Some people call team dynamics unconscious and psychological forces that influence a team’s behavior and performance. I believe they are intentional ways of being. Leadership has to start with someone and it’s the responsibility of the team leader to set the tone for team dynamics.

Feedback, debriefing and difficult conversations are tools used by leaders to build teams.

Feedback is just data. It’s data that allows us to make adjustments. Feedback should be given neutrally. It’s just the other person’s experience of you. Which means it’s not true with a capital T.

Try on taking the feedback and considering it. If it doesn’t fit or work for you then ok you can disregard it, but consider this: If someone tells you once, consider it. If you hear the same feedback a second time, you better take a look at yourself and chew on it a while. If you hear the same feedback a third time, wear it and adjust.

Having a friendly mentor who cares enough to have the difficult conversations is another.

The other tool used by leadership in cardiac codes is debriefing. A debriefing is an open-ended question. Open-ended questions create loops in peoples’ minds. They must work through the loops using critical thinking skills to toss the question around.

The problem is if you ask and answer the question it defeats the purpose. The critical thinking skills provide for self actualization of the answers. Maslow’s Hierarchy of Needs say we peak-out with self-actualization, meaning it’s a sticky lesson.

Being able to have a difficult conversation is the third key to building teams. The key to difficult conversations is neutrality. You can say almost anything if you leave your passionate ego at home and say what needs to be said in a neutral tone. Neutrality removes the emotions that tend to cloud the issues.

The American Heart Association’s, Basic Life Support (BLS) and Advance Cardiac Life Support Course (ACLS) teach Team Dynamics and they include:

  • Clear responsibilities
  • Clear communication
  • Mutual respect
  • Knowledge sharing
  • Constructive intervention
  • Closed-looped communication
  • Knowing ones limitations
  • Re-evaluation of the incident

Clear Responsibilities

Clear responsibilities help everyone know what their job is in an emergency, but things don’t always go in textbook fashion. Drilling with the team is the best way to ensure that all members understand their responsibilities. Not just one drill, but many.

Some science says it takes as many as seven times for some to get all the details ironed out in their mind. Drills and practice codes need to be as close to a real-life incident as possible.

Learning cardiac codes can be fun especially if you have the basics down. There is a need for six members on the team. The leader, airway management, drugs/IV, CPR, monitor, recorder.

But since we live in the real world and only have two EMS responders (Paramedic and EMT), we must train firefighters or other non-medical personnel to assist with the basic skills. Even security personal or a secretary can do CPR and work an AED.

Once a new member has practiced running codes with the team, they must learn to lead them too. One of the quickest ways to learn the codes is to act as the team leader.

Let the rookies step up and run the mock codes until they get it into their bones. Once someone is put on the spot as a leader, they understand the importance of supporting the leader and team dynamics take on new meaning to them.

Clear Communications

Clear communications is key to maintaining calm in the team. During the mock code, clear and deliberate communications from the leader is required. Clear, precise, thoughtful and neutral statements (without emotion) are required among the team.

Practice staying calm and giving orders while fighting for life and death. There is no need for an overly emotional response by anyone. It screams of rookie and lack of leadership skills.

Leaders train themselves in staying calm and doing what my Dad called “The Duck.” The duck is calm on the outside and paddling like hell underneath. He smoothly crosses the pond and it looks effortless. This “Duck” persona comes with practice, practice, practice and a little experience.

Mutual Respect

If you ask most people, they think they show respect for others. Take a look at a Facebook page and you might see something entirely different. If disrespect shows up anywhere, it requires a difficult (yet neutral) conversation.

Respect for a fellow team member goes way past the differences, religions, beliefs, education and the experience one has. Respect (acceptance) is a basic and fundamental need we all have.

Respecting another person says so much about you. Respect even for the rookie that makes multiple mistakes is required. It’s required because we have all made some of those same mistakes and forgiveness was not only nice, it was amazing and so appreciated.

Looking past our superhero ego and into the heart of another person takes real leadership. Leaders take people and make amazing teams out of them. Building an amazing team takes time, attention and some nurturing.

Knowledge Sharing

Having a set of rules to follow is great. Knowledge sharing includes everything from reminders of the rules and regulations to expectations. Company interpretations, understanding of how procedures are applied to the job assignments and other experiences are included in knowledge sharing.

Knowledge sharing means it comes from all you have and without the ego we all tend to have. When sharing with someone your knowledge notice if you begin to feel superior. If so, get off it. Someone shared it with you, and you appreciated it I am sure. You are simply doing the same thing.

My mentor at the fire station shared a lot of knowledge with us. The day he dropped dead of a heart attack, the rookies went into full swing supported with the knowledge shared by him. It made saving his life an easy thing to do.

Constructive Intervention

Constructive intervention by team members is absolutely one of the most important keys to building great teams. Like knowledge sharing, it must be mostly neutral.

When working an emergency cardiac code with a physician he ordered “3 milligrams of epinephrine” be given to a patient. As a paramedic, I serve on his team and it required me to constructively intervene. I repeated the order of 3 milligrams then asked: "Doc, did you mean 3 milligrams or .03 milligrams for the pediatric patient?"

The clarification gave the physician a moment to think. He smiled and thanked me for the polite (an neutral) correction. Privately, he thanked me for being a great team member. I felt a valuable part of his team and it built our respect of one another. We are all humans and fallible. We all have memory lapses. We all need each other.

What is a head without the arms and legs? A missing toe can be the difference of balance to some. We are all in it to win it — together. Teamwork is not a competition.

Consider that real leaders don’t need to fight their way to the top through forcing and controlling everything. They lift everyone around them with praise and appreciation and, in turn, end up being pushed to the top by the team.

Closed-Loop Communications

The problem with communication is the allusion that it has actually happened. Closed-looped communications are required when emergencies are going down. The team leader gives an order/directive and the receiver of the order/directive repeats back for clarification.

For example, a physician orders “300 milligrams of Amiodarone” and the receiver of the order repeats it back. This is used for critical incidents and serves a purpose of clarifying orders received. If an order is given and the expression of the person receiving it has a hint of not understanding, the leader should ask neutrally, what did you understand me say?

Listening fully to the response will let you know if you need to restate or clarify the order.

Knowing Ones Limitations

Team members need to know other members’ limitations. If a leader orders a drug be given by an EMT (thinking they are a paramedic). The EMT should immediately speak up and say what the limitation is for them. “I am an EMT and not trained in giving that drug.”

This allows a leader an opportunity to redirect the order to another member capable of fulfilling on the order. I can always assign the EMT to another skill such as CPR, basic level airway management or recording the event. We all have a place in the emergency and valuing the team member while showing respect is a sign of leadership.


Any ongoing incident requires constant re-evaluation. So, I am working a cardiac code and I am the team leader. Once I have started running the code and into my first cycle of two-minutes of CPR, I use that time to re-evaluate.

For example: The airway management person is asked, “Are you to moving air through the bag easily?” If not, I might consider hypoxia. The CPR person is asked if they are getting tired and the adjustment I make is to switch roles of the members.

Then I begin to work my way down the H’s and T’s of cardiac arrest. Hypoxia, Hypovolemia, Hydrogen ions (acidosis), Hyperkalemia/Hypokalemia, Hypothermia, Toxins, Tamponade, Tension Pneumothorax, Thrombosis (myocardial infraction) Thromboembolism (pulmonary embolism) and Trauma.

Sherrie Wilson is a retired firefighter-paramedic and new EMR editor for Industrial Fire World. She also runs an American Heart Association Training Center Coordinator with 500+ instructors in emergency cardiac care. She teaches team building and leadership classes in the emergency arena.