By Nick Siemens
“How many different types of strokes are there?” the instructor asked.
“Three main types,” responded the fire-medic student confidently. “Ischemic, hemorrhagic and transient ischemic attacks, or TIAs – mini strokes.”
“Excellent,” encouraged the instructor. “Can you tell me the acronym that can be used to recognize when a stroke might be occurring?”
“FAST,” the fire-medic student replied, going through each letter individually: “F is for facial droop, A is for arm weakness or paralysis, S is to remind me to check for slurred speech, and T is for time – when did it start, or for the public, T means it’s time to call 9-1-1 and get help.”
While the student in this scenario was able to correctly recognize the main types and signs of a stroke, there is another type of stroke that is rarely discussed. The type of stroke I’m talking about is not one of the 795,000 annual medical strokes caused by lack of blood flow to the brain; rather, it is a leadership “stroke,” which presents many of the same signs and symptoms identified in the FAST acronym above.
Head-to-toe examination
Leadership strokes can often be recognized by others long before we see the signs in ourselves. Let’s take a minute and do a quick head-to-toe self-assessment to see how we are presenting to our followers. Starting at the head and examining the face will reveal if any of the FAST signs are present and will provide information on other common stroke symptoms.
Patients experiencing medical strokes often complain of blurred vision or trouble seeing. How many people suffering from a leadership stroke are demonstrating vision issues, too? As a leader, are you having trouble identifying an organizational vision for the future? Is the department’s vision unclear or can members plainly see where the department is going? Can you – and do you – communicate expectations and a clear vision to your followers? When you look ahead what do you see for the organization and your people?
F – Facial droop = crew engagement and positivity: After assessing our vision during our self-evaluation, we should next consider our affect, our emotional tone. What outward attitude and behaviors are we demonstrating as leaders? How do we look when we walk into a station to visit our troops? Do we show up with a smile letting the crews know we are glad to see them, or do our crews see a permanent frown and facial droop as we interact with them? It’s possible that one of your EMTs might even ask you to give them a big smile as they internally assess you for leadership stroke. Firefighters are an intelligent group of men and women, and they can quickly identify if their leaders want to be involved at all levels or if the leader feels like visiting the stations is an unpleasant chore.
A – Arm weakness/paralysis = analysis paralysis: As leaders, are we able to move forward with a purpose or are we simply drifting along? When we assess a patient for a medical stroke, we often ask them to hold their arms out in front of them to see if they can keep their arms straight and level. Occasionally we find ourselves caring for a patient who cannot keep one of their arms from drifting downward or to the side. This observed weakness can vary from simply being unable to hold their arms out to complete paralysis on one side of the body. This weakness is often a telltale sign that a stroke may be occurring.
Our followers are always assessing us and watching our movements. As leaders we should be able to avoid drifting weakly along and instead demonstrate a strong and even leadership style. Sometimes it seems as though instead of moving the department ahead with a purpose through training, education and communication, leaders spend more time putting out both hands to stop progress and end up with a drifting organization. Perhaps worse than the drifting leader is the paralyzed leader who is experiencing a leadership stroke. This is the type of leader who is suffering from analysis paralysis and frozen with fear, unable to move. What our followers want are leaders who are strong enough to make important decisions, leaders who can demonstrate reason, compassion, and understanding. They want to work for a leader who can make timely decisions that will move the organization and its people forward in a healthy direction.
S – Slurred speech = communication: While we are interacting with our crews at the stations or on calls, we should take the opportunity to communicate with our members. As leaders, are we speaking clearly with our firefighters? Do we let them know we appreciate them for putting the mission and values of our organization into action? Do we tell them of the positive impact they’re having on their community? Or, instead of clear, positive communication, someone experiencing a leadership stroke may exhibit slurred speech or confusing language. The leader may say negative things about other people or offer slurs that don’t line up with the words we expect to hear from a leader. Ask yourself when you are with your crews, “what, and how, am I communicating?” [Read next: Crisis comms: Saying nothing is the worst strategy]
T – Time: Timeliness may be the biggest factor of all when considering medical and leadership strokes. If left untreated, the damage to the patient and the leader may become permanent. Just as we ask our patients how long they have been experiencing symptoms, we need to step back and evaluate how long we might have been exhibiting leadership stroke symptoms. Our patients may experience several symptoms, such as headaches, blurred vision, or loss of movement. A leadership stroke may result in management headaches, a lack of trust from no vision, or reveal the leader has become out of touch with the personnel responsible for the day to day activities of the department.
Key questions
After the self-evaluation and assessment have concluded, it might be time to step back and ask a trusted friend a few questions:
- How would you say I am doing as a leader?
- Have I established a clear vision for myself and the organization?
- Am I speaking out about issues and providing quality communication to our crews?
- Do they understand the expectations our department has established? What about movement?
- Are we headed in the right direction and acting with purpose?
If the answer to each of these questions and their symptoms associated with the FAST acronym is yes, then you likely have a strong and healthy organization. However, if the response to the self-assessment reveals a negative response, then perhaps its time to recognize that you may be suffering a leadership stroke.
Act FAST
Strokes are responsible for one out of every 20 deaths in the United States annually. Similarly, leadership strokes may result in the death of you as a leader, or worse, the paralysis and death of your organization. Time is of the essence. Act FAST and check yourself for the symptoms of a leadership stroke today!
About the Author
Nick Siemens is the division chief of training for Cheyenne (Wyoming) Fire Rescue. He spent three years as a volunteer firefighter prior to the 18 years he has been with Cheyenne Fire Rescue. Before joining the Training Division, he held the ranks of firefighter, paramedic, engineer and company officer. Siemens has a bachelor’s degree in public safety and emergency management, and a master’s degree in disaster preparedness and executive fire department leadership, both from Grand Canyon University. He is the former program director for the Laramie County Community College Fire Science Program and is the current chair of the Laramie County Training Officers group.