I n t e g r i t y - S e r v i c e - E x c e l l e n c e Headquarters U.S. Air Force Maj Joe Narrigan, Au.D. AFMOA/SGZP Maj Tressie Waldo 74AMDS/SGPO 10 Nov 02 Air Force Hearing Conservation Program

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Basic Components of the HCP Noise Exposure Monitoring Engineering and Administrative Controls

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Basic Components of the HCP OHWG (Team Approach) Audiometric Evaluation (Occupational) Education and Motivation Record Keeping Program Evaluation

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Basic Components of the HCP Compliance with Hearing Protection

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Basic Components of the HCP HCP Audit NIOSH Preventing Occupational Hearing Loss Publication No Or

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Peeling back the layers Identify population needs Schedule Complete audiometric testing Counsel / Motivate Make (Risk Based) Decision(s) Track / Trend React to adverse trends Program Review

I n t e g r i t y - S e r v i c e - E x c e l l e n c e The Devil is in the Details Do you have to be an expert to be successful in HC? No!!! But you have to: 1. Understand the purpose of having a HCP 2. Understand the HC “ROE” 3. Keep good records 4. Know when to make a referral 5. Know what you don’t know 6. Know (and use) your resources

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Purpose of the HCP Protect From Harmful Effects of Noise Early Identification of Noise Induced HL Ensure Hearing Standards for Critical AFSCs The Ability to Hear Warning Signals and Correctly Understand / Respond / React Can Mean the Difference Between Mission Success or Mission Failure Noise can also cause Tinnitus, may contribute to Increased BP & Hypertension

I n t e g r i t y - S e r v i c e - E x c e l l e n c e What are the ROE 29 CFR Occupational Noise Exposure DoDI Hearing Conservation Program AFOSH Std / Interim Guidance DOEHRS-HC HC application revolves around HC rules Don’t “Force Fit” data into the software If normal sequence of events have changed then document and make a decisions on how to proceed Use your Resources

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Keeping Good Records Starts with BE AF Forms 2755 & 2766 (or equivalent) Case Folders Hearing Conservationist Tests Noise Exposed Population Follow HC / DOEHRS Business Rules Public Health Tracks / Trends Hearing Loss Reports Trends to OHWG / BE / Supervisor OSHA Reportable HL to Base Safety Tab F

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Components of Audiometry and Referrals Producing valid audiograms Referral criteria and processes Case studies

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Invalid/Problem Audiograms Test environment Keep background noise to a minimum No phones / pagers / bricks Avoid PC / printer noise, extraneous conversations Patient/worker Tinnitus: inconsistent test results May need manual test Collapsing ear canals

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Audiometric Review Bottom line: Review every audiogram / 2216 for validity New hearing loss in low frequencies? Sawtooth configuration? Consistency among annual and follow-ups? Dealing with negative thresholds

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Know When to Make a Referral Permanent threshold shift (PTS) Asymmetric: 25 dB difference at two consecutive frequencies Conductive vs sensorineural vs malingering Inconsistent testing Change in hearing profile

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Know When to Make a Referral 2nd PTS in same ear Exceeds H-1 on pre-placement C/O inability to correctly hear or understand routine spoken communications, auditory cues or signals Behavior resulting in invalid testing Behaviors that call into direct question ability to perform assigned duties

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Referrals to Hearing Diagnostic Conservation Centers TDY Snail Mail Fax

I n t e g r i t y - S e r v i c e - E x c e l l e n c e From the Unit: Referral / disposition (AF Form 1672 / 600E) Present AND past—continuity Hearing tests (DD Form 2215 / 2216) Audiometric history Case History (AF Form 1753) Noise data (AF Form 2755 or equivalent) Job Fitness Survey (AF Form 1754)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Review Recommendations (From HCDC) Re-establishing the reference Which test to use Follow-up 2 Audiologist’s test Need audiologist’s info Certification number, SSN, AFSC, rank, unit Audiometer info: serial #, calibration date

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Review Recommendations Determination of need for further evaluation Potential medical pathology Asymmetric Conductive vs sensorineural vs malingering Inconsistent testing Follow-up information: freq, by whom Consistent with noise exposure history?

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Case A:

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Case B:

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Case C:

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Case D:

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Asymmetrical Hearing Loss

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Asymmetrical Hearing Loss

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Lessons Learned Diligent review of audiograms Validity check Completeness Taking a thorough case history Medical problems OHC first in identification process Timely action affects outcomes

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Know What You Don’t Know Get Functional on DOEHRS-HC Load / Use the most current version Get a DOEHRS-Data Repository Account Contact LtCol Shumate at the HCDR Your HC data is available under your PAS Code

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Know Your Resources MAJCOM (Each MAJCOM has access to HC SME) Hearing Conservation Referral Centers Each Other Written Guidance DOEHRS Helpdesk Hearing Conservation Data Registry LtCol Bob Shumate (DSN ) Hearing Conservation Policy Maj Joe Narrigan (DSN )

I n t e g r i t y - S e r v i c e - E x c e l l e n c e HCP Changes DOEHRS-HC Build 3 is deployed Working to CoN so we can use LAN Eliminates those Pesky Runtime Errors OSHA Reportable HL will change Jan 03 STS Criteria will change Jan 03 Better Guidance on using a “25-Day Rule” AFSC Merger (Affects AD) AFOSH Std ???

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Occupational Injury / Illness Recording and Reporting 29 CFR 1904 (Final Rule) begins 1 Jan 2003 Report 10 dB Shifts that result in an average of 25 dB or more above audiometric zero (averaged over 2K, 3K, & 4K) Reportable after follow-up period is over ( + 7 days) Report based on the current reference audiogram Only a physician can determine if HL is not duty related Report to Base Safety Office

I n t e g r i t y - S e r v i c e - E x c e l l e n c e OSHA Reportable Example Frequency2000 Hz3000 Hz4000 HzAverage Audiogram10 dB40 dB60 dB37 dB (25 dB >) Reference Audiogram 10 dB20 dB35 dB PTS0 dB20 dB25 dB15 dB (10 dB >)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Change in STS Criteria Frequency2000 Hz3000 Hz4000 HzAverage Audiogram10 dB Reference Audiogram 0 dB STS10 dB 30 dB (or 10 dB /X)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e ARC and the “25-day Rule” In 1997, DoD asked OSHA to allow an Alternative Standard In Aug 2002, OSHA said “NO”, but Referenced Executive Order 12196, stating that Uniformed Members are not covered by OSHA… AFMOA and the ARC MAJCOMs are working together on policy for the implementation of determining when traditional ARC members should be recommended to be on the HCP

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Summary The HCP requires a Team Approach Know the Rules of HC Build your HCP around the Basic Components Know (and use) your Resources Referral Centers MAJCOM Help Desk LtCol Shumate DSN Maj Narrigan DSN Compliance is important…but using the audiometric information to make decisions is critical

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Hearing Conservation is a Beautiful Thing Questions, Concerns, Complaints, Gripes, Moans, Groans, … Thank You for Your Interest in and Support of the AF’s Hearing Conservation Program