Bleeping noises!

[mercurydancer]

Please bear with me on this one as its a little off into left field but I think its the right forum to ask for comments. (I had the privilege of attending a CRM training course and a light went on above my head!)

I am working on an intelligent "bleeping" system for medical and nursing staff which involves sending a GPRS (mobile phone) message to clinical staff both within a hospital and outside it. At present there are pager systems but I feel that this is faulted as all it does is make a noise and clinical staff have to pick up a phone and ask for information. I feel a system that gives both an audible signal and some information is far superior. The GPRS message would give some detail as to how urgent the concern is, but also enabling the clinician to decide how to prioritise thier tasks, but also to divert incoming calls if they are committed to a specificc task. I am searching for examples to illustrate my point in presentations. I imagine that a solitary bleeping noise withut any further information is a menace on a flight deck. Without an audible signal having any meaning, I would suppose that cognitive dissonance is strong and it can be ignored, or misinterpreted, or both, especially at times of stress or fatigue.

I would be most grateful if you guys can recall any annoying bleeps or alarms on the flight deck or within the cabin (or anywhere else I havent thought of) which actually either make the situation worse or disinform. Also I am interested in the whole concept of alerts and prioritisation of tasks and how the human factor can override the most urgent of warnings. Any information from you would be most welcome.

Yes I am an NHS employee and you thought working for BA was bad...............

[west lakes]

From another industry, we are alerted to system failures in a particular area for example Lancashire by Text messaging to individual or groups of mobile phones.
A common message is; -
Fault in the Blackpool area, if you can attend contact nnnnnnnnnn.

this could be modified for a number of situations.
The sending "equipment" BTW is a PC

[mercurydancer]

west lakes

ty...

The call from our intended system would be initiated automatically via a PC if certain perameters were reached.

[mad_jock]

merc

you will not believe what a mobile /dec network will do if you pay for it.

you could have a page a text / full records down loaded in an instant.

Its all a money thing.

I used to work in a coms enviroment 10 years ago and internally we could have delivered 100mbps plus through yur mobile phone to 3000 connections every second. Nobody would pay for it. one connection or 30,000 it is the same cost to the network


The only system which is fault positive in the UK is the power network. And ther is someting daft like 10% of all telephone lines in the UK are level 1 nation interest

What your trying to do erisson engineers have had on there company phones from 1998 onwards without gprs. But they all have a zero account.

With GPRS and a local GSM node you could run the whole network off GSM network connections. The NHS won't pay for the BSC upgrade so you won't get it.

[ITCZ]

Interesting thought indeed.

Before you go roaring off in the direction of modifying a basic alerting system toward an enhanced alerting system, it might pay to take a broader look at operator cognition, safety critical tasks that ought not be interrupted, task focus and workload management. Otherwise you may end up with a system that more effectively overloads the poor operator!

Some areas to look into that may be useful...

The USA Three Mile Island nuclear power station incident, particularly the multiple audio alarms competed for the attention of, and reduced the effectiveness of, control room personnel responding to the emergency.

Manufacturer philosophies of flight deck automation, and airline philosophies as to use of automation. Tony Kern in Flight Discipline gives some examples. The honeywell avionics in the B717 I fly (read MD-95) have a Central Alerting and Warning System that prioritises alerts into one of four categories (Level 3 eg fire, cabin high altitude, Level 2 eg one of two hydraulic systems fails, Level 1 eg autobrake system fail but full braking performance available with manual wheel braking and advisories Level 0 wing antice selected on.) "Non alerts" a the fifth category being abnormals for which there is no cockpit alert.

The philosophy being to categorize alerts by (a) a requirement for immediate crew awareness or not and (b) immediate action to be taken by crew, crew action required but not immediately, or no crew action required.

There is also a system of inhibiting the alerts during flight critical periods. For example, some alerts are progressively inhibited as the aircraft accelerates during the takeoff roll, all audio alert inhibited between liftoff and 400', at which point alert inhibiting is progressively removed depending on how the system designers rated the severity of the alert. The philosophy here being that, in addition to classifying alerts as being 3 to 0, there are times when the alerting system will not 'bother' the pilot when the pilot's attention should not be diverted from the task at hand.


Likewise, alerts are progressively inhibited on final approach until landed and slowing to taxi speed.

Bells, whistles, chimes and warblers for critical functions and alerts are all accompanied by a verbal recorded message to 'decode' the aural alert. Example: The firebell aural alert for an engine fire has the traditional fire bell sound, followed by a harsh female voice announcing 'fire, right engine.' Autopilot disconnect has traditional warning chimes followed by same female voice announcing "autopilot disconnect." Traditional cues, with spoken explanation.

The decision as to when to inhibit certain alerts and when to de-inhibit them is based on a general assessment of pilot cognition and ability and is fixed in the avionics suite programming. The USAF have done some preliminary work on intelligent systems that monitor the pilot's cognitive state (stress level, if you like) and decide whether or not to alert the combat pilot to a threat or abnormality, and if so, which pieces of information and when to convey it! The UK MoD has also researched another side of that coin - what if the operator (medico in your case) had a bit of kit that offered 'augmented cognition' in other words would assist your medico to regain the plot, or avoid unsafe commands or actions, by automatically commanding a set of previously agreed actions if/when the medio is overloaded or otherwise not able to cope with all the information. Cognitive assistance through adaptive automation they called it.

Another interesting line of inquiry is to compare the Boeing "only tell the pilot what he/she needs to know" where the operating system status is invisible to the operator when operating normally, c.f. the Airbus ECAM "in the loop" philosophy of a running commentary of changes to system status. Both have their advocates.

There is some interesting work on future designs of flight decks being touted at NASA and other places. Look up work by
James Reason (Human Error is a great start)
Marianne Rudisill,
Gordon Baxter and Denis Besnard,
Rasmussen, Duncan and Leplat,
Charles Billings.
Earl Weiner
Endsley and Strauch

A good start might be to Google Scholar "flight deck automation" "flight deck design" pilot cognition, and similar.

[mercurydancer]

ITCZ

That is exactly the information I need. Thank you. Its interesting that you cite James Reason as an author.. in fact much of my research is based on his transference of airline safety to healthcare settings.

It is prevalent in my mind to reduce the number of bleeping noises and to incraese the meaningfulness of the messages. I didnt consider the Three Mile Island accident but it looks like a superb place to look for examples. I know I can find parallels with clinicians being overloaded with signals when they have critical tasks mounting up and have to prioritise. Having a framework of message prioritisation could form the next stage to the work we are doing. It does reinforce my feeling that airline and aircraft companies have done this well before us and what we need to do is listen very hard and with attention to the paralleles between the two professions.

Whilst the alert systems for medical equipment attached to patients (such as you would find in an intensive care setting) is reasonably well researched, it certainly is not with messaging systems which operate across wards and hospitals. In many respects we are in the dark ages as soon as a clinican leaves a ward then the only contact is by telephone. Even this week's New England Medical Journal has an article describing a senior medical staff's experience on a large modern hospital and frankly his communication systems could have been equalled before the First World War. Its reassuring as I dont think what I am looking at is rare by any means.

We have explored ways of transmitting clinical information such as clinical observations via GPRS with degree of success. Mad jock.. thank you. We think we have solved this problem by forming an intermediary company (ibleep) (Roy if you detect this with a google sweep just get a curry ordered) which can handle a contract with efficiency and at the moment T Mobile have seen the potential, and have allowed a GPRS connection which the ibleep program can access.

[NutLoose]

Also do a search for something like cockpit warnings on www.faa.gov (http://www.faa.gov)

[4Greens]

Check out the Cypriot airlines crash in Greece in August 2005. There was confusion about a warning horn. It was an oxygen problem (lack of) and was mistaken for another warning.