Another Kind of Circulatory System

In the depths of the hospital, through doors that often go unnoticed by most employees, is a transportation system that plays a huge role in modern health care. The passengers are not people, although some are samples of people – blood samples, that is, secured in a “carrier” and on their way to the hospital lab. The carriers – cylindrical cartridges with a secure latch on each end — race all over the hospital through pneumatic tubes hidden deep behind the walls. Unit nurses can send samples to the lab for testing, or receive blood products and medications to administer to their patients.

Pneumatic tube systems have been used in communications, banking, health care and industry since the mid-1800s to move small things from one place to another much faster than a human could travel — even faster than a car. Digital communication has taken over the conveyance of messages, but when it comes to transporting an actual object across a hospital campus, the pneumatic tube still reigns supreme.

The pneumatic tube system at University of Maryland Medical Center (UMMC) is one of the most complex in existence, according to Pevco, the company that designed and installed it some 20 years ago at UMMC’s University Campus, and has updated and expanded it through the years  The last big upgrade was 2011, when UMMC added two additional miles of pipe, interchange rooms, 25 new pieces of equipment and 10 additional zones.

Before this system was installed, the hospital staff included couriers hired specifically to “run” blood products, lab samples, and pharmaceuticals. They were fast, but no match for the tube system once it was installed. It takes 15 minutes to walk from the two furthest points in the hospital, but only five minutes for a carrier in the tube system.

A pneumatic delivery system transports containers through tube networks using air pressure. The nerve center of the system is a computer that takes up so little space it only requires a small closet. When a nurse or lab technician enters a destination into one of the 99 stations throughout the hospital, the computer selects the quickest available route, waits until the route is clear, then uses vacuum to pull the carrier out of the station into the pipes.

The “whoosh” sound a carrier makes heading down a clear passageway is music to the ear of Richie Stever, CHFM, LEED AP, director of operations and maintenance at UMMC.

“The system is designed like a roadway system,” Stever said. “When the pipe  — think of it as a highway —  is clear, the carrier is lifted from the station with a motor that creates suction, and then it travels through the pipe until it reaches a diverter – like a highway interchange — switches roads, and then is moved with pressure via a motor until it reaches its final destination.”

There are 5.5 miles of pipe throughout the complex, with the average time for deliveries being less than five minutes. To create that kind of power, the tube system is backed by 22 blower motors that push and pull air through the pipes.  There are 22 zones the items can travel through, and 103 diverters. Diverters are used to make bridges from station to station. The diverter is placed at an intersecting point and changes the carrier’s path to a different tube. There are three interchange rooms in the system where the diverters are used to change the direction of the carriers.

The carriers are numbered cylindrical cartridges equipped with two latches on each end as well as foam padding to protect the contents during their trip – sometimes miles at a time.  There are 99 carrier stations throughout the hospital building, with seven in the Central Pharmacy, eight in the North Core Laboratory, seven in the South Core Laboratory, three in the Blood Bank and one at each nurses’ station.

When a carrier comes through to the station, a tone will sound to let those nearby know that a specimen or blood product has just come in. Those 99 stations generate more than 5,000 transactions per day at a speed of around 500 feet per second.

As with any complex machine, things can go wrong, but built-in features kick in to fix them. If a blower is off-line because of mechanical or electrical failure, another blower within the system can do the job. If a cartridge opens up en route and spills the contents, technicians use measurements to figure out where the spill or clog is  before deploying a special “squeegee” — more like a large sponge — that is as big as the inside of the tubes. The squeegee is sent through the tubes multiple times to clean up the spill.

“Twenty years ago, when we installed the first part of the tube system, we never imagined we would be able to send a thousand carriers in a day,” said Scott Kruelle, system operator for the tube system. “Now, we send more than 5,000 carriers a day.”

Celebrating the 46th Anniversary of the First Maryland State Police Medevac Mission: March 19, 1970

By Sergeant Chad Gainey; Maryland State Police Aviation Unit, Flight Paramedic

As we mark Saturday’s 46th anniversary of the first medevac mission completed by the Maryland State Police, we reflect on a few of the accomplishments the MSP Aviation Command has achieved.

The Maryland State Police Aviation Division medical mission profile began in November 1960 with the acquisition of a Hiller UH12E helicopter. This aircraft was used primarily for police missions, however a medical “support” profile was soon established and thus began the idea of medical evacuation for the citizens of Maryland.

medevac 1Although systematic medical care was not provided on board, this aircraft transported medical patients such as heart attack victims and expectant mothers following severe snowstorms. Medical rescues were performed with the Hiller as early as 1966, but not under a complete system of enroute care.

medevac 2Within a few years, that concept would come to life. Dr. R Adams Cowley, perhaps best known for being the father of the “Golden Hour” concept in trauma medicine, collaborated with MSP Pilot Robert Y. Wolfe and other Maryland leaders to close the most significant gap in trauma care.

medevac 3On March 19, 1970 at 11:20 am, the first “Medevac” was completed under a complete system of enroute medical care. Originally called “Helicopter 108”, pilot Corporal Gary Moore and Trooper First Class Paul Benson responded to a traffic accident on the Baltimore Beltway (Interstate 695) and Falls Road and transported a patient to what was then known as the Center for the Study of Trauma, now known as the University of Maryland R Adams Cowley Shock Trauma Center, in a Turbine powered Bell Jet Ranger aircraft.

On that day, MSP formally expanded its role into the world of emergency medical services (EMS). That medevac mission marked the first time a civilian agency transported a critically injured trauma patient by helicopter; never before had this been done in a non-military setting.

Since that time, many changes have occurred to improve what today is called the Maryland State Police Aviation Command and the Maryland medevac system. MSP and Shock Trauma have earned a worldwide reputation as leaders in trauma care.

medevac 4The procurement of the AS365 Dauphin helicopters in the late 1980s provided additional enhancements for the fleet, such as increased speed, the added safety component of two engines, and additional space to accommodate two patients.



medevac 7

In 2013, the Maryland State Police began flying the latest and greatest technology in the form of the AugustaWestland AW139 helicopters. Additional safety measures were incorporated, along with the addition of a second pilot and a second medical provider to the standard flight crew.

More than 148,000 patients have been transported since that day in March 1970. The Maryland State Police Aviation Command, in conjunction with other medical partners around the State, and with the continuing support of our citizens, their government representatives, and other stakeholders, have made the Maryland Medevac system a success story for many patients and their families.medevac photo 6

UMMC Using New ID Application to Check Crash Carts

By Sharon Boston, UMMC Media Relations Manager


You may know RFID (radio frequency identification) as a theft prevention system in libraries and stores. It’s also used for key cards and to check the stock of some hotel mini-bars.

The University of Maryland Medical Center is now the first hospital to use a new application of RFID technology to scan the content of hospital crash carts, which carry medications that are critical during life-threatening emergencies.

The system, called Kit Check, scans an opened crash cart tray in about 10 seconds, identifying medications that are missing or will expire soon. The pharmacist then restocks the tray and scans it again in the specially designed scanning station (which looks a small cabinet or pizza oven) to verify that all items are present and up-to-date.

Want to see it in action? Check out the video at the top of this post.

Each medication has an RFID tag, allowing the entire tray to be scanned and verified quickly, virtually eliminating the chance for human error and removing the need to hand-check each tray twice.

Becoming A Non-Directed Kidney Donor

This four-minute video features living kidney donor Drew Sollenberger discussing why he felt it was important for him to become a non-directed donor. A non-directed donor is an individual who expresses a desire to donate one of his or her kidneys, but who does not have a recipient to receive the organ.

Dr. Matthew Cooper, director of kidney transplantation and clinical research in the Division of Transplantation at the University of Maryland Medical Center, also appears in the video to discuss the process of becoming a non-directed donor, including the benefits available to donors as a result of a new, minimally invasive surgical technique now being employed to remove the kidney from the donor.

Drew’s kidney was donated to a young child who was struggling to survive before the kidney became available.

Related Information:

Our Top 5 Most Watched YouTube Videos

By Malissa Carroll
Web Content Developer

Did you know that the University of Maryland Medical Center has its own YouTube channel?

With more than 460 health-related videos that are viewed an estimated 50,000 times each month by people all over the world, the UMMC YouTube channel is a must-see for anyone searching for the latest and most up-to-date health information on the Web.

Many of the videos are from the program Maryland Health Today — a show that features in-depth interviews on a variety of health topics with University of Maryland specialists.

The five most watched videos on our YouTube channel include:

Leukemia and Lymphoma (Part One)

Leukemia & Lymphoma (Part One) — 51,825 views

Surgery for Lung Cancer (Part One)

Surgery for Lung Cancer (Part One) — 43,136 views

Radiation Therapy (Part One)

Radiation Therapy (Part One) — 39,709 views

Infertility - Advances in Treatment (Part One)

Advances in Infertility Treatment (Part One) — 33,859 views

Aortic Valve Bypass Surgery: Beating Heart Therapy for Aortic Stenosis

Aortic Valve Bypass Surgery: Beating Heart Therapy for Aortic Stenosis — 31,795 views

So, if you haven’t tuned in to UMMC’s YouTube channel yet, take some time today to check out all of the great videos it has to offer.

Whether you’re looking for treatment information, recent episodes of Maryland Health Today or you just want to relive the fun and excitement of a past celebration like “Under the Big Top,” the UMMC YouTube channel is the place to be. Check it out for yourself!

Why Surgeons Suffer Injuries from Minimally Invasive Techniques

By Malissa Carroll
UMMC Web Team

According to the findings of a recent University of Maryland survey, surgeons who engage in minimally invasive, laparoscopic surgery, while providing great benefits to their patients, are possibly doing so at an increased risk to their own overall health and well being.

The survey, developed by Adrian E. Park, M.D., chief of general surgery at the University of Maryland Medical Center and professor of surgery and vice chair of the Department of Surgery at the University of Maryland School of Medicine, found that 87 percent of laparoscopic surgeons have experienced physical symptoms or discomfort as a result of managing the unique surgical constraints associated with laparoscopic surgery.

Dr. Park explains the challenges of performing minimally invasive surgery and how these challenges limit the surgeon’s movements and impact his or her body both during and after the procedure in this video.

Paired Kidney Exchange: A Major Breakthrough in Kidney Transplantation

By Matthew Cooper, M.D.
Director of Kidney Transplantation

Transplantation is about opportunity. The hardest part about choosing a career in transplantation is knowing the limits of perhaps the most ‘valuable’ valuable resource on this earth – lifesaving organs for those that desperately need them. Every day people die on the waiting list as that opportunity never comes, and the numbers of those added to that list grows exponentially.

We can never allow ourselves to think that there is no room for growth in transplantation. We can never be comfortable with the status quo and must continually reach for that next breakthrough, the next discovery, the next opportunity. The University of Maryland’s Division of Transplantation prides itself on being the place where people come for answers when others leave them with questions.

The University of Maryland has always been a leader in both surgical innovation and opportunities for patients in transplantation. Paired kidney exchange (PKE) is yet another opportunity we offer.  The program is designed for patients that have a living donor that is otherwise healthy and suitable for donation but incompatible with their intended recipient.  In years past we were forced to tell both the donor and the recipient that the only option was to wait an expected 3-5 years for a deceased donor transplant, knowing many would never see that day.

As more and more pairs were found to be incompatible we knew we had to find another opportunity.  Through paired kidney exchange we’ve turned ‘no’ into ‘yes’ and are excited about the possibilities. We’ve invested significant resources —  including designated clinical nurse coordinators — to maintain this specialty program and multiple assistants in our office to facilitate such procedures.

In recent months we’ve performed a four-way kidney exchange, involving eight people from four states, a two-way kidney exchange with a hospital in Minnesota and a third exchange involving a patient at Johns Hopkins, and we have more lifesaving kidney exchanges in the works.

The paired exchange program is an opportunity not all centers are able to offer, in part due to the complexity of the organization necessary to plan these procedures either within the institution or with other medical centers.   This may require flying an organ to another part of the country or operating very early in the morning or late at night to minimize the time the organ is waiting to be transplanted.   Also, there needs to be an institutional commitment, especially with the operating room, to provide space for these multiple transplants and/or odd timing for an operation.  We set high expectations for this transplant program, eliminate barriers for patients, and open the door for many to receive the Gift of Life.

This new program has brought great energy to the transplant division.  We’re seeing patients who either because of blood type incompatibility or high levels of antibodies to their donor now are finding matches after long years of waiting.  We’re seeing their intended donors (most of them close family members) excited about the chance to not only see their loved one free from dialysis but also having the opportunity to help another.  The ‘trickle down’ effect is a miracle itself.  Patients are now coming with potential donors for the PKE program that they never considered because of previous knowledge of blood type incompatibility.  Everyone is now an ‘opportunity’ for one another.

We take living donation very seriously.  We are bound by the principle of “Do No Harm” first and foremost.  Our standards of evaluation and safety of living donation are the highest in the country.  We place great value on the trust not only of the donor but of the recipient and their families who look to us to care for their Hero who comes offering this gift of new life.

We believe our standards must be even higher for donors in the PKE program, as they most often have never met the intended recipient of their donated kidney.  Ethically, while we maintain the privacy of all those involved in the exchange, we still demand the informed consent of all donors and recipients and answer all questions until it is clear and understandable.

We will continue to look for new and better answers for patients seeking to avoid the effects of end-stage renal disease.  We can no longer look at incompatibility with a living donor as an excuse to deny kidney disease patients the Gift of Life.  Paired kidney exchanges will become the standard of care across major transplant centers and will be a regular activity here at the University of Maryland, where we are committed to doing all we can to advance the state of the art in kidney transplantation for our patients.

Radiation Therapy and Patient Safety

By William F. Regine, M.D.
Chief of Radiation Oncology

Editor’s Note: In response to an article in the New York Times on January 24, 2010, about radiation injuries to patients, Dr. William F. Regine provided the following comment. Dr. Regine is chief of radiation oncology at the University of Maryland Marlene and Stewart Greenebaum Cancer Center and professor and Isadore and Fannie Schneider Foxman chair of radiation oncology at the University of Maryland School of Medicine.

An article in the New York Times highlights several cases of radiation over-exposure in cancer patients in several New York hospitals in 2005. We are concerned that the article could make some patients fearful of receiving radiation therapy. This would be disastrous, since radiation therapy is by far one of the safest and most effective forms of cancer treatment.

We want to reassure all of our patients that their safety is our number one priority. In fact, our hospital has been recognized as one of the nation’s best hospitals for patient safety and quality of care for the past four years in a row by the Leapfrog Group, a national public assessment of hospital safety and quality performance. We strictly follow the highest standards of quality assurance in providing radiation therapy to patients.

Radiation therapy actually has an extremely low rate of errors, due to the many checks currently in place to ensure patient safety. As noted in the article, an estimated 35 million treatments were administered last year on equipment made by Varian Medical Systems alone, with about 70 instances of mistakes that affected or nearly affected patient care. While this is a very low rate, even assuming significant under-reporting, even one such mistake is too many.

The errors described in the article were associated with the lack of quality assurance processes. At our center, we strictly follow a comprehensive set of safety rules. These include: 1) machine-related QA checks, including a daily check of the beam output and monthly physics checks of all equipment; 2) secondary calculations to verify the accuracy of the radiation dose calculated by our treatment planning systems; 3) a review of all treatment plans by medical physicists; 4) quality assurance checks of Intensity Modulated Radiation Therapy (IMRT) plans prior to treatment; 5) review by the therapist staff to verify agreement between the radiation dose in the treatment plan and the treatment console; and 6) verification of the physician’s written directive, the prescribed dose and the patient’s identity.

Since 2005, when the events described in the New York Times article occurred, two national-level professional meetings have taken place to specifically address errors in radiation therapy. A member of our faculty in the Department of Radiation Oncology was selected to serve on a special task force launched by the American Association of Physicists in
Medicine (AAPM)
to study safety processes in radiation oncology. Both the AAPM and the American Society for Radiation Oncology (ASTRO) continuously work to strengthen training, quality assurance and safety in radiation oncology.

All treatments pose risks, and patients should discuss them with their doctors. Our staff is committed to the very highest standards in the delivery of radiation therapy to our patients. Please feel free to discuss your treatment plan and our quality assurance processes with your radiation oncologist or with any member of our staff.

The Making of UMMC’s iPhone App

By Chris Lindsley
Blog Editor

In July of 2009, the University of Maryland Medical Center launched the “UMMC Medical Encyclopedia” iPhone application. This app, which is available free on the Apple iPhone App Store or on iTunes, was an immediate hit, and has been downloaded about 1,500 times a day by people in more than 50 countries.

This app was the brainchild of UMMC Web Production Manager Marc Laytar, who talks about the steps involved in creating the app, its success and future upgrades in the following interview.

1. Where did the idea for the UMMC Medical Encyclopedia iPhone app come from?

In examining the applications for the iPhone, I noticed that many of the apps were somewhat superficial in the information they provided. Many were simple health tests or symptom checkers, while others were geared toward doctors or other health professionals.  There seemed to be a void that I thought the UMMC Medical Encyclopedia could fill.  I then looked at the steps required to get the app off the ground and it seemed very doable, so we got started.

2. Talk about the process/steps involved to make this a reality.

The first thing I did was work with Russell Vance, our other developer, to flesh out the application and determine what we wanted the look and feel to be. We wanted the application to have the full functionality of our web encyclopedia, but also look good on the iPhone.  Russell then modified our existing encyclopedia pages to be able to detect when an iPhone was visiting, and therefore optimize the look for the iPhone visitors. I created the graphics for the app, and put the whole thing together using Apple’s iPhone Developer tools. The submission process was somewhat daunting, but after about a month of emails back and forth with Apple, the app was finally approved. The UMMC Medical Encyclopedia finally debuted on July 21, 2009.

3. Has the popularity of the UMMC app surprised you?

The popularity of the app was a complete surprise. We knew it would be popular, but not at the levels it has shown. We watched with anticipation as it moved up the charts — from 20th most popular in the first few days up to 3rd by the end of the first week. It stayed at 3rd for about 2 months before dropping to 4th.  What has surprised us the most is its consistency. We are getting a solid 1,600 to 2,000 downloads a day from more than 50 countries without fail. At the end of December we should be hitting the 250,000 download mark, which is very thrilling.

4. What enhancements/improvements do you plan to make in the future?

The enhancements we plan to make in the near future are to the speed and appearance of the application. By downloading more of the data onto the phone itself, we hope to improve the user experience by making the navigation more seamless and efficient. We also plan on adding new graphics and sliding menus to give the application a more up-to-date look and feel.

5. What tips or advice can you share to others thinking about creating an iPhone app?

For those interested in creating an iPhone app, I suggest you get help from a developer that specializes in iPhone apps. There are more and more developers every day who are specializing in mobile apps and iPhone applications in particular. By consulting a pro, you can avoid many of the pitfalls that occur in the development and approval process.

If time is not an issue, and you have someone who is Mac savvy on staff, try doing it yourself.  Apple has created a great development site to get started building iPhone apps.  Here they provide simple templates and step-by-step instructions to getting started with your first app.

Kidney Exchange from the Participants’ Perspective

By Chris Lindsley
Blog Editor

The University of Maryland Medical Center recently completed a four-way kidney exchange involving eight patients from four states.

Get a real sense for what this exchange was like from the participants involved, including several patients, UMMC’s director of kidney transplantation and its transplant coordinator.

1. Ed Behn, the person responsible for making the kidney exchange possible, shares his story.

2. Emmet Davitt talks about why he got involved in the kidney exchange, his experience at UMMC and more.


3. Bob Loudermilk, a 74-year-old dialysis patient, goes from flying cadaver kidneys to hospitals to having a life-changing kidney donation. Read Bob’s story.


4. The mother of Sean Menard, who at 10 was the youngest participant in the kidney exchange, shares her and Sean’s story.

5. Transplant surgeon Dr. Matthew Cooper provides an overview of the kidney exchange.

6. Transplant coordinator Debbie Iacovino talks about the work involved in putting the kidney exchange together.