Studying Homeland Security: The Science of Readiness

For years, administrators at hospitals in New Orleans planned for disaster.

Like their colleagues across the nation, they worked with local, state, and national emergency preparedness officials for the ill-fated day that a fire would break out and patients would need to be evacuated, or that scores of plane crash victims would overwhelm their emergency room. But when Hurricane Katrina slammed into the Gulf Coast in August 2005, causing a break in the levees that put much of the city under water, all who were involved in emergency preparedness recognized too late that traditional disaster planning was far different than planning for a catastrophe.

In front, from left to right: Zhengmin Qian, M.D., Ph.D., assistant professor, health evaluation sciences; Michael Verderame, Ph.D., associate professor of medicine, microbiology andimmunology, and associate dean for graduate studies; Robert Cherry, M.D., associate professor of surgery, trauma program medical director, chief of section of trauma and critical care, and graduate program chair of the Master of Homeland Security in Public Health Preparedness; Bruce Rudy, P.A.-C., orthopaedics and rehabilitation, and a program instructor.

"How do you keep ventilators running when the electricity is down and the generators are running out of fuel? What do you do when you are running out of oxygen or running out of food?"

Emergency plans are predicated upon the existence of certain infrastructures, Cherry said. "And what do you do when those infrastructures don’t exist anymore?" he said. "These were real situations in New Orleans. As homeland security or public health officials, how do we protect ourselves from these situations?" That's precisely the mission of Penn State’s new master’s degree program—to prepare for worst-case scenarios that could seriously impede public health.

Offered as an online degree through the Penn State World Campus, and led by Cherry, the program is the first master’s program in homeland security rooted at a college of medicine. Its mission is to provide graduates with an understanding of the principles of hazard analysis and incident management with respect to natural disasters, as well as chemical, biological, radiological, and nuclear incidents. Students also learn about disaster planning and coordination; agricultural safety and biosecurity; critical infrastructure protection against disaster and terrorist emergencies; and the political, legal, psychological, and social aspects of terrorism and natural disasters.

"Since 9-11, we have this new evolving discipline called homeland security but there aren’t a lot of educational programs to validate the profession," Cherry explained.

Furthermore, he said, there's even less information about how the destruction of critical infrastructure—such as transportation or energy—affects the delivery of health care. Penn State College of Medicine launched the new master’s degree program in January, but its roots actually date to a conversation Cherry had in 2003, following the tragic World Trade Center attacks two years earlier. Cherry, a trauma surgeon at Penn State Hershey Medical Center, was talking with a colleague from the Army National Guard about ways to collaborate to bring advanced education and training to those who work in disaster medicine—especially the kind of sophisticated thinking that would enable planning for a disaster the magnitude of the terrorist attacks and later, as Katrina would prove, a deadly hurricane.

"With Penn State's name recognition and previous initiatives in homeland security, I thought, 'Wouldn’t it be great to start a master's program in homeland security in the area of public health preparedness?' But I had no idea what an enormous undertaking this would be," Cherry said. Enter Michael Verderame, Ph.D., associate professor of medicine and microbiology and immunology, as well as associate dean for graduate studies. “My role in establishing the program was to help Dr. Cherry work the program through the process that Penn State uses to approve new graduate programs," Verderame said. A rigorous process, to say the least. He confesses he was intrigued when he first heard about the proposal.

"My first thoughts were, 'A homeland security master's program based at a college of medicine? Boy, that’s a little different,'"Verderame said. But then when I learned the focus of the program, it made perfect sense. Who better to talk about public health preparedness and the emergencies you can face than a college of medicine?" Two questions that Penn State’s graduate school always asks when a new program is proposed are: Does the program unnecessarily duplicate another program, and are there folks elsewhere in the graduate school who can contribute to the program?

The answers were no, and yes.

With seed funds provided by the Pennsylvania Department of Health, Cherry collaborated with six Penn State schools, eight departments within those schools and located across three separate Penn State campuses to create the 30-credit master of homeland security in public health preparedness. As he readily admits, many outstanding educators played a role in bringing the vision to life. For example, professors in the College of Agricultural Sciences contributed to a course on agricultural biosecurity and how to protect the food supply system. Professors at the College of Earth and Mineral Sciences contributed to a course on the causes and consequences of natural disasters.

"There were a lot of accomplished people making sure it met the high academic standards that all Penn State graduate programs have to meet," Verderame said. "Dr. Cherry did a wonderful job of bringing people together. This was a very interdisciplinary proposal that reflects the complexity of the issue being addressed."

Kevin Murphy, Ph.D., a psychology professor at the State College campus and director of the International Center for the Study of Terrorism at Penn State, collaborated with Cherry on a course titled Disaster Psychology. "It deals with how individuals, organizations, and communities plan for, are affected by, respond to, and recover from disasters (natural and manmade)," Murphy explained. "It focuses on psychological processes (e.g., stress, anxiety, perceptions of risk, and danger), but draws from a number of areas to engage students in individual and team-based activities that will enhance their understanding of disaster psychology."

Years ago, the ninety-mile distance between his State College office and Cherry’s Hershey office would have made collaboration challenging, but thanks to technology, geography isn't the obstacle it once was. "I think Penn State has always been good at managing collaboration across its units, and it was quite easy to work with the medical school," he said. And in the end, "it led to a broadly relevant program."

Cherry’s proposal passed the first three layers of reviews—the Subcommittee on New Programs and Courses, the Full Committee on Programs and Courses, and the Full Graduate Council—with relatively little discussion. "Dr. Cherry did such a great job of seeking input from everyone across all disciplines that it passed fairly easily," says Murphy. Cherry presented the program to the Penn State Graduate School's President and Board of Trustees—the final stamp of approval—on September 11, 2004.

A stunning response

When Penn State College of Medicine began advertising the new program in 2005, the response was overwhelming. More than 200 applications came in from across the country, and the inaugural class of 36 students launched in January 2006. As Cherry and Verderame expected, all but two are adult learners who, in their careers, have gravitated toward homeland security. Twenty-one are men; fifteen are women. One third are Pennsylvania residents; the rest hail from around the nation.

"We really have a diverse group of students," Cherry said. "Nearly one-third of them already have advanced degrees. Nine have nursing degrees. Some are in criminal justice. Some are in emergency health. Some are in government or in the military. We even have one student who is in the Air Force in Turkey."

Rebecca Stivers, 28, an investigator with the federal government, in New York City, enrolled in the program to advance her career and gain a different perspective on the issue of terrorism. "It's so different from the training that I get from the government," she said, explaining that the FBI training focuses on the criminal justice and security response to the issue of terrorism. "The Penn State program is public health oriented, so I'm getting a more well-rounded understanding of the impact of terrorism. I never thought about the hospitals before or surge capacity or the types of injuries that might come about from different (terrorist) events. It gives me more things to think about."

For example, Stivers said, she recently was participating in a classroom exercise with five other students, all of whom work in the health care profession. The students were asked to examine the details of a terrorist attack that took place in Japan in 1995 and develop an action plan based on lessons learned. The students were told to identify the three top mission areas in which failure may lead to the highest morbidity and mortality.

Mission areas included roles such as prevention/deterrence/protection, emergency assessment/diagnosis, emergency management/response, incident hazard mitigation, victim care, and investigation/apprehension. "Coming from criminal justice, I said the capture of the suspect so it doesn't happen again," she said. "But the others felt differently. They said we needed to take care of the injured people. It was interesting to see that other perspective."

The program’s courses include Public Health Preparedness for Disaster and Terrorist Emergencies I and II, Natural Disasters, the Politics of Terrorism, Disaster Psychology, Agricultural Biosecurity, Public Health Evaluation of Disasters and Bioterrorism, Critical Infrastructure Protection of Health Care Delivery Systems, Leadership in Work Settings, and Policy Making and Evaluation.

Students participate in individual and team assignments each week through the Internet and video conferencing. "Even though they are scattered around the country, we try to create a sense of community among the students," Cherry said.

"We give them a virtual city or virtual hospitals and virtual infrastructures and they learn to develop the health care delivery system. We get them thinking about situations—like the ones that happened after Katrina, where you are running out of food and running out of energy. How do you prepare for a situation like that?"

Said Verderame, "I think it's really important to have advanced study on these issues. It’s one thing to have plans, and another thing to test those plans in a real situation. The idea of having folks educated and thinking about these things at a deeper level will help us to be more prepared the next time we face such a situation. It never will be perfect, but preparation is everything. It doesn’t matter why 150
people show up at your ER door—you need to be able to take care of them under every circumstance."