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.