Military Public Health: From Knowledge to Action

1

• Military Public Health From Knowledge to Action
• INITIATIVES TO CONTROL NOISE EXPOSURE AND REDUCE
  HEARING LOSS
• CDR Stanley Jossell, CIH
• Office of the Deputy Assistant Secretary of the
  Navy, for Safety
• Mark Geiger, MS, CIH, CSP
• Chief of Naval Operations, CNO N09FB Safety
  Liaison Office
• Navy and Marine Corps Public Health Center
  Conference
• 18 March 2008

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Initiatives to Control Noise Exposure and Reduce
Hearing Loss

• Outline
• History of the Problem
• SECNAV initiatives
• Other initiatives
• Mechanisms for Action
• How to use the process to provide effective
  feedback for changes
• Lessons learned
• Where do we go from here?

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Industrial Noise and Hearing Loss
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(No Transcript)
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Industrial Noise and Hearing LossWell-described
dose response relationship
INTERNATIONAL PROGRAMME ON CHEMICAL SAFETY
ENVIRONMENTAL HEALTH CRITERIA 12 NOISE World
Health Organization Geneva, 1980
http//www.inchem.org/documents/ehc/ehc/v012eh03.g
if
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Quantifying Noise Hazard Risk

• Occupational noise exposure - the most prevalent
  occupational health hazard in defense operations.
  
• Noise-induced hearing loss (NIHL) is common among
  sailors in the U.S. Navy and other services
• Affects up to 50 of personnel in certain
  specialties.
• Other services similarly affected
• Dose response relationships often established
  for occupational exposures
• Commonly used to set occupational exposure
  standards.
• These relations should be used proactively to
  access risk.

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Landing On the Roof
Flight Operation Noise
International Military Noise Conference

Kurt Yankaskas OASN (IE) SS 202-685-6857 yankask
as.kurt_at_hq.navy.mil
25 April, 2001
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AIRCRAFT NOISE What We Can and Cant Do About It
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Previous Quieting Investments
Limited History of Acoustical Solutions for
CVs
Signature Level
Surface Combatants Submarines Have a Legacy
of Acoustic Quieting (Time Money Investments)
Time
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THE GROWING NOISE PROBLEM Noise Levels in Navy
Marine Corps
Single HP Required (85 dB)
Double HP Required (104 dB)
Max protection w/ latest technology -Technical
limit (129 dB)
Max protection w/ double HP (115 dB)
Noise Level (Decibel)
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Launch/ recovery support personnel exposed to
brutal acoustic loads
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Expeditionary Fighting Vehicle (EFV) Previously
the Advanced Amphibious Assault Vehicle
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The Growing Noise Problem Cost of Hearing Loss
for All Veterans (1977-2006) Total
8,385,892,465 BILLION
Millions
901,472,784
Major VA Disability Only
Costs are approaching 1Billion annually
Data extrapolated from Dec 06 claims
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VA Cost of Hearing Loss for Navy Marine Corps
(1996-2006)
2006 Navy Veterans 161,180,364 Marine
Corps Veterans 74,059,704

• Millions

Navy and Marine Corps Hearing Loss Facts FY06
costs 235,190,068 FY06 new cases 16,010
Total cases 123,758
Year
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The Real Problem is NOT the Cost

• We are not fully protecting our people
• We are placing them in work environments where
  permanent hearing loss is a significant risk.
• We continue to design and procure weapon systems
  so loud that even the best presently
  available-protective equipment can not control
  noise to within or below occupational exposure
  standards
• Future Quality of Life issue for our Sailors and
  Marines.
• In many cases we are too late
• We cant reverse the damage already done.
• 16,000 new VA hearing loss cases among DON
  Veterans in 2006
• The JSF engine and the Expeditionary Fighting
  Vehicle (EFV) will create risk of permanent
  hearing loss if personnel are not fully
  protected.
• PEO TACAIR has acknowledged the noise exposure
  risks for the F/A-18 E/F and EA-18G Engine
  Noise. Yet we are actually accepting the
  probability of permanent injury not the risk of
  the occurrence.

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Ear Plug Effectiveness
100
75
50
25
Hall/McKinley, SAFE 02
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Many Possible Reasons WHY We Have Not Attacked
Sooner..

• Ignorance of the problem If we wear hearing
  protection we assume we are protected from
  injury.
• We design to specifications that assume double
  hearing protection adequately protects our
  people.
• Financial impact is delayed and primarily impacts
  VA.
• VA pays compensation costs as part of their
  annual budget.
• Fixing existing design problems after the fact is
  often prohibitively difficult or expensive.
• Hearing loss doesnt kill, nor does it hurt.

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New and Even Noisier Systems?
What Will the Future Bring?
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RECAPITALIZING DOD WEAPONS SYSTEMSEstimated 40
to 60 Billion/year for each of the next 10
yearsACAT I MAJOR PLATFORM ACQUISITIONS
NAVY-MARINE CORPS
ARMY FMTV Medium Tactical Vehicles BLACKHAWK
Utility Helicopter STRYKER - Armored Vehicle
LONGBOW APACHE Airframe mods -APACHE
Helicopter GMLRS - Guided Multiple Launch
Rocket System .
DDx 21st Century Destroyer Program LCS Littoral
Combat Ship EFV - Expeditionary Fighting Vehicle
F/A-18 E/F HORNET Naval Strike Fighter LPD 17
Amphibious Assault Ship SSN 774 Virginia Class
Submarine V-22 OSPREY Joint Advanced Vertical
Lift Aircraft CVN 68 NIMITZ Class Nuclear
Powered Aircraft Carriers CVN21 New Class of
Nuclear Powered Aircraft Carriers E-2C HAWKEYE
Carrier-Based Early Warning Aircraft T-AKE -
LEWIS AND CLARK Class of Auxiliary Dry Cargo
Ships DDG51 Guided Missile Destroyer STRATEGIC
SEALIFT Naval Transport Ship T-45TS
Undergraduate Jet Pilot Training System LHD 1
Amphibious Assault Ship Ship programs
AIR FORCE EELV Expendable Launch Vehicle JPATS
Joint Primary Aircraft Training
System F/A-22 Advanced Tactical Fighter C-130J
Hercules Cargo Plane C-17A Globemaster III
Advanced Cargo Aircraft
DOD Joint Strike Fighter-F35
NOTE This omits ACAT I programs that are not
major platforms. It also omits upgrade projects.
http//www.acq.osd.mil/ap/mdap/index.html
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Noise andHearing Loss The ProblemPossible
CausesWhat We Can Cant DoAndThe Time to
Act CDR Stan Jossell, ODASN
(Safety) 7 Sep 2007
Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?

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What Can We Do Now?

• Communications Raise Awareness and
  Accountability.
• Comply with intent and management requirements of
  existing Federal (OSHA) standards and DoD / DON
  regulations.
• Future quieter designs and improved protective
  equipment supporting reduced exposures are needed
• Identify and target existing High Hazard
  programs for possible emergent funding to
  incorporate best noise attenuation technology.
• Develop better and more effective, personal noise
  attenuation devices. Consider funding initial
  outfitting as an emergent Corporate Bill.
• Invest in noise control research, targeted to
  work processes with the highest noise level and
  most personnel.
• Ensure Future Weapon Systems are designed to a
  standard that accounts for known attenuation
  capabilities/limitations.

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Responses to VCNO Briefing
Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?

• VCNO indicated that he wanted the brief given to
  the Head of Navy Acquisition (ASN RDA)
• ASN RDA indicated that she wanted a comprehensive
  RDTE Plan
• Initiated Office of Naval Research meetings
• Demanded improved attention from acquisition
  programs

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Six Major Noise Initiatives

• Establish a Noise Communication Plan
• Action Navy Executive Safety Board
• Identify the scope of the hearing loss problem
  for active duty. Action BUMED
• Accelerate the rollout of the flight deck cranial
  and custom molded earplugs.
• Action RDA/BUMED/NAVAIR
• Investigate developing better and more effective
  personal noise attenuation devices and medical
  interventions.
• Action RDA

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Six Major Noise Initiatives (continued)

• Invest in Noise Control Research.
• Action ASN RDA/ONR
• Ensure future weapons systems design standards
  account for known attenuation capabilities/limitat
  ions.
• Action All SYSCOMS

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Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?
The Way Ahead Office of Naval Research Brief
No single approach is sufficient to address the
problem. ONRs total systems engineering
approach
Preserve and Restore Hearing
Prevent Noise-Induced Hearing Loss, Tinnitus
Treat Noise-Induced Hearing Loss, Tinnitus
Reduce Noise
PPE
Bone Conduct Tech
Flight Deck
MC Vehicle
Plugs Muffs
Active Cancel.
Below Deck
Training Education
Dosimeter (badge)
Tactical Weapons
Pharma
Policy
Aq. Microjet, seals nozzles
OCT optical imaging approach
Drugs Cell Replacement
Spray-on dampening thermal (light weight)
Population Analysis
Engine noise
Comfort
Silencers
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Real-World Hearing Protection

• Cranial provides 21 dB protection (without
  earplugs)
• When correctly fit, worn, and maintained
• Leaks between earcup head reduce protection
  3-15 dB
• By letting noise in the earcups

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New Hearing Protection Comm Tech
Cranial Prototypes
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Flight Deck Cranial Summary

• Flight deck noise exposures are among the worst
  in the world
• Even with current double hearing protection,
  noise exposures exceed DOD exposure criteria
• Flight deck noise exposures require double
  hearing protection to protect your hearing
• You need to wear earplugs and earmuffs to protect
  your hearing
• You need to insert your earplugs as deeply as you
  can to get maximum attenuation
• You need to maintain / repair your hearing
  protection equipment
• You can not recover lost hearing
• NAVAIR and Office of Naval Research are teamed
  with the Air Force, other services, and industry
  to develop better hearing protection and
  communication technology
• Officially report hazardous communications
  situations there must be an official
  requirement for the Pentagon to fund a program to
  get better hearing protection / and
  communications technologies that incorporate
  advanced hearing protection to the fleet users.

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Hearing Loss Degrades Combat Performance Word
Intelligibility
Courtesy of Kurt Yankaskas, NAVSEA 05h
Ref Tank Gunner Performance and Hearing
Impairment (Garinther Peters, Army RDA
Bulletin 1990, Jan-Feb 1-5)
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RECAPITALIZING DOD WEAPONS SYSTEMSEstimated 40
to 60 Billion/year for each of the next 10
yearsACAT I MAJOR PLATFORM ACQUISITIONS
NAVY-MARINE CORPS
ARMY FMTV Medium Tactical Vehicles BLACKHAWK
Utility Helicopter STRYKER - Armored Vehicle
LONGBOW APACHE Airframe mods -APACHE
Helicopter GMLRS - Guided Multiple Launch
Rocket System .
DDx 21st Century Destroyer Program LCS Littoral
Combat Ship EFV - Expeditionary Fighting Vehicle
F/A-18 E/F HORNET Naval Strike Fighter LPD 17
Amphibious Assault Ship SSN 774 Virginia Class
Submarine V-22 OSPREY Joint Advanced Vertical
Lift Aircraft CVN 68 NIMITZ Class Nuclear
Powered Aircraft Carriers CVN21 New Class of
Nuclear Powered Aircraft Carriers E-2C HAWKEYE
Carrier-Based Early Warning Aircraft T-AKE -
LEWIS AND CLARK Class of Auxiliary Dry Cargo
Ships DDG51 Guided Missile Destroyer STRATEGIC
SEALIFT Naval Transport Ship T-45TS
Undergraduate Jet Pilot Training System LHD 1
Amphibious Assault Ship Ship programs
AIR FORCE EELV Expendable Launch Vehicle JPATS
Joint Primary Aircraft Training
System F/A-22 Advanced Tactical Fighter C-130J
Hercules Cargo Plane C-17A Globemaster III
Advanced Cargo Aircraft
DOD Joint Strike Fighter-F35
NOTE This omits ACAT I programs that are not
major platforms. It also omits upgrade projects.
http//www.acq.osd.mil/ap/mdap/index.html
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Regulations and Requirements as Leverage for
Noise Control
Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?

• DoD/Navy Acquisition and Capability
  (Requirements) Regulations
• DoD/Navy Occupational Health Requirements
• Military Standard 882 System Safety

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The acquisition and Technology Programs Task
Force will develop a process to provide the DoD
Joint Capabilities Integration and Development
system with recommendations that have the
potential to cost-effectively prevent accidents.
These inputs should include all aspects of the
Mil Std 882 System Safety Process
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Acquisition Safety Suggested Alternative
Legacy noise levels and new system noise can be
described early
Noise control cost can be identified here
Costs including hearing loss costs previously
projected here
Benefits now identified here
Noise control benefits and requirements
identified here
70 of costs committed in preliminary designs
This can be the disposal end
10 RD
20-30 Procurement
60-70 Operations, Maintenance Disposal
Typical life cycle costs in acquisition
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Mil Standard 882 System Safety Overview
System Safety is the accepted methodology for

• Identifying and addressing potential hazards
  during the
• design process
• Managing safety threats to program viability and
  cost
• Tracking and resolving potential hazards
• Reducing hazards overlooked during design process
  
• (Systems or Subsystems already acquired)

www.safetycenter.navy.mil/acquisition
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SYSTEM SAFETY PRIORITY
STEPS 1. DESIGN FOR OPTIMUM SAFETY 2.
PROVIDE SAFETY DEVICES 3. PROVIDE WARNING
DEVICES 4. DEVELOP PROCEDURES,
PROTECTIVE EQUIPMENT AND
TRAINING (Last Resort) THIS HAS OFTEN BEEN THE
PRIMARY NOISE CONTROL. 40 YEARS EXPERIENCE
INDICATES THE LIMITATIONS Navy Undersea Medical
Research Institute Study (2006) suggests only 5-7
dbA effective protection from hearing
conservation program
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Severity Definition Hazards in terms of
equipment/property loss/damage or personnel
death/injury. Dollar values include
replacement/repair costs. I
Catastrophic Equipment/property loss/damage of
1M or more, death, or permanent total disabling
injury. II Critical Equipment/property
loss/damage from 200K but less than 1M,
permanent partial disabling injury, /or 3 or
more people are hospitalized. III
Marginal Equipment/property loss/damage from 20K
but less than 200K, or non-fatal injury with 1
or more lost work days. IV Negligible Equipment/
property loss/damage less than 20K, or non-fatal
injury with no lost work day. Based primarily on
DODI 6055.7 (Accident Investigation, Reporting,
and Record Keeping)
Probability of Occurrence (p) Definition The
probability of incurring a loss over the life of
the system. A Likely Fleet of
systems Continuously, P1 Individual
system Frequently, 1gtPgt10-1 B Probable
Fleet of systems Frequently, 1gtPgt10-1
Individual system Several times, 10-1gtPgt10-3 C
Occasional Fleet of systems Several times,
10-1gtPgt10-3 Individual system At some time,
10-3gtPgt10-6 D Remote Fleet of systems At
some time, 10-3gtPgt10-6 Individual
system Unlikely, 10-6gtP Based on OPNAVINST
3500.39/MCO 3500.27 (ORM)
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Severity Definition Hazards in terms of
equipment/property loss/damage or personnel
death/injury. Dollar values include
replacement/repair costs. I
Catastrophic Equipment/property loss/damage of
1M or more, death, or permanent total disabling
injury. II Critical Equipment/property
loss/damage from 200K but less than 1M,
permanent partial disabling injury, /or 3 or
more people are hospitalized. III
Marginal Equipment/property loss/damage from 20K
but less than 200K, or non-fatal injury with 1
or more lost work days. IV Negligible Equipment/
property loss/damage less than 20K, or non-fatal
injury with no lost work day. Based primarily on
DODI 6055.7 (Accident Investigation, Reporting,
and Record Keeping)
Probability of Occurrence (p) Definition The
probability of incurring a loss over the life of
the system. A Likely Fleet of
systems Continuously, P1 Individual
system Frequently, 1gtPgt10-1 B Probable
Fleet of systems Frequently, 1gtPgt10-1
Individual system Several times, 10-1gtPgt10-3 C
Occasional Fleet of systems Several times,
10-1gtPgt10-3 Individual system At some time,
10-3gtPgt10-6 D Remote Fleet of systems At
some time, 10-3gtPgt10-6 Individual
system Unlikely, 10-6gtP Based on OPNAVINST
3500.39/MCO 3500.27 (ORM)
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Severity Definition Hazards in terms of dosage
(e.g., concentration vs times) of a substance, or
induced loads (e.g., heat, cold, shock). I
Catastrophic Dose of substance or induced stress
levels leading to death or a permanent total
disabling illness. II Critical Dose of
substance or induced stress levels leading to
permanent partial disabling illness, /or 3 or
more people are hospitalized. III
Marginal Dose of substance or induced stress
levels leading to illness with 1 or more lost
work days. IV Negligible Dose of substance or
induced stress levels with no lost work time
no job impairment.
Probability of Occurrence (p) Definition The
probability of exposing occupants, work force or
the public to certain exposure situations over
the life of the system. A Likely Fleet of
systems Continuously, P1 Individual
system Frequently, 1gtPgt10-1 B Probable
Fleet of systems Frequently, 1gtPgt10-1
Individual system Several times, 10-1gtPgt10-3 C
Occasional Fleet of systems Several times,
10-1gtPgt10-3 Individual system At some time,
10-3gtPgt10-6 D Remote Fleet of systems At
some time, 10-3gtPgt10-6 Individual
system Unlikely, Plt10-6 Based on OPNAVINST
3500.39/MCO 3500.27 (ORM)
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Significant Hearing Threshold Shift (STS) vs. Job
Specialty
Overall STS Rate 29
Percentage STS ()
Dentalman
Engineman
Airman App.
Personnelman
Seaman Recruit
Fireman Recruit
Electronics Tech.
Sonar Tech., Sub.
Boatswains Mate
Ships Serviceman
Interior Comm. Elec.
Gas Turbine Tech. (M)
Aviation Machinist Mate
Gas Turbine Technician
Mess Mgmnt. Specialist
Ref Wolgemuth et al (Military Medicine, 5/95)
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EXAMPLE RISK ASSESSMENT MATRIX APPLIED TO CARRIER
DECK NOISE
HAZARD RISK INDEX SUGGESTED CRITERIA 1A, 1B, 1C,
2A, 2B, 3A UNACCEPTABLE (HIGH) 1D, 2C, 2D, 3B,
3C UNDESIRABLE (MA DECISION REQUIRED(SERIOUS) 1E,
2E, 3D, 3E, 4A, 4B ACCEPTABLE WITH REVIEW BY
MA(MEDIUM) 4C, 4D, 4E ACCEPTABLE WITHOUT
REVIEW(LOW) NOTE THESE ARE ONLY THE SUGGESTED
CRITERIA. They may be adjusted IAW agreement
with the Component Authority.
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Conclusions

• Multi-disciplinary approach to reducing and
  preventing hearing loss including line,
  acquisition and medical communities
• Existing regulations and directives appear to be
  suitable, but execution and enforcement needs
  improvement
• PPE is not sufficient alone
• Better design is essential
• Must effectively engage acquisition community
• Requirements for better systems must be
  communicated by the fleet
• You must help educate the fleet to become more
  demanding customers
• Communication is critical

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Back-up
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Mechanisms for Action
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EXAMPLE RISK ASSESSMENT MATRIXHIGHRequires
Service Acquisition Executive (CAE (ASN-RDA)
USSOCOM) Approval1A,B,C,2A,B,3A)
HAZARD RISK INDEX SUGGESTED CRITERIA 1A, 1B, 1C,
2A, 2B, 3A UNACCEPTABLE (HIGH) 1D, 2C, 2D, 3B,
3C UNDESIRABLE (MA DECISION REQUIRED(SERIOUS) 1E,
2E, 3D, 3E, 4A, 4B ACCEPTABLE WITH REVIEW BY
MA(MEDIUM) 4C, 4D, 4E ACCEPTABLE WITHOUT
REVIEW(LOW) NOTE THESE ARE ONLY THE SUGGESTED
CRITERIA. They may be adjusted IAW agreement with
the Component Authority.
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Risk Identification for Current Design Issues
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RISK IDENTIFICATION FOR PRELIMINARY HAZARD
LISTSUPPORT DATA FOR RISK MANAGEMENT
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Other initiatives

• Flight deck cranial
• Navy Undersea Medical Research Institute study
  quantifying the link between noise exposure and
  hearing loss
• Center for Naval Analysis- Cost benefit analysis
  applied to shipboard noise controls
• Defense Safety Oversight Committee (DSOC)
  initiative seeking to extend cost-benefit
  analysis to other systems

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Quantifying Noise Hazard Risk in System Safety
Analysis

• Assessments conducted by the Navy Submarine
  Medical Research Lab (NSMRL) and other evaluators
  
• Provide data on hearing loss associated with
  specific military populations and
• Link rate of hearing loss with particular
  shipboard deployments and associated noise
  exposures.
• Previously, it had been considered too difficult
  to provide reliable estimates of the extent of
  Noise Induced Hearing Loss caused by specific
  military systems.
• This work estimates the various economic costs of
  NIHL and has provided a prototype NIHL estimation
  and cost tool.
• Supports effective platform/system specific risk
  analysis and cost/benefit evaluation of noise
  exposures in the system safety process
• Can support life-cycle risk management and
  control of noise exposures.

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Noise Reduction 98 to 85 dB
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The Way Ahead Reduce Noise

• Immediate (minimal RD)
• Update the propulsion communitys ST goals to
  incorporate noise reduction initiatives
• Apply existing technologies
• quiet propellers, air blankets, improved pumps,
  quiet valves, mufflers
• Gas turbine silencers with reduced back pressure
  and no degradation in acoustic performance
• Consider noise control in breathing air supply
  systems and diving equipment
• Short-term (6.2/6.3 RD, 1-5 years)
• 3 dBA Jet noise reduction
• Apply existing SNAME, ASHRE and ACGIH criteria to
  shipboard ventilation
• Deployment of improved comms systems
• Potential retrofits for shore facility
  ventilation

Preserve and Restore Hearing
Reduce Noise
Flight Deck
MC Vehicle
Below Deck
Tactical Weapons
Engine noise
Aq. Microjet, seals nozzles
Silencers
Spray-on dampening thermal (light weight)
51
The Way Ahead Reduce Noise

• Mid-term (6.2 RD, 5-10 years)
• Civilian silencers on tactical weaponry
• 5 dBA near-field reduction in tactical aircraft
• Improved understanding of physics of turbulent
  exhaust jets
• Diagnostic engine testing
• Hydraulic noise control, updated ventilation
  air conditioning
• Materials research to improve damping, noise
  absorption and transmission loss materials.
• Long-term (6.1 RD, 10 years)
• Muzzle characteristics and recoil control on
  tactical weaponry
• 10 dBA near-field reduction (jet engine noise)
• Improvements in hydraulics, HVAC
• Advanced drive technology such as fuel cells and
  hybrid engine
• Improved materials technology for damping, etc

Preserve and Restore Hearing
Reduce Noise
Flight Deck
MC Vehicle
Below Deck
Tactical Weapons
Engine noise
Aq. Microjet, seals nozzles
Silencers
Spray-on dampening thermal (light weight)
52
The Way Ahead Prevent Treat NIHL

• Immediate (minimal RD)
• Policy for Navy and MC personnel
• Mandate PPE use make PPE part of the uniform
• Mandate hearing readiness for deployment
• Mandate best available comms tech
• Enforce existing requirements (OPNAV INST
  9640.1A)
• Policy for contractors to comply with noise
  control requirements
• Employ a noise badge, an in-ear dosimeter that
  detects overexposure and allows for population
  analysis
• Short-term (6.2/6.3 RD, 1-5 years)
• Training and Education
• Hearing loss simulator
• Proper use of PPE

Preserve and Restore Hearing
Treat Noise-Induced Hearing Loss, Tinnitus
Prevent Noise-Induced Hearing Loss, Tinnitus
Training Education
Dosimeter (badge)
Pharma
Policy
Drugs Cell Replacement
Population Analysis
53
The Way Ahead Prevent Treat NIHL

• Mid-term (6.2 RD, 5-10 years)
• Population analysis of specific environments
  using the in-ear dosimeter
• Pharmacological intervention (NAC)
• Long-term (6.1 RD, 10 years)
• Pharmacological Prevention
• Antioxidants
• Anti-apoptotic drugs, etc.
• Pharmacological Treatment
• Antioxidants
• Anti-apoptotic drugs, etc.
• Hair cell replacement therapies

Preserve and Restore Hearing
Treat Noise-Induced Hearing Loss, Tinnitus
Prevent Noise-Induced Hearing Loss, Tinnitus
Training Education
Dosimeter (badge)
Pharma
Policy
Drugs Cell Replacement
Population Analysis
54
The Way Ahead PPE

• Immediate/Short-term (no RD)
• COTS state of the art plugs and muffs with
  comms, impulse noise control, and/or
  listen-through technology
• 3D digitization for deep insert plugs for a
  custom-fit
• In-ear dosimetry
• Long-term (6.1 RD, 5-10 years)
• Active bone-conduction helmets
• Lighter, more comfortable materials to increase
  compliance
• Note PPE is generally reaching its asymptotic
  limit. However, bone conduction technology
  remains a young field. Otherwise, alternate
  avenues must be pursued.

Preserve and Restore Hearing
PPE
Active Cancel.
Bone Conduct Tech
Plugs Muffs
OCT optical imaging approach
Comfort
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Summary of ONR Recommendations

• A total systems engineering approach is necessary
  to reduce the incidence of NIHL by nearly 100.
• Immediate changes in existing policy, training
  and education paradigms, and increased compliance
  can significantly reduce NIHL now.
• Immediate incorporation of already existing
  technologies can be done to limit noise levels.
• Considerable investment is needed in short-term,
  mid-term and long-term efforts in the areas of
  noise reduction (tactical weaponry, Marine Corps
  vehicles, flight deck and below deck, jet
  engine/exhaust noise reduction technologies), PPE
  and pharmaceutical intervention.

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Integrating Safety and Health into Technology
Development
Technology Opportunities User Needs Identified

• Process entry at Milestones
• A, B, or C (or within phases)

ICD Initial Capabilities Document
CPD Capabilities Production Doc.
Requirements documents
CDD Capabilities Development Doc.
57
System Safety Overview
System Safety is the accepted methodology for

• Identifying and addressing potential hazards
  during the
• design process
• Managing safety threats to program viability and
  cost
• Tracking and resolving potential hazards
• Reducing hazards overlooked during design process
  
• (Systems or Subsystems already acquired)

www.safetycenter.navy.mil/acquisition
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The Acquisition Community
Program Execution
Certification
Acquisition
Warfighting Requirements
SECDEF Joint Chiefs
REQUIREMENTS
EXECUTION
CNO
ASN(RDA)
Combatant Commands
Test Eval.
OPNAV
CINCs
PEOs
SYSCOMS
OPTEV FOR
N45
N17
SPAWAR
NAVAIR
NAVSEA
VCNO
N8
INSURV
N09B Naval Safety Center
N09B Safety Liaison Office
Field Activities
Research Laboratories
N80 Integration
N84 Anti-Sub
N85 Expeditionary
N86 Surface
N093/ BUMED
N87 Submarine
N88 Air
Warfighting Capability
Med Ctrs
NEHC
59
Noise is not the only issue Example
Ergonomics and materials handling

• A key area for acquisition planning
• Human systems integration part of acquisition
  requirements (DoD5000.2)
• Source of many mishaps and occupational illness
• Potential approach to improving safety and
  reducing manpower

60
Effective Fleet FeedbackRequires better risk
communication

• Industrial Hygiene Survey reports also need/ are
  required (?) to go to
• Force Commander
• Identify noise-hazardous operations/ environments
• Identify persons in hearing conservation program
• Additional considerations (better risk
  communication)
• How does noise affect his operations?
• Readiness, stealth, impaired performance of
  troops?
• Should he ask for better equipment?

61
Effective Fleet Feedback better risk
communication

• Industrial Hygiene Survey reports or summary data
  should go to
• Platform Sponsor
• Platform/equipment noise hazards
• Needs for quieter systems/ equipment
• Need for design changes
• Systems Command
• Design issues needed to reduce noise
• Determine if multiple systems are affected
• (Example a particular type of aircraft)
• Technical authority for specific process or
  equipment
• Should better equipment be required/provided for
  the process?
• Explain limitations of protective equipment.
• PPE should not substitute for engineering
  controls.

62
Integrating Noise Control into DOD Acquisition
Projects and Program Evaluations

• Scope of the Issues-
• New equipment and systems without consistent
  noise control
• How the DoD Acquisition System Works
• Points of leverage
• Role of Human Systems Integration (HSI)
• Noise is a neglected human systems integration
  issue!
• Noise is a neglected systems engineering issue!
• System Safety and Military Standard 882
• Noise and hearing loss risks demanding higher
  management evaluation
• Overlapping Efforts Systems Engineering, Human
  Systems Integration and Safety
• Noise control must be part of this effort

63
Be a Joiner - Working Groups

• DoD Hearing Conservation Working Group
• Summarized data
• Supports DoD wide process
• DSOC Acquisition and Technology Working Group
• Initiated project for life-cycle cost evaluation
  of noise-associated hearing loss versus
  engineering controls
• Tasked with developing guidance for JCIDS process
• Operational Safety Committee (OSC)
• CFFC and PAC Fleet Chair
• Reports to Executive Safety Committee chaired by
  VCNO
• System Safety Advisory Board
• Created in accordance with SECNAVINST 5000.2
• OPNAVINST 5100.24 System Safety Process
• Reports to OSC
• System Safety Working Groups for most major
  programs
• Integrated Logistics Assessments Pre-milestone
  review

64
Points of Impact - What can I do?(Whos who is
service specific)

• Capabilities (requirements) for new systems
• Must include ability to operate effectively and
  safely
• Feedback must reflect demonstrated risk and
  limitations of current systems
• Research and development needs must include noise
  controls
• Program involvement
• Ensure existing evaluations are communicated to
  program offices (and their reviewers)
• Assist programs through integrated process teams
• Technical assistance
• Program review process
• Test and Evaluation (should include habitability,
  safety/health and communications)
• Army MANPRINT and service equivalents
• Integrated Logistics Assessments (contribute to
  milestone reviews)
• SECNAV or service equivalent IE Safety input
  into Defense Acq Board (DAB) reviews

65
How to speak acquiition

• Define requirements for noise control
• Requirements documents
• Contract specs and performance criteria
• Test and evaluation standards
• Performance
• Stealth and signal control
• Human systems integration and crew performance
• Compliance with requirements
• Cost and Schedule avoid retrofits caused by
  performance gaps
• Join the club (and learn the language)
• Take Acquisition 101
• Registration and information are available
  through the Defense Acquisition Universities
  websites at http//www.dau.mil/ and
  https//dau4.fedworld.gov/dau
• Participate in system safety working groups
• Participate in Integrated Logistics Assessments

66
Back Up
67
AIRCRAFT NOISE What We Can and Cant Do About It
68
Carrier deck launch support personnel bow
catapult positions (F-35 noise contours)
69

More recently. . .

• This Memo documents our acceptance of noise
  exposure risk for the F/A-18E/F and EA-18G.
  --PEO Tactical Aircraft Program
• Bottom line . . .We are still designing and
  delivering weapons systems TODAY that will damage
  hearing.

70
Compensation Cost VA Disability Calculations
Center for Naval Analysis 2006
71
Quantifying Noise Hazard Risk in System Safety
Analysis

• Occupational noise exposure - the most prevalent
  occupational health hazard in defense operations.
  
• Noise-induced hearing loss (NIHL) is common among
  sailors in the U.S. Navy and other services
• Affects up to 50 of personnel in certain
  specialties.
• Other services similarly affected
• Dose response relationships often established
  for occupational exposures
• Commonly used to set occupational exposure
  standards
• Could these relationships be used proactively in
  the risk assessment and cost-benefit analysis?

72
Projected Future Costs

• 1.9 Billion may be lower bound cost
• 29 of Navy personnel are expected to suffer
  hearing damage (Military Medicine, 5/95).
• This rate would indicate that 107,323 out of
  370,079 personnel would suffer hearing damage
• At 3,900 a claim/year, over a 30 year retirement
  period, this results in a 12,557,000,000 cost
  for hearing damage
• This rate is 8.5X the rate of the general US
  population (3.42).
• CVN personnel 33 of Forces Afloat
• 4,181,000,000 possible cost for hearing damage
  for CVN personnel alone

73
Recommendation and ConclusionsSupport for
increased compliance with existing requirements,
to enhance readiness while reducing both
immediate and long-term personnel impacts

• Actions with medium term impact
• Effective enforcement and monitoring of current
  requirements in existing contracts
• Ensure that OT and DT address compliance with
  existing noise exposure criteria.
• Updating JCIDS guidelines.
• Actions with long-term impact
• Provide JCIDS guidelines and input addressing
  noise control as a performance attribute
• Support focused RDTE efforts for noise control,
  improved communications technology and medical
  evaluation and treatment of personnel affected by
  hearing loss.
• Consider noise control as a performance issue
  that should be monitored, evaluated and rewarded
  in contract evaluation.

74
Recommendation and ConclusionsSupport for
increased compliance with existing requirements,
to enhance readiness while reducing both
immediate and long-term personnel impacts

• Immediate action
• Ensure that personnel are equipped with the best
  available protective equipment technology,
  including communications systems offering
  improved noise attenuation, where appropriate.
• Support JCIDS (Joint Capabilities Integration and
  Development System Requirements inputs that
  consider noise control as a performance attribute
• Consideration of safety factors such as hearing
  conservation compliance in leadership evaluation
• Ensure that education links hearing conservation
  to combat readiness
• 30 years of hearing conservation programs that
  often set the standard of practice demonstrate
  that focus on medical and protective equipment
  issues is critical, but not sufficient to protect
  military personnel from noise induced hearing
  loss.

75
We request your immediate assistance to
accelerate the resourcing of two near-term
solutions ..the flight deck cranial program and
custom-molded deep insert earplugs.
76
Industrial Noise and Hearing Loss
Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?
INTERNATIONAL PROGRAMME ON CHEMICAL SAFETY
ENVIRONMENTAL HEALTH CRITERIA 12 NOISE World
Health Organization Geneva, 1980
http//www.betterhearing.org/hearing_loss_preventi
on/indexDetail.cfm
77
Hearing Loss for US Navy Divers (Left Ear)
Ref. E. Cudahy, NSMRL
78
Steps Must Be Taken to Reverse the Trend
9.3 Billion Spent Between 77 and 05
Ref Army Center for Health Promotion and
Preventive Medicine, Aberdeen, MD
79
Navy Submarine Medical Research Institute Study
2006
HL Hearing Loss 5 dB difference between
predicted and actual hearing loss. This is
predominantly due to noise exposure reduction
provided by protective equipment use
80
Noise-Induced Hearing Loss (NIHL) is a serious
problem in the U.S. Navy and Marine Corps.
81
Research, Development and Acquisition Initiatives
82
Research, Development and Acquisition Initiatives
83
Recommendations for the Prevention Treatment
of Noise-Induced Hearing Loss
Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?
Office of Naval Research Out brief Noise Control
Workshops
February, 2008
Outbrief
84
Currently, at ONR
J. Sheehy - Digital ear canal capture for
deep-insert earplug customization.
J. Kil - A pharmacologic agent that reduces the
effects of traumatic damage to inner
ear hair cells
R. Kopke NAC 4-OHPBN to treat acoustic trauma
L. Marshall prediction tool for NIHL incidence
and economic cost

Prevention Treatment of NIHL
R. Jackson NAC ALCAR SPI 3005 SPI 3006
to treat blast overpressure exposure
L. Marshall - High-fidelity hearing loss
simulator is a training and education tool.
85
Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?
The Way Ahead
No single approach is sufficient to address the
problem. ONRs total systems engineering
approach
Preserve and Restore Hearing
Prevent Noise-Induced Hearing Loss, Tinnitus
Treat Noise-Induced Hearing Loss, Tinnitus
Reduce Noise
PPE
Bone Conduct Tech
Flight Deck
MC Vehicle
Plugs Muffs
Active Cancel.
Below Deck
Training Education
Dosimeter (badge)
Tactical Weapons
Pharma
Policy
Aq. Microjet, seals nozzles
OCT optical imaging approach
Drugs Cell Replacement
Spray-on dampening thermal (light weight)
Population Analysis
Engine noise
Comfort
Silencers
86
DoD Noise Standards Regulations

• Federal OSHA 29 CFR 1910.95, Occupational
  Noise Exposure
• DoD
• DoDI 5000.2, Operation of the Defense
  Acquisition System
• DoD Design Criteria Std., Mil Std 1474D, Noise
  Limits, 12 Feb 97, page 65, par 4.2.1, Aircraft
  Noise
• DoD Mil Std 882, System Safety Program
  Requirements
• DoDI 6055.12, Hearing Conservation Program

87
DoN Noise Standards Regulations

• SECNAVINST 5000.2, Implementation and Operation
  of the Defense Acquisition System and the Joint
  Capabilities Integration and Development System,
  19 Nov 04
• SECNAVINST 4105.1A, Independent Logistics
  Assessment and Certification Requirements
• OPNAVINST 5100.23G (Dec 2005), Navy Occupational
  Safety and Health Program Manual
• NAVMEDCOMINST 6260.5, Occupational Noise Control
  Hearing Conservation
• MCO 3690.2B, Marine Corps Operational Test and
  Evaluation Activity

88
DoD/Navy Occupational Health Requirements

• DoD 6055.12 Hearing Conservation
• Requires system safety approach and hierarchy of
  controls
• Impact limited by focus on hearing conservation
  versus engineering
• DoDI 4715.13 DoD Noise Program
• Links noise control to requirements process and
  mission accomplishment
• OPNAVINST 9640.1A Shipboard Habitability
• OPNAVINST 5100.23 NAVOSH Program Manual

89
Acquisition SafetyNeeds and Status
Outline History of the Problem SECNAV
initiatives Brief to VCNO Responses to
brief Other initiatives Mechanisms for Action
How to use the process to provide effective
feedback for changes Lessons learned Where do we
go from here?
70 of costs committed in preliminary designs
This can be the disposal end
10 RD
20-30 Procurement
60-70 Operations, Maintenance Disposal
Typical life cycle costs in acquisition