Immediate leadership in emergency medical service during the COVID-19 pandemic

Abstract

This case study explores how the COVID-19 pandemic from March 2020 to May 2023 affected the immediate leadership in the Helsinki City Rescue Department (HCRD). There are studies about its effects on the employees and how the pandemic was handled on a city level, but this study focused on the immediate leaders’ experiences in response to the prolonged crisis through the perspective of rescue sub-officers and the paramedic supervisors. Insights for improving crisis management and resilience in an emergency medical service (EMS) are produced with the case study research method. Identification and description of key leadership challenges and best practices during the pandemic can help improve crisis management and resilience in an EMS. The theoretical framework combined crisis leadership theories, infection prevention and control (IPC) practices, the Clean Cab system, and resilience concepts. 11 thematic interviews with immediate leaders, document analysis, and direct observations used in data triangulation improved the validity and reliability of this study. Key findings showed that while EMS operations remained stable and are the organization’s core services for society despite the surrounding situation, immediate leaders experienced significant changes in workload as administrative work grew, leading to decision-making and communicational needs. Effective leadership relied on honesty, adaptability, clear communication, and team cohesion. The basis for the IPC practices was found in the leaders’ previous work history, usually as a firefighter-EMT (Emergency Medical Technician). Adoption of IPC practices was accelerated, fostering a shift in workplace culture, but further focus on the implementation of practices is advised. Challenges included information fatigue, uneven compliance with safety protocols, and role ambiguities. Recommendations for the future include implementation of after-action reviews after significant crises and incidents, enhanced training in immediate leadership, and maintenance of the existing systems supporting leadership. Fostering interdisciplinary collaboration, organizational learning, and cultural change in IPC practices forms a base for future pandemic resilience.