Maj Joe Narrigan, Au.D. AFMOA/SGZP Maj Tressie Waldo 74AMDS/SGPO 10 Nov 02

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Maj Joe Narrigan, Au.D.AFMOA/SGZPMaj Tressie
Waldo74AMDS/SGPO10 Nov 02

• Air Force Hearing Conservation Program

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Basic Components of the HCP

• Noise Exposure Monitoring
• Engineering and Administrative Controls

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Basic Components of the HCP

• OHWG (Team Approach)
• Audiometric Evaluation (Occupational)
• Education and Motivation
• Record Keeping
• Program Evaluation

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Basic Components of the HCP

• Compliance with Hearing Protection

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Basic Components of the HCP

• HCP Audit
• NIOSH
• Preventing Occupational Hearing Loss
• Publication No. 96-110
• 1-800-356-4674
• Or www.cdc.gov/niosh

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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

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The Devil is in the Details

• Do you have to be an expert to be successful in
  HC?
• No!!! But you have to
• Understand the purpose of having a HCP
• Understand the HC ROE
• Keep good records
• Know when to make a referral
• Know what you dont know
• Know (and use) your resources

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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

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What are the ROE

• 29 CFR 1910.95 Occupational Noise Exposure
• DoDI 6055.12 Hearing Conservation Program
• AFOSH Std. 161-20/ 48-20 Interim Guidance
• DOEHRS-HC
• HC application revolves around HC rules
• Dont 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

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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

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Components of Audiometry and Referrals

• Producing valid audiograms
• Referral criteria and processes
• Case studies

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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

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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

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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

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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

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Referrals to Hearing Diagnostic Conservation
Centers

• TDY
• Snail Mail
• Fax
• E-mail

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From the Unit

• Referral / disposition (AF Form 1672 / 600E)
• Present AND pastcontinuity
• 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)

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Review Recommendations (From HCDC)

• Re-establishing the reference
• Which test to use
• Follow-up 2
• Audiologists test
• Need audiologists info
• Certification number, SSN, AFSC, rank, unit
• Audiometer info serial , calibration date

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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?

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Case A
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Case B
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Case C
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Case D
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Asymmetrical Hearing Loss
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Asymmetrical Hearing Loss
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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

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Know What You Dont 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

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Know Your Resources

• MAJCOM (Each MAJCOM has access to HC SME)
• Hearing Conservation Referral Centers
• Each Other
• Written Guidance
• DOEHRS Helpdesk
• 1-800-600-9332
• Hearing Conservation Data Registry
• LtCol Bob Shumate (DSN 240-2940)
• Hearing Conservation Policy
• Maj Joe Narrigan (DSN 297-4330)

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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. 48-20???

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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

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OSHA Reportable Example
Frequency 2000 Hz 3000 Hz 4000 Hz Average
Audiogram 10 dB 40 dB 60 dB 37 dB (25 dB gt)
Reference Audiogram 10 dB 20 dB 35 dB
PTS 0 dB 20 dB 25 dB 15 dB (10 dB gt)
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Change in STS Criteria
Frequency 2000 Hz 3000 Hz 4000 Hz Average
Audiogram 10 dB 10 dB 10 dB
Reference Audiogram 0 dB 0 dB 0 dB
STS 10 dB 10 dB 10 dB 30 dB (or 10 dB /X)
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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

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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 1-800-600-9332
• LtCol Shumate DSN 240-2940
• Maj Narrigan DSN 297-4330
• Compliance is importantbut using the audiometric
  information to make decisions is critical

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Hearing Conservation is a Beautiful Thing

• Questions, Concerns, Complaints, Gripes, Moans,
  Groans,
• Thank You for Your Interest in and Support of the
  AFs Hearing Conservation Program