Volume 5, No. 2 • Summer 1990

Loud Alarms Can Cause More Harm Than Good

Gary L. Fanning, M. D.

To the Editor

I wish to initiate a discussion among anesthesiologists regarding the design of alarm in currently available operating mom monitoring system. I am specifically concerned about monitoring systems with auditory alarms which are loud, continuous, overly sensitive, and impossible to silence quickly and easily with minimal loss of attention.

Perhaps I am uniquely sensitive to auditory alarm signals, but I find it incredibly distracting at the end of a procedure when I am concentrating on my patient’s emergence to have a loud alarm go off telling me something that I already know, such as my patient isn’t breathing. I know my patient isn’t breathing, because I’m purposely hypoventilating him or her to allow the return of spontaneous ventilation; yet this machine starts screaming, needlessly distracting me and everyone else in the room. I find it very difficult to ignore this persistent noise, and silencing it is often difficult and further distracting.

Hearing is an extremely important sense technologically, serving as our early-warning system for dangers coming from any quadrant. Our sense of hearing does not sleep (even under anesthesia), does not disappear with a turn of the head, and cannot be conveniently turned off or ignored. When deep in thought or wishing to concentrate, how many times have each of us scolded our children or others in the immediate vicinity for noisy activities which interrupt that concentration? How many of you or your surgeons enjoy loud music blaring in the operating room during critical or even simple procedures? Sound is truly a distracting influence and unrelenting, obnoxious sound can be so distracting as to be dangerous.

‘Pleasant’ Tone Sought

I have a suggestion regarding alarm systems which I would like to propose, and I would welcome comments from fellow anesthesiologist, equipment manufacturers, and experts in the field of monitoring. I propose that critical alarms consist of an initial series of three pleasant tones of sufficient loudness to attract attention, followed by a continuous flashing bright visual signal which remains on until the alarm condition no longer exists or until an appropriate reset switch is activated. I would concede that the auditory signal might repeat every 60-90 seconds, but I am vehemently opposed to any auditory alarm signal in the operating room which is unrelenting until addressed.

I wish to stress that such intermittent auditory signals are appropriate in the operating room for several reasons: 1) the patient should never be alone in the operating room under any circumstances, and, therefore someone will always be right there to notice the alarm condition; 2) in the vast majority of instances in my own experience and that of my colleagues the alarms sound for inappropriate conditions (such as during periods of purposeful hypoventilation at the end of a procedure or when the breathing hoses are removed from the circuit at the end of a case and the oxygen sensor set to alarm at 30% is now exposed to room air; 3) and most importantly, when a situation exists in which the patient’s safety is truly in question, the last thing the operative team needs is the distraction of an obnoxious auditory alarm relentlessly hindering their ability to think.

I would be most interested to know if others share my frustration and concerns. I am truly frightened that systems which have been so carefully designed to assist us may actually hinder us at the most critical tunes when our attention should be totally focused on the patient and not on a loud noise emanating from a machine.

Gary L. Fanning, M. D.

The McFarland Clinic, Ames, IA