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Toxic Leadership: Navigating the Maelstrom

(Author’s note: The author is not a psychologist. The information contained within this blog is a collaboration of research and sourced from journal articles by recognized authorities on the subject matter.)

Leadership is a key component to delivering effective prehospital emergency services (EMS). However, like any profession, EMS is not immune to the presence of narcissistic leadership.

Narcissistic, often referred to as “toxic” leadership, can have a significant impact on team dynamics, patient care, and overall team morale. In this blog post, we will explore the characteristics of narcissistic leadership, its potential consequences within EMS, and strategies for both identifying and mitigating its effects.

Y Scouts (, 2023) also points out that, in certain cases, some narcissistic traits may be of value to an organization seeking strong leadership.

Understanding Narcissistic Leadership

Narcissistic leadership is characterized by a leader’s excessive focus on their own needs, desires, and achievements, often at the expense of others. Such leaders typically exhibit traits such as lack of empathy, inflated sense of self-importance, a need for constant admiration, and a tendency to exploit and manipulate others for their own gain. (, 2021)

These characteristics combine to create a toxic environment that hampers collaboration, stifles creativity, and undermines the well-being of the entire team.

Identifying Narcissistic Leadership

Lead with vision

On the positive spectrum narcissistic leaders understand the importance of having a vision that people believe in. When an organization lacks solid leadership, such people are able to rise quickly through the ranks as they often perceive situations that don’t exist and attempt to create them.

Desire to be admired

Narcissistic leaders have a great yearning to be admired, and tend to draw a number of “star-struck” followers. Narcissists have a gift of attracting followers with their highly developed verbal skills and articulation. They are usually skillful orators and can deliver moving speeches. There is no lack of charisma in a narcissistic leader. (

Unable to take criticism

Narcissists tend to be extremely sensitive. This makes them particularly sensitive to harsh criticism. They are unable to accept criticism constructively and brood over it endlessly. They cannot tolerate slights or dissenting opinions and can be quite abrasive with those who dare voice negative or opposing opinions.

Inability to listen

Narcissistic leaders are not good listeners. This disinterest in listening presumably develops as a defense mechanism to keep them from acknowledging criticism. Narcissistic leaders also believe that subordinates do not have much to contribute. Their opinions need not be taken seriously.


Also on the positive side, healthy narcissistic behavior involves a real concern for others. The narcissist needs to be liked. Therefore, rallies followers by showing concern and empathy, whether legitimate or feigned. On the other hand, leaders exhibiting destructive narcissistic behavior may not hesitate to devalue or humiliate others with no sense of remorse.


Another healthy narcissistic trait is the leader will have an established set of values and follow a consistent path to follow through with those plans, often without regard for other’s opinions. Narcissism turns destructive when a leader has no ethics, is fickle, changes direction often, and is easily bored or frustrated when things don’t work out as they expected.

Empire building

A narcissistic leader often expresses a desire to “take over the world” and create an empire. They want to leave behind a larger than life legacy and therefore actively seek to expand their sphere of influence, hire loyal subordinates, or increase their reach and authority within the organization.

Lack of empathy

While they crave for empathy and understanding from others, narcissists tend not to be empathetic people. Some of the most charismatic and successful narcissists are not known for empathy. This lack of empathy can actually be a strength in times of chaos and radical change because they are not bogged down by feelings and emotions or the needs of their personnel. In many cases they tend to seek termination of those who disagree with them as a primary resolution.


Narcissistic leaders are ruthless competitors. They are relentless in their pursuit of victory. They take games seriously and see them as a test of their strength and survival skills. Since most narcissists lack a moral compass they are capable of doing whatever it takes to win.

Good leaders are great mentors

Not so much for the narcissist! Since they lack empathy and are extremely self-reliant, it is difficult for a narcissistic leader to mentor or be mentored. Narcissists tend to instruct or dictate rather than coach and try to create protégés who are faithfully subordinate, paler versions of themselves.

Consequences within EMS

Narcissistic leaders can and have caused entire organizations to fail.  Too often the narcissist blames everyone but themselves for such failures.  But these failures can have a greater impact than just collapse an organization.  They can have fatal consequences for those we serve.

Compromised Patient Care: Narcissistic leaders may prioritize their own image and advancement over the well-being of patients. This often leads to rushed decisions, lack of focus on patient needs, and even medical errors.

Dysfunctional Team Dynamics: A narcissistic leader often fosters an environment of fear, competition, and distrust. This can lead to a breakdown in communication, hinder teamwork, and impact the overall performance of the team.

Burnout and Morale: The narcissist tends to accept credit for successful work, even if they had little or no involvement and widely distribute blame elsewhere for failures. They are also quick to dismiss the contributions of others in favor of their own accolades. Constant demands for admiration and the undermining of team members is a common source of burnout and lowered morale. This frequently leads to frustration, decreased job satisfaction, and higher turnover rates.

Mitigating the Effects

Emergency service organizations create plans and processes which identify vulnerabilities and mitigate anticipated disasters and crisis. As indicated earlier, narcissists tend to rise to power during an organization’s period of vulnerability. Putting mechanisms and policies in place which identify and react to narcissistic behaviors early can potentially negate long term effects later on.

Education and Training: Provide leadership development programs that emphasize emotional intelligence, empathy, and effective communication skills. Recognize those who reject these concepts as having narcissistic tendencies.

360-Degree Feedback: Implement a system where team members can provide anonymous feedback on negative leadership behaviors. Administration must be prepared to address these concerns which may help some leaders become more self-aware and work on their shortcomings.

Promote Collaborative Culture: Encourage a culture of teamwork and shared accomplishments rather than individual accolades. This can help counterbalance narcissism.

Supportive Policies: Develop policies that promote transparency, accountability, and open communication within the organization.


Narcissistic leadership can have devastatingly negative impacts within an EMS organization. It is imperative for EMS administrators to recognize the signs of narcissistic behavior, implement strategies to mitigate its impact, and prioritize the well-being of both the team and the patients they serve.

By fostering a culture of empathy, collaboration, and effective communication, EMS can thrive under the guidance of leaders who prioritize the greater good over personal gain.