July 17, 2020
Jack Stout, EMS Pioneer, Dies at Age 76
His innovations changed the way people thought about EMS
Jack Stout, known as the “father of high-performance EMS,” died today after battling with dementia for several years, according to his son, Todd Stout. He was 76.
Renowned for his pioneering efforts in EMS over several decades beginning in the 1970s, Stout’s career did not come without controversy. Todd Stout, founder and President of FirstWatch, said his father was uniquely driven and “larger than life,” but extremely principled. “He could sometimes come across as harsh, as he told people the unvarnished truth as he saw it.”
His ideas for the using EMS resources more efficiently resulted in a new concept—system status management—that was used to deploy resources in innovative ways to get the best results for the system as a whole. To some, that meant deployment strategies that hurt EMS practitioners.
Jon Washko, an EMS consultant and the assistant vice president for the Center for EMS at Northwell Health in New York, disagrees.
“All Jack did was create a set of tools that convert a limited set of resources (dollars) into the highest level of service and quality possible,” he wrote. “Just like any tool can be used for something good (like a hammer can be used to build a house) or can be used to do something bad (like a hammer can be used to bludgeon someone), it’s the end user of the tool that makes all the difference in terms of outcomes.”
Todd Stout added that that when teaching the concept of system status management, his father included a number of objectives; at the top were improving employee morale and retaining the best employees.
Early career didn’t include EMS
Stout didn’t start out with any interest in EMS. After graduating from the University of Nebraska in Lincoln in 1967, he took a job teaching English in rural Nebraska. Just as he was controversial in introducing new concepts to EMS later on, said Todd, he was the same way in academia. Eventually he left teaching to try a variety of entrepreneurial pursuits, including a construction company to build geodesic domes—one became a Stout family home. Eventually he ended up working for the state of Arkansas, in the role of evaluating (and often closing down) mental health facilities. This was a precursor to his work in EMS, said Todd, and led to him directing a new statewide EMS demonstration project in Arkansas in the mid 1970s, funded by the federal Department of Health, Education and Welfare. His future partner, Alan Jameson, officially replaced him in that position. “[It] Turns out we got along together and enjoyed this work, so he remained working with me to finish the project,” Jameson wrote in an email.
After the project ended, Jack went to Oklahoma University in Tulsa to get post-graduate credentials he thought he needed to advance his career, Jameson wrote. While there, he led for a group of researchers and academics who set out to create a new way to provide a systems-based approach to EMS, which they called a public utility model. After finishing that project, Jameson said, Jack left academia and the two former colleagues formed a consulting firm, working with the federal government to successfully manage statewide initiatives related to improving care for the developmentally disabled. In 1977, Stout got a surprise call from Tulsa officials, saying they had read his OU paper on EMS systems—and wanted his help to implement it.
Stout said yes, and his career in EMS was solidified. He helped create the EMS Authority in Tulsa and instituted policies and procedures that were designed with incentives for a private contractor to provide excellent care, as efficiently as possible. One of the innovations was the use of objective performance measures, including fractile-based response times, and the ground-breaking requirement for the authority to have an independent medical director.
Stout went on with Jameson and their consulting firm, the 4th Party, to set up other high performing public utility models in Kansas City, Missouri; Richmond, Virginia; and Pinellas County, Florida, among others. Around this time, Todd Stout left his job as a paramedic to work for his father, who had developed a lifestyle of living on small sail boats as a home base, while travelling to clients. “Jack would dictate articles and reports in the aft cabin and my mother Linda would transcribe them on the forward cabin table, all on a tiny boat,” he recalled. Then Todd would create graphs and charts on his first Apple computer to supplement his father’s writings.
His second wife, Wendy was also a part of his work as they traveled the world continuing his practice of consultation.
Spreading the word
“Jack’s influence on EMS is much deeper than most people realize,” said Mike Taigman, a consultant who serves as improvement guide at FirstWatch. “I’ve visited hundreds of EMS systems throughout the U.S., Canada, Europe, Australia, Israel and Palestine. Every single one of them has at least one component that was invented by Jack. It’s not possible to calculate the lives that have been saved or the suffering that’s been reduced as a result of Jack’s contributions to our world.”
In 1980, Jim Page, another EMS pioneer, founded JEMS, the Journal of Emergency Medical Services, with Keith Griffiths as the founding editor. The EMS Today conference quickly followed. For the next decade Stout wrote dozens of articles and columns in JEMS and spoke at the first EMS Today and many other conferences and workshops, which helped spread his philosophy.
“His unique gift was not only in creating a new way of thinking about EMS systems, but in being a wonderful communicator, able to write and speak with great skill and art, able to motivate and persuade,” said Griffiths.
In the latter part of his career, Jack Stout continued to travel the world, helping EMS leaders improve the service to their communities and sharing his philosophy a systems-based approach to high-performance EMS. He was often accompanied by his wife of 30 years, Dr. Wendy Stout, an emergency physician who also worked with Stout on his consulting projects.
In 2014 the Pinnacle EMS Leadership Forum, representing hundreds of EMS leaders from every service model, presented Stout with the prestigious Pinnacle Lifetime Achievement Award to a standing ovation. (As a surprise, his son Todd won the Pinnacle EMS Leadership Award that same year.) “Jack was an intellectual giant in our profession, who has given us so much,” said Jay Fitch, PhD, a founding partner of Pinnacle sponsor Fitch & Associates, when presenting Jack with the award.
Later Todd would say that his father was overwhelmed by his reception at Pinnacle. “Strangers and friends both would come up to him with stories of how he had helped them and guided their careers,” he said. “I felt like I was standing next to a rock star. I think Jack finally realized then what a difference he had made.
“Jack had mentored hundreds of people in his life, giving extraordinary time and attention to students and young leaders who were attracted to his ideas,” Todd continued. “That legacy will keep his ideas alive, through those who continue to practice the ‘Stoutian’ principles that promoted efficiency, but put the patient, and their providers, first.”
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”Our moral obligation to pursue clinical and service improvement is widely accepted. But our related obligation to pursue economic efficiency is poorly understood. Many believe these are separate issues. They are not. Economic efficiency is nothing more than the ability to convert dollars into service. If we could do better with the dollars we have available, but we don’t, the responsibility must be ours. In EMS, that responsibility is enormous—it is impossible to waste dollars without also wasting lives.” –Jack Stout
Due to COVID-19, an in person memorial celebration of life for friends and family will be postponed until the 2021 Pinnacle EMS Conference in Phoenix, AZ, August 9-13, 2021. Specific details, date, and time will be announced when available.
Many people have asked about sending flowers, etc., and the family suggests you donate to the charity of your choice, or to one of these worthy charities: HoofBeats and PawPrints, a non-profit animal rescue run by his friend and colleague Jay Fitch with his wife Kathy, or to Shriners Hospital for Children, a non-profit that helps children, or to Fisher House Foundation, a non-profit that helps veterans.