Leadership is one of those terms we all use, yet struggle to pin down. In the worlds of prehospital and expedition medicine, where environments shift in seconds and stakes can be genuinely life-or-death, the idea of “leadership” becomes more than a buzzword. It becomes a living, breathing practice.

At its core, leadership isn’t about a title or a badge. It’s about relationship: a dynamic and fluctuating interaction between the person directing and the people following (Leadership < Followership). It’s shaped by the situation the expedition participants find themselves in. This triad – leader, follower, and situation – forms the foundation of effective leadership in any context, but especially in the unpredictable environments we operate in.

Why Situations Matter More Than Styles

Traditional leadership theories often focused on personality; the charismatic hero who inspires everyone just by walking into a room. Early thinkers like Maslow romanticised this kind of great leader approach, but in the field we quickly learn that charm doesn’t stabilise a hypovolaemic patient or navigate a team up a deteriorating ridge in a hurricane.

Contingency theory brought an important idea to the table: Situational context matters. It argued there’s no one perfect style for all scenarios, rather effective leadership depends on matching the leader to the situation at hand. That makes intuitive sense, yet the way this theory frames adaptation is, frankly, too rigid. It assumes one leader per one situation, with little room for the nuance of human capability and growth.

In environments as complex as remote medicine, this rigid “one fit, one scenario” model falls short because:

• No two patients are the same
• No two team members react identically
• And no situation remains static

So if leadership is about people and situations, and these are constantly evolving, then leadership itself must be adaptable.

Situational Leadership: Leadership Meets Reality

That’s where Situational Leadership Theory (SLT) really comes alive for us. It’s my favourite of all the many leadership theories. Instead of locking leaders into a fixed style, SLT teaches that the best leaders adjust not only to the task but to the needs and readiness of the people they’re guiding.

In expedition contexts, this rings true:

• A new team member might need clear, directive leadership on their first high-angle rescue.
• The same person might thrive under coaching or delegation once they’ve gained experience.
• A seasoned medic might require little direction but high support during moments of crisis.

It’s not about changing your personality. It’s about matching how you lead to the needs of your team in that moment.

Research supports this adaptive approach, linking it to stronger team cohesion and performance.

That said, SLT isn’t perfect. In practice, the neat categories of “style” and “follower development” don’t always align cleanly with messy, real situations. But it does underscore something absolutely vital: leadership is relational and responsive, not prescriptive.

Followership: The Underrated Side of the Equation

Leaders do not (should not) work in isolation….

Too often leadership discussions focus only on the person at the front giving orders. But in prehospital and expedition medicine, good followership is just as (correction: ALMOST CERTAINLY MORE…) important.

Followers aren’t passive. They influence decisions, shape team morale, and drive outcomes through engagement (or disengagement). The best teams I’ve worked with are those where leadership is co-created. Voices are heard, competence is recognised, and responsibility is shared. Effective leadership recognises this. It thrives not just by adapting styles, but by valuing the perspectives and growth of those being led.

Leadership as a System

So what does good leadership look like in extreme, resource-limited, high-stakes environments?

It looks less like a toy toolbox of “styles” and more like a responsive system, one that:

• Balances individual needs
• Responds to situational demands
• Aligns with team and organisational goals

In practical terms, that means:

• Being directive when clarity saves lives
• Coaching when team members need development
• Delegating when confidence and competence are evident
• And supporting when stress threatens performance

Above all, it means holding uncertainty with composure; recognising that the situation and people in it will change, and so must our approach.

Final Thought

In prehospital and expedition medicine, leadership isn’t a label. It’s a practice. A living dialogue between who we are, who we serve, and what the moment demands. Adaptive leadership isn’t about perfection. It’s about presence.