Leadership in emergency medical services: An integrative literature review

BACKGROUND: Leadership style in nursing has been associated with job satisfaction and patient outcomes. However, leadership research in emergency medical services (EMS) is limited and often emphasizes clinical encounters rather than system-level leadership. OBJECTIVE: This integrative review aimed to explore how leadership in EMS has been described in scientific research, to provide an overview of key themes, and to generate a synthesis that supports leadership development. METHODS: Searches were conducted in CINAHL, Scopus, and PubMed. Studies focused on clinical leadership were excluded. Two independent reviewers screened and critically appraised 17 articles, synthesizing the findings using a structured, integrative, and inductive approach to identify key EMS leadership themes. RESULTS: The included studies were thematically heterogeneous. Five key themes emerged: leadership models and styles, personnel management, communication and interaction, employee competence development and quality assurance, and transition into leadership roles. The literature showed limited coherence, and few studies examined leadership styles in detail. CONCLUSIONS: Leadership in EMS is complex and context dependent. The relationship between transformational leadership, employee well-being, and system or patient outcomes has not been sufficiently studied. Although transformational leadership appears well-suited to EMS's dynamic and high-pressure environment, it remains underutilized and underexplored.