Editing Firefighter (section)

====Occupational hearing loss====
Another long-term risk factor from firefighting is exposure to high levels of sound, which can cause [[noise-induced hearing loss]] (NIHL) and [[tinnitus]].<ref name="Hong">{{cite journal |last1=Hong |first1=O. |last2=Samo |first2=D.G. |title= Hazardous Decibels: Hearing Health of Firefighters |journal= Workplace Health & Safety|date=1 August 2007 |volume=55 |issue=8 |pages=313–319 |doi= 10.1177/216507990705500803|pmid=17847625 |s2cid=36850759 |doi-access=free }}</ref><ref name="Tubbs">{{cite journal |last1=Tubbs |first1=R.L. |title= Noise and Hearing Loss in Firefighting |journal= Occupational Medicine |date=1995 |volume=10 |issue=4 |pages=843–885 |pmid=8903753 |url= https://www.ncbi.nlm.nih.gov/labs/articles/8903753/}}</ref> NIHL affects sound frequencies between 3,000 and 6,000 Hertz first, then with more frequent exposure, will spread to more frequencies.<ref name="Tubbs"/> Many consonants will be more difficult to hear or inaudible with NIHL because of the higher frequencies effected, which results in poorer communication.<ref name="Tubbs"/> NIHL is caused by exposure to sound levels at or above 85dBA according to [[National Institute for Occupational Safety and Health|NIOSH]] and at or above 90dBA according to [[Occupational Safety and Health Administration|OSHA]].<ref name="Tubbs" /> [[A-weighting|dBA]] represents A-weighted decibels. dBA is used for measuring sound levels relating to occupational sound exposure since it attempts to mimic the sensitivity of the human ear to different frequencies of sound.<ref name="Tubbs" /> OSHA uses a 5-dBA exchange rate, which means that for every 5dBA increase in sound from 90dBA, the acceptable exposure time before a risk of permanent hearing loss occurs decreases by half (starting with 8 hours acceptable exposure time at 90dBA).<ref name="Tubbs" /><ref name="OSHA" /> NIOSH uses a 3-dBA exchange rate starting at 8 hours acceptable exposure time at 85dBA.<ref name="Tubbs" /><ref name="NIOSH" />

The time of exposure required to potentially cause damage depends on the level of sound exposed to.<ref name="NIOSH">{{cite web|title=NIOSH/Criteria for a Recommended Standard--Occupational Noise Exposure, 1998|url=http://www.nonoise.org/hearing/criteria/criteria.htm|website=www.nonoise.org}}</ref> The most common causes of excessive sound exposure are sirens, transportation to and from fires, fire alarms, and work tools.<ref name="Hong" /> Traveling in an emergency vehicle has shown to expose a person to between 103 and 114dBA of sound. According to OSHA, exposure at this level is acceptable for between 17 and 78 minutes<ref name="OSHA">{{cite web|title=Noise exposure computation - 1910.95 App A {{!}} Occupational Safety and Health Administration|url=https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9736|website=www.osha.gov|language=en-us}}</ref> and according to NIOSH is acceptable for between 35 seconds and 7.5 minutes <ref name="NIOSH" /> over a 24-hour day before permanent hearing loss can occur. This time period considers that no other high level sound exposure occurs in that 24-hour time frame.<ref name="NIOSH" /> Sirens often output about 120&nbsp;dBA, which according to OSHA, 7.5 minutes of exposure is needed<ref name="OSHA" /> and according to NIOSH, 9 seconds of exposure is needed<ref name="NIOSH" /> in a 24-hour time period before permanent hearing loss can occur. In addition to high sound levels, another risk factor for hearing disorders is the co-exposure to chemicals that are [[Ototoxicity|ototoxic]].<ref>{{Cite journal|last=Johnson|first=Ann-Christin |last2=Morata |first2=Thais C. |date=2010|title=Occupational exposure to chemicals and hearing impairment. The Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. 44 (4): 177.|url=https://gupea.ub.gu.se/bitstream/2077/23240/1/gupea_2077_23240_1.pdf|journal=Arbete och Hälsa|volume=44|pages=177}}</ref>

The average day of work for a firefighter can often be under the sound exposure limit for both OSHA and NIOSH.<ref name="Tubbs" /> While the average day of sound exposure as a firefighter is often under the limit, firefighters can be exposed to [[Impulse noise (audio)|impulse noise]], which has a very low acceptable time exposure before permanent hearing damage can occur due to the high intensity and short duration.<ref name="Hong" />

There are also high rates of hearing loss, often NIHL, in firefighters, which increases with age and number of years working as a firefighter.<ref name="Hong" /><ref>{{cite journal|last1=Taxini|first1=Carla|last2=Guida|first2=Heraldo|title=Firefighters' noise exposure: A literature review|journal=International Archives of Otorhinolaryngology|date=6 January 2014|volume=17|issue=1|pages=080–084|doi=10.7162/S1809-97772013000100014|pmid=25991998|pmc=4423242}}</ref> [[Hearing conservation program|Hearing loss prevention programs]] have been implemented in multiple stations and have shown to help lower the rate of firefighters with NIHL.<ref name="Tubbs" /> Other attempts have been made to lower sound exposures for firefighters, such as enclosing the cabs of the firetrucks to lower the siren exposure while driving.<ref name="Tubbs" /> NFPA (National Fire Protection Association) is responsible for occupational health programs and standards in firefighters which discusses what hearing sensitivity is required to work as a firefighter, but also enforces baseline (initial) and annual hearing tests (based on OSHA hearing maintenance regulations).<ref name="Hong" /> While NIHL can be a risk that occurs from working as a firefighter, NIHL can also be a safety concern for communicating while doing the job as communicating with coworkers and victims is essential for safety.<ref name="Hong" /> [[Hearing protection|Hearing protection devices]] have been used by firefighters in the United States.<ref name="Tubbs" /> Earmuffs are the most commonly used hearing protection device (HPD) as they are the most easy to put on correctly in a quick manner.<ref name="Tubbs" /> Multiple fire departments have used HPDs that have communication devices built in, allowing firefighters to speak with each other at safe, but audible sound levels, while lowering the hazardous sound levels around them.<ref name="Tubbs" />