Samar Muzaffar, MD MPH, is the State EMS Medical Director for the Missouri Department of Health and Human Services.  She is also a clinical assistant professor in surgical critical care at the University of Missouri-Columbia School of Medicine’s Department of Surgery.

In addition to systems development, Dr. Muzaffar’s area of study also includes injury and violence prevention and emergency preparedness and disaster management.

Dr. Muzaffar took on the role as director in July of 2008, shortly after the death of Dr. Bill Jermyn who was the first EMS Medical Director for Missouri.  A primary purpose for the role of EMS Medical Director is to provide medical guidance for the state emergency medical care system.

Currently, Dr. Muzaffar is guiding the Time Critical Diagnosis (TCD) initiative. This estimated five year effort, a first in the US and brain child of Dr. Jermyn in 2004, will be a statewide emergency response system for victims of stroke and ST-Segment Elevation Myocardial Infarction (STEMI).

The end product will be clear lines of communication and paths for what happens to stroke and STEMI patients as is the case today in the trauma system, i.e., providing patients the right care and getting them to the right place in the right amount of time. This will include proper identification of patient diagnosis, processes for appropriate patient transport, decisions for correct hospital destinations as well as creating guidelines for hospital-to-hospital transfers.  Missouri is the first state in the nation to enact legislation governing a STEMI and stroke statewide system of care.

Originally from St. Louis, Dr. Muzaffar completed her MD at The University of Missouri-Columbia School of Medicine and her Masters in Public Health at the Johns Hopkins School of Public Health. She went on to general surgery training at Case Western Reserve University’s University Hospitals of Cleveland and her Surgical Critical Care Fellowship at Boston University’s Boston Medical Center. She also completed her Preventive Medicine training at Johns Hopkins Bloomberg School of Public Health and is Board Certified in Preventive Medicine.

Her critical care and public health background and a deep personal interest in medical systems development contributed to her fascination with the Time Critical Diagnosis concept when it was first introduced to her by Dr. Jermyn at an EMS workforce conference in Washington, DC in 2006.

Having kept up communications with Dr. Jermyn while finishing her preventive medicine residency and fellowship, Dr. Muzaffar eventually moved back to Missouri and took a position under Dr. Jermyn with the Department of Health and Senior Services.  In September, 2008, Implementation Work Groups for the TCD System were convened under Dr. Muzaffar’s leadership.

The project is broken into components and subsequent tasks which are addressed and managed by a large group of pre-hospital and hospital professionals, including ED physicians, nurses, paramedics and more from around the state.  Each month a consistent group of about 130 people meets in Columbia to focus on making the components of the TCD system functional.  Dr. Muzaffar says she is impressed with the commitment and progress.  Monthly meetings are open to all EMS professionals in the State of Missouri.

The system, she says, is influenced by each of its components.  Protocols for out-of-hospital providers are being developed while hospitals will be designated as stroke or STEMI centers following evidenced-based guidelines. These designation criteria are also currently being worked on.  Smaller rural hospitals, which play a crucial role for patients as they enter the system, often being the first to see them, are highly encouraged to be involved in the system and the process underway.  Protocols and designation criteria for centers are being designed to be sure the system accommodates rural and urban patients.

Planning and development for TCD are expected to be finalized in late 2010 or early 2011.  With hopes for additional state regulations passing at that point, implementation of the system may take another two years.  Regulations are now in the process of being drafted, and the entire process is consensus driven.

A public relations campaign will ensue in the upcoming development phases of TCD to educate general practitioners and the public about the system.

For now, Dr. Muzaffar encourages EMS professionals to attend TCD meetings and participate in the overall process.
 
Specifically, EMS people are encouraged to share TCD information and knowledge with each other and to visit www.dhss.mo.gov/TCD or www.360365.org for more information.