Additional Hearing Conservation Outcomes for Surveillance: Treat Individuals, Think Populations
Thomas Helfer, Ph.D.
Hearing Conservation outcome metrics have traditionally been based on the audiometric data stored in a data repository. These outcome metrics are generally derived from calculations performed on the objective data. Since 1997 there has been an additional set of outcome metrics available from the Ambulatory Data Module (ADM) and Composite Healthcare System (CHCS). Last year the DOD Military Injury Metrics Working Group published a white paper outlining the acquisition, storage, management, and reporting of military injury data. The source injury data are from the ADM and the CHCS. Injury metrics are expressed as categories of ICD-9 CM codes. Military injury data are stored at the Defense Medical Surveillance System at Walter Reed Army Medical Center. The DOD Military Injury Metrics Working Group concentrated on musculo-skeletal injuries and excluded hearing and eye injury ICD-9 codes altogether. The DOD Hearing Conservation Working Group submitted a list of hearing injury ICD-9 codes for incorporation into the military injury database. Of the 12 submitted only three were accepted for incorporation into the injury metrics database. The three accepted and other ICD-9 hearing injury codes include some that would come from the Audiology/ENT clinics separate from DOEHRS. There are codes for acoustic trauma, permanent threshold shift, Tinnitus, hearing losses affecting duty limits and retention in service. These hearing injury data from ADM will be available through the Medical Metrics (M2) database of the Executive Information/Decision Support (EI/DS) system. These are in addition to the outcome metrics stored in and reported from DOEHRS or the military injury databases. In order to “think populations” and take action to reduce risks, program managers should have access to ADM data as well as the DOEHRS data. This multi-source information fusion process allows managers to better evaluate program progress over time taking information from these separate data sources and putting them together to get clearer “situational awareness” regarding risk reduction. This process is called “evidence-based public health.” Download this presentation.
Biochemical Prevention and Treatment of Noise Induced Hearing Loss
CPT Martin Robinette
Animal research has shown that antioxidants can provide significant protection to the cochlea from traumatic noise exposure. USAARL is conducting a study on the effects of the antioxidant N-acetylcysteine (NAC) to protect against noise induced temporary threshold shift in humans. The subjects in this study are given NAC or a placebo prior to being exposed to narrow band noise designed to induce a TTS. Following the noise exposure, thresholds and emissions are measured for several minutes to monitor the effects of NAC on TTS. This presentation will review the methods and results available of this study.
Echelon III Audiology Support in Iraq
CPT Scott McIlwain
Audiometry has long been recognized as an important identifier of soldier readiness. Audiometry has traditionally been conducted before and after deployments. This has been adequate because deployments did not usually exceed 6 months. With the length of deployments now often exceeding 6 months, the soldiers and leaders are at a disadvantage because there is no capability of audiometry. The disadvantage for soldiers is in the form of not getting complete physical exams or thorough medical evaluations. This hinders many soldiers applying for military schooling, maintaining flight status, or general medical inquiries about dizziness, otalgia, or hearing. The leaders are at a disadvantage because hearing is an important part of soldier readiness, particularly urban terrain. Leaders need to know the status of their soldier’s readiness. If there is a concern about a soldier’s hearing, there is no way to quantify his/her hearing acuity without a medical evacuation. This paper details the recent implementation of clinical audiology, hearing conservation, and physical exams hearing screening in the Combat Support Hospitals in Iraq, which directly support combat operations in OIF.
Operation Iraqi Freedom: A Preventive Medicine Commander’s Perspective
MAJ Eric Fallon
While serving as Commander of the 714th Preventive Medicine Detachment, my unit was deployed in support of Operation Iraqi Freedom. Although originally tasked to provide preventive medicine support in Kuwait, the mission changed immediately upon arrival and the unit was sent into Iraq, where is served in Tikrit, Balad and Baghdad supporting units of 5th SF, 3rd ID, 1 AD, 82nd ABN, 4th ID, 2nd ACR and coalition forces. Aspects of pre and post deployment will be discussed as well as experiences while executing the mission in Iraq. The roles and opportunities of active duty audiologists in today’s high OPTEMPO preventive medicing environment will be explored.
The Balkans Project: Forward Deployed Audiology-The Missing Link
CPT Scott McIlwain
NATO military operations in the Balkans have been ongoing for a number of years; since 1995 in Bosnia and since 1998 in Kosovo. Large numbers of personnel deployed to these locations for periods of between 60 and 20 days, but most commonly on six-month rotations. To date, there has been no comprehensive occupational health program, to include hearing conservation, in either location. Recently, at the request of Task Force Eagle and Task Force Falcon commanders, USACHPPMEUR provided site assistance visits to Bosnia and Kosovo to recommend the establishment of comprehensive occupational health programs. Recommendations for both Areas of Operations were similar and included the basic tenets of hearing conservation. Noise surveys were conducted and USACHPPMEUR provided assistance in establishing a DOEHRS-HC System for hearing conservation at Eagle Base, Tuzla and Camp Bondsteel, Kosovo. Working with the Task Force commanders, we have functional hearing conservation programs at both locations. This paper details the process, lessons learned, and success stories about forward deployed audiology.
Hearing Conservation and Preventive Medicine/91S
MAJ Eric Fallon
Field preventive medicine units play a vital role in the prevention of Disease and Non-Battle Injury (DNBI) for soldiers deployed forward. Understanding the makeup, training and mission of these units is vital to ensuring that the Hearing conservation program is represented in the field environment. Currently, although it is part of field units stated mission, very little emphasis is placed on the identification of noise hazards and the steps to promote hearing conservation to deployed soldiers. The role of field preventive medicine units and the preventive medicine technician, their hearing conservation mission, and the necessary training to ensure mission success will be discussed.
MOHV Update
Dr. Don Ciliax
The requirement to provide hearing tests to all military and noise-exposed civilian personnel can be accomplished in any number of venues (e.g., Soldier Readiness Processing Center, Audiology Clinic, Occupational Health Clinic). Another familiar test site of years past has been the Military Occupational Health Vehicle (MOHV). A total of sixteen MOHVs was fielded in 1987 with a life expectancy of ten years. Almost seventeen years have passed and only a few are still being used productively. However, a number of installations have indicated a need for the MOHV and have asked how replacements could be funded. This presentation will: summarize the results of an October 2003 questionnaire that was sent to all audiologists, including those with experience using the MOHV; provide an overview of the current demand and proposed use for the MOHV; and specify the process for justifying, funding and acquiring additional vehicles in the foreseeable future.
Waiver Decision Process-Recommendations
MAJ Marjorie Grantham
Each year, 5000 ROTC Cadets go through camp entrance physical exam at Ft. Lewis. All of them receive hearing conservation education and are fit with earplugs. Most arrive with audiograms in their medical record. All records are reviewed to determine whether they meet accession standards. Those whose hearing exceeds AR 40-501 standard or show ENT concerns receive full diagnostic audiometric evaluation. Out of 63 cadets tested in 2003, 38 clearly met the accession standard. Out of the 25 who did not, only one did not receive a waiver for accession. Clearly, the current standard continues to lack universal enforcement. The waiver decision process needs more active audiologist input. Recommendations for a waiver decision-making process will be discussed.
Proper fitting of the HGU 56/P HP Device
SPC Alisa LaPrath
The HGU 56/P is the Army‘s primary helmet/hearing protective device for Army aviation since only the UH-60 Blackhawk crewmembers are required to wear double protection (helmet and earplugs). Crewmembers often report poor attenuation of the HGU 56/P compared to the SPH4 (the Army‘s old helmet). If properly fit, the HGU 56/P is shown to have greater attenuation than the SPH4. As Army Audiologists/Hearing Conservation Program Managers you need to be proficient at fitting the HGU 56/P so that you can counsel those crewmembers with a significant threshold shift and properly re-fit their hearing protective device (helmet). These skills are also needed to train unit Hearing Conservation Officers as per DA PAM 40-501. This presentation will demonstrate the proper fitting procedure for the HGU 56/P.