Hi, it's a pleasure to be here today and to speak with you. I'm grateful to the International Hearing Society for the invitation to speak with you about the Council for Accreditation in Occupational Hearing Conservation, or CAOC. My name is Andy Merkley. I'm a doctor of audiology and currently serve as the chair of the Council for Accreditation in Occupational Hearing Conservation and represent the Military Audiology Association on the Council. During this talk, I will introduce you to CAOC, its vision, its mission, its goals, and some of its programs that may be interesting to you. This is a fairly standard disclosure statement. The views expressed in this presentation are mine and do not reflect any official position or policy of the Council. I have no financial conflicts of interest to disclose, and the only non-financial conflict is that I am a representative of the Military Audiology Association to the CAOC Council. This is the agenda for my talk. I will briefly discuss the history of the Council, how it was formed, why it was formed, and some recent updates. I'll then discuss three particular courses that CAOC offers to help improve hearing conservation programs across the world. I'll then transition to a short discussion of the current CAOC initiatives and future goals. This is a list of acronyms that you will find in the presentation. Rather than spell them all out on each side, I provide this to you as a reference, although I believe most of you are familiar with these acronyms, if any acronym pops up during the presentation that you're not familiar with, you can refer back to this slide for more information. The Council for Accreditation in Occupational Hearing Conservation is our formal name. At the heart of what we do is training or overseeing the training and credentialing of occupational hearing conservationists, course directors who teach occupational hearing conservationists, and the professional supervisors responsible for the oversight of the audiometric monitoring program. The origin of the Council dates back to the mid-1960s, when the American Association of Occupational Health Nurses reached out to the American Speech-Language Hearing Association, the American College of Occupational Environmental Medicine, and the American Industrial Hygiene Association to address the challenges of implementing a comprehensive hearing conservation program or conservation hearing conservation programs across the United States. After meeting together, they formed what was called the Inter-Society Committee and developed the first guidelines for training audiometric technicians in industry. Then between 1965 and 1969, with the help of a federal grant, over 3,000 nurses, health professionals, and industrial professionals completed training following the guidelines that were set forth by that committee. In 1972, the committee met with representatives of every important organization in the United States connected to the prevention of hearing, occupational hearing loss. A standing committee was defined, was identified, and named the Inter-Society Committee for Standardization of Industrial Audiometric Technician Training and Hearing Conservation. Wow, what a mouthful. The National Institute for Occupational Safety and Health underwrote the formation, development, and the first-year operating funds for this organization. Then in 1973, the name was changed to the American Board of Occupational Hearing Conservation Technicians, and later in that same year, the name changed once again to what it currently is, the Council for Accreditation in Occupational Hearing Conservation. The council originally included representatives from AAOHN, ASHA, ACOM, AIHA, and the American Academy of Otolaryngology. In the years since the council's inception, the American Society of Safety Professionals, the Institute for Noise Control Engineering, and the American Academy of Audiology and Military Audiology Associations have joined the council. Today, each of these organizations remains strong in their support of best practices in occupational hearing conservation. CAOC is supported by our executive director, Ms. Cindy Lemick, and her administrative staff, Ms. Ashley Labby and Monica Jansen Halverson. They are located in Milwaukee, Wisconsin. The council works through a committee structure, which really focuses on improving the knowledge of our customers and consumers. Committees include the Occupational Hearing Conservation Course Director and Hearing Technician Committee, the Professional Supervisor Committee, Hearing Conservation Program Manager Committee, the Noise Control Committee, and the Marketing and Publications Committee. The council is led by an executive committee consisting of the executive director, the council chair, the immediate past chair, vice chair of education, vice chair for standards and advocacy, vice chair for credentialing, and the vice chair of finance. Our committee structure has branched out from being council members only to include OHCs, course directors, professional supervisors, as well as other professionals and industry leaders looking to improve hearing conservation programs and advance CAOC's strategic initiatives. In 2019, just prior to the pandemic, the council held a strategic planning session, the result of which produced new mission and vision statements, as well as new strategic initiatives for the council to tackle. The council's mission is to advance best practices in occupational hearing conservation worldwide through credentialing, standards, education, and advocacy. CAOC's mission is a world without occupational hearing loss. We believe wholeheartedly in our vision and believe it is an achievable goal. We aim to meet our mission and our vision by providing forward-thinking resources to professionals providing hearing healthcare services as part of a comprehensive hearing conservation program. The term worldwide emphasizes that quality hearing conservation training is in demand, much of it driven by multinational corporations, internal noise standards, and economic development. We see a lot of opportunity to bring our training and accreditation to the world. To support and educate our customers, the council has produced multiple resources for hearing conservation professionals. These resources include the Hearing Conservation Manual, which is now in its fifth edition and pending a sixth. This manual was written by several subject matter experts who are industry leaders in the field of occupational noise exposure and hearing conservation. It includes a glossary of terms, full-color illustrations, and is an excellent resource for any professional involved in hearing conservation. It covers all areas of instruction that students becoming certified hearing conservation technicians encounter during their training. CAOC has also developed a workplace noise and a basic anatomy and diseases of the ear video for use in basic OHC training and in many college entry-level communication disorders and hearing conservation courses. The workplace noise video consists of six lessons covering characteristics of sound, the decibel, time-weighted average, permissible exposure limits, noise control strategies, and measuring sound. The anatomy covers a brief introduction to hearing conservation, basic ear anatomy, otoscopy, and the types and causes of hearing loss, including both conductive and sensory neural hearing loss. To help students prepare for the COHC written examination, a study guide was developed. This study guide was created by CAOC's Occupational Hearing Conservationist and Course Director Committee, a working group of active and highly experienced course directors, to provide both course directors and the aspiring Occupational Hearing Conservationists a measure of guidance and focus in preparing for the standardized exam. To advance our mission of hearing prevention, the Council produced three on-demand professional courses. Although available in person for around 20 years, the professional supervisor course has been enhanced and is now available in both on-demand and live formats. This course is designed for professionals who have responsibility for overseeing the audiometric monitoring portion of a hearing conservation program, supervising hearing technicians, reviewing problem audiograms, and making work-related determinations. Although primarily focused toward physicians and audiologists, any licensed healthcare provider, support personnel, and support personnel may benefit from this training. Currently, certification as a professional supervisor is available only to physicians and audiologists, but any healthcare professional with interest in the topic may attend. The course is approved for 13 hours of continuing education. The Hearing Conservation Manager course is the newest of the on-demand training courses and provides basic instruction to staff who have been assigned as the Hearing Conservation Program Manager, responsible for coordinating all elements of the Hearing Conservation Program, like noise assessment, noise control, surveillance audiometry, hearing protection fitting, education, record-keeping, and program evaluation. There is a significant gap in education for the responsibilities of the Hearing Conservation Program Manager, and this on-demand workshop covers all of the important responsibilities. The noise course, or noise measurement course, is an eight-part course that stresses noise assessments, equipment, survey design, data analysis, and follow-up. This course of instruction is appropriate for industrial hygiene professionals and technician staff with responsibilities for noise hazard identification, noise control, and educating employers about noise. Another very useful and free tool for hearing conservationists available through CAOC is the CAOC Update Newsletter. Now, CAOC Update Newsletters are published online. It's not an email-to-out type newsletter, but the update contains articles related to hearing conservation that are relevant to today, as well as updates on research and other aspects of hearing conservation that are of interest to hearing conservation professionals. The Update Newsletter is available on the CAOC website, so just go to the website and select Update, and you can look for whatever topic that might be of interest to you. There's probably an article out there on that topic. Finally, the Council has also updated the CAOC website. Here you'll find information, how-tos for the Certified Occupational Hearing Conservationist, the Course Director, Professional Supervisor, and the Hearing Conservation Program Manager. You can also find links to various products that the Council has developed, the CAOC Learning Center, and your individual CAOC account. You may also find opportunities to volunteer. The Council is always seeking volunteers to assist with its strategic efforts, especially along the lines of education. Every committee is comprised of Council members and volunteers, so if you're interested, please reach out to the Council Administrative Office, either through email or by clicking on the volunteer link or calling the office. Now let's talk about the main educational initiatives of the Council, starting with the Certified Occupational Hearing Conservationist. Nearly every hearing conservation program within the United States has a Certified Occupational Hearing Conservationist. This individual plays an integral role on the hearing conservation team. Certified Occupational Hearing Conservationists come from a variety of professions, including audiology, medicine, nursing, industrial hygiene, human resources, safety, and general industry. Although roughly 60% of COHCs in the United States come from the nursing community, the other 40% is largely technical staff like medical and nursing assistants, paramedics, and even x-ray technicians. Whatever the profession, the COHC may be responsible for performing pure tone air conduction audiometry, fitting hearing protection devices, providing education, and enforcing compliance with the hearing conservation program. Although not required by law, many occupational medicine physicians also become COHCs due to the lack of training in audiometry in their medical and residency programs. So this is what the CAOC COHC training program consists of. In order to become a COHC, a candidate must complete a CAOC-approved 20-hour certification course and pass the accompanying exam. Now this is a minimum amount of time spent in learning. So the minimum amount of time that the class will take is 20 hours, but many take much longer. During that course, students will receive training in 11 major domains of knowledge, including hearing conservation just in general, anatomy, physiology, and diseases of the ear, the physics of sound, and hearing standards and regulations, audiometer in the testing environment, audiometric testing, audiometric review and evaluation, noise measurement and control, hearing protection fitting, hearing conservation training, record keeping. And then they will also receive practical hands-on training in hearing protection fitting, at least 60 minutes of hands-on training with four different types of hearing protectors, and at a minimum 150 minutes of training in conducting pure tone air conduction audiometry, including setting up the equipment, giving instruction to the patient, calibrating the instrument and making sure it's ready to go for the day. Then audiometric technique using the standards outlined in ANSI S3.21, counseling the patient, explaining the test results, and so forth. So these technicians are very well trained in what they do. The COHC scope of practice is quite large, and although they may not be doing all of these tasks in their workplace, it is certainly within their scope of practice, and they receive education in each of these topics during their training. Now unless otherwise qualified through other training or credentialing, the COHC is limited in their scope of practice. They are not allowed to assume the role of the professional supervisor unless they happen to be an audiologist or physician. They're not allowed to instruct other technicians on how to conduct audiometry unless under the supervision of a certified course director. They're not allowed to conduct other audiometry tests like speech or tympanometry or bone conduction audiometry. They're not qualified to diagnose hearing problems, interpret audiograms. Now they can certainly explain audiograms, but not interpret. They're certainly not going to be giving any diagnostic statements. They're also not qualified to conduct noise surveys or be responsible for the noise control initiatives. Now becoming a certified occupational hearing conservationist can be beneficial for individuals working in occupational health and safety, especially those involved in preventing and managing hearing loss in the workplace. Here are some reasons why someone might choose to become a COHC. Number one, expertise in hearing conservation. Certification as a COHC demonstrates specialized knowledge and expertise in the field of hearing conservation. This includes understanding the causes of hearing loss, the principles of hearing protection, and strategies for preventing occupational hearing damage. Number two, compliance with regulations. In many jurisdictions, there are regulations and standards in place to protect workers from occupational hazards, including exposure to high levels of noise. Becoming a COHC ensures that individuals are well-versed in these regulations and can help organizations comply with the legal requirements. Number three, improved workplace safety. Hearing loss is a common occupational health issue, particularly in industries where workers are exposed to loud noise. A COHC can contribute to creating a safer work environment by implementing effective hearing conservation programs, conducting noise assessments, and recommending appropriate protective measures. Employee health. This is number four, employee health and well-being. Occupational hearing conservationists play a crucial role in safeguarding the health and well-being of workers. By identifying and addressing potential hearing hazards in the workplace, they contribute to the overall health and quality of life of employees. Number five, risk reduction. Through proper training and certification, COHCs can help organizations identify and mitigate risks associated with noise exposure. This can lead to a reduction in the number of occupational hearing loss cases, lowering the risk of compensation claims and associated costs to the employer. Number six, professional recognition. Certification as a COHC can enhance one's professional credibility and recognition within the occupational safety and health field. It serves as a validation of the individual's commitment to continuous learning and expertise in hearing conservation. Number seven, career advancement. Individuals with a COHC certification may find increased opportunities for career advancement within the occupational health and safety fields. Employers often value employees who have specialized skills and certifications relevant to the specific needs of the workplace. And then number eight, contribution to public health. By promoting hearing conservation in the workplace, COHCs can contribute to the broader goal of public health. Preventing occupational hearing loss not only benefits individual workers, but also helps reduce the overall societal burden of hearing related issues. Overall, becoming a certified occupational hearing conservationist can be a valuable investment for individuals seeking to make a positive impact on workplace safety and employee wellbeing. As mentioned previously, there are over 21,000 active certified occupational hearing conservationists throughout the world. COHC approved courses are taught all over the world. At the time of this workshop, there are approved classes in 37 states and three countries outside the United States. These are just the courses that are available to the public. Other courses are taught privately and not published on the COHC website. So let's now shift gears and talk a little bit about the professional supervisor and the training of professional supervisors that COHC offers. I'd like to focus a little attention on the certified professional supervisor of the audiometric monitoring program class that COHC, this is a class that COHC offers to physicians and audiologists throughout the United States. In the United States, regulatory guidelines allow qualified and trained technicians to conduct monitoring audiometry for workers exposed to hazardous noise. We just got done talking about the training of certified occupational hearing conservationists. The same regulatory guideline requires that these technicians be supervised by an audiologist, otolaryngologist, or a physician. In a very recent letter of interpretation, the Occupational Safety and Health Administration defined a physician as a medical doctor or a doctor of osteopathic medicine. If an international professional meets those same qualifications without necessarily the designation of an MD or a DO, they may also be considered qualified, but it has to be somebody that's trained in allopathic medicine. What the regulatory guidelines don't specify is what type of physician or audiologist. Any physician, an ophthalmologist, a dermatologist, a gynecologist, a nephrologist, could potentially be managing audiometric technicians. Same for audiologists, it could be a geriatric or a pediatric audiologist, a cochlear implant specialist, for example. For this reason, the council put together a course of instruction for professionals who have the responsibility for supervising hearing technicians, overseeing the surveillance audiometry program, interpreting audiometric test results, addressing problem audiograms, and making work-relatedness determinations. The American College of Occupational and Environmental Medicine published a scope of practice guideline for professional supervisors in order to clearly delineate their responsibilities, pardon me, delineate their responsibilities and help professionals understand the variety of responsibilities that they have. In addition to many potential responsibilities, the professional supervisor is responsible for establishing and supervising the audiometric testing program, reviewing problem audiograms, making work-relatedness determinations, determining follow-up requirements for potential auditory problems, and managing the audiometric database. Many physicians, otolaryngologists, and audiologists may not be comfortable assuming the responsibilities of the professional supervisor based solely on the education that they received in school. The professional supervisor of the Audiometric Monitoring Program, or the CPSA, this workshop is an intermediate-level full-day course designed to specifically address the responsibilities of the professional supervisor and emphasize the real-world application of the professional expertise as encountered in the occupational setting. Lectures review the current literature and recommended practice guidelines. Instructors present employee case studies for the participants of the course to address and use for problem-solving, critical thinking, and small-group discussion. Case presentations discuss the professional supervisor's responsibilities, guidelines for managing problem audiograms, and determining work-relatedness. This workshop is intended for audiologists, physicians, and otolaryngologists who supervise and or review audiometric testing from hearing loss prevention programs. Physicians' assistants, occupational health nurses, nurse practitioners, and other professionals are invited to participate in the course. However, they are not eligible to take the certification exam. They should have prior understanding of governmental regulations and regulations related to the components of the hearing loss prevention program. They also need to have an interest or experience in making work-relatedness determinations for occupational noise-induced hearing loss. Most international courses taught by CAOC run for two days and include additional instruction on hearing protection devices, international regulations, and work-relatedness determinations. Now, in determining the need for this specialized certification, CAOC council committee members considered many issues emerging among health professionals. First, most graduate courses in both audiology and medicine spend very little time instructing students on occupational hearing conservation. Graduates often feel uneasy when asked to review audiograms for the purpose of making a work-relatedness determination. This course fills the gap, sets you apart from other professionals in the field, and demonstrates commitment to ongoing continuing education in the field of occupational hearing conservation. Certification for the professional supervisor is valid for five years and requires attending a recertification course or otherwise demonstrating minimum levels of continuing education and passing a written exam. Professionals who have taken the CAOC professional supervisor workshop report an improved ability to manage the many aspects of the audiometric monitoring program and feel better prepared to engage with companies to improve their hearing conservation programs. Now, as mentioned previously, there are over 150 active certified professional supervisors throughout the world. CAOC offers courses at least three times a year in conjunction with professional organization conferences. And they also, like I mentioned before, have made this education available in a self-paced learning environment on the CAOC Learning Center. Future courses, we're looking at the American Academy of Audiology, but also training internationally as well. So now let's talk and shift focus to the training of the Hearing Conservation Program Manager. And this, almost everybody employed in a noise hazardous occupation may be called upon at one time or another to manage that company's hearing conservation program. Although this responsibility often gets confused with that of the professional supervisor, it is different. Although they might be the same person, they're likely not. For this purpose, the council saw fit to work with the hearing conservation specialists across the United States to develop the Hearing Conservation Program Manager course. This course covers all areas of responsibility a program manager assumes, including oversight of the noise hazard assessment, noise control, surveillance audiometry, hearing health education, hearing protection, record keeping, and the evaluation of the program. The Hearing Conservation Program Manager course is a self-directed online course available through the CAOC Learning Center. It is available as a full course that includes roughly four hours of instruction, or it can be broken down into individual modules for those professionals who have knowledge in some aspects of the program, but not in others. The modules include noise measurement, noise controls, hearing protection, monitoring audiometry, education, record keeping, and program evaluation. This is a relatively new course offering through the CAOC Learning Center, and to date, roughly 400 Hearing Conservation Program Managers have taken the course. Now, as mentioned previously, the council met in 2019 to develop their strategic plan and initiatives. The strategic goals of the council include first, public health impact. So the attitude and beliefs and understanding of protecting ourselves from overexposure to noise is an accepted core public health issue. So this is promoted through educating OHCs, course directors, professional supervisors, through advocacy and partnerships. And today, the council has entered into an alliance with the Occupational Safety and Health Administration. In this alliance, we are currently working on two primary objectives. One, to improve and streamline the process for determining work-relatedness. We are closely working with OSHA to educate providers and employers on their responsibilities when it comes to determining work-relatedness. Second, we are working on an initiative to improve the hearing health of construction workers through education, advocacy, and improved fitting of hearing protection. We also work closely with OSHA on other initiatives that support hearing health, like the Safe and Sound Initiative. During the 2023 Safe and Sound Month, CAOC offered a 50% discount to anyone taking the Hearing Conservation Program Manager course. Second, OHC and the professional supervisor demand. We want employers to seek out and recognize CAOC-trained individuals, the program manager, the CAOC Certified Occupational Hearing Conservationist, and the Certified Professional Supervisor as a best practice for their hearing conservation programs. Third is developing our global brand. We want CAOC to be seen as the leading global authority in occupational hearing conservation for employers, regulators, legislators, professionals, and workers. We partner with the National Institute for Occupational Safety and Health and the National Hearing Conservation Association to promote the Safe and Sound Award. This is a separate initiative from OSHA's Safe and Sound Program and recognizes companies or individuals for their remarkable efforts in any hearing conservation domain. You can visit the Safe and Sound website to learn more about the program and maybe see if your company may be competitive for this prestigious award. We also partner with these organizations to promote best practices in hearing conservation, like personal hearing protection fit testing and a grassroots initiative to reduce OSHA's exposure limit to 85 dBA using a three decibel time intensity exchange rate. Now, we are also partnering with NHCA on quarterly, quality and quarterly webinar series related to anything hearing conservation. This initiative provides timely education to hearing conservation professionals as well as valuable continuing education in the area of hearing conservation. We are also working on a partnership with the International Occupational Hygiene Association, which has a global membership and a very common mission. Fourth, relevant education. CAOC provides in-demand education credentialing programs that are locally and globally recognized and evidence-based, both in their impact on the profession and the professional's impact on the work environment and workers. Through CAOC's Learning Center, professionals in all areas of hearing conservation may obtain valuable and relevant instruction. So in conclusion, the council, CAOC, is a council of subject matter experts from all aspects of hearing conservation and a leading source of information for the hearing conservation community. The educational programs that are available from CAOC support improved hearing conservation programs globally and CAOC strategic initiatives support this CAOC strategic plan, advancing hearing conservation efforts and facilitating partners with similar like-minded organizations globally. So I appreciate the time that I've had to speak with you today. I'm open to answer any questions that you might have. I know this is a virtual course, so I won't be able to answer them directly, but please feel free to reach out to myself directly or through the CAOC administrative office if you have any questions about the content that I've discussed or you would like additional information related to CAOC and its products, its mission, its vision, its goals. Thanks again, and I wish you a wonderful day.

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