Author: Samantha Hilker

Samantha Hilker is the founder of Hilker Project & Strategy Management, LLC. She is a lover of books and favors a facilitative leadership style. Samantha believes the future of EMS, and humanity, resides in our ability to build relationships, work together and play nice in the proverbial sandbox. She is a licensed Critical Care Paramedic in the state of Wisconsin, and her passion for patient care is still a driver for her personally and professionally. Samantha held positions as a paramedic, supervisor, staff development manager and project manager. She has successfully led and managed organizational change, process improvement and public engagement efforts. After finishing her master's degree in organizational leadership, Samantha started her own company with a goal of helping more EMS and healthcare organizations strengthen their leadership teams, effectively share their stories and better engage the communities they serve.

Family Liaisons Following EMS Line of Duty Deaths

I was just a kid when I started in EMS. 23 years old, hungry for adventure, and ready for everything the world of EMS was prepared to give me. Car accidents, gunshot wounds, stabbings, intoxicated shenanigans, elderly falls, fist fights, medical emergencies, strokes, and cardiac arrest were all on my list of expected possibilities. One of the scenarios I had not thought of, and nobody presented to me throughout school and orientation, was the possibility of clocking in for shift and not going home. I do not recall line of duty deaths being a discussion point in the paramedic curriculum, job interview, or orientation process. I had experienced the unexpected loss of a younger sibling due to a motor vehicle crash before I started my journey in EMS, but the fact that life is short and unpredictable did not connect with the fact that I was knowingly and willingly walking myself into unknown and potentially dangerous situations with each response. Even after the UW Med Flight crash happened early in my career, and in my service area, we simply did not talk about our own potential for death as a direct result of our profession.

Years later, after many more line of duty deaths and even more reports of violence against EMS and healthcare workers, this topic weighs heavy on my mind. In my time as Staff Development Manager for a service, I pushed for the DT4EMS courses to train our medics on how to recognize potential dangers, escape those situations, and defend themselves if they are unable to escape.  We all know the ‘scene safe/BSI’ tagline and list of what things might make a scene unsafe is not enough. As the Rescue Task Force (RTF) formed, I watched as some were excited for the opportunity to be involved and others started to question their willingness to respond to so many unknown situations as their young families were beginning to grow. I started asking myself if EMS agencies are doing enough in terms of preparing themselves and their employees for the possibility of a line of duty death.

The Line of Duty Death Handbook, published in part by the AAA, is a great tool to start building policies, protocols and personnel records. The handbook guides you through the importance of having employees fill out emergency contact and next of kin forms, and keeping them updated, as well as assigning family liaisons and how to manage coverage for funeral services. As I reviewed this, I started thinking about the assignment of a family liaison—a member of your agency who knew the individual well and will be the primary contact for everything the family needs once the notification has been made. What type of person should be assigned this role, and what kind of training should they have? I sat down with KC Schuler, MDiv and board member for the Fox Valley Critical Incident Stress Management group to discuss.

What are some considerations services should make when putting together their line of duty death policy/procedure?

I think the first significant consideration should be conducting pre-incident training. I mean, are you starting the conversation about critical incident stress exposure all the way up to, and including, the possibility that they may never go home to their family, at orientation? During onboarding? So many of the EMTs and Paramedics coming in are young, and this may be their first job. In my experience, they can be somewhat blind to the possibilities. Early education and creating a culture of support—including letting them know you have their back (and their family’s back) in every potential scenario is important. The second consideration, I think, is to determine what scope you define as a line of duty death. The on-shift motor vehicle crash or incident resulting in death while on the clock is apparent, but what about suicide? If someone is having significant job-related stress and commits suicide, will that be looked at as a line of duty death, or not? This is something all organizations need to consider before such an event happens.

S: What type of actions would you recommend take place, or are discussed, as part of the orientation process?

KC: This is a great time for employees to fill out the emergency contact and next of kin form—this also provides an opening to discuss the possibility of death and the importance of filling out the form accurately and keeping it up to date. They are the best ones to tell you who you should notify in such a situation; guessing in the event of a death is not ideal. A portion of orientation and annual training should also be spent on mental health, including awareness, recognition of post-traumatic stress symptoms in themselves and their peers, and available support resources. Trained peer support and EAP can be very valuable in the management of work and home related stressors. Again, being intentional to build and sustain an organizational culture of support prior to an unfortunate tragedy like a line of duty death will help all those involved.

S: The Line of Duty Death Handbook talks about assigning a family liaison—a person who becomes the 24/7 primary contact for the family once notification has been made. This person should be available, in person and via phone, and dedicated to the family whether it is household chores such as mowing the lawn and grocery shopping, to communicating with out of town family members and arranging hotels. Who should be considered for such an assignment, and what might the service do to prepare these individuals?

KC: This is a high-intensity assignment, and this role should not be assigned to shifts in the beginning either. Being a family liaison is a big responsibility, and it is not a responsibility that should shift from person to person; ideally, the family will have one liaison for the duration. Trust is a significant factor—the family must trust the individual they are assigned, so that individual must be able to build that trust or recognize early if it is not a good match. Services should consider the following in their selection of a family liaison:

  1. Someone who is specially trained in being a family liaison. The nature of this position is demanding and can significantly interfere with the liaison’s personal life and responsibilities of emotionally supporting another. They need to be able to have clear boundaries, open lines of communication to leadership, and have a stellar support system in place as well. The International Critical Incident Stress Foundation does offer a 2-day LODD course.
  2. Preferably, the family liaison would not have any other roles (such as being an honor guard member) as they will likely have other duties and responsibilities throughout the process and at the funeral itself. The liaison duties need to be 100% dedicated to the family.
  3. Gender sensitivity—If the deceased is a male, you may want to assign a female liaison to the spouse as there can be a lot of strong emotions during this time and unhealthy attachments can form. You should consider gender identity and sexual preference in assigning a liaison as well.

Training and preparation of individuals for family liaison assignment should happen before an event like this ever occurs.

S: If I am a service director looking to send a few people to train for this, what type of people should I look for?

KC: If I had to provide a list of characteristics for liaison selection, it would probably include someone who:

  1. Does not gossip and respects confidentiality.
  2. Can make things happen—someone who is comfortable making, and either has the authority to make decisions on behalf of the service, or has direct contact with someone who can.
  3. Has a great support system of their own.
  4. Understands and respects boundaries—can set limits where appropriate and necessary.
  5. Is comfortable speaking, but also understands and can recognize the importance of silence, or when not to respond.

S: When it comes to families, there are a lot of dynamics a liaison might have to contend with such as divided families or family members that do not get along. If more than one individual is involved in a LODD, such as two members killed in a car accident, there may also be dynamics between those two families that need to be considered. What are your recommendations for addressing those type situations, where either a single family or multiple families may be at odds?

KC: If there is more than one family involved (i.e., two employees) you will want to assign each family a liaison, and those liaisons will need to be in close communication with each other and the organization leadership. One thing agencies may wish to consider is holding family support or family networking events throughout the year, before an event like this happens. I mean, beyond the Christmas parties and summer picnics where all families are invited—events that allow family members of your employees to get together, build relationships, and form a support system between families who understand the dynamic of supporting someone in EMS. If families are meeting for the first time as the result of a fatal accident, the dynamic will likely be much different (and more difficult) than if they are afforded a place to get to know each other and form bonds before such an event would happen. It is a lot easier to blame a stranger than a friend; it is easier to share pain and experience with someone you share a bond.

If there is pre-incident conflict within a family, such as animosity between divorced parents or an ex-spouse, these situations become more difficult to manage. Training will help the liaison better navigate and handle these situations.

S: You mentioned before, the importance of knowing the resources in your area—what would you say to those services who might plan to reach out to their local CISM or hospital for a family liaison or other support in this situation?

KC: As I mentioned before, EAP is a valuable resource but likely not the best as a stand-alone support in the event of LODD, and it certainly would not be able to function as a family liaison. Many hospitals may have pastoral care staff, such as myself; however, many would not have the capacity to operate as a family liaison or the awareness, authority, and connections to make decisions on behalf of your service. So, neither of these options would not be the best plan in my opinion. CISM teams can help in debriefings, but again, that is different than functioning as a family liaison. Some of your staff members that are trained as CISM peer counselors, however, may be excellent candidates for continued training in LODD and more specifically, as family liaisons.

S: You also mentioned how the family liaison should be taken off shift responsibility and assignments while they are functioning as the family liaison. What time frame should a service expect, and could the director or administrative staff function as the liaison to reduce scheduling disruptions?

KC: The time frame will be variable and unique to each situation; this is part of the importance of a service’s selection and training of these individuals. They need to determine when the family needs the high-intensity liaison, when to move to periodic support, and when to transition out to periodic or then eventual annual check-ins. They need to do this without creating a co-dependence.

A director or administrative staff would not be the ideal candidate for the family liaison assignment. The director will be busy dealing with many other operational details and would not be able to devote the time or attention to the family during the high-intensity phase. Ideally, the liaison will be someone the fallen individual knew, worked alongside, and had a good relationship with; someone who can share some stories with the family. The liaison’s ability to do this goes back to the importance of fostering the family/spousal support network as well.

There are many ways in which services can prepare for a line of duty death. Option one is to bury your head in the sand and pretend it will never happen to you. This, we know, is a lie; a lie to ourselves, our employees and their families. Option two is to address the potential with eyes wide open and full support starting in orientation and stretching through the selection of qualified employees for advanced training. Even if I am lucky enough never to experience a LODD personally, I would rather work for an organization adopting option two every time.

“It is a curious thing, the death of a loved one. We all know that our time in this world is limited and that eventually all of us will end up underneath some sheet, never to wake up. And yet it is always a surprise when it happens to someone we know. It is like walking up the stairs to your bedroom in the dark, and thinking there is one more stair than there is. Your foot falls down, through the air, and there is a sickly moment of dark surprise as you try and readjust the way you thought of things.”

― Lemony Snicket, Horseradish

What I Wish I Had Known

Congratulations! You were selected for the Paramedic Supervisor position, if you accept, we’ll start the transition immediately.

I remember the excitement I had when I heard those words so many years ago. The excitement that carried strongly through 2 days of celebrating with my husband, anticipating the new world I was about to be part of; making a mental list of all the mountains I couldn’t wait to move! This excitement was quickly drowned by a sinking feeling deep in my gut. It felt like running out of gas on a country highway at one in the morning and your cell phone is dead; it’s dark, there is nobody around, and you cannot phone a friend.

Whether it comes right away, or later—because of the reaction of people we thought were friends or feeling overwhelmed in a new situation you were expected to handle with precision, we’ve all felt that feeling as a new leader. By sharing our stories with one another, the success and the failures, we all grow.

I remember getting so much advice from those who walked the road before me, some solicited some not. The stories were sometimes shocking, often comical and always gave me perspective and insight into my own blunders – most importantly the stories many shared with me taught me the importance of humility and the ability to laugh at myself, admit my mistakes, learn and move on. At some point, the tide started turning, and friends and colleagues began asking me for my stories and advice. Although I often felt like I wasn’t experienced (i.e. old enough) to be offering any advice I realized it’s not necessarily the age or years of experience behind the story that makes it meaningful. The power is in the ability to share an experience through storytelling—finding common ground amongst the hierarchy of titles and job descriptions.

I think it is easy to lose sight of how our words and actions can affect others as we are wrapped up in our day to day and moving down the checklist of tasks. The influence of a leader in an organization, even an informal leader, is long lasting and not to be taken for granted. Over the past year, I’ve been talking to many EMS leaders of the past and present. I’ve been asking them what they wish they would have known when they first started their leadership journey, and what advice they might give to others just starting out. Here are 10 of the most common answers I received.

Top 10 Things I Wish I Had Known

  1. I wish I would have known I could be myself. Being myself earned me the role, but suddenly it didn’t seem like enough. At first, I thought others were putting all this pressure on me to be an amazing supervisor immediately – in hindsight, I realize I was putting the pressure on myself and it was totally unnecessary. Being myself allowed me to be a more effective supervisor for my team and I wish it hadn’t taken me so long to figure it out.
  2. I wish I would have learned earlier how important listening is. Listening to understand your people, listening to learn and listening to understand the politics that are happening beyond the surface.
  3. I wish I would have known that I didn’t have to be right all the time; I wasn’t expected to be right all the time. I was only expected to be an honest and reliable resource for my team.
  4. Change is slow. PAINFULLY slow. In EMS there is constant instant gratification – you see a problem with a patient, you fix it, you drop them off. Transitioning to an administrative role and learning that change is slow and takes time (SO MUCH TIME!) is more difficult than I ever would have imagined. I had to really learn to see the long game.
  5. It’s not a “day job”. As a leader, you’re never off duty. Whether you’re on a regular rotation as a shift supervisor, or in the office as a manager or director, EMS is a 24/7 world which means you work nights, weekends and holidays right along with your team. You may not be on a truck or at a station—but you’re still available to them all the time.
  6. I wish I would have understood how important mission, vision, and values really are to a company, and how important it is to talk about them with staff.
  7. We’re all learning, and it is OK to ask for help.
  8. Just because a staff member is asking me a question, it does not mean they are challenging my authority. As a leader, it took me a long time to realize that I should embrace a staff member challenging a decision so long as they are doing it in a constructive manner.
  9. I wish I would have known how much of an impact I have on people. I don’t mean that in an arrogant way. I’ve had staff bring up conversations we had years ago, and I had forgotten all about it—but they were still carrying that encounter with them.
  10. That it wasn’t for me. I thought I wanted to be a supervisor – a leader. I was wrong. I was unhappy with the role and everyone knew it but me, and I was becoming destructive.
    When I came to the realization that I wasn’t the right person for the role, my boss allowed me a front row seat to the best example of leadership I have personally witnessed. He allowed me to step back from the role but didn’t forget about me; he continued to invest in me as an employee and as an individual despite the certain protest of others. To this day, he continues to provide guidance on my professional endeavors and is someone I truly look to for honest advice.

5 Can’t-Miss EMS Podcasts

Podcasts are a great way to gain information and insight on a variety of topics.  With the intimidating number of podcasts on the topic of EMS and leadership available, it can take a bit of time to find the one that’s right for you.  I have been a fan of podcasts for several years now, and while some of my favorites have dropped off over the years, I am certain there are many new favorites out there waiting to be discovered.

If you’re not yet listening to podcasts, I encourage you to start exploring – here is a quick list of some of my current favorites in EMS and leadership to get you started. (* We’ve included links are iTunes, but these podcasts can be found on just about any podcast service.)

  1. Prehospital Emergency Care Podcast
    This is a newer podcast, and quickly landed on my subscribed list for the obvious reason; it is the official podcast for the NAEMSP. The first few episodes were recorded during the most recent NAEMSP annual meeting, in the most recent the hosts spend time interviewing authors of studies published in the PEC journal, discussing results questioning when, and how, changes should be implemented based on those results.  I’ve been able to make the NAEMSP conference a few times, and it is truly enjoyable.  This podcast is a nice way to keep up on the research and recommendations coming from the NAEMSP.
  2. EMJ Podcast
    This podcast discusses the research published in the Emergency Medicine Journal (EMJ) and is a great listen, in my opinion. The hosts are easy to listen to and the way they discuss the research and potential application is thought provoking, particularly given the international perspective.
  3. CPR Podcast
    This podcast is a little bit of everything in EMS. While most of the episodes seem to have a clinical education spin, others delve into some standard practice, leadership, and provider health and safety topics as well.  The conversations are well planned without seeming overly rehearsed which ads a measure of sincerity to the commentary.
  4. Dear HBR
    This is a newer podcast and is produced by the Harvard Business Review.  While not directly related to EMS, there is value for EMS listeners.  Individuals write to the show and ask questions – many of which are about how to handle conflicts or difficult situations in the workplace – and the hosts discuss the question at hand and the advice they might give the individual based on personal experience and available research.  There is so much we can learn through the experience of others, and this is a good way to compare our own experience with the experience of others, and perhaps walk away with some good advice.
  5. EM Weekly
    This focus of this podcast is emergency management (EM), but the discussion topics span everything from tactical planning to leadership and future possibilities. The host and guests mix in a bit of the history of EM throughout the episodes which helps provide perspective and understanding of the evolution of emergency management over time, and ideas for the future.

Editor’s Note

Samantha Hilker, author of this article, is the host of the excellent EMS in Wisconsin podcast created by the Professional Ambulance Association of Wisconsin. Don’t miss it!

8 Ways You Can Support Millennials in Your Workplace

Millennials… am I right?

That seems to be the most popular punch line when I am sitting around a table with colleagues discussing organizational change or current challenges in EMS, particularly staffing and development. I recently attended a conference focused on leadership in EMS and if there was a session without mention of the dreaded millennial and how awful they are, I missed it. To be honest, it’s getting old and my ability to filter my exasperation is wearing thin, especially as we are now seeing offers of multi-day trainings for how to work with millennials. The entire concept seems quite strange to me… were there classes offered to the Boomers on how to get along with the Generation Xers?

The words I usually hear associated with the generation at hand are entitled, needy, whiney, lazy, untalented and impatient. I don’t believe anyone I know well or have worked with over the years would describe me with any of these terms (ok… maybe impatient from time to time), although I am in the generational age range for millennials. In fact, I am willing to bet many of you work with people who are within the age range for millennials, yet you would not immediately lump them into the group you find so difficult. According to the PEW Research Center, millennials were initially described as those being born after 1981 are now defined as those born between 1977 and 1992.

While I am not attempting to climb up and be a representative for the entire millennial generation, I do believe this simple list addresses many of the issues I have heard, from both sides of the generational gap, over the past few years.

  1. Stop complaining about millennials.
    Generally, please stop using the word millennials to begrudgingly sum up every challenging situation or conversation you’ve had involving someone younger than you. Specifically, please stop complaining about millennials to me… a millennial. I realize you think my entire generation is made up of needy children who cannot be bothered to show up for work, but is that how you would describe me? I will admit the above description does fit some of my generational cohorts, if you can admit there is a certain irony in constantly complaining (whining) about a generation of whiners.
  2. Get to know me.
    Time is precious, and you don’t have enough of it. Staffing shortages, schedule changes, contract demands, and personnel issues take up so much of your time it can be easy to overlook the simple things that really make a difference in an organization. Something as small as a conversation can drastically change how I feel about, and in, an organization; it helps me learn about the culture of the organization, how I should approach leadership with any issues that come up in the future and how long I’ll stick around. Leadership taking the time to have a conversation, even 15 minutes, will set the foundation for the relationship I will have with the individual(s) as well as the organization.Seriously, take time out of your day to get to know me as a person instead of an employee number. This can start in the interview or orientation process, and continue while I’m on shift. Most EMS organizations have shift supervisors that are also working on the truck and, in many cases, orienting new employees during their first 60 days; take the time to have a conversation about expectations (from both sides), communication preferences and styles, and personal and professional goals. Onboarding someone to your organization is about more than protocol compliance and radio reports.
  3. Stop talking to me about money.
    Yes – money is important, and I expect a reasonable level of compensation for the work I am doing. I want to be able to support myself, my family and my lifestyle but I’m about more than that. By and large, I am value driven; I want to know that what we are doing is making a difference somehow, and that my values are mirrored in the organization I work for. To clarify, money is NOT the primary motivator and when you lecture me about finances (the way my father would), I shut down and know that you do not understand me.PS: Organizations that take the extra time to lay out and explain complete compensation including benefits, insurance costs, etc. and offer resources for budget planning are absolutely adding value to all employees, not just millennials.
  4. Share your vision, so I know the path and the timeline
    I might seem impatient…but my whole life I’ve been told to set goals and reach them. Go to college and get a respectable job. DO better. BE better. Nobody ever told me to be PATIENT. Share the vision of the organization. Share your vision for me (specifically) within the organization, and ask what my vision is. Work with me so I can understand my potential career path and a realistic timeline, so I can be an active participant in my development and, together, we can manage my expectations.
  5. Realize that when I ask you “why” I’m not challenging you.
    I legitimately want to understand why I’m doing what I’m doing. The things we do during downtime, on scene and in the back of the ambulance are all part of a process, not the entire process. Understanding where my “place” in the process is and what happens next helps clarify the importance of specific tasks, particularly those that need to be completed in a certain order or timeframe. It is important for leadership to go beyond the “because I said so” reasoning. I remember being told once, long ago, that I should never tell anyone something I can’t show them. That message stuck with me and I have come to expect the same from others, particularly those handing out orders. Help me see the why and I will gladly complete the task… maybe I’ll even find a way to do it more efficiently.
  6. Stop telling me “Good Job”. It’s a cop out – you know it and I know it. Just stop.
    Recognizing effort is always better than recognizing completion. EMS is a high-stress, mentally demanding industry that can feel somewhat all-consuming. When I take on a project that means extra time away from my family or squeezing more work into my already busy shifts, learning and exercising new skill sets or successfully coordinating the work of others, an “Atta Boy!” just doesn’t cut it. Also, I know I’m not perfect, so when performing my annual review, a blanket “you’re doing a great job…” tells me you’re really not putting the effort into giving me an honest review and you’re not invested in my continued improvement.
  7. Don’t be my punchline.
    This is a simple one… I expect you to practice what you preach. For example, if you implement (and enforce) an organizational policy that says employees cannot call in late or sick via text message, do not cancel a meeting or let me know you will be late via text message. Require a minimum of a 4-hour notice for a sick call? No problem, until you cancel our meeting at the last minute, or even worse, after it has already started, you’re not there and I have to call you. Please do not talk to me about the importance of dedication and doing the right thing even when no one is watching and let me see you leave early when your boss is out of town or hear you complain about meetings that go past 5pm. Coaching me on the importance of follow up? Please, please make sure you set the example of what good follow up looks like, because if you’re enforcing rules that you clearly believe you are exempt from and failing to provide the example, you lose a lot of credibility.
  8. Get Social
    It’s a social world, and we’re proud of what we do and where we work. For many being an EMT or paramedic isn’t just a job, it’s their identity; take the opportunity to post your new hire photos and bios on your social media accounts and tag the employees in the celebrations so their friends and family can share in their pride and success.