5 Things You Should Know About the Making of ‘Escape Fire’

Nate von Zumwalt

ESCAPE FIRE premiered at the 2012 Sundance Film Festival and made its official theatrical release this past October.

Matthew Heineman and Susan Froemke’s new documentary couldn’t have come soon enough. As millions of Americans descended into a media fray wrought with glaring sensationalism and compulsive hyperbole surrounding last fall’s presidential election, the directing duo offered an unparalleled, unflinching, and—quite frankly—unflattering look at one of the most pressing contemporary American issues: our broken healthcare system.

Heineman and Froemke’s Escape Fire manages to transcend party lines in its unwavering pursuit of a veracious answer to an enduring question: What’s wrong with our healthcare system and how do we fix it? Co-director Matthew Heineman recently offered his thoughts on entering a public dialogue already saturated with news coverage, and spoke of the challenges in finding a narrative backbone for an intrinsically convoluted issue and storyline.

What compelled you to confront such a controversial and monumental contemporary American issue?

In 2009, after an initial conversation with Donna Karan and Doug Scott (our executive producer) on the subject of our broken healthcare system, Susan and I spent six months researching the topic to try to figure out whether it was possible to take on such a huge topic. This was just around the time that the healthcare debate was really heating up and dividing our country to some degree.

Like many Americans, Susan and I found the hyperbolic media coverage around the topic confusing. We really wanted to know how did this perverse system come to be? And how could we find our way out of this mess? As we started filming, we began finding characters/storylines that helped answer these questions, and we grew more and more excited that there was an important film to be made.

It’s a big subject for a documentary, and it’s a subject that carries with it decades of debate and misconception. With Escape Fire, we tried to address what might be done to create a sustainable system for the future, to transcend the misinformation, the angry partisan debates and create a clear and comprehensive look at healthcare in America.

What is your hope for how this film resonates with audiences? Was Escape Fire intended to be a call-to-action documentary?

First and foremost, a film has to entertain and get the audience engaged. If it does that, it has the potential to inspire change. And so, yes, our intent was to both entertain and be a call-to-action. Ultimately, our goal with Escape Fire is to provoke a paradigm shift in how our country views health and healing. We hope audiences will come away with a clearer understanding of how and why our system is broken, the barriers to change, and potential solutions, or “escape fires,” that could help fix our system.

We hope people—upset by the powerful financial and political interests pushing to maintain the status quo in American medicine—will be empowered to help push for societal change and recognize the “escape fires,” or solutions, around us. We also hope people will walk away personally inspired to take better control of their own health, realizing that in many cases they have the power to heal. It would be great if Escape Fire can help bring some sanity to the discussion around healthcare and provoke all Americans to look in the mirror and ask, “How do we create a more sustainable healthcare for the future?”

What was the greatest challenge followed by a satisfying breakthrough during production?

Our greatest challenge was getting access to a compelling story with the U.S. military. As with the rest of America, there is a default reliance on using pharmaceutical drugs when treating injured soldiers, and unfortunately this often leads to reliance on potentially addictive painkillers.

We found out about a novel study to reduce drug use by testing acupuncture for pain relief in injured soldiers on a medivac plane returning to the United States. We spent nearly a year trying to get permission to film aboard the plane. It was less than two weeks before the flight, and we were nervous that we were going to miss the opportunity. Finally, just before Christmas in 2010, we got the signoff from the U.S. Army and the U.S. Air Force.

Shooting aboard the C-17 Air Force medivac plane was definitely one of the most exhilarating, moving days of my life. We got some of our most gripping footage on the flight and met an amazing young soldier, Sgt. Robert Yates, who was heavily overmedicated with painkillers.

We were fortunate enough to follow him for months as he attempted to wean himself off a deadly cocktail of drugs through the help of an innovative program at Walter Reed Medical Center. In the edit room, the story of Sgt. Yates’s battle to recovery became the narrative backbone that arcs through the film.

How did you discover the patient and physician subjects in Escape Fire, who manage to put a human face on the issues broached in the film?

We knew we had to boil a very complex topic into something accessible, but we also knew that we wanted to put a human face on it as well. We’ve interwoven interviews, animation, and archival footage with the personal stories in order to show the healthcare system from all angles. It’s a hybrid style, but at the film’s heart is the tradition of cinéma vérité—the art of capturing life as it unfolds before the camera. The personal stories of patients and physicians are all filmed in this vein, taking inspiration from the drama of human experience, allowing our characters to be themselves.

For example, we met one of our main subjects, Dr. Erin Martin, at a fellowship program started by Dr. Andrew Weil. Dr. Martin was there to be re-taught a more holistic, patient-centered way to practice medicine. Like many doctors at the fellowship, she was incredibly frustrated with the state of healthcare in America and considering leaving the industry. We follow her as she leaves a community clinic where she’s being forced to see a revolving door of patients as she embarks on a journey to find a practice where she’s not handcuffed by the system and forced to put band-aid fixes on deeper problems.

The title of the film is in and of itself quite striking. What was behind the decision to call the film Escape Fire?

For over a year, we struggled to find a title for the film. How could we synthesize this complex problem and potential solutions under one label? We were stumped. Then we came across Dr. Don Berwick’s healthcare manifesto, “Escape Fire: Lessons for the Future of Healthcare,” delivered years before he became head of Medicare/Medicaid.

Dr. Berwick draws a striking parallel between our broken healthcare system and a forest fire that ignited in Mann Gulch, Montana in 1949. Just as the healthcare system lies perilously on the brink of combustion, the forest fire began to burn out of control, threatening the lives of 15 smokejumpers.

On the spot, the leader Wag Dodge came up with an ingenious solution: he lit a small fire that consumed the fuel around him. He urged his men to join him, but they ignored him, clinging to what they had been taught. The fire overtook the crew, killing 13 and burning 3,200 acres. Dodge survived, nearly unharmed. He had invented what is now called an “escape fire,” and soon after it became standard fire-fighting practice.

Dr. Berwick applies the “escape fire” analogy to healthcare, exploring how our system is “burning,” while there are solutions right in front of us. Upon reading the manifesto for the first time, we realized how perfectly it fit our subject matter. We knew we had our title, and soon after we contacted him about taking part in our film.

As Dr. Berwick says in the film, “We’re in Mann Gulch. Healthcare, it’s in really bad trouble. The answer is among us. Can we please stop and think and make sense of the situation and get our way out of it?”

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