Who, What, Where, Why, When, How?

Dr. Joe Salomone has been the EMS medical director for Kansas City, Missouri, during two periods of his career as a physician.  Initially, Dr. Salomone was the first full-time paid medical director in Kansas City in 1988, when he served for several years before taking on the role of Chairman for the Emergency Physicians Advisory Board.  He continued to be involved in local EMS and later became the Program Director for the Emergency Medical Residents at Truman Medical Center.  He began his second stint as the Kansas City, Missouri, EMS Medical Director in 2003 when the previous director, Dr. Gratton and his associate Dr. Garza, were activated to military service.  He was elected to the position as Missouri Kansas City EMS Regional Committee (Region A) Medical Director in 2009.

It may be an insightful and matter-of-fact way to put it, but despite his longstanding experience as an emergency physician and medical director, Dr. Salomone says he still struggles to know exactly what the role of the Regional EMS medical director is.

Though there are state regulations and laws requiring the election of a regional medical director by all medical directors in a given region and confirmed by Missouri’s Department of Health and Senior Services (DHSS), the actual role of the medical director has not been completely defined by any entity.  

Also required are the six State EMS regional committees each of which has a regional medical director.  While the director of DHSS appoints committee members, the committee members and others attending in the region define the issues regarding patient care unique in their area and work towards solutions.   The focus of the Region A committee has been communication, education and quality improvement.

Dr. Salomone is by no means at a loss for ways to eventually arrive at a specifically defined role for regional medical directors.  With his years of experience, he knows precisely what the role is not and what it could be.

“I can tell you from my own standpoint and from my own personal vision of the role, that the position of regional medical director is not one to dictate or direct how EMS professionals function in their individual service areas,” Dr. Salomone says.  “Rather, it is one of liaison and coordinator between services, to share information and best practices and to help the medical directors of the varying services.  The object is to define within the state and within the region some common goals so we can facilitate how medical directors should interact with the services in their regions and ultimately benefit the services and the care we all provide in Missouri.”

Dr. Salomone believes the formation of the regional medical director sub-committees at the state level has been a very good step in the right direction for all concerned.

“With Time Critical Diagnosis (TCD) moving forward and with the creation of the regional medical director sub-committee within the State Advisory Council (SAC),” says Dr. Salomone, “we are better organizing EMS in the state, the ultimate goal being the improvement of patient outcomes and care with greater uniformity for pre-hospital care.”

Dr. Salomone says these current EMS events and initiatives are actually helping to carve out and reveal the regional medical director’s defined role.

The target is to build programs across all service areas that lead to positive regional and state outcomes as well as decisions about how EMS care in Missouri is succeeding.  The medical directors of individual services need help implementing changes that are evidence-based in order to create the needed outcome-based system of quality improvement.  Coordination by regional medical directors ensures that changes at this level are evidence-based, since part of the role of the regional committees is education and quality improvement.  

 The first step is defining not just the evidence-based EMS care protocols, but how they are communicated at each level throughout the state.  Dr. Salomone sees his role as one that imparts and facilitates the discussions and processes from a published EMS literature and scientific evidence basis, including prospective trials and retrospective reports on patient outcomes that will determine over time what changes and processes are beneficial to patient care.

“It’s conveying communications from the state EMS director, TCD, SAC and in other regions, to my own region and vice versa,” says Dr. Salomone.  “It’s improved coordination of care, not necessarily standardization but more uniformity in the state so that when services cross districts to provide mutual aid, there is a better understanding.”

For the last nine months, regional medical directors have been meeting monthly on the same day as the State Advisory Council working with various committees with the goal of carrying the discussions back to their respective regions on the individual service level to keep all service medical directors informed and moving towards the concept of uniformity with special emphasis on the TCD issues.

“We are charting new territory but we fully expect to define the roles of the regional medical directors and give direction to the regional committees.  As we solidify the efforts of the state, regions and the individual services we will positively impact patient outcomes in Missouri,” says Dr. Salomone.

Reach Dr. Salomone at joseph_salomone@kcmo.org.