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USAF Hearing Conservation Program, DOEHRS Data Repository Annual Report: CY2009-2010

Authors:
AFRL-SA-WP-TP-2011-0001
USAF HEARING CONSERVATION
PROGRAM, DOEHRS DATA
REPOSITORY ANNUAL REPORT:
CY2009-2010
Elizabeth McKenna, Capt, USAF
Michelle LeMond, SSgt, USAF
Epidemiology Consult Service
June 2011
Air Force Research Laboratory
711th Human Performance Wing
School of Aerospace Medicine
Epidemiology Consult Service
2510 Fifth St.
Wright-Patterson AFB, OH 45433-7913
Distribution Statement A: Approved for
public release; distribution is unlimited.
Case Number: 88ABW-2011-5181,
26 Sep 2011
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1. REPORT DATE (DD-MM-YYYY)
01-06-2011
Technical Paper
3. DATES COVERED (From To)
Jan 2009 Dec 2010
4. TITLE AND SUBTITLE
USAF HEARING CONSERVATION PROGRAM, DOEHRS DATA REPOSITORY
ANNUAL REPORT: CY2009-2010
5a. CONTRACT NUMBER
5b. GRANT NUMBER
5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S)
Elizabeth McKenna, Capt, USAF
Michelle LeMond, SSgt, USAF
5d. PROJECT NUMBER
5e. TASK NUMBER
5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)
USAF School of Aerospace Medicine
Epidemiology Consult Service
2947 Fifth St.
Wright-Patterson AFB, OH 45433-7913
8. PERFORMING ORGANIZATION REPORT
NUMBER
AFRL-SA-WP-TP-2011-0001
9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES)
10. SPONSORING/MONITOR’S ACRONYM(S)
11. SPONSOR/MONITOR’S REPORT
NUMBER(S)
12. DISTRIBUTION / AVAILABILITY STATEMENT
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5181, 26 Sep 2011
13. SUPPLEMENTARY NOTES
14. ABSTRACT
The United States Air Force (USAF) School of Aerospace Medicine (USAFSAM), Epidemiology Consult Service (PHR), Hearing
Conservation Program (HCP) prepares an annual status report on the USAF HCP. This report covers both CY2009 and CY2010 and
provides a corporate view of the current status of the USAF HCP with data reported from the Defense Occupational and
Environmental Health Readiness System Data Repository (DOEHRS-DR). This report covers an overview of a few standard reports
currently available in the DOEHRS-DR database, software implementation status data, hearing conservation program metrics, and
recommendations. The DOEHRS-DR reports cited in this document reflect the data available in the data repository. Local hearing
conservation program records may reflect a lower permanent threshold shift (PTS) rate due to the inability to resolve certain types of
PTS cases within the DR and to import/export difficulties. The differences between the locally reported PTS rate and the PTS rate
with the DR are currently being investigated by USAFSAM/PHR. We strongly recommend installation and major command
(MAJCOM) HCP managers review their respective programs using the metrics given in this report, as they give an initial guideline to
estimate program effectiveness.
15. SUBJECT TERMS
Hearing conservation, permanent threshold shift, threshold shift trends, Defense Occupational and Environmental Health Readiness
System Data Repository (DOEHRS-DR)
16. SECURITY CLASSIFICATION OF:
17. LIMITATION
OF ABSTRACT
SAR
18. NUMBER
OF PAGES
8
19a. NAME OF RESPONSIBLE PERSON
Capt Elizabeth McKenna
a. REPORT
U
b. ABSTRACT
U
c. THIS PAGE
U
19b. TELEPHONE NUMBER (include area
code)
Standard Form 298 (Rev. 8-98)
Prescribed by ANSI Std. Z39.18
1
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5181, 26 Sep 2011
I. Introduction
The United States Air Force (USAF) School of Aerospace Medicine (USAFSAM),
Epidemiology Consult Service (PHR), Hearing Conservation Program (HCP) prepares an annual
status report on the USAF HCP in accordance with Air Force Occupational Safety and Health
(AFOSH) Standard 48-20, Occupational Noise and Hearing Conservation Program, 2.5.8-9, and
Department of Defense Instruction (DoDI) 6055.12, Hearing Conservation Program. This report
covers both CY2009 and CY2010.
The purpose of this report is to provide a corporate view of the current status of the
USAF HCP with data reported from the Defense Occupational and Environmental Health
Readiness System Data Repository (DOEHRS-DR). Major command (MAJCOM) and
installation level reports are available quarterly and by request from USAFSAM/PHR, as well as
by those who have user-defined roles in the data repository. This report covers an overview of a
few standard reports currently available in the DOEHRS-DR database, software implementation
status data, hearing conservation program metrics, and recommendations.
II. Discussion
A. Software Implementation Status Data
During 2009–2010, the DOEHRS Program Management Office released two software
updates. DOERHS-HC software version 3.1.2.112 was deployed March 2009, with mandatory
installation by June 2009. This update now uses the earliest initial, or type 3, baseline (DD
2215) as the reference. Baselines that were entered later in time and coded as a type 1 or type 2
will not be referenced. A letter was disseminated in July 2009 advising technicians to manually
enter or reestablish the actual, current baseline of the individual if DOEHRS-HC is using an
older or original baseline that is inaccurate. Temporarily inflated standard threshold shift (STS)
rates were expected due to this software change.
The Benson Medical Audiometer (CCA-200) software version 6.21 (Benson Medical
Instruments, Minneapolis, MN) was deployed in September 2010. The v6.21 update addressed
the system administrator password requirements for the Air Force Standard Desktop
Configuration for the Windows Vista operating system (Microsoft Corp., Redmond, WA).
Department of Defense subject matter expert testing of the DOERHS-HC version 4.0 single-ear
testing software was completed in May 2011.
B. HCP Effectiveness Metrics
Program Compliance:
One measure of the effectiveness of any HCP is program compliance. Compliance is
defined as the number of people in a particular program who should receive annual audiograms
(denominator data) compared to those people who received their audiograms (numerator data).
This is one of the metrics specified in DoDI 6055.12. While it is a useful metric, it does have
limitations that can influence its accuracy. The number of people on the HCP at each installation
is manually entered by the DOEHRS-DR user-defined role HCP Managers (HCPMs) when they
log into the DOEHRS-DR website. Towards the beginning of March 2011, aggregate data from
Preventive Health Assessment Individual Medical Readiness (PIMR) were obtained that outlined
the number of individuals on the majority of the HCP across the AF; this allowed for missing
data to be entered directly by HCP functionals.
2
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5181, 26 Sep 2011
Tables 1 and 2 represent the compliance data for the USAF for the years 2009 and 2010.
Due to the current lack of real-time methods of updating the denominator in the DOEHRS–DR
database, these rates are only approximate but are representative of the most current denominator
in the USAF HCP.
Table 1. HCP Compliance CY2010 (28 Mar 11 report)
Noise Exposed
People Tested
Compliance Rate
Military: 166,736
Military: 163,834
Military: 98.26%
Civilian: 29,395
Civilian: 25,952
Civilian: 88.29%
Total: 196,131
Total: 190,732
Total: 97.25%
Table 2. HCP Compliance CY 2009 (10 Feb 11 report)
Noise Exposed
People Tested
Compliance Rate
Military: 166,861
Military: 159,628
Military: 95.67%
Civilian: 32,172
Civilian: 25,748
Civilian: 80.03%
Total: 199,033
Total: 186,275
Total: 93.59%
Threshold Shift Trends:
The key metric for any HCP is the standard threshold shift (STS) as specified in DoDI
6055.12. The current data follow the STS criterion specified in DoDI 6055.12. Permanent
threshold shift (PTS) is any STS that persists after the follow-up audiograms are completed and
is a measure of permanent changes in hearing. Temporary threshold shift (TTS) is any STS that
resolves after the follow-up audiograms are completed. TTS is a temporary loss of hearing due
most likely to hazardous noise exposure and can be used to target intervention efforts for
engineering controls and effective use of hearing protective devices. While PTS can be due to
hazardous noise exposure, other factors, such as aging, can cause permanent hearing changes.
Care is necessary when reviewing STS rates. The current rates can only be compared to
themselves for a given point in time. Therefore, inquiries into the DR for threshold shift
information are best viewed as a “snapshot” of the data in the repository for a given day. For
DOEHRS purposes, TTS and PTS rates are directly influenced by the 30-day completion
deadline for civilians and a 90-day completion deadline for military. Therefore, PTS rates are
influenced by follow–up audiograms obtained outside the assigned window.
Table 3 represents the STS/PTS trend data for CY2009 to the end of CY2010. The PTS
rates are essentially unchanged for 2009-2010. These data can be further broken down into
military and civilian trend rates to determine if there are significant differences between these
groups.
A review of the data suggests civilian rates continue to be somewhat higher than military
rates. The difference is most pronounced for the PTS rates. As noted above, factors other than
hazardous noise exposure can influence PTS rates, the most prevalent of which is aging effects
and length of time working in hazardous noise environments. In some instances, military
members retire and may return to the base as civilian employees in the same job duty. The
effects of working in hazardous noise environments for many years will negatively affect the
auditory status of many workers, as exposure over time accumulates. Some individuals will be
3
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5181, 26 Sep 2011
affected by a predisposition for age-related hearing loss and/or noise-induced hearing loss.
Installation and MAJCOM HCP managers are encouraged to pay particular attention to efforts
directed toward civilian worker areas.
Table 3. STS/PTS Trends: CY2009-2010 (10 Feb 11 report)
Year
N with
Periodic
STS
(%)
TTS
(%)
PTS
(%)
CY 2009
164,378
10.01
2.90
7.12
Military
140,323
8.60
2.69
5.90
Civilian
23,415
18.62
4.12
14.50
CY 2010
168,964
9.59
3.19
6.40
Military
144,788
8.19
2.89
5.30
Civilian
23,469
18.25
4.94
13.31
Table 4 represents STS rates for MAJCOMs and the difference in percent between 2009
and 2010 data.
Table 4. MAJCOM PTS Trends: CY2009-2010 (16 Mar 11 report)
MAJCOM
2009
(%)
2010
(%)
Delta
ACC
4.07
3.76
-0.31
AETC
9.47
8.76
-0.71
AFDW
5.83
5.62
-0.21
AFGSC
5.54
2.83
-2.71
AFMC
8.53
7.45
-1.08
AFR
11.23
10.40
-0.83
AFSOC
3.37
3.38
+0.01
AFSPC
14.19
11.44
-2.75
AMC
5.65
5.20
-0.45
ANG
10.16
9.03
-1.13
PACAF
5.16
5.18
+0.02
USAFA
8.96
11.50
+2.54
USAFE
3.86
3.26
-0.60
Table 5 displays hearing profile levels for H-1, H-2, and H-3 levels for military
members. These data change little from year to year. Note that the numbers for cadets differ
significantly from officers and enlisted.
4
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5181, 26 Sep 2011
Table 5. Hearing Profiles (Military) (10 Feb 11 report)
Year
No. of
Personnel
H-1
H-2
≥H-3
No.
%
No.
%
No.
%
CY2010
156,924
144,797
92.2
8,024
5.1
4,103
2.6
Cadet
276
229
82.9
18
6.5
29
10.5
Enlisted
124,934
115,316
92.3
6,314
5.0
3,304
2.6
Officer
31,713
29,252
92.2
1,692
5.3
769
2.4
CY2009
154,387
142,240
92.1
7,943
92.1
4,204
2.7
Cadet
279
237
84.9
20
7.1
22
7.8
Enlisted
123,045
113,428
92.1
6,244
5.0
3,373
2.7
Officer
31,063
28,578
91.9
1,679
5.4
809
2.6
Hazard Assessment Metrics:
Two hazard assessment metrics have been identified in the DoDI 6055.12 hearing
conservation program published December 2010. Specifically, the document requests reporting
of percentage of noise hazardous workplace characterizations completed and index of
unacceptable noise exposures. Calculation of these metrics is outlined in DoDI 6055.05
Occupational and Environmental Health and is under investigation by USAFSAM/PHR to
determine appropriate reporting details.
III. Recommendations
The DOEHRS-DR reports cited in this document reflect the data available in the data
repository. Local hearing conservation program records may reflect a lower PTS rate due to the
inability to resolve certain types of PTS cases within the DR, and to import/export difficulties
related to baselines older than 1998. The differences between the locally reported PTS rate and
the PTS rate with the DR continue to be investigated by USAFSAM/PHR, which will soon
provide additional guidance on management of this discrepancy (Attachment 1).
We strongly recommend installation and MAJCOM HCP managers review their
respective programs using the metrics given in this report, as they give an initial guideline to
estimate program effectiveness. Installation level reports are available for installation HCP
managers to use. If not already obtained, HCPMs are encouraged to apply for a DOEHRS-DR
website password to gain access to these reports. MAJCOM HCP managers can also request
MAJCOM access to assess trends in their respective MAJCOM. All are encouraged to contact
the Hearing Conservation Program Manager at USAFSAM/PHR for assistance.
5
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5181, 26 Sep 2011
Attachment 1
DEPARTMENT OF
THE
AIR.
FORCE
HEADQ
U
AR
T
ERS
UNITED STATES
AIR
FORCE
WA.SHINGTON DC
MEMORANDUM
FOR
ALMAJCOM/SG
FROM: HQ USAF/SG3
1500 Wilson Boulevard, Suite 1200
Arlington, VA 22209
4 February 2010
SUBJECT: Use
ofDefense
Occupational1
md
Environmental Health Readiness System Hearing
Conservation (DOEHRS-HC) v3.2.0.112
to
Perform Hearing Conservation
Program (HCP) Audiograms
The
newest
version
of
DOEHRS-HC v3.2.0.112,
issued
in
March 2009, incorporates a
major change
in
the
way
significant threshold shifts (STS) are calculated. DOEHRS-
HC
now
uses the earliest dated DD Form 2215 "Baseline Audiogram" (reason 1 or 2
DD
Form 2215) to
determine the presence
of
an
STS for
an
arurmal
audiogram, unless a later baseline
has
been
reestablished following
an
STS (reason-3
DD
Form 2215).
In
previous versions
of
DOEHRS
software, the baseline audiogram used
to
calculate
an
ST S was the
most
recent
baseline,
regardless
of
the
1
~
eason.
As
a resulLofthe software change, ammal occupational audiograms which would
otherwise "pass" compared
with
their most current reference
may
be
STSs compared
with
their
earliest dated reference. This
bas
affected STS
and
permanent threshold shift (PT S) rates across
the
Air
Force. A
recent
DOEHRS
report
for
May-Oct 2009 indicated the overall
Air
Force
PTS
rate increased nearly 3 percentage points compared
with
the previous reporting period, which
gained
AF
leadership visibility
and
scrutiny.
With
these
new
DOEHRS-HC business rules,
the
following actions should
be
taken
to
minimize the impact
to
Air
Force data
and
the HCP:
a.
When
an
annual audiogram results
in
an
ST S
based
on
the
new
business rules,
technicians should treat the audiogram
as
an
ST S
and
conduct a tallow-up
lAW
AFOSH STD
48-20. After a physician
or
audiologist confitms the PTS, reestablish the reference based
on
this
annual audiogram as a reason-3
DD
Form 2215.
The
reestablishment
of
a reason-3
DDForm
2215
is
a crucial step
in
enswing
that
future annual audiograms are calculated approptiately.
b. Technicians performing audiograms should apply the correct
reason
when
they
establish a reference baseline
in
accordance
with
instructions for
box
15
on
the
DD
Form
2215.
Note: a reason-2 baseline audiogram
should
only
be
applied
to
individuals
who
do
not
have a
reason-]
DD
Form 2215
in
DOEHRS-
HC
rmd have previously worked
in
hazardous noise areas.
c.
In
accordance
with
AFOSH
STD 48-20; ''workers terminated from the
HCP
who
subsequently return
to
hazardous noise duties should have a current audiogram compared
to
their original reference audiogram.
If
the
c1llrrent
results
do
not
indicate a STS, the original DD
6
Distribution Statement A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2011-5181, 26 Sep 2011
Form 2215 will setve as the reference audiogram.
If
an
STS
is
present, use t
he
ne
w audiogram
to establish a reference." This new reference should
be
a reason-3DD Form 2215. No follow-
up
is
required for
an
STS
in
this situation.
My POCs for this memorandum are Maj Natalie Johns, (703) 588-6468,
DS
N 426-6468,
natalie.johns@pentagon.af.mil, and Maj Bridget McMullen, (210) 536-2940, DSN 240-2940,
btidget. mcmullen@ brooks. af.mil.
SG3D
oc 2010-013
T MA
SJ.L
a,
I"-H:::m
M 'or Ge
3.1
, USAF, MC, C
FS
Assistant Surgeon General, Health Care Operations
Office
of
the
Surgeon General
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