The short history of EMS has been driven by the wisdom, foresight, and innovation of countless individuals. As the field ages into its second half-century and its origins fade to the past, it’s worth commemorating the greatest pioneers of prehospital emergency medical services. This series honors these trailblazers.
J.D. 'Deke' Farrington
"The father of modern EMS"
While most of the early efforts that established modern American EMS date to the 1960s, physician J.D. “Deke” Farrington’s started a decade earlier. As early as 1958 Farrington was training Chicago firefighters in a prototype of what became the initial EMT-A course. He believed lessons learned caring for combat casualties in World War II and Korea would improve care if applied to civilians.
A year after publication of the seminal white paper, Accidental Death and Disability: The Neglected Disease of Modern Society, in 1966, Farrington published Death in a Ditch, a piece with a similar thrust that proved nearly as important. It highlighted the dangers of car crashes on America’s highways and outlined Farrington’s vision for reducing their toll, which included emergency medical care at the scene and during transport, provided by at least two trained and certified attendants. President Lyndon Johnson’s Committee on Highway Traffic Safety subsequently recommended creating a national certification agency to establish standards for training and examination of ambulance care providers. The National Registry of Emergency Medical Technicians formed in 1971 with Farrington as its first chair, and that year the Registry conducted the first EMT-A exam. (Read Death in a Ditch via the American College of Surgeons.)
Even earlier, however, Farrington played a key role in development of Wisconsin’s state system. Its EMS section was created in 1968, with local physicians providing the training. In 1969 Farrington coordinated the first nationally recognized training course for EMTs in Wausau. He was also an early advocate of extrication and is credited with inventing the spine board and approving the original DOT use of the AMA’s Star of Life as a symbol for EMS.
Public utility model, system status management, high-performance EMS
An economist by trade, Jack Stout applied concepts from that field to improve the operation of EMS systems through landmark concepts such as the public utility model, system status management, and high-performance EMS.
Under the public utility model (PUM), jurisdictions contract with a single official provider of ambulance services—as they do with other utilities such as power—selected through competitive bidding and evaluated based on established performance requirements. This controls costs for the jurisdiction while mitigating 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.
Matching supply to demand is the key economic principle underlying system status management, by which ambulance deployment is fluid based on hour of the day and day of the week, and posting locations are determined by what’s efficient to answer calls. Unit-hour utilization rates measure effectiveness and guide decisions. Implemented properly, such dynamic deployment allows faster responses and reduced costs.
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 and was a regular contributor to industry publications and speaker at national conferences for many years before retiring. He received many awards, including the Pinnacle Lifetime Achievement Award in 2014. Many of his writings are compiled at www.jackstout.com. Jack’s son Todd has continued the family tradition of innovation as the founder of FirstWatch, which has served public safety for more than 20 years.