[throwaway542134]

This actually seems like a really interesting problem to me.

I don't think there's one pretty solution here. You'd have to break it down a bit.

- Do the patients go to the machine, or machine to the patient? Wireless makes sense for the latter, not the former.

- What's the failure mode? An alarm/alert to the nurse station, or death? Wireless makes sense for the former, I think.

- Are there any machines at every bedside? Do all of them need to be used at once? Detachable/modular cabling might make sense here.

- Are the cables different? Or can you come up with a "standard" cable/connector for most of the gear?

The audio world solved the "cables being knocked out" problem a long time ago with locking connectors (not screw-ins, so they're still quick connect) like Speak-On and XLR. The former is much more formidable.

[lostlogin]

> The audio world solved the "cables being knocked out" problem a long time ago with locking connectors (not screw-ins, so they're still quick connect) like Speak-On and XLR. The former is much more formidable.

Audio has the advantage of both ends being heavy and solid. Attaching a line that goes into a person with stitches or a balloon (urinary catheter) is done, but what happens when those get yanked forcefully is bad.

[Balgair]

Thanks a ton for the questions and the thoughts! It is a terribly hard problem to solve, hence the plea to others on HN.

> - Do the patients go to the machine, or machine to the patient?

In an ICU, where these problems are most acute, the machines come to the patient. You can fill a good sized room with these machines if the patient is in an especially dire state. Like, maybe 30 carts if it is really bad.

> What's the failure mode? An alarm/alert to the nurse station, or death?

It's death. Death is the failure mode. There are others, like severe organ damage, but death is one worth talking about.

> Are there any machines at every bedside? Do all of them need to be used at once?

It depends. If the patient is fairly alright, you'll have maybe a few machines for vitals and not much more. If they are not alright, then you can have a LOT of machines in the room. Though you can have machines on stand-by, if they are in there, they are being used generally.

> Are the cables different? Or can you come up with a "standard" cable/connector for most of the gear?

Again, it depends. Some companies will standardize their cables and tubes, but they tend to not do so across companies. Also, cable and tube diameter is pretty much set by the need. Airways need laminar flow, so they tend to be larger, blood is more viscous, so it needs less than an airway, but it's still got to have some girth. Electrical can be very small, but if you need to deliver a lot of amps, then the cables grow. I'm sure you could come up with the optimal size across a lot of different applications and get a list of all the possible sizes, but that matrix would be very large all the same and might as well be continious.

> The audio world solved the "cables being knocked out" problem a long time ago with locking connectors (not screw-ins, so they're still quick connect)...

Yeah, there are a lot of quick connects out there, but the issue is that you have a patient that is in ICU psychosis trying to break out, or a panicked parent thrashing about, or a doc trying to lurch for the right tools or get to the patient. In these types of situations, you have to plan for the totally crazy events, not the calmer ones. Like, imagine trying to do audio mixing in the middle of the mosh pit. You're trying to plan for that event.

[killjoywashere]

This might be a "problem where every instance is bespoke". Another would be nuclear a weapon detonation or a major hurricane. You can plan for it and run simulations all you want, but your resource constraints aren't known until after the event.

ICU rooms contain patients teetering at the edge of death, who might take months to heal or die. They might be "almost out" and suddenly crash into a totally different crisis than the one they were wired up for an hour ago (cardiac patient has a stroke, stroke patient has an MI, bariatric surgery patient throws a pulmonary embolus, etc). Ventilation, gastric tube, rectal tube, urinary catheter, 10 central venous drips, an arterial line, and a 5-lead EKG and pulse ox, all on in a patient who's on a pneumatic mattress that is constantly rocking the patient to prevent bedsores, is not uncommon.

And there are three vendors attached to every device. For example, Masimo has the pulse ox device, but the leads are from Cardinal Health under license (no doubt produced under subcontract in China, with soy-based insulation) and the sensor sticker is held on with a second layer of generic silk tape because that's what the nurse had at the time.

If you really wanted to do this, you'd have to have the entire suite designed by a single engineering firm with an obsessive focus on supply chain management. You'd need the Boeing or Airbus of ICUs. But doctors are generally convinced they don't need engineers, so good luck with that.