Implications of Hearing Loss

For First Responders and Disaster Planners

Jonathan O’DellCommunication Access, Training and Technology Services

Massachusetts Commission for the Deaf And Hard of Hearing

COMMUNICATION PROTOCOL

Role of CART Provider/InterpreterPlease feel free to participate

actively; be as kind as to raise your hand if you have a question so I may respond

Thank you for taking time to attend this presentation!

Who we are • MCDHH is under the Executive

Office of Health and Human Services

• Offices in Boston, Plymouth, Worcester, Springfield and Pittsfield

• Contract with regional DHILS centers for IL Services

• About 48 staff statewide• 3 departments:

– Communication Access Training & Technology

– Interpreter and CART Services– Case Management

• Children and Family Services, Mass EDP

Have you ever been in an emergency situation

where you wish you were able to

communicate more effectively?

THE ADAThe Americans with Disabilities Act is the

most significant law dealing with civil rights and discrimination issues for persons with disabilities.Title I addresses Employment Title II addresses the responsibilities of State

and Local GovernmentTitle III addresses Places of Public AccommodationTitle IV addresses Telecommunications

Section OneUnderstanding Deafness and Hearing Loss

Population Demographics

Approximately 622,000 citizens of Massachusetts live with some degree of hearing loss or deafness.

The National Institutes of Health suggests that one out of every eight persons in the United States lives with a significant hearing loss. This translates into 28 million people

HEARING LOSS IS INVISIBLE

• Because of this, it is often impossible to visually identify people who need additional assistance to follow verbal directions and audible clues in an emergency

• Deafness and hearing loss prevent the absorption of “incidental” information that could prevent or minimize risk exposure

MANY CAUSES OF HEARING LOSS

• Illness – mother at birth, post-birth

• Genetics – inherited and spontaneous

• Medication• Trauma• Etiology Unknown • Aging – “wear and tear”• Occupational and long term

exposure• Sudden Hearing Loss

Hearing Loss• There are two kinds of hearing

losses:– Conductive, in which something

blocks the passage of sound into the ear

– Sensorineural, in which the mechanism for the pickup of sound waves and their conversion into electrical signals is somehow disrupted

– Conductive losses may sometimes be reversible. Sensorineural losses, which are far more common, are usually irreversible. Either way only an ENT can make a correct diagnosis.

Undamaged Hair Cells

Damaged Hair Cells

The Inner Hair Cells, which respond to higher frequencies, are the first to be affected by wear and tear. This leads to high frequency hearing losses, in which understanding what one hears, not volume alone, is the problem

Hearing Aids• Hearing Aids amplify sounds. They do not

make them any clearer, or distinguish between

desired sound sources and background noise

• They DO NOT EVER restore normal hearing.

• They require batteries to operate, and are

sensitive to moisture and chemicals. Hearing

aids will be destroyed by most

decontamination procedures.

Understanding the Populations

• Culturally Deaf Persons

• Oral Deaf Persons

• Hard of Hearing Persons

• Late Deafened Persons

• DeafBlind individuals

Understanding the role of ASL interpreters

• Each country has its own sign language and different regions within countries often have different “dialects”.

• American Sign Language (ASL) is a language in its own right with its own syntax and structure, used by Deaf individuals living in the United States to communicate with one another.

• An ASL interpreter interprets between ASL and English just as a “regular” interpreter might interpret between French and English.

• An ASL interpreter must complete an accredited study program, and must at a minimum pass screening/certification by the Registry of Interpreters for the Deaf.

• Interpreters develop different skill sets and specializations – medical, legal, substance abuse, to name several examples.

• A CDI, or Certified Deaf Interpreter, is a Deaf interpreter who can interpret between a formal ASL interpreter and “home signs” or “visual gestural” communication.

WHY USE A PROFESSIONAL SIGN LANGUAGE INTERPRETER ?

• Accuracy of information guaranteed when using certified and screened interpreter

• Ease and fluency of communication for both parties

• Ethical and interpretative issues when using a family member or friend to interpret

Factors influencing understanding

• Poor acoustics• Visual

distractions• Insufficient

lighting• Background

noise• Seating

arrangements• Distance from

speaker

• Speaker’s speech pattern and/or accent

• Poor signing skills

• Speaker movement

• Facial hair• Poor speech-

reading skills• Anxiety/

Nervousness• Fatigue

Communication Tips for first responders

• Get the person’s attention before starting to communicate

• Maintain eye contact, use gestures and mime

• Keep your face and mouth unobstructed

• Make sure light is sufficient and on your face, not coming from behind you; avoid visually distracting backgrounds.

• Be aware that having food, gum or other objects in your mouth while talking distorts lip movements

More Tips

• Speak clearly and at a moderate pace; do not overcompensate or shout

• Limit number of responders interacting with any given victim

• Give cues when introducing and changing subjects

• Talk to the person directly - not to the interpreter, CART reporter or companion

Section TwoDeafness and

Hearing Loss in Disaster Planning

and Recovery

Facts• Hearing and Understanding are NOT the same

thing, amplification rarely addresses communication issues

• Written information is great but not helpful to culturally Deaf individuals, at least not if complex

• Environmental factors play a great role in the success or failure of communication

• A high percentage of shelter seekers will be older individuals with attendant hearing losses

• There are many overlapping solutions to communication issues that will benefit most population subgroup members

What to think about• Identification of affected individuals in your

community is essential to planning and response.

How?– Councils on Aging, Senior Centers, Visiting Nurse

Associations, supported living facilities, MCDHH and DHILS

– Audiology offices and ENT practices; hospitals, pharmacies

– Targeted and Mainstream Media

• Prior communications and targeted planning ensure

smoother and faster emergency response. How?– Reverse 911, voluntary registries, communication

accessible community information sessions

• The nature of the emergency may disrupt communication– Sudden and extended power outages will render electronic

devices useless immediately or when recharging is not possible.

• House to house notifications/searches– If you know someone who is Deaf or HOH/LD lives at a particular

location, and there is no response to first responders at door, their alerting systems are probably not working due to power outage and they cannot hear you.

• Implementing evacuations and triage– Do not separate family members based on disability, have

written directions/maps and visual tip sheets/communication aids on hand

– Prepare for possibility that decontamination procedures will leave people without hearing aids and cochlear implants; purchase several inexpensive assistive listening devices to be used by triage staff

• Take into account communication methodologies employed by the targeted population. How?– More visual, less audible and textual.– Electronic communications for mobile devices, email, HTML– Use icons and universal signage/symbols, simple language– Open and closed captions on televisions– Strobes, visual alerts to get attention to message boards– Short ASL video clips formatted for mobile playback.

Shelter Considerations

• Light is absolutely essential for communication.

– Any emergency kits must contain flashlights for use by Deaf or Hard of Hearing: LED’s are best, broader illumination with less falloff

• Ability to recharge SmartPhones, pagers and CI batteries if person had enough forethought to bring devices and chargers with them

• A supply of 675 and 13 size hearing aid batteries,

the most commonly used sizes

• Have printed scripts, ASL video clips on hand

dealing with shelter SOP’s and “canned”

emergency information

– If purchasing any media, ask that they be

provided with captions or subtitles

• Be aware that some Deaf and hard of hearing

people may have Hearing Ear Dogs.

Vital Next Steps:

• At all levels, a uniform method of sharing disaster information and response with Deaf and hard of hearing people must be established.• Notifications should be geographically user-

selectable but complementary with one another

• Notifications cannot simply be complex text messages; need to be adjusted for target population

• Icons and simple text, mobile ASL clips

• Examples of messages conveyed via one or two-way

pager and open captioned TV:– Hurricane coming at 3:00 AM. Please go to shelter number 5

(assuming map with marked locations was distributed)

– Bad dangerous flu. Do not leave home. Turn on TV watch local

cable channel 3 for information.

– Danger in your area. Police ask you to leave home. Please go

to shelter number 5 right now.

Environmental Considerations

In the above scenario, the intake or triage nurse behind the desk is sitting with her back to the window. This makes the evacuees squint into the light while her face will be in the shadows.

In the above scenario, the staff behind the desk is sitting with her back to the wall, the light falls on her face. This improves speechreading and communication.

TECHNOLOGY

TDD/TTY

Phone Ringers & Amplifiers

Listening Systems

Smart Phones

TRS, VRS, IP Relay, CapTel and VP

TRS

VRS

IPRelay

VP

CAPTel

In-home Hazard Alerts

The most important environmental alerts are those potentially signaling threats to an individual’s health or life. In an emergency, however, this definition could expand to mean a telephone or doorbell alerting system

Local and Regional Hazard Alerts

Weather Radio with Strobe and Vibrator

Portable battery operated SAME WR with audible and flashing LED

alert

Accessibility Signage

TTY Closed Caption

ed

Amplified

Phone

Interpreter

Hearing Loss

AccessCART Informati

on

Questions and Answers

Thank you for coming today!

For feedback: Jonathan.ODell@massmail.state.ma.usMCDHH website : www.mass.gov/mcdhh