When Charlotte Palmer Roy graduated from Penn State College of Medicine’s graduate program in homeland security in 2012, she had no idea her new found knowledge would be put to the ultimate test just one year later during the Boston Marathon bombing. Palmer Roy is the emergency management coordinator at Newton-Wellesley Hospital outside Boston.
Every year the marathon route runs past the hospital, at mile 17, and it’s Palmer Roy’s job to prepare the staff and facility for the usual influx of race-related injuries and illnesses.
As Palmer Roy recalls, the day of the horrific event—Monday, April 15, 2013—started out relatively uneventful. At 2:49 p.m., when the bombs detonated near the finish line, her emergency operations center team was getting ready to close up shop.
Instead of heading home for the day, the team braced for the emergency.
Newton-Wellesley is not a trauma facility, so the hospital didn’t receive bombing victims. But the threat of secondary devices meant runners needed to get off the race route as soon as possible, so Palmer Roy’s team set up respite areas in the hospital. A few hours later, the runners were moved to Newton City Hall and then bussed back to the finish line in Boston.
Throughout it all, Palmer Roy said, hospital staff anxiously awaited news of coworkers and loved ones participating in and working at the race.
The next four days continued to be challenging, culminating in a shelter-in-place order on Friday during the manhunt for bombing suspect Dzhokhar Tsarnaev.
“We were told that he was potentially injured, potentially seeking medical care and potentially wearing a suicide vest,” Palmer Roy said. “That was a challenge because none of the hospitals with an exception of one in Boston are armed.”
Palmer Roy brought in the National Guard to protect the hospital staff and patients in case the bomber showed up there.
“We learned a lot that day about what shelter-in-place means for a hospital,” Palmer Roy said. “It meant that we could not get staff in or out, and we could not get supplies in. We also could not get discharged patients out, but two hospitals in Boston were diverting their ambulances to us. So we were very quickly surging out at the seams.”
The shelter-in-place status was lifted that evening, but the aftermath of the bombing was not short-lived.
“It was an emotional roller coaster from Monday through the following year, until we got through another marathon,” Palmer Roy said. “We typically plan for the race beginning in February. Well, we started planning for the next year’s marathon the day after that marathon.”
In 2014, and again this year, Palmer Roy coordinated security for the race not just at the local and state level, but also with the Department of Homeland Security, the FBI, the CIA and the National Guard.
“Security along the route was phenomenal. We had 20 SWAT team members and bomb-sniffing dogs here on our campus.”
Palmer Roy said her training at Penn State College of Medicine was invaluable in helping her deal with the bombing and its aftermath.
“For example, I took a course on agriculture biosecurity,” she said. “When we were planning for the marathon the year after the bombing, we were looking at anything and everything that could possibly happen. The agroterrorism piece came in because we had to make sure we were protecting our food and water supply.
“The disaster psychology course helped me understand what needed to be done within our hospital collaborative to support the staff,” she continued. “It helped me understand what people needed initially, and also to recognize the fact that this wasn’t going to be a quick fix for anybody. Anniversaries bring back memories, and watching things on TV can cause secondary trauma. I learned that in the course, so we cautioned people to stay informed but not be overly engrossed in the media.”
Penn State College of Medicine began offering the nation’s first graduate degree in homeland security with a medical focus in 2006. The online intercollege Master of Professional Studies (iMPS) in Homeland Security with an option in Public Health Preparedness is offered through the Penn State World Campus. A working mom, Palmer Roy attended classes at night for two years.
“It was the only way I was going to be able to reach my goals, so it was a perfect fit for me,” she said.
Palmer Roy said the program prepared her not just for the marathons but also for threats like a recent homegrown terrorist plot to behead Boston police officers.
“There are things in Penn State’s courses on critical infrastructure, terrorism and communications that I use every day,” she said. “Some I wish I never had to use, some I thought I never would use.”
This spring semester, the former student became a teaching assistant for the Critical Infrastructure Protection of Health Care Delivery Systems course. Palmer Roy also recently contributed to a son how healthcare and emergency-preparedness workers prepared for and recovered from the 2013 marathon.
“A lot of the preparedness efforts that go into a marathon and disaster and emergency planning here at the hospital, locally and statewide really all did come together and work that day,” Palmer Roy said of the events of 2013. “I hope it never has to again.”
PaTH Network starts studying patients at four institutions with support from the Patient-Centered Outcomes Research Institute
Which health outcomes really matter to patients? That’s the question the PaTH Network is starting to investigate with the help of nearly $7 million in funding from the Patient-Centered Outcomes Research Institute (PCORI), a non-profit created through the Patient Protection and Affordable Care Act.
Four major university health systems—Penn State, University of Pittsburgh, Temple University and Johns Hopkins University—make up the PaTH Network. It’s one of 29 health data networks across the country and a coordinating center, collectively known as PCORnet, funded by PCORI.
PCORI’s mission is to help patients, their caregivers and healthcare providers make informed healthcare decisions based on outcomes that are relevant to those living with a particular condition. That means designing studies that track these patient-centered outcomes.
“It’s traditionally been the researchers who have determined what the outcomes should be in studies,” said Dr. Cynthia Chuang, professor of medicine and public health sciences and Penn State’s lead principal investigator on the project. “For a long time, that really seemed to make sense, until you think about: How do we know that these are the outcomes that really matter, and who should the outcomes matter to? When you think about it that way, it should be the patients who say, ‘Having my condition, these are the things that are most important to me.'”
While researchers typically focus on scientific measures like lab values, Chuang said, patients might be more focused on their quality of life, whether or not they can walk without using a walker or how they can take fewer medications.
The PaTH Network is using PCORI’s funding to study patient-centered outcomes for atrial fibrillation (AF or A fib, the most common type of irregular heartbeat) and idiopathic pulmonary fibrosis (IPF, a rare lung disease with an unknown cause). All of the clinical data research networks in PCORnet, including the PaTH Network, are also working together to better understand the development and treatment of obesity, as well as how some people maintain a healthy weight across their lifetime. By joining forces with other institutions, researchers will have far more patients involved in the study—potentially 3 million in the PaTH Network alone—making the study results much more powerful.
The benefits of larger studies are perhaps obvious for rare conditions, like IPF, for which a lone institution might only have a handful of participants. But large groups of participants also help advance research in more common conditions, like atrial fibrillation, that have many treatment options and no gold standard of care.
When Dave Ruppert found himself in the emergency department of St Joseph Medical Center in Reading in 2012 with symptoms that eventually led to a diagnosis of pancreatic cancer, he also found a new healthcare home. Impressed by the professionalism, personal attention and level of service he found at St. Joseph during that tough time, Ruppert later had all his medical services transferred to St. Joseph.
“It wasn’t just any one person, but everyone from the providers to the billing department,” he said. “They are willing to help you out, they understand you and you don’t get shuffled around. They take care of you as an individual, not as a number.”
When it was time for surgery, Ruppert benefitted from St. Joseph’s oncology partnership with Penn State Hershey that meant he was able to get the highest level of care through recommendations from local doctors.
That’s why Ruppert was pleased to learn that St. Joseph Regional Health Network has become part of Penn State Health, the university’s newly-formed health system that will also include Penn State Milton S. Hershey Medical Center.
“I always recommend St. Joseph to people, and I have high expectations for this,” he said. “I think it’s a really good move.”
Ruppert isn’t the only one who believes St. Joseph is a special place and that becoming part of the Penn State family will only improve it.
Marc Rovito, medical director of St. Joseph Cancer Center, has been a Penn State employee at St. Joseph for four years through a provider-service agreement with Penn State Hershey.
Three sets of shoulder presses, chat about the weather.
Three sets of chair stands, joke with the person on your right.
Three sets of arm pulls, encourage the person on your left.
This simple recipe – which combines strength training with socialization – has become a successful formula for older adults who participate in Band Together peer exercise groups throughout Central Pennsylvania.
Now, the program will expand to other parts of Pennsylvania thanks to $14 million in funding to Penn State College of Medicine from the Patient-Centered Outcomes Research Institute (PCORI). The money will be used to study the effectiveness of integrating strength training, balance exercises and walking for older adults who have had a fall-related fracture.
“I assumed it was because they never exercised,” he said.
After researching available programs, Sciamanna decided to start his own to help his patients develop the muscle and balance they needed to avoid falls. He knew it had to be something that wouldn’t require a gym membership, complicated equipment or heavy dumbbells. An exercise physiologist in cardiac rehab suggested using resistance bands.
What he came up with was a 45-minute routine that mixes five different strength-training exercises with one minute breaks in between for socialization and, recently has added some balance exercises.
In church halls and community rooms – basically anywhere the groups can meet for free – trained volunteers lead the sessions, setting up chairs in a circle and pulling out small duffel bags the colors of the rainbow – each matching the color of bands inside.
Yellow, at three-to-six pounds resistance, is the easiest band to use. Participants advance to other colors as their strength improves, eventually working with as much as 35 lbs. The most ambitious members use two bands at once, since the handles are thin enough, going up to 70 pounds. Exercises using the resistance bands are done seated, or standing and holding onto a chair.
Nancy Boerger of Hershey has been doing Band Together for a year and says she can now get up from a regular height toilet without problems.
“It’s much easier, and I’m sure it is from these exercises,” she said.
Anna and Jack Manning attend the classes together in common space where they live at Hershey Plaza. In the past year, both have been using their canes less.
“I have a walker, but I don’t need to use it anymore,” Anna said.
And then there’s Lois Leonard of Palmyra, who, at 86, is the oldest in her group. She started the program after her daughter in Texas saw an article about it in a Lebanon newspaper online and suggested she try it.
“I wasn’t looking for anything, but it is good exercise and good camaraderie,” she said.
The classes are free and open to anyone. “It seems to me that this is something all older adults should have access to as a service,” Sciamanna said.
That’s why, when the opportunity came to submit a proposal to PCORI, Sciamanna decided to see if he could get money to do a study to find out whether a program such as Band Together could prevent people from falling and breaking bones.
First, he had to get support from other organizations and institutions, and find some to partner with. “I had to see if it was a question worth asking and if others would be willing to partner with me,” he said.
What he came up with was a five-year study that will follow 2,100 older adults with a history of falls – half of whom will be randomly assigned to Band Together. For three years, those participants will attend walking groups and Band Together sessions with a coach, doing exercises for both strength and balance. Each year, all participants will take part in either a phone call or in-person meeting with study investigators.
Researchers will record information about fall-related injuries; muscle strength, bone strength, loneliness, depression and use of emergency medical care by study participants at 50 new sites in central Pennsylvania, Philadelphia and Pittsburgh.
Building on the patient involvement behind the Band Together initiative, three patients will be co-investigators on the current study and provide input. Other partners on the study include Health Dialog, The American College of Sports Medicine, American Orthopaedic Association, National Osteoporosis Foundation and Highmark Blue Shield.
Sciamanna’s hope is that the study will show that those who participate in Band Together have fewer falls. Then, he can apply to Medicare so it will pay for all Americans to participate in such programs.
“It’s a little pie in the sky, but they already pay for some things that are not that different than this,” he said. “It’s a very formal process, but by the time this is finished, we will be well positioned to make an application.”
By studying a larger sample of adults, insurance companies and Medicare will have the data to determine if such a service should be covered.
Rachel Moury, director of donor communications and stewardship for Penn State Hershey, said Honor Your Doctor funds that Sciamanna received made it possible for him to create the program and draw national attention to its potential.
“Some people think that a $50 gift doesn’t matter or can’t do much,” Moury said. “But it can combine with other $10 or $50 or $100 gifts to add up and raise attention for the work someone is doing.”
For Sciamanna, those donations led to the $14 million in funding that can potentially benefit many more people in the future.
- Jennifer Vogelsong
Identifying poisonous snakes and knotting climbing ropes to form a makeshift litter are not typically taught in medical school.
But emergency medicine doctors need to be creative, flexible and have a broad knowledge base.
That’s why Dr. Jeff Lubin, associate professor of emergency medicine and Life Lion division chief, took emergency medicine residents and medical students out of the emergency department and into the wild.
“It is very applicable,” Lubin said of the first wilderness medicine training offered by Penn State Hershey. “One of the things they need to understand is what happens outside the hospital, because they are going to be receiving those patients.”
Lubin worked with Life Lion flight paramedic and wilderness medicine enthusiast Saul Elertas to design the training at the Boy Scouts of America’s Camp Bashore near Jonestown in Dauphin County.
Dressed in fleece, sweatshirts and hiking boots against an unseasonably cool May morning, Elertas reminded the residents of basic rules about making assumptions, planning ahead and taking care of themselves outdoors.
None were complaining about the assignment.
“This was mandatory, but I would have volunteered anyway,” said Keane McCullum, a first-year medical student who is working as Lubin’s research assistant for the summer.
Dr. Neal Thomas has made research his life’s work.
The newly named associate dean for clinical research hopes to help Penn State Hershey’s clinical research mission grow. One reason he is vested in seeing the expansion of clinical research is because he was personally affected by it — twice.
“In 2002, my youngest son was born premature and was given a medicine called surfactant into his lungs to combat lung disease that can happen from prematurity,” Thomas, a professor of pediatrics and public health sciences, said.
Being a researcher involved with surfactant use in older children, and also studying the surfactant genes and their impact on young children with lung disease, he was aware of the early clinical trial literature treating premature lungs. The fact that his son benefited from that early work would strengthen Thomas’s research interest in surfactant for years to come.
“It probably saved his life, but it certainly affected his lungs so that he is completely healthy now,” Thomas said. ”That wouldn’t have happened if scientists and physicians hadn’t conducted the clinical research to get to that point.”
He personally benefited from clinical research last year after having a heart attack.
Dr. Rodrigue Mortel has received the Penn State Alumni Association’s Honorary Alumni Award. This award recognizes those who are not Penn State graduates but have made significant contributions to the university’s welfare through their commitment and service.
Dr. Mortel joins fewer than 100 people who have earned this distinction since its establishment in 1973.
“I know that only two to four people are selected each year, and that since the award has been set up, only three faculty from the College of Medicine have been recipients of this award,” Mortel said. “I am proud to find myself in a very small circle of distinguished people to be selected from the College of Medicine.”
Mortel served in a number of positions during his 30 years at Penn State Hershey. He was promoted to full professor in 1977, only five years after joining the faculty, and later became the chair of obstetrics and gynecology in 1983.“His leadership at Penn State has been so very instrumental in establishing this Medical Center as one of the premier institutions in the country,” said Dr. Chester Berlin, professor of pediatrics, in a nomination letter for Mortel. “Penn State was so very fortunate in having Dr. Mortel in leadership positions so early in the life of Penn State Hershey.”
Added Dr. A. Craig Hillemeier, dean, Penn State College of Medicine, CEO, Penn State Milton S. Hershey Medical Center and Health System and senior vice president for health affairs, Penn State, “Dr. Mortel’s prolific efforts over the years have supported the growth and reputation of Penn State College of Medicine and Penn State Milton S. Hershey Medical Center. By helping train aspiring physicians and conducting groundbreaking research in our labs, Dr. Mortel deserves to be recognized for his service to Penn State.”