Pinnacle Honors EMS Pioneer Jack Stout

A pair of events honored late EMS pioneer Jack Stout Wednesday at the Pinnacle EMS Conference in Marco Island, Florida.

Stout, who died in July 2020, developed the concepts of system status management, where ambulance deployment is based on patterns of demand and units are stationed where calls are likely to come, and the public utility model (PUM) of EMS provision, where services compete for markets rather than within markets.

The final conference session of the day gathered a panel to discuss Stout’s legacy. The group included Stout’s son, Todd, founder and president of the EMS data-analysis company FirstWatch; Jonathan Washko, MBA, FACPE, NRP, assistant vice president of the Center for Emergency Medical Services at Northwell Health in Syosset, New York; Keith Griffiths, founding partner of the RedFlash Group and longtime editor of Stout’s work in the Journal of Emergency Medical Services; and Joseph Ryan, MD, adjunct clinical assistant professor of emergency medicine at Stanford University. The four all worked closely with Stout during his illustrious career.

So did panel host Mike Taigman, a veteran EMS leader who’s also now with FirstWatch. Taigman offered an opening anecdote that described Stout’s keen mind: Taigman was staying at Stout’s house, and around midnight one night they decided to cowrite an article. They retired, but at 4 AM Stout came banging on Taigman’s guestroom door, wanting to get started. They began the collaboration. Taigman proposed an idea. “No,” Stout told him, “That goes in the second paragraph on page 2.” Another idea. “No, that goes in this other part.” Finally Taigman asked, “Is this already written in your head?” Stout said it had been, between midnight and 4 AM.

Stout was also known to verbally record lengthy consulting contracts extemporaneously and send them directly to transcriptionists and then to clients without review. “That kind of mind,” Taigman said, “just blew me away.”

Jack Stout’s intellect wasn’t always well received, Todd Stout said; his early high school teaching career in Nebraska was cut short by “heretical” ideas, and he was kicked out of military school. That continued when he was tapped to run an early federal EMS project in Arkansas. There were no paramedics or 9-1-1 at the time, and funeral homes still did the lifting, but Jack Stout was already developing a perspective of EMS as a system.

He became a research fellow at the University of Oklahoma, where he refined his conception of EMS as a “natural monopoly”—duplicating such resources in a community didn’t make sense. This ultimately grew into the PUM concept. He wrote a paper on it, then returned to Arkansas, where he was contacted by officials from Tulsa, who wanted to put his ideas into practice. This led to the EMSA system and Stout’s career as a consultant.

Washko described Stout as a peer to giants like statistician and management expert W. Edwards Deming and physician Don Berwick. He solved numerous problems both intended and unrecognized, Washko said, and his work saved countless lives and billions of dollars. His ideas have informed systems around the world. He even beat Berwick to an early version of the Triple Aim, envisioning EMS systems as a balance of patient care, employee well-being, and long-term sustainability. (The Institute for Healthcare Improvement’s later take did not include employee well-being.)

More anecdotes followed: Stout bringing audiences to “pandemonium” with his views of EMS potential. His efforts to experience EMS encounters as a patient might. His deft handling of local governments in crafting contracts. Writings so tight they couldn’t be edited (see for yourself through the National EMS Museum). And an occasionally salty personality that persisted most all the way through.

Todd Stout concluded by recalling an exchange 15 years ago, at the second Pinnacle conference. Someone suggested to Jack Stout that his work was overly focused on response times. Jack acknowledged that no one had realized 35 years earlier that those times didn’t really matter much for most patients, but they’d done the best they could with what they knew then. “And if, 35 years later, you haven’t fixed it,” he retorted, “how is that my problem?”

Celebration of Life

Later in the evening the same players and more gathered for a celebration of Stout’s life—he died just months into the COVID-19 pandemic, forcing the delay of a proper EMS memorial.

More stories surrounded a tribute video by On Assignment Studios’ Janet Smith and Chris Swabb. Washko recalled being directed to Stout as a 19-year-old college sophomore interested in system status management. Stout talked to him for 6 hours—a generosity of time that was a recurring theme.

The Jack Stout Fellowship, Endowed by FirstWatch and developed in cooperation with the Fitch EMS Foundation, is a new award given to aspiring EMS leaders seeking to gain the knowledge and skills to lead systems. The first one was given to Columbus (Ohio) Fire Capt. Matthew Parrish. For more on the fellowship, see https://firstwatch.net/jack-stout-ems-fellowship/.