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Over the ear Tactical Communication and Protection System use by a light infantry (airborne) brigade in Afghanistan.

HISTORY

The acronym TCAPS, for Tactical Communication and Protection Systems, was introduced in the Army Hearing Program Special Text 4-02.501, released in 2008, (1) and is quickly becoming a known and understood acronym in the vernacular of many American Soldiers' Army line units. Broadly categorized as in-the-ear, over-the-ear, wired, or wireless, TCAPS is the generic term for the growing selection of amplified hearing protection systems available for purchase.

A number of manufacturers have employed modern hearing aid technology to create these systems for the military population using a variety of modern digital signal processing algorithms, including digital compression and/or active noise reduction. In 1993, the Bose Corporation (Framingham, MA) became the first company to supply an active noise reduction (ANR) system to the US Army's armored vehicle personnel with the combat vehicle crewman headset. (2) The more current TriPort Tactical Headset Series 2 ANR headset was used in many wheeled armored vehicles throughout Operation Iraqi Freedom and continues to be used today in noise hazardous military vehicles such as the M-1114 High-Mobility, Multipurpose Wheeled Vehicle and the Stryker. In 2007, the US Marine Corps contracted with Honeywell Safety Products (Smithfield, RI) to provide Marines with in-the-ear, wired TCAPS under the trade name of Integrated Intra Squad Radio Hearing Protection Headsets. (3) In 2012, the US Army Rapid Equipping Force acquired a source of supply code for the Peltor over-the-ear ComTac III headsets (3M Personal Safety Division, St Paul, MN) TCAPS for regular Army purchase through the Defense Logistics Agency. Previously, the source of supply code had been maintained and used only by Special Operations Forces. (4) The TEA INVISIO X50 (TEA Inc, Brewster, NY) is one of the most current TCAPS receiving attention from the US Army Hearing Program. In October 2013, the US Army's Program Executive Office Soldier awarded a $7.5 million contract to TEA Inc for INVISIO X50 systems to address the TCAPS requirement. (5) The X50 will be fielded to 3 brigade combat teams during 2014 at Ft Campbell, Ft Drum, and Ft Bragg. (6) Even amidst these large scale contracts and research endeavors, we still see small groups of Soldiers who spend precious, limited unit funds or even their personal funds on one or more TCAPS devices and accessories.

Data Collection

This quality assurance data report concerns a US Army Alaska light infantry brigade (airborne) which redeployed to their home duty station, the Fort Richardson side of Joint Base Elmendorf-Richardson, after a yearlong combat tour in Afghanistan. The infantryman's job description includes 3 tasks: shoot, move, and communicate. Good hearing is a force multiplier. A sudden temporary or permanent hearing loss from acoustic trauma in combat has the potential to render the individual Soldier, or even the entire unit, ineffective, which could result in mission failure. Experience has shown that Soldiers completely understand the importance of both having robust, clear, communication abilities on the battlefield and the protection of the precious sense for that capability--hearing.

All Soldiers who deploy or redeploy from combat are required to undergo a series of health assessments through a process known as Soldier Readiness Processing. US Army Alaska refers to this process as deployment cycle support (DCS). At the Fort Richardson Soldier Centered Medical Home, the DCS health assessment process includes, among other things, a check of each Soldier's current hearing ability to determine and document each individual's Hearing Readiness status in the US Army Medical Protection System per Army Regulation 40-501" The Soldier is fitted with a new pair of hearing protection, typically filtered (nonlinear) or nonfiltered (linear) hearing protection in conjunction with the DCS hearing check. The entire process is fairly intense, with long lines of jetlagged, homesick Soldiers who want to finish quickly so that they can go home and decompress with their family and friends. It was during the post-deployment DCS hearing check and earplug fitting that each Soldier was asked: "what type of hearing protection did you wear in Afghanistan?" After asking this question to the first few hundred troops, we noticed that several indicated they had used an identical brand of over-the-ear (OTE) TCAPS during dismounted operations. Recognizing this to be a good opportunity for data collection and quality assurance reporting, I prepared a questionnaire that evening and began handing it out through the rest of the DCS process to any Soldier who reported that he had used this particular OTE TCAPS. In addition to analyzing the subjective data from the surveys, objective data (the pre- and postdeployment hearing tests) of the 56 OTE TCAPS users was compared to the nonTCAPS users. Both subjective and objective outcomes are presented.

Subjective Responses: Questionnaire Results

Fifty-six surveys were collected from October 13 to October 21, 2012. All respondents were male. The average age was 29 years. More than 50% were infantry or mortar team Soldiers (43% and 11% respectively). The survey used a Likert scale of 5 simple "smiley faces" ranging from a big smile to a big frown, shown in Figure 1, for Questions 1 to 4. The smiley face Likert scale was selected over a numeric scale because the goal was to keep the survey as simple and user-friendly as possible, especially given that the respondents were, for the most part, very sleepy and experiencing jetlag, and were not enthusiastic about the DCS process.

[FIGURE 1 OMITTED]
The subjective data collected from Questions 1 through 5
of the surveys are as follows:

1. How do you rate the comfort of the OTE TCAPS?

Very   Good   Neither    Bad   Very
Good          Good Nor         Bad
                Bad
41%    36%      21%      2%     0

2. How do you rate the clarity of radio communications
with the OTE TCAPS?

Very   Good   Neither    Bad   Very
Good          Good Nor         Bad
                Bad
75%    25%       0        0     0

3. How clear was spoken language from other Soldiers
around you using the external microphone in dismounted
operations (not radio communications)?

Very   Good   Neither    Bad   Very
Good          Good Nor         Bad
                Bad
54%    39%       5%      2%     0

4. Overall, how much do you think the OTE TCAPS helped
to improve your warfighter lethality and survivability
on the battlefield?

Very   Good   Neither    Bad   Very
Good          Good Nor         Bad
                Bad
63%    33%       4%       0     0

5. Did the OTE TCAPS improve your situational awareness?
Yes     No       No
              Response
84%    14%       2%

Many responses to Questions 6 and 7 included
additional information and/or explanations which
are synopsized as follows:

6. What OTE TCAPS feature did you LIKE the most?

Radio communications           40%
Dismounted operations          19%
Localization of sound          14%
Other                          27%


The 27% of respondents who indicated "Other" for Question 6 typically included some explanation of how impressed and satisfied they were with a system that amplifies quiet speech sounds while dampening unexpected impulse noises, which is encouraging for Army audiologists who are searching for incentives to convince Soldiers to wear hearing protection in hazardous noise environments. The statistic that 14% of Soldiers indicated that they liked the ability to localize sound is surprising. Situational awareness is key for survivability on the battlefield. The human brain uses subtle differences in intensity, spectral, and timing cues in an open, uncovered ear to determine the location of a sound source. One of the concerns with OTE TCAPS is that covering the ear adversely affects the ability of the wearer to use interaural time delays between the ears and the head shadow effect, which could compromise their ability to localize the origin of dangerous sounds. This is especially true given the microphone placement on the front of the OTE TCAPS, which would give the wearer the impression that all sounds originate directly from the front. However, consider the infantry patrol for a moment. Every dismounted patrol is set up with a point, rear, and flank guard. Each individual is responsible for their assigned sector in front of them, which may explain why amplifying sounds from directly in front helped this group of Soldiers, primarily infantrymen, and gave them the impression of improved localization ability.

In response to Question 7, 60% specifically wrote that the OTE TCAPS became too hot and/or too tight after a while, typically after 8 to 12 hours of continuous use. Several surveys described pouring out their "sweat pools" that collected in the ear cups after extended periods of use. At first this appears contradictory to the responses in Question 1, in which 77% described the comfort as Good or Very Good. But it is also possible that the comfort issues that arise after 8 to 12 hours of continuous use may be a reflection of their environment. The vast majority of Afghanistan is undeveloped, usually only dirt and sand, where Soldiers can go for days without a shower. Sweat will always attract dirt and sand. The combination of sweat and dirt may have made the OTE TCAPS feel like sandpaper being worn on their ears, and yet the 56 survey respondents continued to wear them. The comfort issues described may have more to do with the basic challenges a Soldier faces living in a war zone than issues with the fit or design of the OTE TCAPS.
7. What did you DISLIKE the most about
the OTE TCAPS?

Too hot and/or too tight after        60%
extended wearing, typically 8 to
12 hours

Wires                                 7%
Other                                 33%

8. Would you recommend that OTE TCAPS           Yes   No
a unit issue for Soldiers?

In your military occupational specialty (MOS)   98%   2%
In another MOS                                  75%   25%
In every MOS                                    49%   51%


The responses to Question 8 speak to the frugality of experienced Soldiers. Perhaps not all Soldiers need TCAPS. If everybody had one, it could get very costly which should be considered during this time of fiscal constraint. Then again, every Soldier is exposed to noise just by being in the Army, especially in field training and deployed environments. Priority should initially be given to those who need them the most, but a universal Army-wide or even Department of Defense-wide TCAPS issue is something that almost half of this survey group would like to see.

[FIGURE 2 OMITTED]

OBJECTIVE DATA: COMPARISON OF PRE- AND POSTDEPLOYMENT HEARING LEVELS

Every US Army Soldier's hearing test data is stored in the Defense Occupational and Environmental Readiness System-Hearing Conservation (DOEHRS-HC) data repository. Queries to that repository for data of the 2,801 Soldiers who underwent postdeployment hearing tests at Fort Richardson from October 13 to October 21, 2012, indicated that 1,068 were non-OTE TCAPS users assigned to the same units as the 56 OTE TCAPS users who responded to the questionnaire. Further, comparison of pre- and postdeployment hearing test data showed a positive, significant threshold shift (STS) in 85 of those 1,068 non-OTE TCAPS users, as shown in the Table. The Department of Defense uses the Occupational Safety and Health Administration's definition of an STS8: a change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at 2000 Hz, 3000 Hz, and 4000 Hz in either ear. Only one of the 56 OTE TCAPS users showed a STS, which is equivalent to a 1.78% STS rate. Figure 2 presents the average pre- and postdeployment audiograms for the 56 OTE TCAPS users. In contrast, the non-OTE TCAPS group from the same units had a 7.95% STS rate.

A [chi square] analysis compared the STS rate in the group of 56 OTE TCAPS users to the STS rate in the group of 1,068 non-OTE TCAPS users, with the assumption that, given that they were assigned to the same units, a portion of the 2 groups of Soldiers must have gone together on the same missions, and therefore were exposed to a similar level (if not the exact same) of hazardous noise. Results showed a significant difference between the 2 groups' STS rates (P=.022642), demonstrating that OTE TCAPS users had significantly less hearing loss than those who did not wear OTE TCAPS.

SUMMARY AND CONCLUSION

The value of this quality assurance data report is that it was initiated at the individual Soldier level, using one of the oldest and most basic OTE TCAPS technologies available. The device that was used by the Soldiers in this report meets ruggedization standards perMIL-STD 8109 and electromagnetic compatibility per MIL-STD-461.10 Also of interest considering the repeated exposure to often considerable perspiration, these OTE TCAPS meet the standard for salt water submersion (3 feet for 30 minutes). (11) Over-the-ear devices do not require special fitting, as opposed to in-the-ear devices which must be fitted by medically trained personnel. (12) Although the system is technically complex and sophisticated, it is very user-friendly. There are only 2 control buttons on this OTE TCAPS: press and hold one button to turn on or off; press each button in short duration to adjust the volume level to louder or softer. Batteries (AA) are easy to find, inexpensive, and last approximately 270 hours. Analog compression technology uses a peak clipping strategy to block any hazardous impulse noise. There is no active noise reduction for protection from steady state noise, but the tight fitting and well-sealed gel ear cups provide maximum passive attenuation. There are optional push-to-talk (PTT) devices for radio connectivity. Soldiers who carry 2 radios can use 2 PTTs, or a single PTT with a toggle switch. Given the current and future TCAPS innovations using smaller, smarter digital, custom, and wireless technology, there is considerable potential for advancement in active noise reduction for protection from steady-state noise, as well as digital compression for protection from hazardous impulse noise. As the Army continues to endorse a more preventive approach and emphasis in all aspects of healthcare, the provision of hearing aids for service-related hearing loss may some day become only a minor component of the Army Hearing Program.

REFERENCES

(1.) Special Text 4-02.501: Army Hearing Program. Fort Sam Houston, Texas: US Army Medical Department Center & School; February 1, 2008. Available at: http://militaryaudiology.org/site/wpcontent/images/st_4_02_501.pdf. Accessed February 17, 2014.

(2.) Military Application: Combat Vehicle Crewman Headset page. Bose Corporation Web site. Available at: http://www.bose.com/controller?event=view_ static_page_event&url=/professional/military/ crewmanjsp. Accessed February 19, 2014.

(3.) Defense Update. International, Online Defense Magazine [serial online]. Available at: http://de fense-update.com/newscast/0907/news_27_09_07. htm#quietpro. Accessed February 19, 2014.

(4.) Peltor No Longer Restricted. PS Magazine online. Fort Belvoir, VA: US Army Logistics Support Activity; 2012;715:50. Available at: https://www.logsa. army.mil/psmag/archives/PS2012/715/715-50.pdf. Accessed February 19, 2014.

(5.) TEA Headsets Awarded TCAPS Order For INVI SIO X50 System. Soldier Systems [serial online]. October 9, 2013; Comms section. Available at: http://soldiersystems.net/2013/10/09/tea-headsetsawarded-tcaps-order-for-invisio-x50-system/. Accessed February 19, 2014.

(6.) Cissna M. Aberdeen Proving Grounds, MD: US Army Public Health Command; email, December 4, 2013.

(7.) Army Regulation 40-501: Standards of Medical Fitness. Washington, DC: US Dept of the Army; December 14, 2007 [revision August 4, 2010]:116[chap 11-4.g]. Available at: http://www.apd.army.mil/pdf files/r40_501.pdf. Accessed February 20, 2014.

(8.) Occupational Noise Exposure, 29 CFR [section]1910.95(g). Available at: https://www.osha.gov/pls/oshaweb/ow adisp.show_document?p_table=standards&p_ id=9735. Accessed February 20, 2014.

(9.) MIL-STD-810G: Department of Defense Test Method Standard: Environmental Engineering Considerations and Laboratory Tests. Washington, DC: US Dept of Defense; October 31, 2008. Available at: http://www.atec.army.mil/publications/ Mil-Std-810G/Mil-Std-810G.pdf. Accessed February 20, 2014.

(10.) MIL-STD-461F: Department of Defense Interface Standard: Requirements for the Control of Electromagnetic Interference Characteristics of Subsystems and Equipment. Washington, DC: US Dept of Defense; December 10, 2007. Available at: http:// snebulos.mit.edu/projects/reference/MIL -STD/ MIL-STD-461F.pdf. February 20, 2014.

(11.) Fallon E. Technical Services, 3M Personal Safety Division; email, 2013.

(12.) Department of the Army Pamphlet 40-501: Hearing Conservation Program. Washington, DC: US Dept of the Army; December 10, 1998. Available at: http://www.apd.army.mil/pdffiles/p40_501.pdf. Accessed April 11, 2014.
Questionnaire Data Used for [chi square] Analysis.

         TCAPS Users   No TCAPS Use   Rest of Brigade   Total
          Surveyed       Surveyed      No TCAPS Use
          Oct 13-21     Oct 13-21      10% STS Rate
            1.78%         7.59%
          STS Rate       STS Rate

STS           1              85              168          254
No STS       55             983            1,509        2,547
Total        56           1,068            1,677        2,801


MAJ Leanne Cleveland, MS, USA

MAJ Cleveland is Officer in Charge, Army Hearing Program US Army-Alaska, Joint Base Elmendorf-Richardson, Alaska.
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Author:Cleveland, Leanne
Publication:U.S. Army Medical Department Journal
Article Type:Report
Geographic Code:9AFGH
Date:Jul 1, 2014
Words:2748
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