Subclause 6.3.3.1 – Characteristics of auditory ALARM SIGNALS -  [List element b)] - Alternative Technology

ü        A different technology implies something other than electronically generated tones.

ü        There are a variety of means for generating auditory ALARM SIGNALS, including buzzers, electronic sound generators and speech synthesizers.

?       At least some of the methods described above can be used to indicate priority regardless of the means of generating the signal.

Table 3 – Characteristics of the BURST of auditory ALARM SIGNALS

Table 4 – Characteristics of the PULSE of auditory ALARM SIGNALS

ü        Table 3 and Table 4 are based on the requirements for auditory ALARM SIGNALS that were found in ISO 9703-2 [26]. These distinctive patterns or rhythms have been used for more than a decade and have been well accepted clinically. Table 3 and Table 4 are slightly different from the equivalent tables in ISO 9703-2.

?       The modifications were intended to simplify interpretation and increase flexibility rather than introduce significant change.

כיצד?

?       Auditory ALARM SIGNALS that complied with ISO 9703-2 should also comply with this collateral standard.

מדוע?

ü        Spatial localization of an auditory ALARM SIGNAL is useful because it helps the OPERATOR to identify the source of the ALARM CONDITION promptly.

ü         Ensuring that four or more audible higher-frequency harmonics are present in an auditory ALARM SIGNAL enhances spatial localization.

?       Spatial localization is poor at low frequencies, so the lower acceptable limit for fundamental frequency is set at 150 Hz.

מסקנה שגויה, לדעתי, מכיוון שההרמונית הגבוהות מספקות את הכיווניות. מצד שני, כנראה שמגבלה זו אינה יוצרת בעיה

ü         Hearing impairment from noise exposure or age usually impairs perception of higher frequencies, so that to ensure that all harmonics are audible, the upper limit for fundamental frequency is set at 1 000 Hz.

ü         Selection of the INTERBURST INTERVAL requires RISK ANALYSIS and careful consideration.

ü         Shorter INTERBURST INTERVALS can result in noise pollution and impair communication among OPERATORS or other personnel who are trying to address the problem, and are inappropriate for equipment that is intended to be continuously attended by the OPERATOR in NORMAL USE. On the other hand, longer INTERBURST INTERVALS can negatively affect the ability of the OPERATOR to identify, in a timely manner, the source of the ALARM CONDITION. This is particularly true for equipment intended to be unattended by the OPERATOR in NORMAL USE.

נראה לי שבמצב שהמשתמש נמצא ליד החולה ומטפל בו, צריך לאפשר לו או לכבות את ההתרעה זמנית (עם תזכורת) או לשלוט במרווחי הזמן בין מקבצי התרעות.

?       MANUFACTURERS are encouraged to use the longest INTERBURST INTERVAL consistent with the RISK ANALYSIS.

זוהי מסקנה חלקית. בסעיף הקודם הוצגו שני סיכונים. סעיף זה מתייחס לסיכון השני (למרות שזה לא צוין בפירוש).

ü         Writers of particular standards are encouraged to consider the longest appropriate INTERBURST INTERVAL of the auditory ALARM SIGNAL for the particular ALARM SYSTEM application.

גם כאן, ההתייחסות היא לסכון השני בלבד.

The main differences between ISO 9703-2 and this collateral standard and the reasons for the current requirements, are described below:

כל הסעיף הזה היה צריך להופיע בדיון של List element b) ולא כאן

ü         The new PULSE spacing intervals are defined differently from ISO 9703-2 and provide greater design flexibility. PULSE spacing is now defined as the time from the end of one PULSE to the start of the next. As a result there is no possibility of overlap, which could occur in ISO 9703-2. The actual values permit all auditory ALARM SIGNALS complying with ISO 9703-2 except for HIGH PRIORITY ALARM SIGNALS in which the PULSES almost overlap. For obvious reasons, very few MANUFACTURERS actually did this. The committee considered that PULSES should have reasonable gaps between them, and that near overlapping of PULSES should not be permitted.

M b) In ISO 9703-2, the intended rhythm could not be achieved if each PULSE spacing was the same. The redrafted Table 3 addresses this problem. To ensure that the distinctive pattern is achieved, yet provide some flexibility in overall timing, this standard requires all INTERBURST INTERVALS within a BURST to have the same duration. A tolerance of ±5 % seemed appropriate.

לדעתי, המרווחים הקבועים תורמים לתחושת החירום. המעבר למרווחים משתנים יוצר אוירה של חגיגה.

ü       c) The time between the two five-PULSE groups that comprise a HIGH PRIORITY ALARM SIGNAL (time between 5th and 6th PULSES) is now defined as the time from the end of the last PULSE in the first group to the start of the first PULSE in the next. The equivalent requirement in ISO 9703-2 was defined as the time from the start of the first group to the start of the next. In practice, this time could be unacceptably short. Therefore, few MANUFACTURERS actually complied with this ISO 9703-2 requirement. Instead, they chose the interpretation that is now used in this collateral standard. The intent of the pause was that the first group of PULSES would attract the OPERATOR'S attention, and the second group would emphasize the importance of the ALARM CONDITION and aid in identifying the source of the ALARM CONDITION once the OPERATOR'S attention had been gained.

ü       d) A greater range of INTERBURST INTERVALS is permitted. The existing requirement in ISO 9703-2 is not suitable for ALARM SYSTEMS that are unattended by the OPERATOR in NORMAL USE.

û       Selection of the most appropriate INTERBURST INTERVAL requires RISK ANALYSIS and careful consideration of the clinical requirement for the ALARM CONDITION in its intended environment of use. Short INTERBURST INTERVALS can result in noise pollution and impair communication among OPERATORS or other personnel who are trying to address the problem, and are inappropriate for ALARM SYSTEMS that are always attended by the OPERATOR in NORMAL USE. On the other hand, long INTERBURST INTERVALS can negatively affect the ability of the OPERATOR to promptly identify the source of the ALARM CONDITION. MANUFACTURERS and writers of particular standards are encouraged to use the longest INTERBURST INTERVAL consistent with the RISK ANALYSIS.

קטע זה הוא העתק של קטע קודם

Factors to consider include:

whether the ALARM SYSTEM is intended to be always attended by the OPERATOR in NORMAL USE. In this case a longer INTERBURST INTERVAL is appropriate;
 
EXAMPLE Anesthesia machines.  

the kind of equipment involved;

   EXAMPLE An enteral feeding pump should have a longer INTERBURST INTERVAL than a critical care ventilator.

השיקול הוא של מצב החירום, ולא של סוג המכשיר

whether the ALARM SYSTEM is connected to a remote DISTRIBUTED ALARM SYSTEM, e.g. a central monitoring system. An ALARM SYSTEM that is not so connected (standalone equipment) should consider a shorter INTERBURST INTERVAL, in order to facilitate identification;

האם יש כאן טענה שבמערכת מבוזרת אין צורך לזהות את החולה? אולי הכוונה היא שבמערכת שכוללת זיהוי אוטומטי של החולה, ניתן להגדיל את המרווחים?

-  the presence and effectiveness of additional or alternative notification systems (secondary visual ALARM SIGNALS, vibratory ALARM SIGNALS, ALARM SIGNAL lights in hallways, alarm paging systems, etc). Effective alternative generation of ALARM SIGNALS will permit longer INTERBURST INTERVALS.

זה לא בשליטת היצרן. מתקבל הרושם שכדאי לפצל את כל המסמך לשני חלקים: הנחיות ליצרן והנחיות ללקוח

ü         e) HIGH PRIORITY auditory ALARM SIGNAL PULSES should be “faster” than MEDIUM PRIORITY auditory ALARM SIGNAL PULSES to ensure that they are perceived as being more urgent. Hence, the requirement that the effective PULSE duration for HIGH PRIORITY ALARM SIGNALS is less than that for MEDIUM PRIORITY.

ü         f) The LOW PRIORITY auditory ALARM SIGNAL is optional, but if present can comprise one or two PULSES. It should be relatively unobtrusive and perceived as less urgent than a MEDIUM PRIORITY ALARM SIGNAL.

ü         g) Pitch is now permitted to rise and fall during a BURST. ISO 9703-2 required that changes in pitch proceed in one direction only. The committee considered this to be without safety advantage and excessively design restrictive.

ü         h) The ISO 9703-2 requirement for the presence of four harmonics has been slightly modified. Reflections and standing waves from pure sine wave auditory signals can make it very difficult to find where they are coming from. Ensuring that four or more audible harmonics are present in an auditory ALARM SIGNAL enhances spatial localization. These harmonics should be neither so soft as to be inaudible nor so loud as to be excessively dominant. Because tight control of harmonic content can be extremely difficult in simple systems, a value of plus or minus 15 dB (relative sound pressure level) was chosen as a reasonably achievable goal. Decibels were used to express the ratio between the sound pressure level of the fundamental and the sound pressure level of the harmonics because they are commonly used to describe relative sound pressure levels. The choice of harmonic content is very flexible and permits sounds of very different tonal quality to be created.

i) Fall time for pulses is now less restrictive. It can be any duration that does not overlap the next pulse.

זה לא מספיק טוב. צריך להגדיר מרווח מינימום, והוא צריך להיות גדול יחסית בכדי להשיג אפקט של תחושת סכנה.

ü         In contrast, ISO 9703-2 sounds were required to have the same fall time as rise time. The committee found this to be excessively design restrictive.

?       Manufacturers are now permitted to create sounds with more distinctive envelopes (e.g., bell-like decays or reverberation effects).

לא בטוח שזה טוב. צריך לבדוק

ü        RISE TIME for PULSES is specified as 10 % to 20 % of PULSE duration. There is no significant change from ISO 9703-2. More rapid RISE TIME can be intrusive and startling, but can express greater urgency.

ü        There is no change in the PULSE frequency requirement. Spatial localization is poor at low frequencies, so the lower limit for fundamental frequency is set at 150 Hz. Hearing impairment from noise exposure or age usually impairs perception of higher frequencies, so that to ensure that all harmonics are audible, the upper limit for fundamental frequency is set at 1 000 Hz. MANUFACTURERS can choose any frequency they like from within this range. Higher pitch is associated with greater urgency. [11]

ü        The difference in amplitude between any two PULSES in a BURST should not exceed 10 dB. Again, this refers to a relative sound pressure level ratio (i.e., not an absolute volume difference in dBA). This requirement is unchanged from ISO 9703-2. It is easier to make all PULSES the same amplitude, but if the amplitude of the early PULSES in a BURST is a little less than subsequent PULSES, it can be less startling.

ראוי שתכונה זה תתבטא בדרישות