Running head: FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 1

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1 Running head: FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 1 Fire Safety Education for the Deaf or Hard of Hearing Zenith Lee Parker Forsyth Co. Fire Dept., Cummings, GA

2 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 2 Fire Safety Education for the Deaf or Hard of Hearing CERTIFICATION STATEMENT I hereby certify that this paper constitutes my own product, that where the language of others is set forth, quotation marks so indicate, and that appropriate credit is given where I have used the language, ideas, expressions, or writings of another. Signed:

3 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 3 Abstract Forsyth County Fire Department strives to meet the needs of the citizens of Forsyth County. The problem is the Forsyth County Fire Department does not provide fire safety education for the deaf or hearing impaired. The purpose of this research is to identify who makes up the deaf or hard of hearing community and identify how to reach them with fire safety education. The descriptive research method was used to conduct the research. The research included a literature review of current authors on the deaf and hard of hearing population, their fire risks, resources to aid them, and fire and life safety programs for the hearing impaired population. Surveys were completed by fire similar fire departments to identify existing programs within Georgia. The surveys asked: 1. Has your department recognized deaf or hearing impaired members/groups within your jurisdiction? If so, how did you identify these individuals/groups? How many have you identified? 2. What fire and life safety programs does your department offer for deaf or hearing impaired residents? (Smoke alarms, fire/safety awareness, severe weather, etc.) Are the programs tailored to certain age groups? (children or older adults) and 3. Does your department offer flashing or vibrating smoke alarms for the deaf or hearing impaired? If so, how are they attained by the department? The research determined that the deaf or hard of hearing population is increasing as the as the age increases. The deaf or hard of hearing are a population at greater risk of fire related injury or death, but there are resources to aid in alerting them and reducing the risk. Only a small percentage of fire department actually has programs for the hearing impaired. Several recommendations for FCFD include getting department buy-in for a new program, using public service announcements and seeking grants for funding.

4 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 4 Table of Contents Abstract 3 Table of Contents.4 Introduction..5 Background and Significance..6 Literature Review.9 Procedures.. 21 Results...24 Discussion..46 Recommendations..49 References.. 51 Appendices

5 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 5 Introduction Forsyth County Fire Department (FCFD) strives to meet the fire and life safety education needs of the community. The Public Safety Education division works to educate the public about fire prevention and the dangers of fire, as well as the many services offered to the community by the fire department. (Forsyth County Fire Department, 2012) This division works in local schools, installs smoke detectors for elderly and needy citizens and offers fire safety education to any interested party. The problem is the Forsyth County Fire Department does not provide fire safety education for the deaf or hearing impaired. The purpose of this applied research project is to identify who makes up the deaf or hard of hearing community and identify the best way to reach them with fire safety education. The descriptive research method was used to conduct the research. The research included a literature review of current authors on the subject. Surveys were completed by several fire departments within the state of Georgia. Research will answer the following questions: 1. Who are the people that make up the deaf or hard of hearing population? 2. What are the fire risks facing the deaf or hard of hearing community? 3. What resources are available to meet the fire safety needs of the hearing impaired community? 4. What fire and life safety programs does FCFD offer to the community? 5. What programs for the deaf or hard of hearing exist in similar fire departments?

6 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 6 Background and Significance Forsyth County Fire Department (FCFD) began as a volunteer fire department in 1972 in response to a residential fire claiming the life of a county resident. From its beginning, there has always been a grass roots desire to help those within the community. The initial draft of the fire department regulations stated our objective shall be the preservation and protection of life and property from and during such fires as may occur in Forsyth County. (Forsyth County Fire Department, 2012) Currently, the first department goal listed in the FCFD Annual Report is prevent incidents from occurring through code enforcement, public education and fire prevention activities. (Forsyth County Fire Department, 2012) The Public Safety Education division operates within the Office of the Fire Marshal. Three Fire Prevention Training Officers are assigned to the division and they work routinely in local schools, offer fire safety education to citizens, install smoke detectors for citizens, and operate the departments fire safety house. Additionally, these dedicated members run two summer fire camps for local youth, host an annual fire safety poster contest, and offer a Trunkn-Treat event stressing the importance of Halloween safety. To keep up with all of the programs, the training officers are provided with assistance from the 120 plus firefighters in the Operations Division. However, through all of these efforts, nothing has been considered for the deaf or hard of hearing community. It is estimated that 30.0 million or 12.7% of Americans 12 years and older had bilateral hearing loss from 2001 through This estimate increases to 48.1 million or 20.3% when also including individuals with hearing loss in just one ear. Overall, the prevalence of hearing

7 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 7 loss increases with every age decade. The prevalence of hearing loss is lower in women than in men and black vs white individuals across nearly all age decades. (Lin, Niparko, & Ferrucci, 2011) The population of Forsyth County at the time FCFD was formed was around 17,000 people. (Forsyth County, 2013) However, because of its great location just 45 minutes north of downtown Atlanta, Georgia, Forsyth County has experienced significant growth. The estimated 2012 population was 187,928. (U.S. Census Bureau, 2014) The American Fact Finder section of the U.S. Census Bureau estimated that Forsyth County s 2012 population with hearing difficulty included 1,690 males and 1,973 females. (U.S. Census Bureau, 2012) These figures reflect all males and females ranging from birth to age 75 and older. Together, these numbers account for approximately two percent of the population of Forsyth County. Couple these figures with the fact that Forsyth County s demographics show that 87.5 percent of the population is white alone, while 10.2 percent of the population is over age 65; both demographics have an increased prevalence of hearing loss. The deaf or hard of hearing population can be expected to increase in the future. Hearing loss is one of the most common conditions affecting older and elderly adults. Approximately one in three people between the ages of 65 and 74 has hearing loss and nearly half of those older than 75 have difficulty hearing. Having trouble hearing can make it hard to understand and follow a doctor's advice, to respond to warnings, and to hear alarms. All of this can be frustrating, embarrassing, and even dangerous. (NIDCD, 2013) Forsyth County estimates that by 2030, the largest proportion of the population will be 65 years of age and older as reflected in Table 1. If the future estimates are any indication, Forsyth County s deaf or hard of hearing population among the elderly alone could be 9,000-13,500 by

8 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF and 14,000-21,000 by 2030 based on the National Institute on Deafness and other Communication Disorders (NIDCD) statistics. Table 1: PROJECTED AGE DISTRIBUTION FORSYTH COUNTY AGE Percent 2020 Percent 2030 Percent GROUP 65+ 6,940 15, % 27, % 42, % Total 98, , % 250, % 370, % (Forsyth County, 2012) This project is directly related to the Executive Analysis of Community Risk Reduction (EACRR) ultimate goal to implement a plan to reduce preventable occurrences and/or mitigate loss from risks that cannot be stopped. (National Fire Academy, 2013) The risk exists in Forsyth County for a deaf or hearing loss citizen to be injured or killed by fire or other emergency. This specific demographic is not being reached currently. This research will attempt to identify programs that can be used to reach these citizens. This project is further related to the United States Fire Administrations goal of reducing the risk at the local level through prevention and mitigation. (United States Fire Administration, n.d.) The research will show that deaf or hearing loss citizens are an at risk group within the community. Next, the FCFD Public Safety Education division will use the research and recommendations to develop a plan to reduce the level of risk to this group.

9 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 9 Literature Review Statistics for the number of deaf people are a huge problem. Most census counts tend to ignore deaf people as a separate category. When deaf people are recognized at all, they are usually lumped in with all other disabled/handicapped people or, if the census is conscientious about differentiating among disabilities, will lump all individuals with "hearing loss" together. (Harrington, 2012) Harrington adds "hearing loss" is another big problem; it brings up questions about the definition of "deaf": at what point does a person cross over from "hearing" to "hard of hearing", from "hard of hearing" to "deaf"? Estimates of the number of deaf and hard of hearing persons in the United States are typically based on one of two national household surveys conducted by the federal government: the National Health Interview Survey (NHIS) or the Survey of Income and Program Participation (SIPP). (Mitchell & Cole, 2011) The NHIS is conducted annually by National Center for Health Statistics (NCHS). Degree of hearing loss or deafness is determined by an individual's or informant's response to the question, "Which statement best describes your [child's] hearing (without a hearing aid): good, a little trouble, a lot of trouble, or deaf?" The NHIS results from the 2010 U.S. Census were compiled by the U.S. Department of Health and Human Services, Center for Disease Control and Prevention. The report showed that overall, 37 million adults (16 percent) aged 18 years and older experienced some hearing difficulty without a hearing aid. Men were more likely to have experienced hearing trouble than women (21 million or 19.1 percent compared to 16 million or 12.7 percent respectively). Age was positively associated with hearing difficulties (without a hearing aid). As age increased, the percentages of adults with hearing trouble increased. There were 500, year olds with hearing trouble (6.7 percent), 2.9 million year olds (18.9 percent), 2 million year

10 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 10 olds (31.2 percent) and 3.5 million (45.2 percent) aged 75 and older. When results are considered by sex and ethnicity, non-hispanic white men were more likely to have had hearing trouble compared with other men or women. Note: Respondents were asked These next questions are about your hearing WITHOUT the use of hearing aids or other listening devices. Is your hearing excellent, good, [do you have] a little trouble hearing, moderate trouble, a lot of trouble, or are you deaf? For the previous results, a little trouble hearing, moderate trouble, a lot of trouble, and deaf are combined into one category. (Schiller, Lucas, Ward, & Peregoy, 2012) In its supplemental questionnaires on adult and child functional limitations, the Survey of Income and Program Participation (SIPP) contains questions about whether respondents had difficulty performing a specific set of functional and participatory activities. For many activities, if a respondent reported difficulty, a follow-up question was asked to determine the severity of the limitation. Using these responses and others to questions about specific conditions and symptoms, this report presents disability as severe and non-severe, defined in Figure 1. These two measures combine to provide an overall estimate of disability prevalence. (Brault, 2012) Brault (2012) defines difficulty hearing as experiencing deafness or having difficulty hearing a normal conversation, even when wearing a hearing aid. Those who were deaf or unable to hear a normal conversation were described as having a severe difficulty. About 7.6 million people (3.1 percent) experienced a hearing difficulty, including 1.1 million people who had a severe difficulty hearing. About 5.6 million people (2.3 percent) used a hearing aid, of which 2.2 million reported some difficulty hearing. For people aged 65 and older, 4.2 million or 10.8 percent had difficulty hearing. About 4.2 million people aged 65 and older reported hearing aid use, of which 1.7 million had difficulty hearing. (Brault, 2012)

11 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 11 Gallaudet University, the world s only university with programs and services specifically designed to accommodate deaf and hard of hearing students, was established in 1864 by an Act of Congress. They have a unique obligation to contribute knowledge likely to benefit deaf and hard of hearing people. Accordingly, the Gallaudet Research Institute conducts studies related to demographics and assessment of deaf and hard of hearing people in the educational system. (Gallaudet University, 2013) They do not manage surveys of the adult deaf and hard of hearing population. Nonetheless, because of repeated inquiries, they have developed their own rough estimates based on data. Harrington (2012) presented the estimates in Table 2. Table 2: American Deaf Population, by Galluadet University Total U.S. Population Have hearing problems Percentage U.S. 294,043,000 38,225,590 13% >6 years old Not listed 691, % Ages ,414,000 2,309, % Ages ,019,000 2,380, % Ages ,668,000 2,634, % Ages ,217,000 3,275, % Ages 65 and over 30,043,000 8,729, % Mr. Harrington also points to an older analysis where the Gallaudet Research Institute divides deaf into three different definitions. The first definition used is deaf in both ears, which resulted in.18 percent of the population. Next he uses the definition cannot hear and understand any speech, resulting in.23 percent of the population. The final definition at best,

12 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 12 can hear and understand words shouted into the better ear showed results of.49 percent of the population. (Harrington, 2012) The American Community Survey (ACS) is an ongoing survey that provides data every year -- giving communities the current information they need to plan investments and services. Information from the survey generates data that help determine how more than $400 billion in federal and state funds are distributed each year. (U.S. Census Bureau, 2013) To help communities, state governments, and federal programs, the survey asks about: age, sex., race, family and relationships, income and benefits, health insurance, education, veteran status, disabilities, where you work and how you get there, where you live and how much you pay for some essentials. The question pertaining to hearing as it appears on the survey is: Is this person deaf or does he/she have serious difficulty hearing? (U.S. Census Bureau, 2013) The Table below shows the results of the 2012 American Community Survey 1-Year Estimates for the noninstitutionalized population of Georgia and Forsyth County, Georgia.

13 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 13 Table 3: 2012 American Community Survey 1-Year Estimates, Georgia and Forsyth County Georgia total Population 9,719,411 (U.S. Census Bureau, 2012) Forsyth County, Georgia 187,149 (U.S. Census Bureau, 2012) Male Ages Total Hearing Ages Total Hearing 4,691,533 Difficulty 92,538 Difficulty Under 5 341,922 2,972 Under 5 6, ,327 6, , ,105,808 9, , ,833,488 66, , ,163 43, , ,825 44, Female Ages Total Hearing Ages Total Hearing 5,027,878 Difficulty 94,611 Difficulty Under 5 3,291, Under , , ,166, , ,011,072 34, , ,383 20, , ,602 53, ,318 1,209 The number of deaf or hard of hearing is important to know when trying to reach the community. It is also important to put the numbers into perspective within your community.

14 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 14 This can be accomplished with more information. The Hearing Loss Association of America (HLAA) is the nation s leading organization representing people with hearing loss. Their website states that according to the National Center for Health Statistics, 48 million (20 percent) Americans have some degree of hearing loss making it a public health issue third in line after heart disease and arthritis. (Hearing Loss Association of America, 2014) They also state that at age 65, one out of three people has a hearing loss and 60 percent of the people with hearing loss are either in the work force or in educational settings. The Hearing Health Foundation reports more interesting facts on hearing loss. According to their estimates: (Hearing Health Foundation, 2013) Almost 50 million Americans have hearing loss in at least one ear, including 1 in 5 teenagers. 60% of veterans returning from Iraq and Afghanistan come home with hearing loss and tinnitus; it is the #1 war wound. Depression and isolation are common among those with hearing loss. Those with a mild hearing loss are twice as likely to develop dementia, and this risk increases with the severity of the hearing loss. Over a six-year study, the cognitive abilities of older adults (ages 75 to 84) with hearing loss declined 30% to 40% faster than in older adults whose hearing was normal. On average, older adults with hearing loss developed a significant impairment in their cognitive abilities 3.2 years sooner than those with typical hearing. Men are more likely than women to experience hearing loss.

15 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 15 In the United States, three out of every 1,000 children are born deaf or hard-ofhearing. Hearing loss becomes more prevalent with age; hearing impairment occurs in about 18% of American adults between ages 45 and 54, 30% of adults between ages 65 and 74, and 47% of adults ages 75 and older. About 26 million Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud noises at work or in leisure activities. When describing hearing loss, there are three aspects that are generally considered according to the American Speech-Language-Hearing Association (ASHA): type of hearing loss, degree of hearing loss, and configuration of hearing loss. (American Speech-Language-Hearing Association, 2011) They go on to state that there are three basic types of hearing loss. Conductive hearing loss occurs when sound is not sent easily through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Possible causes of conductive hearing loss include fluid in the middle ear from colds or allergies, ear infection, too much earwax or foreign body in the ear canal. Sensorineural (SNHL) hearing loss happens when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain. SNHL cannot usually be medically or surgically corrected and is the most common type of permanent hearing loss. Some possible causes of SNHL include drugs that are toxic to hearing, genetic or hereditary hearing loss, and exposure to loud noise and aging. Mixed hearing loss occurs when a conductive hearing loss happens in combination with an SNHL such as damage in the outer ear and in the inner ear.

16 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 16 Degree of hearing loss refers to the severity of the loss. A number is assigned to represent the patient s hearing loss range in decibels (db HL). One of the more commonly used classification systems is represented here: Degree of hearing Loss Hearing loss range (db HL) Normal -10 to 15 Slight 16 to 25 Mild 26 to 40 Moderate 41 to 55 Moderately Severe 56 to 70 Severe 71 to 90 Profound 91+ The configuration, or shape, of the hearing loss refers to the degree and pattern of hearing loss across frequencies (tones) as illustrated in a graph called an audiogram. High frequency loss affects the high tones and its configuration would show good hearing in the low tones and poor hearing in the high tones. The opposite would hold true for low frequency loss. Some configurations are flat, indicating the same amount of hearing loss for high and low tones. (American Speech-Language-Hearing Association, 2011) There are two common views on deafness and Deaf individuals according to the Executive Office of Health and Human Services (EOHHS) for the Commonwealth of Massachusetts. (Commonwealth of Massachusetts, 2014) The first is often referred to as the medical/pathological model. Supporters of this viewpoint regard a deaf individual as someone who cannot hear, who is lacking auditory capability, who is deficient in some way because he or

17 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 17 she may not be able to communicate by speaking and hearing. This viewpoint is narrow and negative, viewing Deaf persons as needing assistance and deafness as requiring a cure. The opposing viewpoint is referred to as the cultural model. Supporters take the stand that the inability to receive audible information is not the sole and exclusive defining characteristic of any individual or group. They view a Deaf person for what they can do rather than what they cannot. This view is promoted by advocates and professionals working within the Deaf community and by Deaf persons. According to the United States Fire Administration (USFA), decreased hearing may limit a person's ability to take quick action and escape during a fire emergency. (United States Fire Administration, 2012) They go on to add that people with hearing impairments cannot rely on the traditional audible smoke alarm, but can rely on visual alarms equipped with strobe lights. Doctor Neil Bauman (a former volunteer firefighter) runs the Center for Hearing Loss Help and stresses the importance for the hearing impaired to have an effective alerting system. He states that it s scary to think that roughly 40% of the people killed in home fires die in their sleep without ever waking. It s even more alarming to realize that roughly 30% of deaths due to fires in the home are caused by fires in which a smoke alarm is present and operating properly! (Bauman, 2009) It is obvious to him that many people are not hearing their smoke detectors warning them. Bauman believes that one reason for this is that most smoke detectors produce a relatively high-frequency (3,100 Hz) sound. Recent studies have revealed that this frequency of sound is not particularly effective in waking up various classes of people with normal hearing such as children, heavy sleepers, people in deep levels of sleep, people taking sleeping pills and other medications and people who have had too much to drink. In addition, high-frequency

18 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 18 alarms are almost totally ineffective in alerting people with high-frequency hearing loss (which includes more than 90% of hard of hearing people) and all deaf people. (Bauman, 2009) Bauman adds that another reason that hard of hearing people are at greater risk from night-time fires is that their hearing aids or cochlear implants are peacefully reposing on the bed table beside them resulting in their smoke detectors futilely trying to warn them. This is why those of us with hearing loss need special alerting devices to wake us up. (Bauman, 2009) The USFA stated that the most pressing fire safety issue for people who are deaf or hard of hearing is whether they will be alerted to the danger in time to escape. (United States Fire Administration, 1999) They add that smoke and toxic fumes are non-discriminating killers. To an individual unable to hear, conventional smoke alarms are of limited use. A hearing family member or caregiver overcome by fumes may not be able to alert a sleeping deaf person in tome for both to escape. Manufacturers have responded to this need by developing specialized smoke alarms that use flashing lights and vibrating materials to alert hearing-impaired occupants of a fire. Flashing lights are only useful if they are installed where a hearing impaired person can see them. A flashing alarm does no good if the hearing impaired person is asleep in a room without one. To combat this, certain manufacturers have devised alarms that vibrate the bed or pillow to arouse a sleeping individual. Ideally, all alarms in the home would be interconnected so that if an alarm in one part of the house detected a fire, all alarms would activate. (USFA, 1999) The National Fire Protection Association (NFPA) states that smoke alarms utilizing strobe lights to wake a person are available for people who are deaf (those with profound hearing loss). Vibration notification appliances, such as pillow or bed shakers, are also available and are

19 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 19 currently activated by the sound of a smoke alarm. (National Fire Protection Association, 2013) The NFPA offers the following safety tips: As people age, their ability to hear high-pitched sounds decreases. Research from NFPA s Research Foundation showed that older adults are unlikely to respond to alarms with strobe lights. Older adults or other people who are hard of hearing (those with mild to severe hearing loss) can use a device that emits a mixed, low-pitched sound. In its current form, this device is activated by the sound of a traditional smoke alarm. Always choose equipment that has the label of a recognized testing laboratory. Make sure everyone in your home understands and reacts to the signal (light, vibration, or sound) used in their situation. All smoke alarms should be tested at least monthly. Replace smoke alarms and equipment for people who are deaf or hard or hearing according to manufacturer s recommendations. The NFPA also states that most major smoke alarm companies offer alarms with strobe lights. For information on availability and pricing, go to the manufacturers' Web sites. They recommend manufacturers, distributors, and retailers of smoke alarms that meet U.L. standard 1971 for people who are deaf or hard of hearing include: Ace Hardware Corporation, BRK Electronics, Gentex Corporation, Kidde Fire Safety, and Menards, Inc. (NFPA, 2013) Public fire education has made great strides in this country and around the globe according to the USFA. (USFA, 1999) The deaf and hard of hearing are at high risk from fires and fire related injuries, however they are a much overlooked community for a variety of reasons. There is a lack of quantifiable measures of fire deaths and injuries in the deaf and hard

20 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 20 of hearing community. In many scenarios, the fire service cannot determine whether an auditory, visual, mental, or physical disability prohibited the victim from escaping the fire based on the evidence at hand. Of these disabilities, deafness and hearing impairments may be the most difficult to detect. (USFA, 1999) Effective fire safety education typically begins in the early school years, yet the vast majority of school programs are designed exclusively for the hearing community. (USFA, 1999) With increasing numbers of deaf and hard of hearing children being mainstreamed into traditional school settings, it is imperative that they are not overlooked in fire safety programs. Schools and fire departments must ensure that the deaf and hard of hearing children know how to react in a fire emergency independent of a hearing individual. (USFA, 1999). Deaf and hard of hearing people rely on varying means for communication with each other and the outside world. The mechanisms vary with the degree of hearing loss and include a hearing aid, lip reading and sign language. In the event of a fire, a person s line of sight may be hampered by smoke, making it difficult or impossible to see to read a person s lips or hands. Additionally, during chaotic events such as a fire, voices and sounds are often muffled, contributing to the inability to follow instructions and escape the event. (USFA, 1999) Communication considerations should also be made when firefighters are conducting fire safety education demonstrations. In summary, numbering the deaf or hard of hearing is only one part. One important fact to consider is that the hearing impaired population increases as age increases. There are types and degrees of hearing loss, and it also varies across high and low frequencies. The hearing impaired are at greater fire risk because of their inability to hear a standard smoke detector. However there are resources such as strobes and bed shakers to aid in alerting them.

21 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 21 Consideration should be given as to ensuring the fire safety message is communicated properly and that it is started at an early age and continued. Procedures This research began in August of 2013 upon return from the Executive Analysis of Community Risk Reduction course at the National fire Academy. The topic was selected because a need was identified by Forsyth County Fire department (FCFD) Fire and Life Safety Educator, Laura Coleman. When asked if there were any topics within the department that needed research for the purpose of community risk reduction, she stated that she had a desire to reach out to the deaf or hard of hearing community to provide fire safety education, and research on the topic might justify starting a new program. The author selected the topic through encouragement from L. Coleman and with the goal of helping FCFD reach the deaf or hard of hearing community in Forsyth County, Georgia. In general, an extensive literature review was performed. The internet provided the vast majority of information. First the author checked the National Fire Academy s Learning Resource Center online search for previous research papers that had been completed on the topic. Next, the Google search engine was used to gain further information. Some of the key words and or phrases included: deaf or hard of hearing, statistics, fire education programs, populations, demographics, culture, smoke detector, strobe and bed shaker. Numerous articles, reports, web sites and web pages were read to gain a better understanding of the research topic. The following procedures were used to answer the research questions: 1. Who are the people that make up the deaf or hard of hearing community? To estimate the number of deaf or hard of hearing in the community, the Google Chrome search engine was used with the key words: deaf or hard of hearing, demographics, population,

22 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 22 numbers, United States, Georgia, and Forsyth County. Several national surveys were identified and researched. The surveys are used by the U.S. Census Bureau to gather their demographic information about the deaf or hard of hearing. Some specific surveys used were the National Health Interview Survey (NHIS), the Survey of Income and Program Participation (SIPP), the Gallaudet University survey and the American Community Survey (ACS). Additionally, to answer this question, personal interviews were conducted. The author interviewed an acquaintance who is hard of hearing and uses hearing aids. The author also interviewed a local audiologist. Both of these interviews were helpful in gaining a different perspective into the deaf or hard of hearing culture. 2. What are the fire risks facing the deaf or hard of hearing community? The fire risks facing the deaf or hard of hearing community was determined by using the web browser Google Chrome. Key words included: deaf or hard of hearing, fire, risks, etc. The United States Fire Administration (USFA) website was instrumental with information as was a document entitled Fire Risks for the Deaf or Hard of Hearing. (USFA, 1999) Another great resource was the National Fire Protection Association. Their website had stated demographics that were helpful in determining fire risks facing the deaf or hard of hearing population. 3. What resources are available to meet the fire safety needs of the deaf or hard of hearing community? To answer this question, the web browser Google Chrome was again used. Key words and phrases included: deaf or hard of hearing, resources, safety, smoke detector, bed shaker and strobe. The search led to the USFA and the NFPA websites and web pages which identified the resources available to meet the fire safety needs of the deaf or hard of hearing community. 4. What fire and life safety programs does FCFD offer to the community?

23 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 23 A personal interview was conducted with FCFD Fire Safety Educator Laura Coleman to identify the fire and life safety programs offered to the community by the FCFD. Additionally, the FCFD 2012 Annual Report was used as a reference for statistical information. 5. What programs for the deaf or hard of hearing exist in similar fire departments? A survey was created and ed to 35 fire departments across Georgia to gather information to determine what similar departments are doing for the deaf or hearing impaired. The survey asked the following questions: 1. Has your department recognized deaf or hearing impaired members/groups within your jurisdiction? If so, how did you identify these individuals/groups? How many have you identified? 2. What fire and life safety programs does your department offer for deaf or hearing impaired residents? (Smoke alarms, fire/safety awareness, severe weather, etc.) Are the programs tailored to certain age groups? (children or older adults) 3. Does your department offer flashing or vibrating smoke alarms for the deaf or hearing impaired? If so, how are they attained by the department? There were limitations in the research. First, there was an inadequate amount of current, 2013, data on the population of the deaf or hard of hearing. Most references stretched back to the 2010 Census or earlier. The author assumed that current demographics data would be overflowing. Next, there was a lack of fresh material from the United States Fire Administration (USFA) related to the deaf or hard of hearing. The best document the author found was dated Newer documents viewed by the author from the USFA did not have as much information as the older document or contained the same information as the older reference. Lastly, the survey did not have a high return percentage.

24 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 24 Results After countless hours of searching websites and reading articles on the internet, the author was pleased with the results of the research. The first research question, who are the people that make up the deaf or hard of hearing community, had the following results: The number of deaf or hard of hearing is a difficult number to obtain. Estimates are based on a number of surveys conducted by the U.S. Census Bureau. Brault (2012) states that the definition of disability differs from survey to survey; he cautions researchers from making comparisons across different sources. As an example, the National Health Interview Survey (NHIS) Respondents were instructed, These next questions are about your hearing WITHOUT the use of hearing aids or other listening devices. Is your hearing excellent, good, [do you have] a little trouble hearing, moderate trouble, a lot of trouble, or are you deaf? The report showed that overall, 37 million adults (16 percent) aged 18 years and older experienced some hearing difficulty without a hearing aid. Men were more likely to have experienced hearing trouble than women (21 million or 19.1 percent compared to 16 million or 12.7 percent respectively). Age was positively associated with hearing difficulties (without a hearing aid). As age increased, the percentages of adults with hearing trouble increased. There were 500, year olds with hearing trouble (6.7 percent), 2.9 million year olds (18.9 percent), 2 million year olds (31.2 percent) and 3.5 million (45.2 percent) aged 75 and older. When results are considered by sex and ethnicity, non-hispanic white men were more likely to have had hearing trouble compared with other men or women. (Schiller, Lucas, Ward, & Peregoy, 2012) The Survey of Income and Program Participation (SIPP) defines difficulty hearing as experiencing deafness or having difficulty hearing a normal conversation, even when wearing a

25 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 25 hearing aid. Those who were deaf or unable to hear a normal conversation were described as having a severe difficulty. About 7.6 million people (3.1 percent) experienced a hearing difficulty, including 1.1 million people who had a severe difficulty hearing. About 5.6 million people (2.3 percent) used a hearing aid, of which 2.2 million reported some difficulty hearing. For people aged 65 and older, 4.2 million or 10.8 percent had difficulty hearing. About 4.2 million people aged 65 and older reported hearing aid use, of which 1.7 million had difficulty hearing. (Brault, 2012) Harrington (2012) noted that Gallaudet University does not manage surveys of the adult deaf and hard of hearing population, but because of repeated inquiries they have developed their own rough estimates based on U.S. Census data. Their survey simply asked for a response to: "Have hearing problems" (includes both deaf and hard of hearing). The results are presented in the following figure: Table 4, American Deaf Population by Gallaudet University Total U.S. Population Have hearing Percentage problems U.S. 294,043,000 38,225,590 13% >6 years old Not listed 691, % Ages ,414,000 2,309, % Ages ,019,000 2,380, % Ages ,668,000 2,634, % Ages ,217,000 3,275, % Ages 65 and over 30,043,000 8,729, % These three surveys, the SIPP, the NHIS, and Gallaudet University differ greatly, but one must realize that the three are asking different questions from varying demographics. The American Community Survey (ACS) attempts to give communities current information needed to plan investments and services. This survey information generates data that helps determine how more than $400 billion in federal and state funds are distributed each year.

26 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 26 (U.S. Census Bureau, 2013) Concerning hearing, the survey question reads: Is this person deaf or does he/she have serious difficulty hearing? (U.S. Census Bureau, 2013) Brault (2012) states that when making comparisons of disability estimates across different geographic levels (such as comparing state prevalence rates to the national rate); one should attempt to use the same survey. Therefore the U.S. Census Bureau s 2012 American Community Survey 1-Year Estimates for the non-institutionalized population of Georgia and Forsyth County, Georgia were examined to determine state and local estimates of the number of deaf or hard of hearing. The results are shown in the following table: Table 5: 2012 American Community Survey 1-Year Estimates, Georgia and Forsyth County Georgia total Population 9,719,411 (U.S. Census Bureau, 2012) Male Ages Total 4,691,533 Hearing Difficulty Forsyth County, Georgia 187,149 (U.S. Census Bureau, 2012) Ages Total 92,538 Under 5 341,922 2,972 Under 5 6, ,327 6, , ,105,808 9, , ,833,488 66, , ,163 43, , ,825 44, Female Ages Total 5,027,878 Hearing Difficulty Ages Total 94,611 Under 5 3,291, Under , , ,166, , ,011,072 34, , ,383 20, , Hearing Difficulty Hearing Difficulty ,602 53, ,318 1,209

27 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 27 The numbers presented above give us an idea of the population of the deaf or hard of hearing in the nation (approx. 37 million), the State of Georgia (approx. 295,619) and Forsyth County (approx. 3,673). That begins to answer the first question, but the who is not just a number. The who of the first question is also a person that makes up a community. They are the young school age boys and girls, the middle age or working age men and women, and the mature or elderly men and women. Some other demographic results include: (Hearing Health Foundation, 2013) In the United States, three out of every 1,000 children are born deaf or hard-ofhearing. Almost 50 million Americans have hearing loss in at least one ear, including 1 in 5 teenagers. At age 65, one out of three people has a hearing loss. 60% of the people with hearing loss are either in the work force or in educational settings. 60% of veterans returning from Iraq and Afghanistan come home with hearing loss and tinnitus; it is the #1 war wound. Depression and isolation are common among those with hearing loss. Over a six-year study, the cognitive abilities of older adults (ages 75 to 84) with hearing loss declined 30% to 40% faster than in older adults whose hearing was normal. On average, older adults with hearing loss developed a significant impairment in their cognitive abilities 3.2 years sooner than those with typical hearing.

28 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 28 Hearing loss becomes more prevalent with age; hearing impairment occurs in about 18% of American adults between ages 45 and 54, 30% of adults between ages 65 and 74, and 47% of adults ages 75 and older. About 26 million Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud noises at work or in leisure activities. Men are more likely than women to experience hearing loss. Each of these groups is important to the make-up of the community. Though they suffer from the same disability and have the same basic physical needs, each group will require different methods to reach them with a fire safety education message. According to the American Speech-Language-Hearing Association (ASHA), hearing loss is described by type, degree and configuration. People born with a genetic or hereditary defect, exposure to loud noise, and aging are all results of Sensorineural (SNHL) hearing loss. This happens when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain. SNHL cannot usually be medically or surgically corrected and is the most common type of permanent hearing loss. Conductive hearing loss results when sound is not sent easily through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Possible causes of conductive hearing loss include fluid in the middle ear from colds or allergies, ear infection, too much earwax or foreign body in the ear canal. Degree of hearing loss refers to the severity of the loss and a number is used to represent the person s hearing loss range in decibels. A commonly used classification system is represented here:

29 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 29 Degree of hearing Loss Hearing loss range (db HL) Normal -10 to 15 Slight 16 to 25 Mild 26 to 40 Moderate 41 to 55 Moderately Severe 56 to 70 Severe 71 to 90 Profound 91+ The configuration, or shape, of the hearing loss refers to the degree and pattern of hearing loss across frequencies (tones) as illustrated in a graph called an audiogram. High frequency loss affects the high tones. The opposite would hold true for low frequency loss. Some configurations are flat, indicating the same amount of hearing loss for high and low tones. (American Speech-Language-Hearing Association, 2011) A personal interview with Stephanie Cahill provided more insight to the who of the first question. (Cahill, 2014) Stephanie is a very active, thirty-something, mother of two small children that attends the same Crossfit gym as the author. If her hearing aids were not visible, one would never know she was hard of hearing. Stephanie would be classified under the cultural model viewpoint according to the Executive Office of Health and Human Services (EOHHS) for the Commonwealth of Massachusetts. (Commonwealth of Massachusetts, 2014) This viewpoint on deafness or Deaf individuals views a deaf person for what they can do rather than what they cannot. The opposing view, the medical/pathological model, regards a deaf individual as someone who cannot hear, who is lacking auditory capability, who is deficient in some way because he or she may not be able to communicate by speaking and hearing. This viewpoint

30 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 30 is narrow and negative, viewing Deaf persons as needing assistance and deafness as requiring a cure; not at all who Stephanie is. Stephanie revealed that she has been hard of hearing since birth. Though she could not remember the degree of her hearing loss, she stated that she has approximately 90 percent loss of hearing. She wears a hearing aid in each ear and stated that she cannot hear a normal smoke detector without them. (Cahill, 2014) An audiologist was interviewed next to gain another point of view. Dr. Kris Panks has been an audiologist for 17 years. She stated that from her personal experience, the number of deaf or hard of hearing is increasing. Most of her patients are older patients (65 and older) that need hearing aids. She does expect her patient load to increase as the Baby Boomer population continues to age. (Panks, 2014) Research question two asked what are the fire risks facing the deaf or hard of hearing community. The United States Fire Administration (USFA) advises that decreased hearing may limit a person's ability to take quick action and escape during a fire emergency. (United States Fire Administration, 2012) They go on to add that people with hearing impairments cannot rely on the traditional audible smoke alarm, but can rely on visual alarms equipped with strobe lights. Doctor Neil Bauman (a former volunteer firefighter) runs the Center for Hearing Loss Help. He stresses the importance for the hearing impaired to have an effective alerting system. He states that it s scary to think that roughly 40% of the people killed in home fires die in their sleep without ever waking. It s even more alarming to realize that roughly 30% of deaths due to fires in the home are caused by fires in which a smoke alarm is present and operating properly! (Bauman, 2009)

31 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 31 Bauman (2009) believes that one reason most smoke detectors are not heard is that most smoke detectors produce a relatively high-frequency (3,100 Hz) sound. High-frequency alarms are almost totally ineffective in alerting people with high-frequency hearing loss (which includes more than 90% of hard of hearing people) and all deaf people. Bauman adds that another reason that hard of hearing people are at greater risk from night-time fires is that their hearing aids or cochlear implants are peacefully reposing on the bed table beside them. This is why those of us with hearing loss need special alerting devices to wake us up. (Bauman, 2009) The USFA (1999) stated that the most pressing fire safety issue for people who are deaf or hard of hearing is whether they will be alerted to the danger in time to escape. They add that smoke and toxic fumes are non-discriminating killers. To an individual unable to hear, conventional smoke alarms are of limited use. A hearing family member or caregiver overcome by fumes may not be able to alert a sleeping deaf person in tome for both to escape. Research question three focused on meeting the safety needs of the deaf or hard of hearing. Question three asked what resources are available to meet the fire safety needs of the hearing impaired community. Smoke alarm manufacturers have developed specialized smoke alarms that use flashing lights and vibrating materials to alert hearing-impaired occupants of a fire. Flashing lights are only useful if they are installed where a hearing impaired person can see them. A flashing alarm does no good if the hearing impaired person is asleep in a room without one. To combat this, certain manufacturers have devised alarms that vibrate the bed or pillow to arouse a sleeping individual. Ideally, all alarms in the home would be interconnected

32 FIRE SAFETY EDUCATION FOR THE DEAF OR HARD OF 32 so that if an alarm in one part of the house detected a fire, all alarms would activate. (USFA, 1999) The NFPA (2013) also recommends strobe lights or vibration notification appliances to wake a person who is deaf (those with profound hearing loss). One such device is a pillow or bed shaker that is activated by the sound of a smoke alarm. They also offer the following safety advice: As people age, their ability to hear high-pitched sounds decreases. Research from NFPA s Research Foundation showed that older adults are unlikely to respond to alarms with strobe lights. Older adults or other people who are hard of hearing (those with mild to severe hearing loss) can use a device that emits a mixed, low-pitched sound. In its current form, this device is activated by the sound of a traditional smoke alarm. Always choose equipment that has the label of a recognized testing laboratory. Make sure everyone in your home understands and reacts to the signal (light, vibration, or sound) used in their situation. All smoke alarms should be tested at least monthly. Replace smoke alarms and equipment for people who are deaf or hard or hearing according to manufacturer s recommendations. Doctor Panks (2014) was aware of the strobe and vibrating smoke alarms that are available on the market. She stated that she was not aware of any patients that used these devices and she does not make it a point to recommend them either. However she does believe that the devices would be helpful for some of her patients.