zCore Business Solutions Inc., Round Rock, TX 78681, USA.
Defense Health Agency Hearing Center of Excellence, JBSA Lackland, TX 78236, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):759-766. doi: 10.1093/milmed/usae262.
"Good hearing" (DoDI 6030.03 6.5&6.6) is a combat multiplier, critical to service members' lethality and survivability on the battlefield. Exposure to an explosive blast or high-intensity continuous noise is common in operational settings with the potential to compromise both hearing and vestibular health and jeopardize safety and high-level mission performance. The Joint Trauma System Acoustic Trauma Clinical Practice Guideline was published in 2018, providing recommendations for the assessment and treatment of aural blast injuries and acoustic trauma in the forward deployed environment. Combat care capabilities responsive to current threat environments emphasize prolonged casualty care. Despite recommendations, auditory system health has not been assessed routinely or in its entirety on the battlefield. This is due primarily to the large footprint of an audiometric booth and to the heavy logistical burden of providing high-quality, comprehensive auditory system (including vestibular) examinations in the combat environment.
The Defense Health Agency Hearing Center of Excellence has completed a Doctrine, Organization, Training, Materiel, Leadership & Education, Personnel, Facilities, and Policy (DOTmLPF-P) analysis of battlefield auditory system assessment and treatment, using 67 existing DoD documents and artifacts related to operational medicine.
Our analysis found that acoustic trauma is generally not addressed in any of the DOTmLPF-P domains. We recommend that auditory system assessment and treatment be incorporated across the continuum of care on the battlefield. This should be addressed through Prolonged Field Care and Tactical Combat Casualty Care guidance and in all Tactical Combat Casualty Care training programs. Equipment sets should be modified to include boothless technology and associated materiel for auditory system assessment. Policy and Doctrine changes would be required to mandate and support the implementation of these services. Uniformed audiologists should be added to the organizational structure at role 3 or higher to provide direct patient care; consult with other health care providers and commanders; develop and support enforcement of noise hazard guidelines; track hearing readiness; and, when necessary, provide specialized hearing protection devices that can compensate for hearing loss.
These recommendations aim to help the DoD bring about necessary assessments and interventions for acoustic trauma so that service members can have better hearing outcomes and maintain critical auditory system function on the battlefield.
“良好的听力”（DoDI 6030.03 6.5&6.6）是战斗力的倍增器，对战场上士兵的杀伤力和生存能力至关重要。在作战环境中，暴露于爆炸冲击或高强度连续噪声中很常见，这可能会损害听力和前庭健康，危及安全和高级任务表现。2018 年发布了《联合创伤系统声创伤临床实践指南》，为前部署环境中听力爆炸伤和声创伤的评估和治疗提供了建议。应对当前威胁环境的联合创伤系统作战护理能力强调延长伤员护理。尽管有建议，但战场上并未常规或全面评估听觉系统健康状况。这主要是由于测听室占地面积大，以及在作战环境中提供高质量、全面听觉系统（包括前庭）检查的后勤负担过重所致。
国防卫生局听力卓越中心已完成对战场听觉系统评估和治疗的学说、组织、训练、物资、领导力与教育、人员、设施和政策（DOTmLPF-P）的分析，使用了 67 份与作战医学相关的现有国防部文件和文物。
我们的分析发现，在 DOTmLPF-P 的所有领域中，声创伤通常都未得到解决。我们建议将听觉系统评估和治疗纳入战场护理的连续体中。这应通过延长现场护理和战术战斗伤员护理指导以及所有战术战斗伤员护理培训计划来实现。应修改设备套件，以纳入用于听觉系统评估的无隔间技术和相关物资。需要修改政策和学说，以授权并支持这些服务的实施。应将穿着制服的听力学家加入组织结构中第 3 级或更高级别，以提供直接的患者护理；与其他卫生保健提供者和指挥官协商；制定和支持噪声危害准则的执行；跟踪听力准备情况；并在必要时提供可补偿听力损失的特殊听力保护装置。
这些建议旨在帮助国防部对声创伤进行必要的评估和干预，以便士兵在战场上能有更好的听力结果，并保持关键的听觉系统功能。
