New York City Department of Health and Mental Hygiene
Engagement of technical and scientific experts in LHD policy issues: the creation and utilization of NYCâ€™s Radiological Advisory Committee (RAC)
New York City (NYC) is the most populated city in the United States, occupying 305 square miles with a population of approximately 8.4 million residents, increased to over 9 million on an average day with visitors and commuters. The average population density is roughly 43 people per acre. The building stock includes commercial, residential, and mixed-use with approximately 1 million structures in NYC, many built before modern building codes were implemented. Additionally, the metro region contains a population of approximately 22 million people with complex, interdependent critical infrastructure systems.
NYC is made of a very diverse population in terms of languages spoken, ethnic and cultural backgrounds, economic backgrounds, and access and functional needs risks. Over 30 percent of all households have children under 18 and more that 10 percent of New Yorkersâ€”approximately 1 million residentsâ€”are over the age of 65. Over 200 languages are spoken in NYC (with an estimated 23 percent of New Yorkers who speak and understand English less proficiently). Over 21 percent of the city's population lives below the Federal poverty line. An estimated 10 percent of New Yorkers have a disability (defined as sensory, physical, self-care, and go-outside-the-home disabilities).
The structural aspects and population diversity, coupled with the heighten risk of terrorist threats, highlights the need and value of careful and considered emergency planning, especially for highly impactful events such radiological events. The clinical and environmental considerations a public health agency must consider in such an event can quickly outstrip in-house expertise. Within the NYC Department of Health and Mental Hygiene (DOHMH), the Office of Emergency Preparedness and Response (OEPR) is charged with planning for radiological emergencies including radiological dispersal devices (RDDs), improvised nuclear devices (INDs) and other related radiological concerns that arise due to the proximity of the Indian Point Nuclear Power Plant 25 miles to the north.
Due to the technical and specialized nature of radiological health issues such as these, New York City's Radiological Response and Recovery Plan (RRRP) incorporates the formation of a Radiological Advisory Committee (RAC) from which volunteer expertise can be drawn in whole or in part during an emergency or to provide planning support and fill a recognized gap the agency had identified. While DOHMH has radiological specialist staff members, potential members for the RAC were identified among radiological specialists from more varied fields that could provide not only technical expertise but also academic, remediation, medical and governmental perspectives to the anticipated radiological issues that would impact our ability to respond. Without the addition of RAC members, DOHMH is less able to address the complex and difficult questions that arise with a radiological event in a location as sensitive as NYC.
The RAC is innovative and responsive to local needs by creating a formal standing committee of national experts focused on radiological events impacting New Yorkers able to help formulate agency and citywide policy during planning initiatives and assist with a response if such a need arises. Additionally, RAC members commit to making themselves available, in person or remotely, to assist with radiological decision-making, including during an emergency.
While new, the RAC has already demonstrated that they are an effective expert group capable of advising on public health decisions involving the impact a radiological event would have in a dense urban area like NYC. Within DOHMH, the RAC program has been viewed as a model for the creation of other, similar technical advisory groups as a low-cost way to expand access to expertise during the planning and response phases of an emergency.
NYC DOHMH's website is: http://www1.nyc.gov/site/doh/index.page
Cooperation between various City agencies through the Radiological Response and Recovery Committee (RRRC; an interagency committee that determines the response objectives for radiological incidences and coordinated citywide radiological planning) and the RAC highlight an overlooked component of emergency response: the engagement of technical and scientific expertise through a standing committee engaged in planning phase and response phases, allowing for innovated and integrated policy development.
Prior to the creation of the RAC, radiological planning and responses to inquiries about radiological issues, particularly complex issues, were addressed by agency staff or informally speaking to local or national experts on an ad-hoc, as-needed basis. This is problematic as radiological experts are a very small and highly specialized set of professionals who may not always be available, thus to respond to spontaneous inquiries from LHDs. Furthermore, Agency staff would likely be unable to address the significant issues rising from a radiological incident in NYC, risking the ability to provide an adequate and comprehensive response for the City. An example of this gap is seen with the utilization of radiological safety officers: before the creation of the RAC, agency employees would discuss issues with hospital radiation safety staff, but during a radiological emergency this resource would be unavailable to the agency due to their commitments to their employers. Conversely, RAC members are consistently and reliably available during planning phases and have committed to being available during the response and remediation phases.
Due to the complexities of a radiological event, there is no specific demographic that can be targeted with radiological planning and response, however the unique population densities and heighten risk associated with terrorism in NYC makes planning for such an event critical for all New Yorkers.
The first meeting of the RAC was held in May 2015 with approximately 30 participants including Committee members and local emergency planning partners interested in radiological issues. The group was given an overview of the NYC Incident Management System and the New York State and federal assets that could be expected to be made available during a radiological event. Subsequent RAC meetings and engagement covered other issues with a meeting of the primary RAC members planned annually.
To formalize membership and operational capability, a RAC membership handbook was written and shared with members indicating the committee's function and where it resided within the DOHMH incident command structure. Since the first meeting, RAC members have been further engaged in policy and planning discussions and membership has expanded through recurring e-mails.
While the creation of the RAC was not directly based on evidence-based practices, DOHMH has researched the issue and submitted an abstract for presentation at the 2017 Preparedness Summit on the value of integrating scientific and technical expertise into the incident command system structure, of which the RAC is an example of.
The RAC was created once a gap was identified in NYC's RRRP plan's outlining the role of a Radiological Advisory Committee, which had not been formed. Using a minimal outlay of accrual funding (approximately $6,000 to cover the cost of travel, hotel, and food expenses for out-of-town members), DOHMH's radiological planning staff contacted national clinical and environmental radiological experts who were known to them through various conferences and previous collaborations to gauge their interest and if they knew of others who may wish to join. At this time, there are currently 19 formal members representing local, state, federal, academic, and research areas and more individuals who are less formally involved but who have either attended RAC meetings based on expertise or individual interest in particular issues or have provided comment on emerging issues.
In parallel, planning staff developed a RAC membership handbook outlining the needed expert competencies for the committee, including:
Environmental radiation measurements
Dose assessment and interpretation
Knowledge of Environmental Protection Agency (EPA) Protective Action Guides (PAGs) for sheltering and evacuation
Knowledge of potential impacts to critical infrastructure and key assets
Dose management using decontamination
Mental health response
The handbook additionally described the planning and emergency structures the members would be engaged in and the expectations for the committee's participation and availability.
Once interest in participating was established, the first, all-day workshop of the RAC was planned and executed within four months. The agenda included an overview of emergency response in NYC for radiological events, expected federal and state assets for such an event, and an overview of the Community Reception Center (CRC) response operation to be used to provide public monitoring and decontamination after an RDD event. The Committee was then broken into two groups: environmental policy and clinical policy in order to discuss outstanding issues DOHMH had about how to respond during a radiological emergency. Note takers captured the discussions and a document was provided to all the participants within a few weeks of the workshop that acted as the formal record of the discussions and outcomes.
Subsequent to the initial workshop, RAC members have been regularly engaged through phone calls and emails and second workshop, similarly funded and documented with a special focus on discussing potassium iodine (KI) distribution a year later. The RAC is both informed on ongoing planning and policy discussions and tasked with reviewing documents and provide commentary on new research being published that might impact such planning in NYC. At this time, there are plans to hold another all-day workshop in the spring of 2017, to continue annually.
At this time there is no formal evaluation of the efficacy of the RAC due to its highly specialized nature. However, the utilization of the RAC for policy formation illustrated several advantages to having a standing committee of radiological experts that can be called upon to rapidly advise on a problem set:
The second annual meeting of the RAC was structured around discussing the viability of protecting NYC residents from radioactive iodine released in a catastrophic incident at the Indian Point Nuclear Power Plant in Westchester County, NY. Specifically, an inquiry was made to DOHMH to research pre-staging of potassium iodide (KI) for a segment of the NYC population within a certain radius of the Indian Point facility. Initial policy inquiries were addressed by DOHMH staff; however, further questions requiring specialized knowledge motivated DOHMH to convene the RAC to formulate a citywide KI distribution policy. The RAC was uniquely qualified to respond to this problem set, with many members having responded to and advised the US government after the Fukushima Daiichi incident (2011), specifically had expertise in the use of KI as a countermeasure, and/or had deployed to Japan to analyze data or make measurements of radiation levels. DOHMH was additionally able to recruit into the RAC a nuclear engineer familiar with the risk of catastrophic accidents at nuclear facilities. The ability of the RAC to tap into such expertise illustrates how valuable a network of specialists can operate, easing the technical and expert knowledge needed by a local department in order to respond and protect its constituents. The result was that the Committee was able to be rapidly convene and address the sensitive policy issue authoritatively and was able to formulate a KI policy for NYC during a one day meeting based soundly on experience, science, and a perspective that included the history of domestic and international KI use.
The Committee was able to form quickly due to a sense of professional obligation many individuals within the radiological academic, medical, safety, and response community have toward radiological response. Based on direct observation of the Committee meetings and noted by Agency leadership, the RAC was easily engaged and comfortable in a deliberative setting that included presentations of the issue, technical presentations concerning the scientific questions at hand, and discussions that involved sensitive and often disparate views.
An indirect benefit of membership composed from several agencies and organizations is that it represents groups and experts DOHMH would not normally be in contact with. Such connections are invaluable for a LHD who would not normally have the internal expertise to advise on technical and scientific issues outside of what is normally supported work. As an example, a Committee member who is a physicist with an expertise in risk analysis, was able to articulate clearly the extremely low risks of nuclear power plant disaster coupled with environmental conditions that would bring about a scenario where NYC warranted the development of a KI distribution plan. This information was otherwise not easily obtainable by DOHMH and would have represented an unanswerable policy question by existing staff, possible resulting in spending and planning inefficiencies.
Although the RAC is primarily utilized for DOHMH policy formulation and development, this Committee is also expected to inform partner City agencies during a radiological emergency. Additionally, the RAC has an emergency response role in the case of a radiological incident in NYC. Therefore, it is a citywide asset whose expertise can influence and inform other city agencies and their operations and represents a key planning and operational assets.
A cost/benefit analysis was not conducted; however the cost of supporting annual meetings of the RAC, primarily used to cover the cost of travel, hotel, and food costs for visiting Committee members, is minimal and funded through the use of reallocated accrual funds. The rapid planning turn around needed for the annual meetings means that between January, when the funding is released and June, when the funds must be spent, DOHMH was able to fully spenddown the amount requested and allocated while provided a low-cost, high-impact benefit for both DOHMH and citywide emergency management.
A RAC can be sustained on a relatively small budget especially if experts in radiological health and radiation medicine can be found locally. Several medical and environmental radiation expertise on the current NYC RAC work within the city or nearby on Long Island at Brookhaven National Laboratory. Similarly, other LHD can consider their local expert assets as a way to develop expertise depth.
The existence of the RAC is mandated by the NYC Radiological Response and Recovery Plan (RRRP), as such, DOMHM is committed to maintain it. DOHMH additionally anticipates that there will be no issues in the future commitment of RAC members, indeed many RAC members have been very enthusiastically supportive of the work done and see it as a useful tool for not just local radiological policy development, but also providing a forum for experts to meet and discuss broader issues regularly, benefiting a larger, national conversation on these issues.
The RAC program has been viewed as so successful that it has been use as a model at DOHMH for the creation of other, similar technical advisory groups as a low-cost way to expand access to expertise during the planning and response phases of an emergency. Similarly, other LHD could consider looking a location or scenario-specific issues they feel that they have internal gaps in and consider the feasibility of creating an advisory committee of local and/or national experts from the public and private sector to help formulate policy and provide advice during emergency responses.