Transcript 'Operationalizing' ESOH:

Headquarters U.S. Air Force
Integrity - Service - Excellence
Air Force Hearing
Conservation Program
Maj Joe Narrigan, Au.D.
AFMOA/SGZP
Maj Tressie Waldo
74AMDS/SGPO
10 Nov 02
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:
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
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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
 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
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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

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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 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)
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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
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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 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
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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)

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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 >)
Reference
Audiogram
10 dB
20 dB
35 dB
PTS
0 dB
20 dB
25 dB
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15 dB
(10 dB >)
Change in STS Criteria
Frequency
2000 Hz
3000 Hz
4000 Hz
Audiogram
10 dB
10 dB
10 dB
Reference
Audiogram
0 dB
0 dB
0 dB
STS
10 dB
10 dB
10 dB
Average
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 important…but 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 AF’s Hearing Conservation Program
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