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If you’ve read a newspaper, watched TV, or scanned any social media since early February, you already know Dr. Jullette Saussy resigned as medical director of Washington, D.C. Fire and EMS. The reasons for her decision, stated in her January 29 letter to Mayor Muriel Bowser, have led to the most intense scrutiny of the District’s emergency medical services since USA Today’s “Six minutes to live or die” exposé of 2003.
Even more important than the DC matter is the relevance of Dr. Saussy’s quality-of-care concerns to the rest of our nation’s 800,000-plus EMS providers. If you’re a paramedic or EMT–part time or full time, paid or volunteer–you’re going to want to know what Saussy has to say about your careers.
Quality Over Quantity
“EMS professionals have a unique skill set–part medical professional, part social worker, part grief counselor and part mental health provider,” says Saussy, who worked as a paramedic in New Orleans for two years after graduating from Tulane. “There’s a vast and exciting future ahead for EMS.
“To get there, we need to take a long, hard look at the way we educate our EMTs and paramedics. We need to be more selective about accepting people who not only have the aptitude for practicing prehospital emergency medicine, but also the desire.
“It’s a matter of quality over quantity.”
Educators who can best identify and nurture promising candidates aren’t necessarily the most senior field providers. Good teaching involves preparation and interaction with students beyond the effusive retelling of war stories.
“Just because you’ve done something impressive doesn’t mean you’re good at teaching it, and vice versa,” Saussy says. “We can’t just make anyone an instructor. We have to pick people with a gift for educating, a strong background in anatomy and physiology, and an understanding of disease processes.
“Teaching students how to recognize who is sick and who is not is the foundation for creating medics who can save lives. A focus on basic skills progressing to advanced skills cannot be overemphasized. Also, repeated patient contact under the watchful eyes of more experienced providers must occur to assure that our patients are getting providers with the right knowledge and capabilities.
“It’s imperative EMTs and paramedics show up, even on their worst days, ready to treat whatever illness or injury presents itself. The public doesn’t know what education we have or how we get it; they just trust it’s enough. Often it isn’t.”
Measure What Matters
Saussy says education shortcuts aren’t the only ones hurting EMS. Evaluating prehospital performance according to contrived standards is another example of convenience taking priority over value.
“We need to measure things that impact outcomes–not rely on arbitrary response standards like NFPA (National Fire Protection Association) 1710 that says we should have an EMT on scene by six-and-a-half minutes and two paramedics by eight minutes, regardless of the call. Where does that come from? Not from science.
“What’s a true response time? Most people will say it’s from the moment the unit gets dispatched until they arrive. To the public, though, it’s from the time they call 9-1-1 until we’re kneeling next to them or their loved ones. That’s a true response time. By analyzing those things, particularly in the context of specific illnesses, we can do better.
“Let’s measure what matters and quit focusing on what doesn’t.”
Saussy concedes responders and educators aren’t the only components of EMS that should be evaluated. Medical directors are on that list, too.
“I can’t say I’m going to assess everybody but not be assessed myself,” the Dallas native reasons. “I think that’s part of being accountable.
“We should all know how a medical director’s system is functioning: What are the outcomes? How do the providers feel? How do they perform? What kind of remediation exists? What about QA?
“Medical directors are accountable to their citizens every day. Paramedics operate as a delegated practice under our licenses so that, if you take it very literally, every time one of these men or women walk into a house or business, they’re an extension of our philosophy–how we feel about compassionate delivery of care. Many of us think about that 365 days a year.”
Focus on Patients, not Politics
Combining quality EMS providers, instructors and medical directors isn’t enough to establish a patient-oriented culture. Those of us in EMS still struggle to form our own traditions of excellence.
“Anyone who thought I expected to change DC’s culture in seven months clearly missed the point in my (resignation) letter. You don’t change a culture in seven months. More important, I’m not even certain the ship is heading in the right direction.
“Does the medical culture belong with fire? That’s a question that doesn’t have a quick answer. What’s important is that our culture embrace the practice of medicine as a privilege, not as a right. In some systems, I think we need to back up and take a look at our organizational charts and who the EMS leaders report to.
“At the (Gathering of) Eagles conference, I was asked for one word I would use to describe what needs to be improved in EMS. I broke the rule–I gave two words:
“The first was leadership, because although we have people heading up the system, we don’t necessarily have leaders. Leaders are different from managers.
“The second was cohesiveness. For whatever reasons, we can’t seem to get it together. We spend more time on infighting, politics and power struggles than we need to.
“We have to pull together. This is about patient care; provider satisfaction and safety, too, but in the end, patient care. We’re so focused on power struggles and other extraneous things, we’ve lost sight of our patients.”
Saussy again raises accountability as a key to improving prehospital results.
“Accountability means being honest and transparent. That means telling the public about the good, the bad and the ugly. To do that, we have to measure how we’re doing–not based on mythical standards, but on real evidence. If we don’t know how we’re doing, we can’t improve.”
A Passion for EMS
What’s next for Dr. Saussy?
“I’ll be practicing emergency medicine in Virginia and will certainly stay involved in EMS,” she says. “I take pride in having the same background as many of you–working as an EMT and a paramedic in both rural and urban systems.
“It’s kind of special to be part of a group of medical providers uniquely qualified to go where most won’t. I don’t know many doctors who’d feel comfortable treating patients in their living rooms or on the side of the road.
“The odd thing is, I think that’s where we feel most comfortable.”
Do you think EMS has a culture? If so, how would you describe it? Let us know how you feel about EMS culture and other issues raised by Dr. Saussy. E-mail editor@emsworld.com.
Mike Rubin is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.
