Amy Walsh, MDP MD Dr. Jullette Saussy isn’t afraid of much—especially not a challenge. She has faced down Hurricane Katrina and uterine cancer. The mother of five’s work has been in the news recently after the public release of her resignation letter for her position as medical director of the Washington DC EMS.
Saussy grew up in the New Orleans EMS system. She worked as an EMT and a paramedic in college. Eventually she completed residency at Charity Hospital and ascended to medical director of New Orleans EMS, which was her post during Hurricane Katrina. Her experience during the superstorm was transformative. She felt that her military colleagues were exemplary and tried to learn about their leadership style. “You don’t have to be an expert in everything. You need to find good people and listen to them.” She also learned a lot about the people who follow her. “My ‘foxhole people,’ the people who have my back, were different than who I expected. Some of the people I expected to be really strong ran away. Some of the people I didn’t expect much of really rose to the occasion. There is something pretty cool—almost beautiful—about seeing people do more than they ever thought they could.”
Politics can have a very destructive influence in disasters, Saussy says. In fact, it can “create a disaster within a disaster,” in her opinion. “It was not smooth, decisions were made based on political parties, inadequate assessments, and predisposed feelings about the city. While we slept on the Superdome concrete, Governor Blanco needed ‘24 more hours’ to assess whether we needed to call in the military other than the National Guard. Everything was a fight during Hurricane Katrina and as we prepared for Hurricane Gustav. When we created a City Assisted Evacuation Plan. Getting Amtrak and National Disaster Medical System to play was no easy task.”
It was vitally important to Saussy that something good come out of New Orleans’ Katrina experience, notably, the importance of preparedness and the impact of post-traumatic stress. “In the middle of a disaster, if you’re working, you’re a victim of the disaster. You may not want to think about it like that, but it’s important to acknowledge that to heal.”
Saussy feels that women in Emergency Medicine are uniquely poised to strengthen leadership. “We are primed to participate in a movement to create transformative experiences from difficult events because of the nurturing and compassionate side of women. In particular, running an EMS team during a disaster leaves you in charge and in the somewhat maternal role of assuring that your team is OK.” After Katrina, New Orleans EMS was left with a clean slate. “Everything changed. We had a new image, new trucks, new uniforms. We were more patient-centered. The regionality we had before, of this being ‘my area’ and that being ‘your area’ was gone.”
After getting engaged to her now husband, Saussy moved from New Orleans to Washington DC in 2012. In 2015, with a new mayor and a new fire chief in place, she was optimistic that change could be on the horizon. After her experience with reforming a system in New Orleans, Saussy felt she could make a difference in the embattled system and took on a new challenge as the medical director of Washington DC’s EMS system. After assessing the situation, Saussy had a series of recommendations. At the same time, though, it became clear why there had been so much turnover for her role. Her proposed changes met with significant resistance.
She recommended new performance measures, some as simple as accurate response times. Though 82 percent of DC Fire and EMS calls are pre-hospital care, the leadership structure does not reflect this. In fact, as medical director, she did not have EMS providers directly reporting to her or the ability to make policy change. The union blocked her request to assess the competence of Advanced Life Support practitioners. After seven months on the job, she concluded that she and the Fire Chief “were not philosophically aligned.”
When discussing a potentially preventable death, Saussy stated, “it really seemed like there was an immunity to grief. I don’t cry after every patient death, but you feel something. You recognize that loss of life. It didn’t seem like they did that. How do deaths not affect you? Especially when you could possibly change it?” The pace of change was far too slow for her taste, too. “When I took over, reformation didn’t mean 100 years to me. It meant we need to make changes right away.”
Other agencies in Washington DC have been able to address reform quickly and aggressively. Take the handling of recent maintenance shut downs for the DC Metro. “He [Paul Wiedefeld, General Manager and CEO of Metro Board of Directors] saw that [the metro] had become a public safety issue and he took action right away, even though he knew he could lose his job over it. The board supported him…He was not willing to have his name on something dangerous. Why couldn’t EMS have responded similarly?” Washington DC doesn’t lack money or personnel, “but there is a giant vacuum of leadership,” She feels. The Fire Department proposed a $12 million plan to privatize part of EMS services for low-acuity calls. Saussy believes this was ill-advised because they could effectively improve the situation with restructuring at minimal expense. With the unwillingness to consider her recommendations and out-of-touch counterproposals Saussy felt they were at an impasse. After seven months on the job, she chose to resign, but didn’t expect to do so in such a public way.
You can read her resignation letter in full here.
Her letter fell on deaf ears amongst the intended audience. “The mayor did not respond to my letter, nor did the Fire Chief. They responded with clichés. We spoke to the council for many hours. Two of my colleagues (fellow urban EMS directors) came and spoke on a panel with me for many hours. When the Fire Department came up, there was a void.”
Their plan was the $12 million proposal noted above. The City Council on the other hand, “took an immediate, in-depth look at the situation and really turned their focus on this issue. They want to do they right thing.” Similarly, the public and medical response has been very supportive. Her peers in EMS have generally said, “I’m glad it wasn’t me, but thanks for saying it out loud.” Some were concerned that Saussy would experience significant blowback after going public with her concerns because she is a woman. http://www.medscape.com/viewarticle/858815 Saussy finds that untrue, at least as of yet. “I never really thought about gender bias or talked about it prior to this job, but if you are passionate, it can be perceived as being emotional or weakness.”
Saussy is getting back to clinical shifts and contemplating her next role in the EMS world, debating whether to go back to being a medical director or take a different avenue for reforming EMS. She hopes to increase the role medicine and science play in EMS systems. Many systems are driven by unions, politics, and whether the system is public or private. “With the training of care professionals, we need to think about what kind of product we want. Education-wise, we have been sacrificing quality for the sake of quantity. With a few exceptions, education was better when I trained thirty years ago. With strong leadership we can recognize a deficiency and fix it, but without any authority or teeth, it won’t work.”
Dr. Saussy kindly offered to answer any questions readers have, so please feel free to leave a comment with questions for her.
I heard you speak at a conference in Huntsville Alabama in October 2015. I was so impressed with your talk and admire your grit and knowledge. I wished then that I could have worked with you in my career as an ER nurse. I find it so ironic that of all places to experience gender bias our nations capital is where it reared its ugly head. You deserve better. Shake the dust off your feet and move on.
I just want to say that for high performing EMS providers everywhere, you are a hero. DC FEMS has been an embarrassment for EMS as a profession as well as US EMS as a representation of our country for well over 15 years. You have brought the brightest spotlight yet on a festering sore on EMS (lack of) leadership.
So here is my question, which you kind of answered above. In the OIG report after the David E. Rosenbaum death, described a “culture of indifference” to EMS. Has that changed at all?
Mr Cole just because you read something foes not make it so having served 30 years in the trenches of the DC Fire Department.. Rosenbaum was a olitical event driven by yhe media on behalf of one of their own. Mistakes were made but in the end David Rosenbaum was taken to a trauma facility where he was transfered to hospital staff, he died after being ignored by hospital healthcare providers not fire department. Yet the FD suffered the brunt of political expediance. The incident had its share of FD, PD and especially Hospital errors . A blanket statement of… Read more »
The comment made by Mr. Pignataro that ‘David Rosenbaum was taken to a trauma facility where he died after being ignored by hospital healthcare providers not fire department’ quite frankly demonstrates the enormity of the problem in DC Fire. Pointing fingers at other segments of the health care continuum rather than critically looking at how your part in this could improve and work as a SYSTEM to ensure the best care is being provided, cannot result from this type of finger pointing. Given the reputation DC Fire has nationally (and yes you do) of sweeping things under the rug, circling… Read more »
R. Cole- In my opinion they have given “lip service” to EMS and continue to go through the motions but there remains a deep and well entrenched “culture of indifference” which has resulted in the frustrating lack of change. That is not to say all providers are indifferent. In fact, DC Fire and EMS has some extremely dedicated and talented medics who are just as frustrated as the rest of the nation with the environment they have chosen to work in for years. The “indifference” may be just ignorance (a lack of really understanding what high performing medicine looks like… Read more »
Where would one start? US EMS needs repair. A Full Arrest in California may not be ran the same as it is in New York. Why would SMOs be so different? BLS rigs in one system may not have authority to check blood sugar or carry Narcan or King Airways but in other systems they do, and more. So my question is, do you believe moving EMS from DOT to another agency could help propell EMS in the direction it should be? I believe our training standard are lacking. I believe we have massive pay disparities that affect the overall… Read more »
Mike- I don’t know if changing a lead agency alone will make a difference. We have had some very committed leaders at DOT. Federal groups such as FICEMS etc have not been able to make sweeping change. I do believe that there must be national standard (that has much tougher enforcement, educational standards and oversight) that is followed that reflects the very high performance needed to provide pre-hospital medical care. Our voices have been diluted by the varying delivery models and the politics that plague those models. Until we unite with one voice with strong representation from all EMS delivery… Read more »
Thank you so much for bringing this issue to light. We all know that it exists-in many different ways in our profession-but cannot speak about it. It’s hard to explain.. EMS needs change…… badly.
I’ve only met Dr. Saussy once – through a mutual colleague. However her reputation is stellar and the DC EMS system is legendary for poor care and political mismanagement. Not surprising that the Chiefs don’t care about EMS. They want to spend the money on shiny Fire engines while EMS earns all the money. Disgusting. I wish Dr.S the best in whatever direction her career path takes her.