from Hacker News

Alarms in medical equipment

by gaudat on 6/7/24, 6:45 PM with 112 comments

• by throw46365 on 6/8/24, 12:36 AM

  I remember my Dad, in his last day conscious, with a fluid line in that kicked off some sort of pressure alert every time he raised his hand to his face… which he did compulsively because of his confusion on top of his dementia.

  The nurses obviously couldn’t respond to it each time, but nor could they switch it off altogether, and it didn’t reset after any period of time.

  My siblings and I took turns to gently hold his arm down on the side of the bed… which became just holding his hand, which I still miss.

• by ijustlovemath on 6/8/24, 3:21 AM

  We're building a life critical medical device, and I haven't seen this mentioned, so I thought it was worth contributing:

  The use of these alarms is not something imposed by the manufacturers, but by the standards, eg 60601, 62304 etc. For devices involved in diagnostic, or more importantly interventional care, you are required to have alarms within certain auditory and visual thresholds, and a lot of them have mandated silence times (in a life critical system, you can only silence a true alarm for 120 seconds at a time).

  Then again, "ALARM" as dictated by the standards means something truly emergent, though the wording can feel a bit fuzzy at times. Trust me, alarm fatigue is a known phenomenon to these manufacturers, and theres been a recent trend (with, eg, the Dexcom G7) of giving users more control over delaying alarms, silencing them until you can respond etc etc, which has its benefits, especially as quality of life is concerned.

  You'll have a hard time convincing the FDA of this for critical devices like those found in hospitals though.

• by LorenPechtel on 6/7/24, 7:41 PM

  And how about the fact that there are simply too many of them!

  I was once in the recovery room with my wife. For some reason the sensor was having a very hard time reading her pulse. The normal bips would frequently fail. Too many failures in a row and the alarm would start it's EEEEEE scream we've all seen from Hollywood. It would shut up as soon as it managed to pick up a beat.

  Hers was definitely not the only one in the room occasionally screaming. The nurses were completely ignoring it. Quite understandably so as it was obviously doing false alarms. But in a flood of false alarms like that are the real ones going to be noticed??

• by tux3 on 6/7/24, 8:00 PM

  Trying to figure out which melody was which in an emergency doesn't seem like the most human-friendly.

  Contrast with the GPWS warnings in aviation, which tells you what the problem is (TERRAIN TERRAIN) and what to do (PULL UP) in a progressively more alarmed voice as things get worse.

  (Well.. Sometimes you hear of some particularly bright individuals who think the bank angle warning is a checklist item, but it's generally hard to get these wrong, compared to many other beeping warnings)

• by blackeyeblitzar on 6/7/24, 8:17 PM

  I absolutely hate the poor design of medical equipment found in hospitals. The worst thing by far is the constant beeping and noises in the room, which totally disrupts rest and hurts recovery. It is SO obvious that this hurts patients (and visitors), that I cannot believe the entire medical industry (nurses, doctors, hospital administrators, equipment makers, insurance companies) have failed to do anything about it. It also makes it hard to know if some sound is expected or if it is a signal that something is wrong. In addition to this, I’ve seen nurses make mistakes several times because the equipment is too confusing. Once, I had to page the nurse myself because the IV they thought they set up was not functioning and I was able to discern that from the screen on the IV machine (which said one particular drug was not active) but they had not noticed, essentially administering an imbalanced cocktail of drugs for a period of time.

  My take - the medical industry has too many barriers to competition, and it is too difficult for people who work with these things to do anything about it as well. It’s unclear who the buyers are at a hospital or how a startup could reach them. It’s also unclear what sort of interoperability (for example with Epic for charting) is needed. Regulations also make it difficult to get devices approved and investors are less likely to support a startup in this space.

• by tverbeure on 6/7/24, 8:34 PM

  A friend of mine used to have a small side business selling loudspeakers for medical equipment. She order them in Asia and had her own little certification lab at home: heat chamber, impedance testing, that kind of stuff. Every so often, she’d receive an order of a few hundred speaker, and test them one by one.

  It’s a low volume but high margin business. Some of the issues were the constant fight against the factory not following design requirements to cut costs, knockoffs etc.

• by strnisa on 6/7/24, 9:46 PM

  The standardization of medical alarms was important when introduced, providing consistent and clear communication across devices and countries. However, with modern technology, these standards may now limit innovation.

  It seems to me that clear verbal alerts like "BLOOD PRESSURE VERY HIGH" could be more immediately understandable than tones. A hybrid system combining verbal alerts with alarm tones might be a good compromise for clarity and international usability.

• by odiroot on 6/7/24, 7:15 PM

  I was looking for some good notification sounds for my ESP Home's buzzer. These are a great inspiration.

• by kioleanu on 6/8/24, 7:57 AM

  Only very slightly tangential, I remember when my son had his surgery and had to be in the hospital, they would have these dosing machines for the medicine and they would start throwing a warning sign 3 minutes before the syringe was empty, every 30 seconds and then a proper alarm when it was empty. Now, we were supposed to call a nurse to remove the syringe, and each nurse had their own preference on when to be called. Some said call us when the warning starts, some said call us a minute before and some said call us when the red alarm goes off. We found this strange until one of them explained it is simply related to the amount of chit chat they wanted to do with us, as the syringe always had to go out at the red alarm

• by davidw on 6/7/24, 8:14 PM

  It gives me anxiety just looking at this. Add this to the list of things I don't want to work on.

• by ano-ther on 6/7/24, 8:31 PM

  I seem to remember that some of these sounds (perhaps the one with syllables) were originally part of a joke paper and that the author was quite astonished how they became part of a standard.

  Unfortunately, I cannot find the article anymore.

• by jill4545 on 6/8/24, 7:14 AM

  An amendment to IEC 60601-1-8 introduces the concept of acoustic icons. These are the alarms that mimic the sound of what the device does e.g. a ventilator would be a sighing/breathing sound as well as a pulse to indicate if its alarm with a priority. This directs the clinician to know immediately which device is alarming and how high the priority is as opposed to a plethora of beeps and pings all merging together. Could be a game changer.

• by chess_buster on 6/8/24, 8:47 AM

  There's a dissertation from a Professor of Health Care about Alarms in ICUs: https://uol.de/f/2/dept/informatik/download/Promotionen/Cobu...

• by bouvin on 6/7/24, 7:30 PM

  Fascinating. Interesting to hear the differentiation in severity in the same class of error.

  Though a bit disappointing that there is no machine that goes PING! [1]

  [1] https://youtu.be/VQPIdZvoV4g?si=Ov4AuyKgeKtmYmz9

• by g15jv2dp on 6/7/24, 8:02 PM

  What's not clear from this webpage is whether these are actually used anywhere. Are they? I couldn't tell.

• by userbinator on 6/8/24, 3:44 AM

  Some of them remind me of YouTuber Ashens' intro sound.

• by roughly on 6/7/24, 9:19 PM

  The cardiac alarm tone is unexpectedly jaunty.