Remembering my friend and mentor, Jack Stout
Jack Stout, the father of system status management and high-performance EMS, planted the seeds for patient-centered EMS
Jack Stout, remembered for decades of groundbreaking work in emergency medical services, died today at age 76 after a battle with dementia. Stout introduced the concepts of the public utility model, system status management and high-performance EMS as he explored new thinking about how EMS is delivered. Read more about Stout's legacy with reflections from EMS leaders.
Our condolences to his son, Todd, and his family, friends and colleagues.
When I was a young medic, I’d see Jack Stout’s articles in “JEMS.” They were not clinical, so as a medic, I didn’t pay much attention to them.
While I was attending an EMS Today conference in San Diego in the mid-1980s, a young guy with a big smile was sitting in the row behind me. He stuck out his hand and said, “Hi, I’m Todd Stout.” We instantly became fast friends. He ran a resume and referral business for EMS providers. When I decided that I was ready to leave the streets and try my hand at leadership, I gave him a call at his home in Florida.
I told him what I was looking for and Todd said, “You should really talk with my dad. Here let me put him on.” Jack talked with me for two hours, asking me about what I was hoping for in my future. He then said, “I’m running a system status management workshop here in Miami next week. Get yourself down here, you can stay at our house, I’ll comp your registration. You can help pass out materials or something, and you’ll meet someone who will offer you a job.”
This guy who I’d never met, who I’d just figured out was kind of a big deal in the EMS consulting world, who was inviting me to a workshop that he charged $800 for in 1987 dollars, was making me the kindest offer I’d ever had. I called the Denver Paramedic Division and told them that I needed to take a few vacation days the next week and drove to the airport to buy a plane ticket (yes, that’s what we did before the internet).
When I arrived, Jack, his wife Linda and Todd treated me like family. The four-day SSM workshop blew my mind. I’d never thought about EMS from a systems perspective. It was a crash course that changed the path of my professional life instantly. Just like Jack said would happen, I met Joe Ryan, MD, one of the members of Jack’s inner circle at the workshop. Joe and I hit it off and he said, “I think we ought to work together.” A couple of weeks later, Joe said that he’d created a position for me as assistant to the medical director in Pinellas County, Florida. I put my house up for sale, put in my two-weeks’ notice, rode my motorcycle into the back of a moving van full of my stuff, and headed to Florida in February of 1988.
After I’d been studying and working with Jack for a few years, I was staying in the guest room at his house. He knocked on the bedroom door at 4:30 one morning saying, “Come on! You’re young, get up! I’ve got an idea for an article we should write together.” Blurry eyed, I sat down at his computer with him and we started to brainstorm an article on quality in EMS. After the third time I suggested an addition and he responded with something like, “actually that goes at the end of the sixth paragraph,” I asked him, “Do you already have this whole thing written in your mind?” He did.
Fascinated, I asked him how that worked, because my brain could not function that way. He told me how he approached an EMS assessment when he first started consulting:
“We were living on a boat in the Caribbean and we’d pull into port and I’d go to a payphone and call my answering service. They would tell me where the next job was, and I’d buy a plane ticket and fly there. I’d meet with the mayor, city council, EMS folks, etc. Then I’d evaluate everything I could in three or four days. Then I’d fly back to Miami, thinking about the system the whole way back, and then I’d check into a hotel room. I’d push all the furniture to the side of the room, shut the blinds, and sit on the floor with a Dictaphone and a pile of tapes. Then I’d dictate a 200-page system design including contracts in one sitting. I knew when I started what was going to be on page 74 and 106, and so on. When I was done, I’d put the tapes in an envelope and mail them off to my transcriptionist who would type them up and send the result directly to the customer.”
At that moment, I realized what a true genius he was and how lucky I was that he’d taken me under his wing.
Over the years, Jack has imparted so much wisdom that’s woven its way through my DNA to become a big part of who I am. Here’s a couple of examples of things that Jack said that I keep in the front of my mind all of the time:
“A dollar wasted here is not available to be wasted anywhere else.”
“EMS is the practice of medicine. Since doctors know the most about medicine, shouldn’t we design systems so that doctors are in charge of clinical stuff?”
No matter what group of people were in the room with Jack, they always seemed mesmerized by what he had to say.
When friends become family
My wife Sascha and I had a daytime wedding full of friends, food and a drum circle. On our wedding night, after a long day of fun, we checked into our hotel room to find Jack and his wife Wendy sitting on our bed watching TV. Sascha said, “Well if this is going to be a party, I’m calling my best friend and her husband to join us.” We ordered room service and the six of us sat in a circle talking. Somehow, the subject of alternative medicine came up and Jack started describing some of what he’d learned about Ayurvedic medicine. The three physicians in the room, two of which are faculty at a prestigious medical school, were mesmerized by Jack’s stories and perspective. It was a wonderful way to kick off our marriage.
The last time Jack and I had a long visit, he got to spend time with Sascha and our son Ax, who was about 7 years old. We went to a little playground near Todd’s house with a remote-controlled car Ax had been gifted for his birthday. Jack and Ax spent hours coming up with ways to test the limits of this toy on the slide, teeter totter and in the sand box. After that visit, Jack would call me and say, “Hi Mike, I don’t really want to talk with you, can you put Ax on the phone?” Ax would go off and the two of them would chat about who knows what.
Planting the seeds for patient-centered EMS
If you cut open an apple, it’s easy to count the number of seeds inside it. But if you plant one of those seeds in fertile soil, water it, fertilize it and help it grow, there is no way to count the number of apples that could come from it.
Jack planted the seeds of patient-centered system design in our EMS world long before EMS Agenda 2050. I’ve visited hundreds of EMS systems all over the world and every single one of them has at least one component, one element of something that Jack invented.
I think that Ax has picked up some of the kindness and magic from Jack. I certainly have. I’m really going to miss him.