By Naseem S. Miller
Orlando Sentinel
ORANGE COUNTY, Fla. — Central Florida’s emergency medicine and EMS community lost a friend, a mentor, a teacher and a leader this week.
Dr. Salvatore Silvestri died unexpectedly on February 26 at age 56.
Dr. Salvatore Silvestri, a central figure in Orange County’s emergency medicine and public safety who made all emergency medical service practices based on evidence-based protocols and implemented programs that have become national standards, and a man who mentored hundreds of residents and emergency physicians, died unexpectedly on Sunday. He was 56.
“It was a total shock,” said Dr. Jay Ladde, assistant program director for the emergency medicine program at Orlando Regional Medical Center. “Aside from my father, he was the most influential person in my life.”
Silvestri — better known as Sal by friends and colleagues — was born in Bronx, New York, in 1960.
As a young man, he was the environmental and janitorial services supervisor at a New York hospital ER and wanted to become a doctor. He eventually returned to that same hospital as a physician and became its director of emergency medicine education.
He completed his emergency medicine residency at Johns Hopkins University School of Medicine and was a devoted fan of Baltimore Orioles.
Public health and emergency medicine were his passion.
“He devoted his professional life to making sure that a well-trained [first responder] shows up with state of the art, evidence-based protocols and do the best without causing harm,” said Dr. Jay Falk, academic chairman of department of emergency medicine at Orlando Health.
Silvestri first arrived in Florida in early 1990s, in Putnam County, through the federal Public Health Service program that helped him pay his student loans in exchange for practicing in an underserved area.
There, he founded the Acute Care Education, a non-profit organization that provided advanced life support education. He was the medical director of Putnam County Emergency Medical Services, Medical Director of Paramedic and EMT Training program in St. Augustine, and Medical director and attending physician at the emergency department at Columbia Putnam Medical Center.
He later returned to New York and became director of Institute of Emergency Medicine Education, Research, and Prehospital Medicine at The Mount Sinai School of Medicine.
He came to Orange County in 2000 when he was hired as the medical director of the county’s Emergency Medicine Services.
He was in that role for five years, before becoming the program director of the Department of Emergency Medicine at ORMC, a position he held until the end. He continued to serve as the Associate EMS Medical Director for Orange County EMS.
“It’s not like losing a co-worker but like a family member,” said Dr. George Ralls, who took on the director role at the county when Silvestri stepped down. “He was my best friend.”
One of Silvestri’s biggest contributions was making out-of-hospital endotracheal intubation, a high-risk procedure for placing a breathing tube in a patient, safe, by making the measurement of carbon dioxide pressure a requirement. Monitoring the carbon dioxide levels helps confirm that the breathing tube is inserted in the right place.
“He got some pushback at first,” Ralls said. “But he was very firm and gentle to maintain the focus that this was about patient safety.”
In a follow-up study, he showed that the paramedics who used the protocol had a 0-percent error rate.
That practice is now a nationwide standard.
His latest research, which is being carried on by his colleagues and students, focuses on early detection of sepsis.
Silvestri was soft-spoken. A man of few words. And a great listener.
“When you were sitting in front of him — it didn’t matter who you were, medical student or mailman or a hospital administrator, he’d sit there and listen and absorb what you were telling him,” said Ladde.
His lunches were legendary.
“We used to call it a Sal Date,” Ralls said. “It could go on for hours. But the conversations were really meaningful. A lot of the things we do today came out of those lunches.”
His leadership was about elevating those around him and helping them become who they wanted to be.
“His mantra was setting up whatever you’re leading to not need you to succeed,” Ladde said. “It was never about I. He was the last person to give himself credit.”
With Silvestri’s encouragement, Dr. Josef Thundiyil an emergency physician at ORMC, finished a fellowship in toxicology and obtained a Master’s in Public Health.
“He makes me want to be a better teacher and physicians and want to carry his legacy that everybody should be treated like family, humanely and with respect,” said Thundiyil. “He’ll be missed greatly.”
Silvestri had a knack for reaching out to people.
“When we were at the service, there were at least 50 people in the room who would say that they’re his best friends. There were at least 100 people who would say he was their mentor. And 1,000 people would say that he’s their role model,” said Ralls.
He gave a colleague who was a baseball fan, a Baltimore Orioles T-shirt. When Falk was sitting shiva earlier this year for his brother, Silvestri showed up with an expensive bottle of Scotch and spent several hours by his side. When he went to Italy, he brought Falk an Italian tie.
“Sal was a tremendous Neapolitan Italian dresser,” Falk said. “He wore stuff that only an Italian man could wear. His saying was that there are only two kinds of ties: Italian ties and ties that wanted to be Italian ties.”
And he gave Ladde’s 4-year-old son his first baseball glove. “When he found out about Sal, he asked us if he could come to the funeral in New York,” Ladde said.
And above all, he loved his family.
“The guy worked countless hours, but he always made time to go to his daughter’s dance recital and his son’s baseball games. He made it look so easy,” said Ladde.
Hundreds attended his memorial on Wednesday before his body was flown to New York.
An Orange County rescue truck carried his body to the airplane’s cargo hanger and Orange County Sheriff’s Office Honor Guard carried his coffin.
Silvestri’s funeral is on Saturday in New York. Many from the Orlando community are attending.
“I’m flying out early Saturday morning and I know at least eight other people who are on the same flight going to his funeral,” Ladde said.
Silvestri is survived by his wife and two children, both of whom are students at Johns Hopkins University.
His family has created a Go Fund Me page to raise money for Orange County School AED program. The fund had raised more than $60,000 since being established on Feb. 28.
Copyright 2017 The Orlando Sentinel