Alarm fatigue or alert fatigue describes how busy workers (in the case of health care, clinicians) become desensitized to safety alerts, and as a result ignore or fail to respond appropriately to such warnings. Alarm fatigue occurs in many fields, including

construction Construction is a general term meaning the art and science to form objects, systems, or organizations,"Construction" def. 1.a. 1.b. and 1.c. ''Oxford English Dictionary'' Second Edition on CD-ROM (v. 4.0) Oxford University Press 2009 and ...

and

mining Mining is the extraction of valuable minerals or other geological materials from the Earth, usually from an ore body, lode, vein, seam, reef, or placer deposit. The exploitation of these deposits for raw material is based on the economic ...

(where backup alarms sound so frequently that they often become senseless background noise), healthcare (where electronic monitors tracking clinical information such as

vital signs Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a ...

and

blood glucose Glycaemia, also known as blood sugar level, blood sugar concentration, or blood glucose level is the measure of glucose concentrated in the blood of humans or other animals. Approximately 4 grams of glucose, a simple sugar, is present in the bl ...

sound alarms so frequently, and often for such minor reasons, that they lose the urgency and

attention Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Att ...

-grabbing power which they are intended to have), and the nuclear power field. Like

crying wolf Crying is the dropping of tears (or welling of tears in the eyes) in response to an emotional state, or pain. Emotions that can lead to crying include sadness, anger, and even happiness. The act of crying has been defined as "a complex secre ...

, such false alarms rob the critical alarms of the importance they deserve.

Alarm management Alarm management is the application of human factors and ergonomics along with instrumentation engineering and systems thinking to manage the design of an alarm system to increase its usability. Most often the major usability problem is that ...

and policy are critical to prevent alarm fatigue.

Healthcare

The constant sounds of alarms and noises from blood pressure machines, ventilators and heart monitors causes a "tuning out" of the sounds due to the brain adjusting to stimulation. This issue is present in hospitals, in home care providers, nursing homes and other medical facilities alike. The US

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

cataloged 566 deaths from ignored alarms in the period 2005-2008. The United States-based Joint Commission's sentinel event reports 80 alarm-related deaths and 13 alarm-related serious injuries over the course of a few years. On April 18, 2013, the Joint Commission issued a

sentinel event A sentinel event is "any unanticipated event in a healthcare setting that results in death or serious physical or psychological injury to a patient, not related to the natural course of the patient's illness".https://www.pressganey.com/docs/default ...

alert that highlighted the widespread problem of alarm fatigue in hospitals. Their recommendations included establishing guidelines to tailor alarm settings, training all members of the clinical team on safe use of alarms, and sharing information about alarm-related incidents. This alert resulted in designation in 2014 of clinical alarm system safety as a National Patient Safety Goal and it remains a goal in 2017. This Goal will force hospitals to establish alarm safety as a priority, identify the most important alarms, and establish policies to manage alarms by January 2016. ECRI Institute has listed alarms on its "Top Ten Hazards List" since 2007; in 2014, alarms were listed as the number one hazard.

Unintended outcomes of alarms

The large number of alarms, especially of false alarms, has led to several unintended outcomes. Some consequences are disruption in patient care, desensitization to alarms,

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil Turmoil may refer to: * ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte * ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...

in hospital staff and patients,

sleep deprivation Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either chronic or acute and may vary ...

and depressed immune systems, misuse of monitor equipment including "work-arounds" such as turning down alarm volumes or adjusting device settings, and missed

critical events An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...

. Some additional outcomes include workload increase, interference with communication, wasted time, patient dissatisfaction, and unnecessary investigations, referrals, or treatments.

Solutions

There are many solutions proposed to reduce alarm fatigue in healthcare settings: * Change alarm sounds to be softer and friendlier in order to improve identification of alarms by sound alone. Another recommendation is for clinicians to adjust the

parameters A parameter (), generally, is any characteristic that can help in defining or classifying a particular system (meaning an event, project, object, situation, etc.). That is, a parameter is an element of a system that is useful, or critical, when ...

and delays to alarms to match the patient's traits and status. However, this directly trades sensitivity for specificity. * Use

centralized alarms Centralisation or centralization (see spelling differences) is the process by which the activities of an organisation, particularly those regarding planning and decision-making, framing strategy and policies become concentrated within a particu ...

. In this approach, alarms don't fire at the bedside, but fire at a central monitoring station where a trained healthcare provider evaluates each alarm and alerts the bedside clinician if they should intervene or evaluate the patient. * Adjust alarm

algorithms In mathematics and computer science, an algorithm () is a finite sequence of rigorous instructions, typically used to solve a class of specific problems or to perform a computation. Algorithms are used as specifications for performing ...

. Currently, the alarm systems are very sensitive but not specific. This leads to a large amount of false alarms. The algorithms used can be adjusted to balance between sensitivity and specificity to limit the number of false alarms and still detect true deterioration.

Child abduction

The

amber alert An Amber Alert (alternatively styled AMBER alert) or a child abduction emergency alert (SAME code: CAE) is a message distributed by a child abduction alert system to ask the public for help in finding abducted children. The system originated in ...

system used in countries such as the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., federal district, five ma ...

and

Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tota ...

to notify the public of a

child abduction Child abduction or child theft is the unauthorized removal of a minor (a child under the age of legal adulthood) from the custody of the child's natural parents or legally appointed guardians. The term ''child abduction'' includes two lega ...

has been theorized as being susceptible to alarm fatigue. A 2018 abduction in

Thunder Bay Thunder Bay is a city in and the seat of Thunder Bay District, Ontario, Canada. It is the most populous municipality in Northwestern Ontario and the second most populous (after Greater Sudbury) municipality in Northern Ontario; its populatio ...

resulted in an amber alert being sent to cell phones as far away as

Ottawa Ottawa (, ; Canadian French: ) is the capital city of Canada. It is located at the confluence of the Ottawa River and the Rideau River in the southern portion of the province of Ontario. Ottawa borders Gatineau, Quebec, and forms the core ...

, some 15 hours' drive from Thunder Bay, followed one hour later by a second alert which notified individuals that the first alert had been resolved. A similar double alert occurred on a single night in February 2019, leading to concerns over alert fatigue.

Public transport

In the New York City Subway, the

Metropolitan Transportation Authority The Metropolitan Transportation Authority (MTA) is a public benefit corporation responsible for public transportation in the New York City metropolitan area of the U.S. state of New York. The MTA is the largest public transit authority in t ...

installed sirens in 2006 to discourage subway users from using

emergency exit An emergency exit in a structure is a special exit for emergencies such as a fire: the combined use of regular and special exits allows for faster evacuation, while it also provides an alternative if the route to the regular exit is blocked. ...

s to evade fares; the sirens had little effect other than irritating passengers and were removed in 2015.Matt Flegenheimer
Exit Alarms in the Subways Are Silenced by the M.T.A.
''New York Times'' (January 1, 2015). Alarm fatigue has sometimes contributed to public transport disasters such as the 2009 train collision in Washington, DC, caused by a faulty

track circuit A track circuit is an electrical device used to prove the absence of a train on rail tracks to signallers and control relevant signals. An alternative to track circuits are axle counters. Principles and operation The basic principle behind t ...

which failed to detect the presence of a stopped train. Though the

automatic train control Automatic train control (ATC) is a general class of train protection systems for railways that involves a speed control mechanism in response to external inputs. For example, a system could effect an emergency brake application if the driver ...

system generated alerts notifying train dispatchers to the presence of such faulty circuits, the rate of such alerts was about 8,000 per week. An investigation by the US

National Transportation Safety Board The National Transportation Safety Board (NTSB) is an independent U.S. government investigative agency responsible for civil transportation accident investigation. In this role, the NTSB investigates and reports on aviation accidents and inci ...

concluded that "the extremely high incidence of track-circuit alarms would have thoroughly desensitized

he dispatchers He or HE may refer to: Language * He (pronoun), an English pronoun * He (kana), the romanization of the Japanese kana へ * He (letter), the fifth letter of many Semitic alphabets * He (Cyrillic), a letter of the Cyrillic script called ''He'' in ...

Weather

Some people think the large number of deaths from

Hurricane Ida Hurricane Ida was a deadly and extremely destructive Category 4 Atlantic hurricane in 2021 that became the second-most damaging and intense hurricane to make landfall in the U.S. state of Louisiana on record, behind Hurricane Katrina in 200 ...

New York New York most commonly refers to: * New York City, the most populous city in the United States, located in the state of New York * New York (state), a state in the northeastern United States New York may also refer to: Film and television * '' ...

and

New Jersey New Jersey is a U.S. state, state in the Mid-Atlantic States, Mid-Atlantic and Northeastern United States, Northeastern regions of the United States. It is bordered on the north and east by the state of New York (state), New York; on the ea ...

may have been the result of too many warnings. Since 2012, weather alerts have been sent out to cell phones, but in 2020, federal officials set up a three-tier system so people would get this warning for the most serious situations.

References

{{reflist Security technology Alarms Warning systems Safety