In addition, each alarm was embedded (within the first second) with an auditory pointer comprising three notes followed by two notes after a gap, with the entire sequence repeated after a longer gap. With medical alarms, the conveyed “concepts” derive from the category of alarm, and the International Electrotechnical Commission standard specifies eight such categories: cardiovascular, ventilation, artificial perfusion, drug administration, oxygenation, temperature, equipment failure, and a general “catch-all.” For this study we focused on an example set of icon alarms described in table 1 (also refer to slide show presentation, Supplemental Digital Content 1,, and 2,, with embedded audio of icon and current standard alarms used in this study, respectively), all of which were studied previously in a laboratory setting except for the “general alarm.” In order to standardize the perceptual loudness within and between the alarm sets, each individual alarm was processed to maximize audibility through level dynamic range compression and normalization. This derives from the design principle of directly conveying a concept instead of an encoded message, the latter being the case with the current standard alarms. The advantage of icons is that they are immediately intuitive, even upon first audition, and therefore should be easy to learn. Icons alarms are real-world sounds that are somehow associated with the process that they represent. 6 On the basis of these results, the International Electrotechnical Commission Alarms Joint Working Group, which is in a position to recommend the specific details of any update to the standard, has called for the development and testing of a set of icon alarms to be considered for adoption into the standard (written personal communication from Dave Osborn, B.S.E.E., M.E.E., chair of International Electrotechnical Commission Alarms Joint Working Group, Philips, Salem, Massachusetts, April 2016). 6, 7 Additionally, icon alarms were easier to localize in an experimental setting. Relative to the abstract and tonally similar current standard alarms, icon alarms were found to be easier to learn and discriminate when studied in nonclinical, computer-based settings using lay, nonclinical participants. Conceptually similar icon designs are easily relatable to medical alarms ( table 1). For example, the auditory icon alarm for “file deletion” on a personal computer is typically designed to sound like the crumpling up of a waste paper. Icon alarms are commonplace and acoustically complex sounds that mimic the underlying meanings they are meant to represent. 1 However, no clear precedent has been established on how to best test the effectiveness of novel alarm sounds.ĭevelopment of an updated version of International Electrotechnical Commission 6 is currently underway, and “auditory icons” 6 (referred to here as icon alarms) are considered for replacement of current standard alarms. 6 Device manufacturers are not required to adopt the International Electrotechnical Commission standard and can implement proprietary alarm sounds that at least demonstrate equivalence. 1 Several studies have demonstrated that the current standard alarms are therefore difficult to learn (especially in the musically uninitiated), and alarms within the set are easily confused with one another 2–5-factors potentially contributing to alarm fatigue, and certainly the cause of unnecessary confusion. Although the melodic contour varies across the different alarms in the alarm set, other aspects of composition and instrumentation are fixed, including timbre/pitch, key, duration, rhythm, and tempo, leading to very little acoustical variation, or heterogeneity, within the set. 2–5 Each alarm sound is a distinct melody meant to facilitate appreciation of the alarm meaning or etiology. However, the current standard alarms have been shown to function poorly by researchers in the fields of human factors and psychology. 1 Parts 1 to 8 of the standard specify performance requirements for alarm sounds and systems and contain an example set of auditory alarms that complies with the normative portions of the standard (referred to here as current standard alarms). The International Electrotechnical Commission (Geneva, Switzerland) published a standard in 2003 (most recently revised in 2012) known as International Electrotechnical Commission 60601, which specifies basic safety of medical electrical equipment and governs almost all medical equipment across the globe. They play a vital role in patient safety by alerting caregivers of patient or medical equipment state changes. AUDIBLE alarms are essential sounds within the clinical soundscape important for patient monitoring.
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