[tux3]

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)

[unsignedint]

One significant difference between verbal warning systems in airplanes and those in medical environments, such as hospitals, is the level of environmental control. In an airplane, the environment is highly controlled, with a single set of systems specific to that aircraft. In contrast, hospitals often have multiple systems operating simultaneously in the same room or nearby. This can lead to cognitive overload when multiple systems issue verbal warnings simultaneously. In such scenarios, tone alarms might be easier to manage and differentiate than multiple overlapping verbal warnings.

[akira2501]

> In an airplane, the environment is highly controlled

Aircraft systems are developed independently and added as options to planes. Which means they get swapped out, there are variants in capabilities, and multiple manufacturers involved.

> This can lead to cognitive overload when multiple systems issue verbal warnings simultaneously.

This is a known phenomenon on flights as well. There is some speculation it played a part in Air France 447. The plane technically _was_ telling the pilots the _precise_ problem they faced, but in the sea of other warnings they were entirely lost.

> tone alarms might be easier to manage and differentiate than multiple overlapping verbal warnings.

If you're a nurse, is the fact you have a ventilation alarm in one room and a temperature alarm in a different room that can be discerned without visual confirmation a useful feature in a health care setting?

I think the big difference is your flight has 2 people responsible for hundreds of lives. In the hospital you would hope the ratio would be more favorable.

[Dalewyn]

>Aircraft systems are developed independently and added as options to planes. Which means they get swapped out, there are variants in capabilities, and multiple manufacturers involved.

He means there is only ever one aircraft (the one you're flying) and hundreds of patients in a hospital.

Imagine if you will, hundreds of GPWS alarms are blaring off all screaming TERRAIN PULL UP TERRAIN PULL UP PULL TERRAIN UP UPTERRAIN PULL TERRPULLAINUP UPULLPTERRAIN TERRPULLAINUP PULLRAIN TEUPR...

That's both alarm fatigue[1] and the alarms being wholly impractical to begin with. For starters, which GPWS wants to be pulled up again? You can't know, there's hundreds! And that's even assuming you can make out TERRAIN PULL UP in the maelstrom of noise.

[1]: https://en.wikipedia.org/wiki/Alarm_fatigue

[akira2501]

Yea, I kinda got myself there in a roundabout way in the end.

In any case, if that's the environment, then it reminds me of our solutions for broadcast studio alarms. There was a combined master tone alarm in the engineering control room, and a set of annunciators for each station, with three levels of severity for each. You'd hear the tone, snap your head around to look at the board, and quickly be able to tell what you were dealing with and where the priority problems were.

Likewise, in the hallway leading up to the studios, there were colored flashing lights above each studio door that also displayed the alarm level for that studio. Those were completely silent, for obvious reasons, but their flashing pattern got your attention anyways. They were arranged vertically according to severity so even if you were color blind you could understand them at a distance.

Then inside the studios there were more detailed annunciators that would actually display which part of the air chain monitoring was causing the global alarm signal. These were also silent, but did not flash, and had a clock that would pause when the first error became displayed.

[graypegg]

I wonder how much information any 1 medical device with an alert knows though. GPWS has the benefit of being part of 1 system, where (I think, no experience here) hospitals seem to treat equipment as singular items that do 1 thing or are meant for a specific area of responsibility in an operation. Like a vitals monitor might not know what the drug pump is doing.

I could imagine

    ventilation? arrhyth-*C-chord*-ARRHYTHMIA! CHECK PUMP! HEART RATE!

coming from different devices to be pretty distracting.

I think GPWS can set windows of cases where an alert is given. Like, a terrain warning isn't much help when landing. Maybe there's something like that already for medicine, but a device who's job is to consume information from other devices, and only provide alerts based on rules the staff can configure before an operation, could be a thing that's useful.

[HeyLaughingBoy]

That's really the problem many here are describing. 60601 mandates what alarms shall be active, but it spans a single device. If you have, e.g., 10 ventilators in a room that are alarming, you can't silence them all with a single button press.

[graypegg]

I can kind of understand why it ended up that way. There's some benefit to just assuming, nothing works together. It's at least a consistent state of affairs. You can just wheel in any heart rate monitor, and you only need to understand that heart rate monitor.

But it seems like a space that's really ripe for improving. We have very reliable simple protocols you could hook these all into. Imagine it was law that every medical device had to emit the numbers it displays on something like an ODB2 port. Something that can be visually checked to be plugged in, be unplugged and replugged with no handshake, and handle daisy chaining so in the event the "network" breaks in two, or a device goes down, you still get information from the remaining network/it can reroute.

For such a highly regulated industry... you kind of wish they would regulate. I guess status quo is also a regulation.

[HeyLaughingBoy]

Interoperability is definitely a problem. I've been in the industry for quite some time, and at one job we got to shadow med lab techs, since they were the operators of the machines that we built. Their workload is insane and after an hour watching them work, I could identify a number of new products that would help them. I brought it up to my management and learned that "marketing is aware of those problems and we're devising solutions." No idea if those solutions ever hit the market -- this was over 10 years ago.

At the time, the solution to interoperability was to buy all your lab equipment from one manufacturer, who would use their own (usually proprietary) protocols to tie things together. That way, at least even if they weren't actually interoperable, the UI's and workflows were mostly consistent.

A large part of the problem is that hospital IT is understandably hostile to anything connecting to their network, so all the stuff we were building at the time that talked to each other, had to use its own standalone network, or serial ports (ugh!).

Standards like IEC-60601 or 62304 (my daily bread) are easier to adopt because they address patient safety. I suspect it would be much harder to mandate an interoperability standard unless you could show that it improved safety instead of "just" making the healthcare provider's job easier. Or maybe it exists, but just never came up on my radar.

[fhsm]

Inter op has a lot of different standards but support for all those standards is limited. Here’s an example:

https://www.astm.org/f2761-09r13.html

As you point out the corporate network operators tend to have a different set of priorities but even there too standards exist. Here’s an example:

https://www.iso.org/standard/72026.html

[sebmellen]

GPWS warnings should be the gold standard for any sort of urgent audio alarm.

Examples: https://www.youtube.com/watch?v=W5Z-d1Zx02o

[imglorp]

At :42 I think the buzzing sound is the "stick shaker" stall warning. It literally shakes the pilot's control yoke. So not only is it an alarm, it's also reminding the pilot of the correction needed: to push the control forward.

[varjag]

Wouldn't that be pull backward?

[krisoft]

What i heard is that it is designed to imitate the stick sensation smaller airplanes have as the wind buffets the controll surfaces when a stall develops.

And pilots from an early stage in their flying training conditioned to push the stick forward when that happens.

[seabass-labrax]

Not in this case, because the 'stick shaker' activates when the aircraft is stalling or close to stalling. The only sensible option in this scenario is to lower the angle of attack, that is, pitch forward. If you have both the GPWS 'terrain, pull up' warning and the stick shaker warning simultaneously then you are in a sticky situation indeed.

[krisoft]

> If you have both the GPWS 'terrain, pull up' warning and the stick shaker warning simultaneously then you are in a sticky situation indeed.

Yeah. To quote the movie Wargames: “The only winning move is not to play.” That is a pilot should do their best to avoid getting into anywhere near that situation.

[flemhans]

I used to have pull up as my ringtone, freaked my uncle out (who's a commercial pilot) when he was over for dinners. Or at least he pretended to be :P

[krisoft]

I was half-asleep travelling on a train when a kid blew a wistle near me which sounded exactly like the stall warning horn of the Cessna-150 i was learning to fly around that time. It jolted me awake right away. I had this clear clarity in my mind that i have to push the controls forward until i realised that I am nowhere near an airplane.

[masto]

Now I have this.

https://looptube.io/?videoId=W5Z-d1Zx02o&start=77.1286764705...

[Lammy]

Making this my PagerDuty alert sound https://youtu.be/fbfVGIBcD8c?t=77

[yread]

They also have their share of cavalry charges and buzzers. Plus the plane sometimes calls you a retard

[kmoser]

At least chimes are language-agnostic. Verbal warnings like "pull up" are only good if you have a reasonable grasp of English.

[turrican]

True, but professional pilots from all countries are expected to be fluent in Aviation English. https://en.wikipedia.org/wiki/Aviation_English

[kmoser]

Yes, but in a high-stress environment, your ability to process words--especially those not in your native language--goes down the tubes quickly. Even if you were to tune out sounds to the same degree that you tune out words, at least the sounds would still have a relatively universal meaning, e.g. loud klaxon for big problem, soft chime for minor notification.

[graypegg]

At the very end, there's some examples of more literal sounds. It says there hasn't been a study, but I would bet they're a lot more clear with out having to resort of the aviation standard of "just learn basic english".

buh-bump is cardiac stuff. wiSShhh... wooosSH is respiratory stuff.

Only thing is, I bet you can hear sounds similar to those in a hospital. The "beep beep" they put over it might not be enough. Still a really interesting research topic!

[flemhans]

Another good thing is that they allow for talking over them better. The same way you may sing along to an instrumental-only music track using whichever lyrics you prefer.