1. The Army Hearing Program: Supporting the Soldier from Training to Combat National Hearing Conservation Association Orlando, FL February 2010 COL Vickie Tuten CPT(P) Jillyen Curry-Mathis CPT Kara Cave

2. Briefing Outline PURPOSE: Provide an overview of the Army Hearing Program, its impact on the Warrior in training and the role of the deployed Audiologist 1.Introduction to the Army Hearing Program 2.Training Warriors for Combat 3.Proposed “Best Practices” Initiative 4.Early Roles of the Deployed Audiologist 5.Relocation of Theater Assets 6.Evolution of Role in New Setting 7.Future Directions for the Army Hearing Program 8.Conclusion

3. The Army Hearing Program Brief Overview

4. Army Hearing Program The Army Hearing Program (AHP) is a new initiative from Office of The Surgeon General aimed at improving communication abilities on the battlefield and decreasing the rate of noise-induced hearing loss among soldiers. There are four elements to the AHP IAW Special Text (ST) Document 4-02.501, which was implemented in February 2008 Hearing Readiness Hearing Conservation Operational Hearing Svcs Clinical Hearing Services

5. Answering the Challenges of Combat What’s Changed? Hearing ConservationArmy Hearing Program Seven ElementsFour Components 1)Hearing Protectors 2)Health Education 1) Hearing Readiness 3)Monitoring Audiometry2) Clinical Services ***** Missing Piece ***** 3) Operational Services 4)Noise Hazard Identification 5)Engineering Controls 4) Hearing Conservation 6)Enforcement 7)Program Evaluation Bonus: Command Emphasis Traditionally Garrison-BasedBridges the Gap: Garrison Theater

6. Training Warriors for Combat From Basic Combat Training (BCT) to Deployment

7. Hearing Readiness Hearing Readiness implies that Soldiers have the required hearing capabilities, personal protective equipment (PPE), and medical equipment that are needed to train and deploy. Hearing Tests Pre-Basic Combat Training Hearing Evaluations Annual, Pre/Post-deployment Hearing Tests Personal Protection Pre-Range & Pre-Deployment Hearing Protection Fittings Regular Range Support for Soldiers Required: Wear of Earplug Carrying Case on Uniform Installation Requirement Moving to Army-wide Requirement

8. Hearing Readiness Personal Protection TRADOC Doctrine Change – “Best Practices” Initiative Combat Arms Earplug (CAE) Fittings on all Basic Training Soldiers –Fittings will no longer be completed at reception during in-processing –Combined Operational Hearing Briefing & CAE Fittings within 2-3 days of Range Training –Units will be required to contact Army Hearing Program to Schedule Class Required: Wear of Earplug Carrying Case on Uniform –Cadre/Permanent Party Soldiers wear case/earplugs on front right belt loop of ACU trousers –IET Soldiers wear case/earplugs in left-arm pocket (non-flag arm) Easy check of uniform using right hand taps Reinforce transfer of pocket contents when changing uniforms Prevents loss during drills and corrective actions

9. Clinical Hearing Services Clinical Hearing Services are required in both garrison and deployed settings. Although there is some overlap, the variance in services delivered between these two environments is operationally driven. The AHP evaluates all Soldiers failing hearing tests: Hearing Waivers of Recruits converted to Profiles – describes impact of loss on Soldier’s performance to Basic Training and Future Leadership (Safety Issue) H2/H3 Profiles – Soldiers obtain profiles to determine deployable status and to describe impact on performance of mission to leadership Rehabilitative Services – Hearing Aids –Protective Equipment: Combat Arms Earplugs, Tactical Communication & Protective Systems (TCAPS), etc. Medical Services for Treatable Hearing Loss

10. Hearing Conservation The Hearing Conservation Program (HCP) is designed to protect Civilian and Military personnel from hearing loss due to occupational noise exposure. The essential elements of the occupational HCP include the seven essential elements outlined in the original Army Hearing Conservation regulations.. Noise Hazard Identification -Industrial Hygiene Hearing Protectors - Occupational Health Monitoring Audiometry - Occupational Health Hearing Education Courses -Army Hearing Program AHP – Oversight with support from Preventive Med Assets

11. Operational Hearing Services Hearing injury prevention and communication enhancement services delivered to the Solider in every environment with the primary objective of enhancing survivability and lethality. Services include use of TCAPS, noise surveillance, and injury prevention. Required Annual & Introductory Education Courses Integrate within Basic Combat Training Courses – Formal/Informal Classes and Fittings can be done in almost any environment, easiest is classroom Critical for class to be within days of ranges to minimize loss and maintain relevancy Drill Sergeants will be reinforcing correct use/wear of earplugs with BCT Soldiers Annual courses for Cadre Range and Field Exercises with TCAPS Variety of ranges: BRM, urban warfare, convoy ops Different TCAPS systems for different needs Noise Abatement Surveys

12. Roles of the Deployed Audiologist Evolution of Roles in Theater

13. Historical Role of Theater Audiologist Full diagnostic evaluations including: –Fitness-for-duty/Profiles –Hearing Aid Selection and Fitting –Acoustic Trauma –Dizziness –Evacuation to Higher Echelons Theater Consultant for Iraq Area of Operations (AO)

14. Historical Role (cont’d) Guide Theater Policy Oversee Data from 8 Pure Tone Testing Sites Teach CAOHC Classes Promote Hearing Readiness Camp Taji

15. Handover: Move from Level III to Level II Baghdad, International Zone Joint Base Balad Clinic Locations

16. New Opportunities Average Encounters –157/month OCT 06-07 –125/month NOV 07-08 – 85/mo DEC 08-OCT 09 Garrison ≈74/month JBB home to 20,000+ Service Members Co-located with ENT Clinic Doubled as Classroom Co-located with Preventive Medicine Detachment –Conduct noise surveillance throughout theater Access to More Patients and More Noise!

17. 100.9 dBA Closer to the Culprit!

18. Preventive Medicine Detachment & Audiology 332 nd supports with equipment Audiology Notified PM and/or Audiology conducts noise survey Audiology interprets findings, generates report and recommendations Unit Safety Officer briefed, Health Education Briefing, and Hearing Protection Fitted (including TCAPS!) Report filed with PM and Audiology

19. Lessons Learned Annual testing allowed monitoring even in theater. –Tracking of unit trends –Identification of patients meant monitoring of area Hands-on noise surveillance allowed for more specific recommendations Synergy between noise measurers and interpretation expanded services throughout Iraq Great opportunity for education, motivated audience Fueler = 98.6 TWA

20. Future Directions Detachment Great Model for Audiology to Follow Independent Unit, Increase Mobility Coordination If Services Available, They Will Use It! Systematic Means for Prevention Definitely Needed Bring Services to the Soldiers, Don’t Wait for Them to Come to You Not All Pre-deployment Services Created Equal, Need Services in Theater

21. Conclusions Components of the Army Hearing Program Translate Well to Theater AHP Components Require Support in Theater –Hearing Readiness –Clinical Services –Operational Hearing Services Challenges Include Getting Audiologist into Theater Other AOC Models Exist to Imitate (i.e.; ESEO) 72C Roles Must Vary to Meet Different Operational Needs