EMS pioneer Jack Stout, an economist who applied concepts from that field to create efficient new models for answering emergency medical calls, died on July 17 after battling dementia for several years, according to his son, Todd Stout. He was 76.
Jack Stout conceived several landmark concepts common in EMS today, including the public utility model (PUM), under which jurisdictions contract with a single official provider of ambulance services like they do other utilities, and system status management (SSM), by which ambulance staffing and deployment dynamically matches supply to demand.
Under the public utility model, an ambulance provider is selected through competitive bidding and evaluated based on established performance requirements. This controls costs for the jurisdiction and controls the negative effects of unconstrained competition at the patient-care level. Many of the concepts developed by Stout for his PUMs are still used today by hundreds of jurisdictions in their contracts for EMS service.
Ambulance deployment under system status management is based on hour of the day and day of the week, and posting locations are determined by what data shows is efficient to answer calls. Unit-hour utilization rates measure effectiveness and guide decisions. Implemented properly, such dynamic deployment allows faster responses and reduced costs.
Stout was also known as the father of high-performance EMS. High-performance EMS involves maximizing the value produced by the resources fed into a system. Its key goals are clinical proficiency, operational effectiveness, and fiscal efficiency. Along with clinical excellence, Stout touted an obligation for systems to pursue economic efficiency: “Economic efficiency is nothing more than the ability to convert dollars into service,” he said. “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.”
Stout first implemented his ideas in Tulsa, Okla.’s successful EMSA system. They weren't without controversy; “He could sometimes come across as harsh, as he told people the unvarnished truth as he saw it,” said Todd Stout, founder and CEO of FirstWatch.
Jack Stout graduated from the University of Nebraska in 1967 and taught English before moving on to other efforts, including work with a construction company that built geodesic domes. In the mid 1970s a job evaluating mental health facilities for the state of Arkansas led to involvement in a new federally funded statewide EMS demonstration project.
Once that concluded Stout pursued postgraduate study at Oklahoma University in Tulsa, where he led a group of researchers and academics that first described a new systems-based public utility model for EMS. Tulsa officials were persuaded by the idea and contacted Stout in 1977 to implement it.
He subsequently helped create the EMS Authority in Tulsa and instituted policies and procedures designed around care incentives a private contractor would meet as efficiently as possible. One component 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. Other public utility models followed in Kansas City, Mo.; Richmond, Va.; and Pinellas County, Fla., among others.
“Jack’s influence on EMS is much deeper than most people realize,” said Mike Taigman, a veteran consultant and 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 2014 the Pinnacle EMS Leadership Forum presented Stout with the prestigious Pinnacle Lifetime Achievement Award. Many of his writings are compiled at www.jackstout.com.