EMS Only Rank Structure?

PotashRLS

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I have been searching old threads and haven't really found what I am looking for regarding EMS rank structure.

Our volunteer/paid on call EMS only department does not have a rank structure in place for the operational side of our service. We have member elected officers (Pres., V.P, Sec., Treas. etc.) that handle business and meetings and such but no real supervisory structure based on license level, experience and training/qualifications. Our county is now a MABAS Division and some of the changes will be best addressed through a rank structure.

With that said, I would be interested in your experience with EMS appropriate ranking and some advice on the pros and cons of having it. I suspect we would need only a very basic structure for operational/training oversight. FYI...We are totally separate from the local fire departments and don't need to integrate with them in terms of supervision or service. Thanks.
 

RocketMedic

Californian, Lost in Texas
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I have been searching old threads and haven't really found what I am looking for regarding EMS rank structure.

Our volunteer/paid on call EMS only department does not have a rank structure in place for the operational side of our service. We have member elected officers (Pres., V.P, Sec., Treas. etc.) that handle business and meetings and such but no real supervisory structure based on license level, experience and training/qualifications. Our county is now a MABAS Division and some of the changes will be best addressed through a rank structure.

With that said, I would be interested in your experience with EMS appropriate ranking and some advice on the pros and cons of having it. I suspect we would need only a very basic structure for operational/training oversight. FYI...We are totally separate from the local fire departments and don't need to integrate with them in terms of supervision or service. Thanks.

I would hesitate to base operational leadership solely on certification level, but in general terms, the veteran paramedic is generally a better leader than the new EMT. I would suggest you place the veterans in supervisor/leadership roles and the training officer role and assign the newer employees to specific shops- ie supply, maintenance/cleaning, documentation, etc. Rotate every quarter for variety if needed.
 

bstone

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MABAS Division?
 

46Young

Level 25 EMS Wizard
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When I worked fro Charleston County EMS, a single role muni 911 provider, they had a paramilitary structure. An EMT was a Private, a new hire medic was a Corporal, a medic crew chief was a Sergeant, the senior crew chief, who's in charge of the station is a Lt I, the field supervisor was a Lt II, then their boss was a Capt, then Major, then the Director was the Colonel. It worked because as soon as the medic was cleared to be a crew chief, they were in charge of the unit.

By contrast, in my fire department (bear with me), we're dual role w/ 911 txp. The renk for medics goes: firefighter/medic, Technician-EMS, Master Tech-EMS, EMS Lt, EMS Capt I, EMS Capt II, EMS BC, and EMS DC. From FF/medic to Master Tech, you'll either ride lead on an EMT/medic unit, or drive an EMS Lt or Capt I. The Capt II is a field supervisor, and beyond that is office positions. It becomes a problem when you have two medics on the bus, and the tech has to defer to the Lt, even if he is only an EMT-I and the tech is an EMT-P. By contrast, if I'm on a one and one as a tech, and the engine officer is a Capt II w/ ALS, I can tell him or her to go scratch unless they want to put their engine out of service, assume pt care, and fill out my ePCR for me.

Yes, this is a fire based employer, but the above example could also be utilized by an EMS only organization. IMO, when you have two providers of equal certification working on an ambulance, the officer-subordinate dynamic is a very poor fit for EMS. The chain of command works well otherwise.
 

Martyn

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When I worked fro Charleston County EMS, a single role muni 911 provider, they had a paramilitary structure. An EMT was a Private, a new hire medic was a Corporal, a medic crew chief was a Sergeant, the senior crew chief, who's in charge of the station is a Lt I, the field supervisor was a Lt II, then their boss was a Capt, then Major, then the Director was the Colonel. It worked because as soon as the medic was cleared to be a crew chief, they were in charge of the unit.

By contrast, in my fire department (bear with me), we're dual role w/ 911 txp. The renk for medics goes: firefighter/medic, Technician-EMS, Master Tech-EMS, EMS Lt, EMS Capt I, EMS Capt II, EMS BC, and EMS DC. From FF/medic to Master Tech, you'll either ride lead on an EMT/medic unit, or drive an EMS Lt or Capt I. The Capt II is a field supervisor, and beyond that is office positions. It becomes a problem when you have two medics on the bus, and the tech has to defer to the Lt, even if he is only an EMT-I and the tech is an EMT-P. By contrast, if I'm on a one and one as a tech, and the engine officer is a Capt II w/ ALS, I can tell him or her to go scratch unless they want to put their engine out of service, assume pt care, and fill out my ePCR for me.

Yes, this is a fire based employer, but the above example could also be utilized by an EMS only organization. IMO, when you have two providers of equal certification working on an ambulance, the officer-subordinate dynamic is a very poor fit for EMS. The chain of command works well otherwise.

So who makes the tea? Throughout EMT school I was told 'EMS is NOT a military organisation' but then I get out in the REAL world and...
 

akflightmedic

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My old service was easy...

Paramedic
Lieutenant
Captain
Battalion Chief

We were all paramedics.

LT was a time in grade position and responsible for the truck/station, call and paperwork. A paramedic could work as an out of rank LT to cover sick call, vacation whatever...there was a clearance process and time in grade and exam before you could be out of rank.

The Capt ran on the truck at the main station (unless there were extra bodies and he had a LT or OOR medic to fill in)...15 station county FYI.

Captain also did paperwork review, rosters, first step in complaint issues, etc.
He was probably the most overworked persona s he was office/field position.

The BC had it "easy". He rode around in his groovy truck, responded to all the cool calls, did on spot field evals, greeted the stations during the day...
 

DrParasite

The fire extinguisher is not just for show
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2nd Lt, 1st Lt, Asst Capt, Captain (head of organization)

Logistics Lt, Rescue Lt, EMS Lt, Logistics Capt, Rescue Capt, Logistics Capt, Deputy Chief, Chief (head of organization)

Supervisor (1 on every 6 days), Operational Supervisor, Director (head of organization

Person/Paramedic in charge/acting supervisor, EMS supervisor/ALS Supervisor/Communications Supervisor, Operations Coordinator, EMS Director (head of department)

Those are the 4 I am familiar with.

The actual titles you use are pretty irrelevant. What is important is that you have clearly defined roles and responsibilities for each position.

I like having a Chief or Captain officer, with an assistant or deputy right below, so if the COD is not available, the ACOD can step up, and it's still a C level officer (which looks good when dealing with other agencies).

Also keep in mind, your head of organization is equal to the Fire Chief, and the Police Chief. That means your agency head doesn't discuss issues with a Lt, he speaks to a chief. and the COD is the operational head of the organization, which mean he or she deals with a lot of paperwork.

EMS (in general) needs operational officers, but they are 90% of the time administrative. They usually aren't managing scenes, they are ensuring paperwork is done properly, equipment checks are completed, dealing with complaints, ordering equipment, and doing other stuff that doesn't directly involved emergency scenes.

Many volunteer agencies have EMS officers on the ambulance as providers, but that's typically because they want to be on the ambulance or because staffing requires it. but when they are on the ambulance, they are functioning as a provider, not an officer (despite having the shiny gold badge and clean white shirt, a paramedic supervisor can do no more than a paramedic, an EMT supervisor can do no more than an EMT, etc, operational ranks don't affect clinical abilities).

Pick a command structure you like (with the accompanying insignia to identify rank and position), assign tasks to get all the jobs done, and do what your specific agency requires. What works for everyone else might not work for you.
 
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mycrofft

Still crazy but elsewhere
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It can be Head Poobah, Queen of the May and Generalissimo, but in a vollie department, you will need authority to enforce any rank structure you decide upon.
The tiptop of the pyramid (Chief) needs to be passed on by the organization which ultimately runs the service and paid, with authority and responsibility to admit, decline or remove members. I would then select more tiers (one, at least at first) to spread breadth of control, call them Captains (2) ; as with a real job, consider their experience, their history, and if they can and/or have commanded coworkers respect and obedience. Eventually you could grow your structure to a Capt per shift, senior and junior responders, a trainer (staff position, not line of command).

The Chief runs the Trainer and the Captains and signs off all personnel actions. The Captains run their shifts. The trainer (Czar of Training, big title, little office) keeps and maintains training records and propels members to keep current and progress in their training, as well as discovering and facilitating advances in the art and in the law. (Trainer would best be paid after a while, probably, going to control a lot of expensive training equipment and potentially affect the whole department).
 
OP
PotashRLS

PotashRLS

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Excellent feedback so far. I really appreciate it.

Just to clarify.....MABAS stands for Mutual Aid Box Alarm System. It is preplanned mutual aid that was designed as a structured/tiered fire response for multiple alarm incidents. You can google it for more info. We as EMS are basically along for the ride because generally fire has taken over on the career/paid side of EMS operations and MABAS is designed for fire. However all our local fire departments are basic volunteer departments with the exception of one being a small municipal paid department that is both fire/rescue.

What is kinda happening is the MABAS policies and sogs utilize ranking officers for operations (some ICS positions too) on incident scenes. On our EMS department, our administrative officers are elected by the general membership. These elected officers may hold no caregiver licensure, have varying experience and be anything from a driver to our highest licensed caregiver. FYI.....our caregivers are either licensed first responders, EMT-Bs or EMT-ITs (EMT-IT = EMT-A in other states I suppose). We have no real issues when our EMT-ITs run a call together. They treat the patient based on a team effort, not by who is senior in experience, generally. The most senior will provide oversight when it is needed however.

My thoughts are to implement a simple supervisory structure that takes into account licensure, experience, education/training, leadership and membership stature. We just need to come up with job descriptions for clarity.

Any other ideas or experiences??? Thanks again.
 

WolfmanHarris

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The EMS Chiefs of Canada have adopted a standardized eppaulet and rank structure which is starting to take off, at least in Ontario.

Chief
Deputy Chief
Commander
Superintendent
Captain
Paramedic (PCP or ACP)

Superintendents are the highest level actively on the road. We have one DC assigned to be on call per shift but outside of office hours they're not on the road at all.

Captain is currently a non-management position assigned to Performance and Development. They run our CME, research programs, recruitment and the like. Apparently the rank will be expanded at some point to create another field mentorship/leadership position that is non-management (still in the union).

We also have acting Superintendents who are assigned on short term (~ 1 yr) posts. This is different then most services where the acting posts still work a regular truck and switch into a white shirt if needed to Sup for the day.
 

Bullets

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Round these parts our squad runs

Captain: oversees all operational aspects of the squad, everyone reports to him

1st Lt: Handles all vehicle repairs, supply ordering, oxygen delivery

2nd Lt: handles all scheduling, requests for special events, training

Engineers: Responsible for upkeep, stocking, noting breakdowns of specific vehicles, scheduling vehicle specific training. Each vehicle has an engineer, currently 3 in my organization
 

Veneficus

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could introduce a radical idea?

Do you really need a rank structure or just a plan of who is going to do what?

If you are part of mutual aid, you are basically a worker bee who is going to treat and transport patients.

The normal authority of the area will assume all command functions according to their agency and plans.

For your own area I can say from my experience, the outcome of a given event is almost always decided by the first in crew. (which is why the fire service has a habbit of putting captains on apparatus, especially engines which can often reliably arrive before a BC in larger depts)

For an EMS only agency, one of the first people on scene can assume command and call additional resources, the partner becomes triage.

The second in unit becomes treatment, and subsequent units delegated to treatment or transport.


If you expect an extended operation you will probably have to pull a transport crew to supply rehab and potentially logistics.

If required because of inexperience etc, the first in unit can basically formally hand off its command to a more experienced/capable person, and assume a transport/logistics role.

I would not suggest a rank structure is a bad idea, but especially in volunteer agencies it is often a popularity contest, not something based on ability. (there are obviously exceptions to all rules)

By the time field supervisors etc. show up, things are either running smoothly and require no intervention, or are a complete cluster **** and it will take a very charismatic leader (not to be confused as synonomous with officer) to pull things out of the gutter.

At the same time, an officer arriving on scene later and trying to start the event over or retool after interventions are put in motion can unravel a well working scene faster than any other event.

The reason I put this forward is because nonfire EMS does not usually function as a cohesive unit, but more of a group of independant units. I have also noticed that EMS seems to attract and cultivate these personalities.

Rather than completely retool, why not just expand on what you have?

Your milage may vary.
 

Medic Tim

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We have medics, medic coordinators, field training medics and driver trainers. The coordinators fill shifts, take sick calls, etc. they have no discipline or extra authority. The FTPs and driver trainers are medics who have extra duties outside of normal working hours. On the management side we have a local operations manage. They do payroll dicipline , typical manager duties. They do not respond to calls unless they absolutely have to. Above that is regional manager. I work in a 140 truck. Close to 1100 medic system run off of a province wide ssp.(we are the only ambulance service in the province)

We have a few circumstances where a medic with seniority would take controls of a scene bit it is generally not needed or done often
 
OP
PotashRLS

PotashRLS

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Do you really need a rank structure or just a plan of who is going to do what?

If you are part of mutual aid, you are basically a worker bee who is going to treat and transport patients.

The normal authority of the area will assume all command functions according to their agency and plans.

For your own area I can say from my experience, the outcome of a given event is almost always decided by the first in crew. (which is why the fire service has a habbit of putting captains on apparatus, especially engines which can often reliably arrive before a BC in larger depts)

For an EMS only agency, one of the first people on scene can assume command and call additional resources, the partner becomes triage.

The second in unit becomes treatment, and subsequent units delegated to treatment or transport.


If you expect an extended operation you will probably have to pull a transport crew to supply rehab and potentially logistics.

If required because of inexperience etc, the first in unit can basically formally hand off its command to a more experienced/capable person, and assume a transport/logistics role.

I would not suggest a rank structure is a bad idea, but especially in volunteer agencies it is often a popularity contest, not something based on ability. (there are obviously exceptions to all rules)

By the time field supervisors etc. show up, things are either running smoothly and require no intervention, or are a complete cluster **** and it will take a very charismatic leader (not to be confused as synonomous with officer) to pull things out of the gutter.

At the same time, an officer arriving on scene later and trying to start the event over or retool after interventions are put in motion can unravel a well working scene faster than any other event.

The reason I put this forward is because nonfire EMS does not usually function as a cohesive unit, but more of a group of independant units. I have also noticed that EMS seems to attract and cultivate these personalities.

Rather than completely retool, why not just expand on what you have?

Your milage may vary.

Your description above is pretty close to how it normally runs now. The issue we are trying to address is to have the ability to put ranking people into the IC roles and functions when the incident calls for it. Outside of seniority, how do we get the "right" or "most appropriate" people into these functions without some sort of simple rank structure. Yes we could pre-plan for it with our people but that would become the same popularity contest you speak of. At least with some sort of simple rank structure, we can stipulate the qualifications for each rank that make sense for our department.

Also with the mutual aid, the inflicted department may request ranking officers to help fill their IC structure for running the incident. Without some sort of rank system in place, how does a department keep any joe blow on the department from claiming he/she carries the same provider license that everyone else does and respond in an officer's role. While it isn't all that likely, freelancing is a problem that occurs and this may help.

The other thing to keep in mind is that we are talking about small community departments, in a mostly rural county, where experienced command personnel are at a premium.
 

EMS4LIFE4EVER

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Well, I worked briefly as an Provisional Paramedic In NYC, and even thought it was with the NYFD, they have an okay rank structure.
It went:
Chief of Department
Chief of EMS Operations
EMS Chief
EMS Deputy Assistant Chief
EMS Division Chief
EMS Deputy Chief
EMS Captain
EMS Lieutenant
Paramedic / Emergency Medical Technician
Provisional Paramedic / Provisional Emergency Medical Technician

I would add the rank of Senior EMT/Paramedic or I also liked the idea of a Chief before Lieutenant, as it seemed like a gaping hole in the rank structure.
But then again, this is a big city EMS, so this is just a sugegstion
 

Summit

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Bumping a 4 year old dead thread as a first post...
 

Woodtownemt

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Since this zombie has risen. How do you guys feel about EMS related citation ribbons and the like? (i.e. military) Do you feel it is an effective tool for employee morale?
 

Summit

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Since this zombie has risen. How do you guys feel about EMS related citation ribbons and the like? (i.e. military) Do you feel it is an effective tool for employee morale?

I thought it was ****ed up when at a state EMS education conference an "EMS Honor Guard' is full dress uniforms with ****ing RIFLES and a yelling drill sargent type MARCHED down the aisle with the state and US flags. What the hell does EMS want to be? A paramilitary buncha wannabees with white gloves, salutes, honor guards, ribbons, badges, saluting, and medals? Maybe we should peel potatoes and do push ups when we make a mistake!

I'd rather us be educated healthcare professionals.

Do you see Nurses or Doctors or RRTs or LCSWs or PTs or OTs wearing that ********? NO WAY!

/rant
 

Woodtownemt

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I thought it was ****ed up when at a state EMS education conference an "EMS Honor Guard' is full dress uniforms with ****ing RIFLES and a yelling drill sargent type MARCHED down the aisle with the state and US flags. What the hell does EMS want to be? A paramilitary buncha wannabees with white gloves, salutes, honor guards, ribbons, badges, saluting, and medals? Maybe we should peel potatoes and do push ups when we make a mistake!

I'd rather us be educated healthcare professionals.

Do you see Nurses or Doctors or RRTs or LCSWs or PTs or OTs wearing that ********? NO WAY!

/rant
i understand what you are saying but I think EMS should be at the very least slightly influenced. Doctors, RNs, RRTs aren't expected to be on scene. We do the heavy lifting and over reaching. We should be more mindful of or overall health for this reason. As far as Honor Guards go I see nothing wrong with taking pride in your profession, country,and appearance. There is nothing saying that its either that or education. I have worked with plenty EMT's who have bachelors of some sort as well as Medics with masters degrees. Our problem as a profession is that there is no set path to take. As we speak the next chapter is being written (community para-medicine) and it is not until we establish a education ladder similar to our brothers and sisters in Europe,Australia, Canada, etc. that our profession will move forward. This is my opinion. Agree to disagree.
 

Summit

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Do you want EMS to be a public safety vocation and the red-headed-stepchild of healthcare? We already are... and if we want to stay that way, then by all means adopt medals and decorations, meeting and surpassing the firefighter culture of paramilitarism. The rest of healthcare will keep giggling while we march in step with the IAFFs regressive stance on education. But maybe we can get a shiny medal for doing really good compressions!

Do we want to be a field of educated healthcare professionals respected by other healthcare professionals? I want us to...


It is not until we establish a education ladder similar to our brothers and sisters in Europe,Australia, Canada, etc. that our profession will move forward.

And it sounds like you do too!

So I'd ask again... do you see MD, RN, DO, NP, PA, RRT, LCSW, PharmD, PT, OT, PsyD, etc going for the paramilitarism of ribbons, medals, and decorations?
 
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