexpected challenges at the scene.

Resourcefulness: Team members should be prepared to adapt their approaches, including improvising when resources are limited or when things don’t go as planned.

9. Physical and Emotional Support

Physical Support: Team members should assist each other with physically demanding tasks, such as patient lifting or moving equipment, to prevent injuries.

Emotional Support: High-stress situations can take an emotional toll, so it’s important for team members to support one another mentally, recognizing signs of stress or burnout and offering encouragement or a break when needed.

10. Preparedness and Training

Ongoing Training: Regular team training, including scenario-based exercises, helps build trust, coordination, and familiarity with each other’s strengths and weaknesses.

Cross-Training: Team members should be cross-trained in multiple roles so they can step into different positions as needed in the field.

By understanding and applying these elements of teamwork, EMS providers can improve patient care, operational efficiency, and overall team morale in the prehospital environment.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Fernandez, W. G., Benzer, J. K., Charns, M. P., & Burgess, J. F. (2020). Applying a Model of Teamwork Processes to Emergency Medical Services. Western Journal of Emergency Medicine 21(6): 264-271 Accessed September 12, 2024

Foster, D. T., Goertzen, B. J., Nollette, C., & Nollette, F, P. (2013) Emergency Services Leadership - A Contemporary Approach. Burlington, Massachusetts: Jones & Bartlett Learning

Knox, A. G. S. (2018) Conflict Resolution & The Importance of Teamwork in EMS. EMS1. Accessed September 12, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

EMS Leadership - Embracing a Growth Mindset

As EMS providers, we are constantly in high-stakes situations where quick thinking and adaptability are essential. Carol Dweck’s concept of a growth mindset —believing that abilities and intelligence can develop through dedication and hard work— is gaining traction across various fields, and it's especially relevant in the fast-paced world of emergency medical services.

A growth mindset is not just a trendy term; it has real implications for how we operate in the field, how we approach challenges, and how we support our teams. However, like any popular idea, misconceptions can arise. Some believe a growth mindset is simply about praising effort, but this isn't enough in EMS, where outcomes can be a matter of life or death. Effort matters, but so do results. The key is understanding that while some treatments may not lead to the desired outcome, the lessons learned from these experiences are invaluable.

In EMS organizations, it's common to hear motivational phrases like “adopt a growth mindset, and good things will happen.” It’s easy to agree with ideals such as growth, empowerment, and innovation, but what do these words mean without the policies and support systems to make them attainable? As EMS providers, we must ask: How are these values being put into practice in our everyday operations?

Organizations that truly embrace a growth mindset create an environment where calculated risk-taking is encouraged, knowing that not every decision will have the desired outcome. In these environments, it's not just about whether a protocol worked perfectly; it’s about the critical lessons learned, the shared knowledge within the team, and how we can improve care in the future.

But there's another piece to this puzzle. As individuals, we can't solely rely on our organization to foster this mindset. Whether you’re new to EMS or a seasoned veteran, the responsibility for your growth rests with you. This means continuously developing your skills, learning from your experiences, and seeking feedback. When you take ownership of your growth, you become not only a more effective provider but also a leader who influences the team for the better.

By cultivating a growth mindset on a personal level, you're more likely to become an agent of positive change—both for your patients and within your EMS team. The more invested you are in your own development, the more you contribute to the collective success of the team, enhancing both your leadership skills and your role as an engaged, proactive team member.

Further Reading:

Dweck, C. S. (2007) Mindset: The New Psychology of Success. New York, NY: Ballantine Books

Dweck, C. S. (2016) What Having a “Growth Mindset” Actually Means. Harvard Business Review (January 2016).  Accessed September 6, 2024

Dweck, C. S. & Yeager, D. S. (2019) Mindsets: A View From Two Eras. Perspectives on Psychological Science 14 (3):481-496. Accessed September 6, 2024