Human Factors for Emergency Response and Critical Care

In this blog post, Liv System’s Nigel Scard talks with Courtney Grant, a Senior Human Factors engineer with Transport for London (TfL). Nigel and Courtney worked together for a number of years at TfL on a number of station and line upgrade projects. A few years ago, Courtney applied his Human Factors and research skills with great tenacity, to a serious healthcare related incident which impacted him personally.  This resulted in an important, lifesaving change to ambulance service procedures. In this interview Courtney describes this in detail and also describes his recent work in supporting the Chartered Institute of Ergonomics and Human Factors (CIEHF) in supporting the response to the Covid-19 pandemic.

Emergency response procedures

I understand you were involved in some work with London Ambulance Service (LAS) a few years ago related to their procedures associated with dealing with people showing symptoms of a stroke, so could you tell us about that?

Yes, a loved one collapsed whilst she was at work and the paramedics came out very quickly, but despite the fact she was unable to speak and unable to properly move one side of her body, they quickly concluded that she was suffering from an anxiety attack. Over an hour went by before they started to suspect it might be something more serious, such as a neurological event. They then administered the FAST test (Face, Arms, Speech and Time), but decided it was inconclusive on the grounds that she was unable to speak. They administered it twice more and came to the same conclusion each time but decided to take her to a Hyper-Acute Stroke Unit (HASU) to err on the side of caution. The HASU confirmed that she had suffered a massive stroke and she almost died. At that point I decided to look into the situation further and made a formal complaint to the LAS. They replied that they didn’t have any concerns about the clinical care provided. However, I saw certain things in the clinical care that were troublesome.

As a Human Factors specialist, I could see that there must have been an element of confusion here, but I wasn’t quite sure exactly what it was because healthcare wasn’t my domain at that point. But I was able to use my HF and research skills to get to the root cause of what happened. I began by speaking to some of the world experts on stroke, such as the clinical director for stroke, for NHS England at the time. The feedback I got from him was that any problem with speech should immediately be classified as FAST positive.

I also got a copy of the LAS patient report form. There were some basic Human Factors issues on there, which in my opinion could lead the paramedics to make this mistake. So, I went to one of the LAS board meetings, where I met Malcolm Alexander, who is the chair of LAS independent patient’s forum, and through him I was able to gain more access to the LAS and more information from them. The more information I got, the more apparent the potential for system-induced human error became.

This is starting to sound like a detective story!

Yes, that’s what it was like, I was having to piece together various bits of information to understand what had happened here. I also applied to the Parliamentary Health Service Ombudsman (PHSO), who upheld my case and confirmed that this amounted to service failure. I showed the PHSO exactly what the HF issue was on the patient report form, why it’s causing confusion and how the LAS could go about improving it. I did a mock-up of an amended patient report form, that would eliminate that error, by removing the ambiguity they were experiencing because of how it was designed. I also discovered that there was a clinical update which had been issued a month before the incident happened, where the LAS Deputy Medical Director expressed concerns about this same issue, stating that a number of paramedics were missing the signs of stroke because they were misinterpreting the speech element of the FAST test. So, this was not an isolated incident, this was a systemic problem.

I also raised the issue with Boris Johnson, who was the Mayor of London at the time. One of his Deputy Mayors then contacted the Chief Executive of the LAS directly, who then responded to the Deputy Mayor by listing out all the actions they would take to amend the situation. This included changing the patient report form in line with my HF recommendations, and making it very clear to their paramedics that the diagnosis of anxiety attack is a diagnosis of exclusion, in that they should not come to that diagnosis until more serious diagnoses have firstly been eliminated.

What happened is that they jumped to that conclusion too early, that’s where the human error first came in. Based on the availability heuristic, they jumped to that assessment whereas in fact they should have gone through the diagnosis of exclusion process.

I then had meetings with the LAS Medical Director and training team, to work with them to develop a training video based on this case study to help ensure this doesn’t happen again. The feedback that I got from the chair of the independent patient’s forum was that it was being well received by the frontline staff. I also went out on an ‘ambulance ride out’, where the senior paramedic who accompanied me mentioned how hard hitting that training was, and how useful it was to highlight the issue.

You mentioned the ‘availability heuristic’, so you think that was the underlying cause of that human error mode?

Yes, that’s based on the work of Daniel Kahneman, as described in ‘Thinking Fast and Slow’ as one of the common cognitive biases.

What would have been underpinning that though? Was it the fact that she is a relatively young person so that usually for someone of her age, when they see those symptoms, it’s usually caused by an anxiety attack?

Yes exactly. In fact, one of the paramedics said that whilst they eventually started considering a neurological event, they believed that it was highly unlikely given her demographic.

That might point to a flaw in the ‘recognition primed decision making’ approach to expert decision making, whereby experts make rapid decisions based on recognising patterns as a result of years of experience. That approach applied to this type of situation would actually have drawbacks. Maybe that’s what happened here, they saw a young person, exhibiting certain symptoms, and they had encountered this type of situation many times before, when it was a panic attack, so they thought they recognised the situation, but in this case it was something more severe.  

Yes, I believe this is what happened here. And this is why reflective practice is so important.

Supporting the CIEHF response to Covid-19

I understand that more recently you’ve been helping the CIEHF with developing healthcare procedures in response to the Covid-19 pandemic? Were any of the insights you gained from your involvement with the ambulance service helpful for this?

Well, it has been slightly different, but my experience with the LAS was insightful because it was my first deep dive into the world of healthcare. But the research question was slightly different. With the LAS, I was looking at a situation where highly experienced and skilled professionals got tripped up on the recognition primed decision making aspect. But what I found, at least with the work I was doing with the CIEHF during the first wave of Covid-19 was that, because of the unprecedented nature of the pandemic, we were in a situation where clinicians who specialised in one field had to move into a completely different area, namely caring for critically ill Covid-19 patients. So, we produced guidance mostly for people who were less familiarised with that particular domain.

There are a number of different Covid-19 pandemic related healthcare procedures that have been produced by the Chartered Institute of Ergonomics and Human Factors, which of those were you involved in?

As part of the CIEHF Covid-19 Expert Panel, I worked with Professor Paul Bowie’s team to develop good practice on how to produce work procedures. We put together general good principles to reflect the work as done rather than the work as imagined. We emphasised working with the end users to develop those procedures and tied it in with general HF best practice and principles as to how to develop procedures, down to using plain language, sentence length, line lengths, and so forth. I also worked with Professor Sue Hignett to develop the bedside procedures for Routine Tracheostomy Care and Ventilator Emergency Care for Covid-19 patients. Again, this was primarily aimed at clinicians who are used to working in a different domain, so the question was how can we lay out the information in a really easy to use format, to reduce the anxiety for the person using it, reduce the likelihood of them making errors and improve the efficiency with which they can respond to the patient.

There seems to have been quite a lot of people involved in producing these procedure guides. I understand they were divided up into gold and silver teams?

Yes, the gold team was a small team at the top and there were a number of different silver teams. The silver teams were comprised of people with a lot of healthcare expertise and people such as myself, predominantly coming from other industries, such as rail in my case, but with HF expertise.

What were your specific contributions?

Well, I drew on some of the experiences from projects we worked on together at London Underground, where we used to produce detailed equipment lists required for control rooms. When it comes to caring for Covid-19 patients, one of the challenges they had was if they had to move a patient from point A to B, how to ensure they have all the necessary equipment? What they were finding was that on part of the journey they might not have everything they need.  So, I applied a technique from our rail projects, of producing a list with all the equipment, including the number of items, illustrations and so forth, being really meticulous about it and removing any ambiguities when it comes to what’s needed to provide effective care.

Another aspect was my understanding of the literature, making sure all the things we were adding to the procedures were underpinned by sound HF rationale.

Looking at the procedures the graphic design looks very good. Did you have any input into the graphic design of the layout of the guides?

Well, the institute have their own graphic design team who designed the visual presentation of the guides, but I did review the visual presentation and had some input into that also. But the primary focus from an HF perspective was the content.

Is your involvement in this work ongoing or is it completed now?

The work on the bedside guides is completed but I’m now involved in developing the strategic guidance for the Covid-19 vaccination programme. I’ve been looking at the HF literature on the use of particular types of syringes such as pre-filled syringes, and if there is anything there which can help with the efficiency of the use of the vaccine. We’ve also been putting together a task analysis of the whole process in terms of bringing the patients in, doing the admin, vaccinating them, understanding where there is potential for errors, what the consequences of those errors could be, what are the existing error recovery strategies and what additional ones might be needed.

Have you noticed any differences in the approach to HF in the healthcare sector, compared to the rail industry?

My understanding is that HF integration in the healthcare sector is not as deeply embedded as it is in domains such as rail, or air traffic control, so there’s still a long way to go in terms of HF having more impact and working with healthcare professionals to adopt recommendations from HF practitioners. There does seem to be a demand for it though.

In the rail sector, there is a lot of focus on physical ergonomics, on the layout of equipment in control rooms and train cabs etc. Has there been much attention to that on the work you’ve been doing relating to Covid-19?

Physical ergonomics has been coming up a lot in relation to the vaccine roll out, we’ve been looking at accessibility issues for wheelchair users, do they have enough space for the turning circles, accessing the areas for the admin and then the areas for receiving the vaccine itself. Also screening off the areas where people receive the vaccine.

The Neuroscience of Navigation and Implications for Design


For the second in our series of interviews with specialists who work in fields which impact on Human Factors and User Experience design, Liv System’s Nigel Scard talks with Kate Jeffery, Professor of Behavioural Neuroscience at University College London, whose area of special interest is the neuroscience of navigation.

Kate chairs the Cognition and Navigation Special Interest Group (CogNav) of the Royal Institute of Navigation, which is a community of academics and industry professionals who are interested in how the neuroscience of navigation can be used to improve the design of built environments and technologies which make navigation easier and more efficient.

Current research interests and implications for design

Could you describe your current research interests?  Are there any recent developments in your own work or neuroscience more generally which may have implications for providing navigation assistance or for urban design?

My work as a neuroscientist is focusing on how the brain makes a map of space. When you walk around the environment and you have certain perceptions, knowledge and information that comes in and your brain is assembling all of this and using it to build a map of where you are and then remember that map for future use. We’re trying to understand the mechanics of that map, how does it work, where in the brain is it built, how does the information come in, what happens to it and where is it stored. To do that we study rats and mice because we can actually record neurons from these animals, and they make the same type of mental maps that humans do and as far as we can tell that’s something that evolved a long time ago.  We’re learning a lot about the brain from studying rats and mice and it seems a lot of what we’re learning has the potential to be useful for design, where we’re trying to make life easier for people who are navigating, to make it easier for them to find their way around.

One of the things I want to do is to try and extract, from the findings from neuroscience, things that might be useful in design. I think one of the really important things that comes out of our work is the fundamental importance of the sense of direction to building the map. Knowing which way around you’re facing is critically important to knowing where you are, and if you don’t make it easy for people to do that, you don’t make it easy for them to build mental maps. I’ve noticed as I’m walking around built spaces like train stations and conference centres, those spaces are often very difficult to orient in because there’s just not the information that your brain likes to use. For example, the spaces are quite symmetrical so it’s not obvious from just looking which way round you’re facing. There may be signs, but your sense of direction doesn’t use signs.

From studying rats and mice we’ve found that there are things that are important, like the shape of the environment or things that introduce asymmetry such as a big difference in the lighting between one end and the other.

The other thing that’s important is for there to be a very obvious linkage between spaces. If it’s easy to see how a room that you’re in relates to the adjacent rooms, for instance if there’s a glass wall between them, then it’s much easier to build a map that has lots of rooms in it. However if you’re in an environment which has lots of enclosed spaces, so that wherever you are you can’t really see your surroundings, then it’s much harder to build an integrated map. A lot of our buildings are like that. Hospitals for example: if you walk around a hospital it’s a bunch of small windowless rooms and you very quickly get confused and horribly lost, frustrated and stressed.

Where would you like to see the research findings on the neuroscience of navigation having more impact?

There are a variety of ways in which it could have impact. One of them is to inform the specifics of design but the other is the methodology of scientific enquiry. Something I’ve discovered in my dealings with architects, designers and planners is that our way of gathering information is very different. An architect will often say they design something this way for a given reason, but when I ask them where that reason comes from they’ll say it’s experience, and then when you ask them what kind of experience it boils down to something like “well I asked my architect friends and they agreed that it seemed like a good idea”. It’s passed down from architect to architect, “this type of building has this effect”, and yet it’s never been demonstrated that that is really the case. There’s a lot of scope for development of beliefs that don’t have any factual basis. I think we’re now at a point where we should be moving beyond that and where it should be possible, with our modern data collection and analysis methods – high speed computers and virtual reality –  to really test whether or not a particular idea really has the effect that people think it has, before spending millions building it.

So you’re saying there’s a bit of a cultural disconnect between the way the scientific community operates and the design community?

Yes, I think designers could learn from scientists, but it’s a two-way dialogue: the real world operators can influence science in the way that they suggest ideas and hypotheses to be tested, because there’s a lot of creativity and thinking outside the box. Scientists tend to narrow down and focus on paradigms that work well in an experimental setting, but which are not always useful.

What about people with accessibility needs, such as visual or cognitive impairments, how might we be able to better assist navigation for them?

I think neuroscience has a lot to say about that, and not just the obvious accessibility issues such as people with visual impairments, but also there are individual differences in how people process information. There tends to be a one-size-fits-all approach to design problems, assuming that everyone who doesn’t have some kind of disability are a kind of cookie-cutter stereotype, all processing information in the same way. But really, when you look at individuals, people navigate differently. Some people prefer to use a mental map and a global sense of orientation and other people prefer to use local objects and landmarks that they anchor their actions to, so they maybe don’t care so much about the overall orientation or the overall relationship between things. They rely on landmarks such as a particular shop, or set of stairs. And some people do rely heavily on signs, which of course if you have a visual impairment that’s much harder.  The trick is to find a way of layering all these different types of information in a way that different people with their different needs can use them, whilst ensuring they don’t interfere with each other. So that, for example, the signs aren’t annoying the people who are trying to build a mental map or aren’t substituting for the information that those people need.  It’s a really interesting and difficult problem: how do you meet everyone’s needs, and I think attention is focusing a lot more on that these days.

You mentioned landmarks, but don’t landmarks help people develop that overall sense of orientation?

Yes, they do but we don’t fully know which landmarks. For example, for your head direction system, which is the compass system in the brain which works out which direction you’re facing, the studies in animals suggest that system prefers to use landmarks which are a long way away because they don’t change their relative direction as you are moving around. If it’s a mountain far off in the distance it’s always in the same direction relative to you, no matter how much you walk around.  We don’t yet fully know what types of landmarks are useful for the sense of direction and what aren’t. For example, a picture at the end of a big hall… is that useful for the head direction system or not? It probably is, but we don’t have any evidence yet.

With digital navigation aids, such as smart phones with navigation apps, leading people to their destination, are there any downsides to that? Will we be losing something?

I get asked that a lot. I don’t think we know the answer yet. A lot of speculation goes on about this, people say it’s terrible, people not having to navigate for themselves, that we’re going to lose function in our brains. But we don’t have any evidence for or against that.   My own sense is that there are pluses and minuses from the point of view of your own cognitive function. It’s true that if you’re navigating with your phone you’re not attending so much to the outside world you’re not making a mental map so much. On the other hand, often when you’re trying to navigate in the real world you just get completely lost and you don’t end up forming a mental map anyway. If you have a phone, it’s helping you understand the relationships of the regions you’ve been in and so maybe it’s supporting your mental map. So, there’s a lot of work that needs to be done to answer that question.  But phones aren’t going away, people will use whatever makes the process easier.  I would like to see the development of the app technology, so it works with the mental mapping system, so that the easiest thing for people to do is also the thing that helps them build a good mental map that anchors them in the real world.  If you do have a good mental map of your surroundings you feel more comfortable in it. Whereas if you don’t have a sense of your surrounding and where everything is, that’s a less satisfying, less happy state to be in. If we want people to really enjoy their urban environments, we need to help them in that.

I think when people feel lost or disoriented that can trigger a kind of stress reaction.

Yes, but stress can often be a positive thing, part of that stress is the brain saying “I don’t know where I am, and I need to switch on our mapping machine”. If you put a rat into an environment it’s not familiar with it will explore, it will become very active and explore all the little corners. Then if you take it out and put it straight back in that environment, it won’t explore nearly as much because now it knows it and recognises it. That’s all dependent on this mental mapping structure in the brain called the hippocampus and one thing that’s been found is that if the hippocampus degenerates, like it does in Alzheimer’s disease, one of the side effects is that people wander and go exploring. I think one of the possible reasons that could be is that they’re not getting the message that says, ‘I’m familiar with this environment, so I can stop exploring”.  They’re constantly in “explore mode”.

Is there any evidence of generational differences in terms of wanting to know which way is north, of thinking in terms of compass directions? 

I think it’s quite likely there is a generational difference. Those of us who grew up with paper maps… to use those maps you had to have a sense of compass directions, to line the map up correctly, whereas the phone does that for you.  So, I think quite plausibly people are losing that connection to the global directions, and I think that might make it harder for them to make larger scale mental maps.

Future technology developments

What do you see as the likely future developments in terms of navigation assistance technologies?

Well, phones will get better and better, and one improvement would be for them to work as well indoors as outdoors for finding your way around. But I’m quite intrigued by the possibilities for Augmented Reality. Instead of having your information source in a device you hold in your hand, you have that integrated through your glasses, mixed in with your perception of the world. I think that technology will come along pretty quickly.  I love technology but I do prefer when technology works with my own cognition rather than as an alternative to it: it’s more seamless and more efficient.

Do you have any ideas about how AR smart glasses might be used to assist navigation, do you think it would just be a case of superimposing arrows on people’s view or using more imaginative techniques?

Even just arrows would be a start, you could either follow the arrow directly or go exploring based on that. But for people who like compass directions it would be useful to have an arrow which told you which way was north.

Also, you could make use of the overlay capacity: so for example you could look at a building and by adjusting a setting make the building transparent so you could see though it to see what’s behind it. You could make the city “glass,” in a way. One of the things that’s confusing about navigating through streets with tall buildings is that because you can’t see past your immediate surroundings you don’t really get a sense of the broader relationships.

Also giving you information indicating what various buildings are, for example this is a museum, that’s a hospital etc.

I think in a city like London, if you could see through buildings using AR then that would be useful for being able to see landmarks such as the Shard etc.

Yes, and also with AR, if you were in a suburb with no landmarks, only streets and houses, you could create fake landmarks, such as a big monument, so that you then had something to anchor your sense of direction. There are all sorts of fun things that you could do.

We may end up spending more time navigating virtual worlds as VR becomes more widespread in the future. How might such navigation differ from navigation in the real world? Does VR offer any opportunities for new types of navigation or enhancing our navigation skills?

Yes, I think VR is going to be a really useful tool: partly for just studying people, trying out architectural designs or trying to understand what information people use. I’ve started to get interested in using VR myself to look at things like how people process the symmetry of buildings. I think it offers the opportunity to be a really useful tool in other ways also. For instance, we know that the brain’s spatial map is a really useful way of organising information in our own heads, people will often use a spatial strategy to remember things. We’re best at remembering things that happened in particular places, so if you’re trying to teach a history student something, you might create a virtual environment such as a virtual museum.

Also, you could play around with worlds that aren’t possible, such as you could fly through space or create a 4-dimensional world.  I’ve been thinking about that and whether we could make a mental map of a 4-dimensional world if we had the opportunity to explore one.

Do you mean 4 spatial dimensions?

Yes, the laws of mathematics allow for 4 dimensional spaces. So, in theory it ought to be possible to build a 4-dimensional virtual space. It would be interesting to know if we could make a mental map of a space like that.

Navigating 3-dimensional spaces

Are there any special challenges in terms of how to help people navigate the kind of 3-dimensional multi-level spaces which are common in our urban environments?

There’s been some work looking at people’s propensity to get confused in multi-level buildings, but there’s not much research on this yet. One reason might be that people don’t process vertical distances so effectively, but it might also be that often in multi-level buildings the levels resemble each other. Just as we find in horizontal spaces, where spaces resemble each other, our mental maps are confused by that. What you would do to try to stop that confusion is to try to make each level look really different, so give different levels different shapes with different directional cues. You can use different colours, but that doesn’t work that well since the spatial system doesn’t care about colours.

On the London Underground, at some large stations with multiple exits, e.g., Bank station, often you have no idea where you are going to pop up when you exit the station. How could we help people understand better the connection between where they are underground and their location at surface level?

One of the things you’re deprived of when you come up from underground is that you have no compass information, you have no idea which way you’re facing in the world at large. There are signs telling you what the different exits are, but if you don’t already have the knowledge of what those mean, it’s not very helpful. But you may know that for instance, that when I come out of this station, I want to head north, so if you had some compass information that would make it easier. Also, if you have some compass information, the first time you go into that space you could become oriented in such a way that lets you make a mental map of that space so that the next time you enter that space you have a better understanding of where you are. That’s a really good example of the type of built space that I think could be much better done, by taking into account the kind of information the brain needs. One thing that I would love to see is a compass rose at the top of every escalator. It would be interesting to start to add that sort of information and seeing if it makes people’s experience better.

Signage design

Are there any common mistakes you see in terms of signage design to assist wayfinding?

One thing is assuming people know where they’re going. For example, when you come up the escalator into the Piccadilly Circus station concourse, there are signs indicating exits for different streets, which presupposes that you know what those things mean. You may not have memorised the names of the streets. You know that you want to go north up to Oxford Circus for instance, but you didn’t know that that was Regent’s street.

Other issues with signs are, there may be too many of them, sometimes the text is too small or there is a sign as opposed to something more naturalistic that would have helped you orient more easily.

Signs have their place but they’re also very difficult to process cognitively, they rely on the language centres of the brain which are evolutionarily very recent, so it’s hard work and if you don’t speak the language or you’re visually impaired then they’re useless. So, I’d like to see a lot less signage and a lot more naturalistic design.

Human Factors and… Sound Design

Today we start a new series of interviews where we talk with different specialists associated with Human Factors and User Experience Design. The idea is to find out how HF Specialists are perceived by other disciplines, where our interests overlap, and how we can work better together to improve the design of products and services for all.

Our first interview is with Gareth Worthy a Sound Designer working in audio post-production and music and sound design for video and film. Gareth has advised us on a number of projects where sound and the auditory environment were important user experience considerations. We caught up with Gareth to get his views on sound design, in particular on the Human Factors of audible alarms and using sound to enhance the user experience in public places.

Some of our readers might not have realised that sound design is a profession! Could you describe what a sound designer does?

A sound designer is the person responsible for all (non musical) sound creation for specific projects. I generally work in audio for broadcast. My role as a sound designer would involve creating the non musical sounds that you would see on screen. That could be anything from making animated characters come to life, robotic movements, adding ambiences or foley sounds, such as footsteps and other natural sounds.
Within the industrial world a sound designer would be responsible for sound creation of a wide range of applications, it could be the “ping” of an elevator door opening, an alarm sound or the confirmation sounds of a self service checkout.

Do you think that the role of sound design in public places like stations and airports might change post COVID-19?

I think there is a possibility for this to happen. My thoughts are that some tasks that are normally performed by humans could become much more automated. Any type of task such as an airport check-in may become fully automated. Whilst using the systems the user would encounter a wide range of sounds such as human voices in the form of instructions, confirmation sounds when tasks are completed, error sounds when processes are incorrect and many more. There are so many changes happening across the world at the moment I think it’s quite difficult to predict how this will change.

What sort of sound design mistakes do you see in public places, like public address systems or door opening chimes, for example?

From my perspective the worst and most common would be the use of public address systems. I’m sure everyone can relate to being on the underground and the PA is so badly distorted you have no idea what it is saying. It’s certainly what I notice the most and always falls into three categories, too loud, too quiet or distorted/generally poor quality and inaudible.

From a sound design point of view, what makes a good audible alarm?

We have learned experiences of what alarms sound like (car alarm, fire alarm, alarm clock), so we need to work within an existing framework for it to be understood as an alarm.
There are two main aspects to this, pitch and amplitude. Firstly pitch or tone. An alarm needs to alert someone enough to trigger a specific response, such as complete a task. Generally speaking we all know what a fire alarm sounds like, if we changed the sound of the alarm to a calming harp sound we can all agree that it wouldn’t have the same effect. The same can be said for amplitude. It must be loud enough to be heard and prompt a response, but not so loud as to completely disorientate the subject. A balance of these is required.

How could people achieve this? (make a good audible alarm)

I think there are two aspects to consider, one is the actual alarm sound production, the other is the delivery system. The first steps must be to do the correct research on human response to frequency and amplitude, once you have this work alongside a sound designer to ensure that the source material is of a high quality. The second aspect is quite self explanatory. The delivery system (PA, Speaker etc) must be able to reproduce the alarm in a sufficient quality to be effective.

Why do you think that people ignore sounds or audible alarms sometimes? (I see that happen a lot)

We have already spoken about poor delivery systems so I won’t speak about that again but it’s certainly an aspect. An alarm that is not “alarming enough”, so I would class that as poor design. I think repetition would play a part in people ignoring alarms. If an alarm was sounding many times I think it would become ignored. Finally I think that if the alarm is not deemed important or dangerous enough by the listener, it would also lead to being ignored.

For anyone that has an audio aspect to their project, would you have one piece of advice for them?

It would be not to overlook the audio aspect of a project or leave it to the last minute. In my experience audio is often left until the last moment. Audio can provide such an important element to any project and giving the professionals who work with it enough time to really produce great results should be important to any company.