HEARING LOSS: AN AVOIDABLE HAZARD

HEARING LOSS: AN AVOIDABLE HAZARD

Concern about firefighter hearing loss has grown over the past decade. Many fire departments have recognized this problem, which has become more urgent with the advent of the technological advances of the past 20 years. Among these changes are the replacement of gasoline-powered engines for pumpers and ladder trucks with those powered by diesel fuel; the cab-over-engine design of apparatus, which places the passengers in close proximity to the engine compartment; and the increase in the number of apparatus equipped with both a siren and an air horn. Also, many buildings in the municipality now are equipped with audible fire alarm systems, ranging from batterypowered alarms, which sound at various levels, to multiple klaxon horns.

While some departments have taken major steps to implement hearingconservation programs, unfortunately, far too many departments are ignoring the problem. Some fire service leaders simply fail to recognize hearing loss as a problem; others feel that hearing loss is just another one of the many unavoidable hazards of firefighting. The most common excuse used to justify avoiding the responsibility of protecting the work forces is the lack of money, but a concerned fire service leader can compensate for budgetary deficiencies by seeking out resources within the community.

In November-Deeember 1990, the Occupational Health and Safety Committee of Local 950 of the International Association of Fire Fighters (1AFF) conducted a Hearing Screening and Sound Level survey among the members of the Brookline (MA) Fire Department. The study was coordinated by Mark Jefferson, a member of the 1AFF Local 950 Safety Committee. It targeted several areas of concern that could adversely affect firefighters’ hearing. Although the Local 950 Occupational Health and Safety Committee states in its report that “no member [of the Safety Committee] is qualified to make an assessment as to how much hearing loss is related to this occupation [firefighting], to recreational activity, to military service, or any other source” and acknowledges that there are “unquestionably scientific flaws in the methodology used in this survey,” the study, the report for which 1 wrote, has led the Committee to suspect that hearing loss may be the most common permanent injury firefighters suffer.

Among the survey’s findings were the following:

• It appears that in the 4,000and 6,000-1 Iz ranges, the average 45-yearold firefighter with 20 years of service has a hearing level comparable to that of a “normal” male in his late sixties.¹
• Individuals with 20 or more years of service appear to be the most severely affected. (They constituted 44 percent of the department members eligible to participate in the survey, but only 38 percent of the survey’s participants.)
• The results of the screening conducted for the survey were compared with the average decibel loss reported in an anonymous, scientifically controlled screening. The average decibel loss at 4,000 Hz, 6,000 Hz, and 8,000 Hz in the Worcester (MA) Fire Department for a firefighter with 20 years of service was reported to be 39 db, 47 db, and 38 db, respectively.² The results at the same frequencies for a firefighter with a similar length of service in this department were 39 db, 45 db, and 37 db, respectively.

IDENTIFYING THE PROBLEM

A hearing-conservation program consists of much more than providing hearing-protection devices for workers, although many fire departments have failed to do even this. It should encompass education of the work force, hearing testing and follow-up medical care where required, soundlevel testing, record keeping, and problem resolution. The overall goal is to protect firefighters from the deleterious effects of being exposed to excessive noise.

Research. The fire service leader or the appointed safety officer should research this subject to gain a rudimentary understanding of the problems that noise exposure can cause for members of the fire service. Fire service journals are excellent reference sources. The National Institute for Occupational Safety and Health (NIOSH) has done a number of studies on this subject, and the reports of these studies are available to the public. The International Association of l ire Fighters (IAFF), as already mentioned, is a valuable information source, as is the National Fire Protection Association (NFPA). Any fire department or union that has done a study can serve as a reference source. Usually, the authors of these studies are more than happy to answer questions and share information on the effectiveness of actions they have taken. Having a basic understanding of the problem and a knowledge of some of the ways to address it will enable you to use your community’s resources to your advantage.

Screening and education. You might be fortunate enough to find a state, federal, or municipal agency willing to conduct a sound level analysis, a hearing screening program, and an educational program for you. In all probability, you will have to contact a number of public and private sector organizations to accomplish your objectives. If your community is the home of a medical school, a school of public health or engineering, or a college with a speech pathology or communications disorder unit, it is quite possible that it may assist you. The institution may even be willing to handle the entire project for you. Audiology students need subjects to test to earn training credits. The fire department can provide the subjects on a yearly basis. This type of relationship would benefit the students, the school, and the fire department. If these kinds of schools are not nearby or if you cannot get as much help as you need, don’t give up. Many other resources are available.

The hearing tests are very important. They assess each individual’s hearing status and reveal how your department as a whole has been affected. When the overall results have been compiled and compared with tables reflective of a population with normal hearing, you probably will be convinced that the problem should be addressed immediately.

You can encourage participation in the hearing screening in several ways. You could send notices to the homes of department members announcing the dates and times of the testing. Doing this helps increase members’ participation: In many cases, the member’s spouse, who usually is aware that the firefighter is losing his/her hearing long before the firefighter is, will read the letter. The spouse will encourage the firefighter to participate in the screening.

The announcement also should present questions such as the following:

• Does your family tell you the television is turned up too loudly?
• Do you often find yourself asking, “huh” or “what”?
• Do you hear people speak but have trouble understanding the words?
• Does it sound as if people are mumbling?
• Do you have trouble hearing what your kids are saying?

Hearing loss is a social and medical problem. The members of the hearing-impaired firefighter’s family must deal with the impairment every day. They have a great interest in seeing the decline of their loved one’s hearing stopped.

Workers must be educated about the hazards of being exposed to excessive noise on and off the job. Who is qualified to act as an educator in this area? In addition to an expert from a local school or university, you may be able to negotiate for the services of an ear, nose, and throat (ENT) specialist, a speech pathologist, or an audiologist from a local hearing aid store. What better advertising opportunity is there for that store than to appear on the front page of the local newspaper receiving your thanks for educating the local firefighters and testing their hearing free of charge? If any of the resource people suggested are not willing to conduct the hearing screening, it is possible that the firefighters’ health insurance carrier may pay for the test and any follow-up medical care that may be needed.

The educational session should take less than an hour. It could be videotaped and shown to each work group, reducing the time the educator has to spend teaching your personnel about noise-induced hearing loss. The videotape also can be used to educate new recruits and for continuing education purposes. An educated work force can help you find ways to address the problems.

A major objective of this program is to prevent firefighters from becoming hearing deficient as a result of their employment. If the hearing screening is voluntary and firefighters fear dismissal, the most seriously impaired individuals will not participate. It would be helpful to announce, therefore, that personnel found to have hearing problems will not be dismissed or reassigned. If indicated, however, they should be referred for follow-up medical care.

Audiograms should be given when firefighters are hired and every year thereafter. As medical records, test results should be kept confidential. Annual audiograms can help identify hearing deficiencies, many of which can be treated and prevented from developing into major problems.

ADDRESSING THE PROBLEM

Let’s say that you’ve been fortunate: Your resourcefulness has allowed you to complete the hearing screening, the sound level survey, and the educational program without having to spend any of the municipality’s money. You’ve identified problem areas, but now what? How do you ameliorate the problems without major expenditures?

Once again, you must be creative. Unless you can find a manufacturer willing to donate earmuffs and earplugs, you will have to buy hearingprotection devices. They are inexpensive and well worth the investment. Earmuffs are relatively inexpensive when compared with the cost of bilateral hearing aids, which can run to a thousand or more dollars.

The Occupational Safety and Health Administration’s (OSHA) existing standard for occupational exposure to noise (29 CFR 1910.95) specifies a maximum permissible exposure level (PEL) of 90 db(A)—slow response for a duration of eight hours per day. The employer must administer a continuing, effective hearing program when the time-weighted average (TWA) exceeds the action level (AL) of 85 db(A). The program must include monitoring, employee notification, an audiometer testing program, hearing protectors, training programs, and record keeping |29 CRF 1910.95 (c) through (o)].

When exposed to noise levels in excess of the OSHA PEL of 90 db(A), feasible engineering or administrative controls shall be implemented to reduce the workers’ exposure levels. An effective hearing program also shall be implemented/

Both NIOSH in its Criteria for Recommended Standard^ and the American Conference of Governmental Industrial Hygienists (ACGIH) in its threshold limit values (TLVs)⁵ propose an exposure limit of 85 db(A) for eight hours.

The NIOSH and OSHA standards depend on the TWA noise limits. For this survey, a dosimeter was not used to attempt to determine the TWA exposure level. The results of several fire department health hazard evaluations that discovered noise levels under the 100 percent level uncovered a noise-induced, hearing-loss problem among the tested firefighters.^{6,7 8,9}

Your personnel should be required to use hearing-protection devices in all situations where the sound level may exceed 85 to 90 db(A). NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, (1987) requires that firefighters be provided with and wear hearing protection devices when sound levels are in excess of 90 db(A).

For most fire companies, this would be every time the apparatus is started or moved for any reason, including maintenance checks. It also would include any time the auxiliary equipment is used or air bottles are filled. Alarm systems in the fire stations— whether bells, horns, or both —should be adjusted to the point where they alert the firefighters, not destroy their hearing. It is not necessary to have alarm signals as loud as chainsaws. If station alarms are too loud, the sound level is not adjustable, and money is not available to replace them with adjustable alarm bells or horns, you still have some options. You can, for example, reduce sound levels by taping foam rubber over the horn or on the striker mechanism. The sound level meter can be used to ensure that the sound has been reduced to a level that is desirable but still loud enough to alert the firefighters. A sound level of 75 to 80 db(A) might be reasonable, but the selected level should be discussed with your resource person. Also, signaling devices can be relocated to more advantageous locations. The resource people in your community can explain how to determine desirable locations for station alarm devices. In general, encourage any measures that reduce unnecessary noise insult (see sidebar on page 74).

Hearing-protection devices should be used whenever the environment is excessively noisy, not only when riding on the apparatus. These situations include responding to incidents in factories where the ambient noise is high or in any buildings equipped with loud fire alarm systems.

You have to decide which guidelines will best serve your department and community. There is no excuse for failing to protect the hearing of your work force. The problem will not disappear. The longer you wait, the more severe the problem will become. Begin to address this problem today; its solution begins with you.

In the two years since the study’s release, the Brookline Fire Department has purchased earplugs for its personnel, but there is no mandate that they be used. A comprehensive hearing-conservation program has not evolved, and most of the study’s recommendations have not been implemented.

References

1. A. Spoor, “Presbycusis Values in Relation To Noise Induced Hearing Ixiss,” International Audiology VI1:56, July 1967. (Leiden, Netherlands: University of Leiden).
2. Courtney, The Worcester Firefighter, XXVII-17:2, September/October 1990.
3. U.S. Department of Libor, Occupational Safety and Health Administration, Code of Federal Regulations, labor, 29, Parts 1900 to 1910, rev. July 1, 1985, As cited by R. I.. Tubbs, Health Hazard Evaluation: Memphis Eire Department IIIIE Report No. HETA 86-138-2017. (Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1990), p i
4. National Institute for Occupational Safety and Health. Criteria for a Recommended Standard: Occupational Exposure to Noise (Cincinnati, Ohio: OHEW (NIOSH | publication no. 73-11001, 1972). Cited Tubbs, Memphis Fire Department report, NIOSH, 1990, p.4.
5. American Conference of Industrial Hygienists. Threshold l imit Values and Biological Exposure Indices for 1080-1090. (Cincinnati, Ohio: AGGIH, 1989). Cited by Tubbs in Memphis Fire Department report, NIOSH, p 5.
6. R L. Tubbs, J. P. Flesch. Health Hazard Evaluation. Newburgh (NY) Eire Department, HUE Report No. HETA 81-059-1045 (Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1982).
7. R L. Tubbs, Health Hazard Evaluation. Pittsburgh Bureau of Eire, Interim Report No. /, HETA 88-290 ((-inti., Ohio: National Institute for Occupational Safety and Health, 1988).
8. Letter/Initial Results of Audiometric Testing Phase from R. L. Tubbs of NIOSH to R Duffy of LAFF, February 1989, Pittsburgh Bureau of Eire Health Hazard Evaluation
9. R. L. Tubbs, Health Hazard Evaluation: Memphis Fire Department Report.