IEC 60601-1-8:2003

INTERNATIONAL IEC
STANDARD
60601-1-8
First edition
2003-08
Medical electrical equipment –
Part 1-8:
General requirements for safety –
Collateral standard:
General requirements, tests and guidance
for alarm systems in medical electrical
equipment and medical electrical systems
Appareils électromédicaux –
Partie 1-8:
Règles générales de sécurité –
Norme collatérale:
Règles générales, essais et guides
pour les systèmes d'alarme dans l'équipement
électromédical et les systèmes électromédicaux

Reference number
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As from 1 January 1997 all IEC publications are issued with a designation in the

60000 series. For example, IEC 34-1 is now referred to as IEC 60034-1.

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The IEC is now publishing consolidated versions of its publications. For example,

edition numbers 1.0, 1.1 and 1.2 refer, respectively, to the base publication, the

base publication incorporating amendment 1 and the base publication incorporating

amendments 1 and 2.
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INTERNATIONAL IEC
STANDARD
60601-1-8
First edition
2003-08
Medical electrical equipment –
Part 1-8:
General requirements for safety –
Collateral standard:
General requirements, tests and guidance
for alarm systems in medical electrical
equipment and medical electrical systems
Appareils électromédicaux –
Partie 1-8:
Règles générales de sécurité –
Norme collatérale:
Règles générales, essais et guides
pour les systèmes d'alarme dans l'équipement
électromédical et les systèmes électromédicaux

 IEC 2003  Copyright - all rights reserved
No part of this publication may be reproduced or utilized in any form or by any means, electronic or
mechanical, including photocopying and microfilm, without permission in writing from the publisher.
International Electrotechnical Commission, 3, rue de Varembé, PO Box 131, CH-1211 Geneva 20, Switzerland
Telephone: +41 22 919 02 11 Telefax: +41 22 919 03 00 E-mail: inmail@iec.ch  Web: www.iec.ch
PRICE CODE
XB
For price, see current catalogue

– 2 – 60601-1-8  IEC:2003(E)
CONTENTS
FOREWORD . 4

INTRODUCTION .6

SECTION ONE – GENERAL
1 Scope and object . 7

1.201 Scope . 7

1.202 Object . 8

1.203 Relationship to other standards. 7
1.203.1 IEC 60601-1 . 7
1.203.2 Particular standards . 7
1.203.3 Normative references . 8
2 Terminology and definitions . 8
6 Identification, marking and documents .12
6.3 Marking of controls and instruments .12
6.7 Indicator lights and push-buttons.12
6.8.1 ACCOMPANYING DOCUMENTS .12
6.8.2 Instructions for use .12
6.8.3 Technical description.13
SECTION TWO TO TEN – NOT USED
201 ALARM SYSTEMS .13
201.1 ALARM CONDITION .13
201.1.1 General .13
201.1.2 ALARM CONDITION priority .13
201.2 Disclosures for INTELLIGENT ALARM SYSTEM.14
201.3 Generation of ALARM SIGNALS .14
201.3.1 General .14
201.3.2 Visual ALARM SIGNALS .14
201.3.3 Auditory ALARM SIGNALS .15
201.3.4 Characteristics of verbal ALARM SIGNALS .18
201.4 Disclosure of delays .18
201.4.1 ALARM SYSTEM delays .18

201.4.2 Delays to or from a DISTRIBUTED ALARM SYSTEM.19
201.5 ALARM PRESETS.19
201.5.1 General requirements .19
201.5.2 Manufacturer-configured ALARM PRESETS.20
201.5.3 USER- and OPERATOR-configured ALARM PRESETS.20
201.5.4 DEFAULT ALARM PRESET .21
201.5.5 Interruptions of less than or equal to 30 s .21
201.6 ALARM LIMIT.22
201.6.1 General requirements .22
201.6.2 Adjustable ALARM LIMIT .22
201.7 ALARM SYSTEM security .22
201.8 ALARM SIGNAL inactivation states .23
201.8.1 General .23
201.8.2 Termination of inactivation of ALARM SIGNALS.23

60601-1-8  IEC:2003(E) – 3 –
201.8.3 Indication and access .23

201.9 ALARM RESET .24

201.10 NON-LATCHING and LATCHING ALARM SIGNALS .24

201.11 DISTRIBUTED ALARM SYSTEM .25

201.11.1 Existence OF DISTRIBUTED ALARM SYSTEM .25

201.11.2 Requirements for DISTRIBUTED ALARM SYSTEM communication of

ALARM CONDITIONS .25

201.12 ALARM CONDITION logging.26

Appendix D (normative) Symbols on marking .27
Annex AAA (informative) Rationale and guidance.32
Annex BBB (informative) Cross-reference of identification, marking, and documents.61
Annex CCC (informative) Guidance for auditory ALARM SIGNALS.64
Annex DDD (informative) Verbal ALARM SIGNALS .65
Annex EEE (normative) Reserved melodies for ALARM SIGNALS.67
Bibliography.68
Index of defined terms.70
Figure 201 – Illustration of temporal characteristics of auditory ALARM SIGNALS.17
Figure AAA.1 – Graphical representation of components of ALARM SYSTEM delay.48
Table 201 – ALARM CONDITION priorities .13
Table 202 – Characteristics of alarm indicator lights .15
Table 203 – Characteristics of the BURST of auditory ALARM SIGNALS .16
Table 204 – Characteristics of the PULSE of auditory ALARM SIGNALS .16
Table 205 – ALARM SIGNAL inactivation states.24
Table D.201 – Graphical symbols for ALARM SYSTEMS .28
Table D.202 – Alternative ALARM SYSTEM related markings .31
Table AAA.1 – Reference interpretation of Table EEE.1 .60
Table AAA.2 – Reference interpretation of Table EEE.2 .60
Table BBB.1 – Cross-reference of Marking.61

Table BBB.2 – Cross-reference of ACCOMPANYING DOCUMENTS.62
Table BBB.3 – Cross-reference of instructions for use .63
Table BBB.4 – Cross-reference of technical description .63
Table CCC.1 – Attributes of perceived urgency .64
Table EEE.1 – Equipment encoded auditory ALARM SIGNALS categorized by ALARM
CONDITION and priority complying with Tables 203 and 204.67
Table EEE.2 – Auditory LOW PRIORITY ALARM SIGNAL complying with Tables 203 and 204.67

– 4 – 60601-1-8  IEC:2003(E)
INTERNATIONAL ELECTROTECHNICAL COMMISSION

___________
MEDICAL ELECTRICAL EQUIPMENT –

Part 1-8: General requirements for safety –

Collateral Standard:
General requirements, tests and guidance for alarm systems

in medical electrical equipment and medical electrical systems

FOREWORD
1) The International Electrotechnical Commission (IEC) is a worldwide organization for standardization comprising
all national electrotechnical committees (IEC National Committees). The object of IEC is to promote
international co-operation on all questions concerning standardization in the electrical and electronic fields. To
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technical committees; any IEC National Committee interested in the subject dealt with may participate in this
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(ISO) in accordance with conditions determined by agreement between the two organizations.
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5) IEC provides no marking procedure to indicate its approval and cannot be rendered responsible for any
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9) Attention is drawn to the possibility that some of the elements of this IEC Publication may be the subject of
patent rights. IEC shall not be held responsible for identifying any or all such patent rights.

International standard IEC 60601-1-8 has been prepared by a Joint Working Group of IEC
subcommittee 62A: Common aspects of electrical equipment used in medical practice, of
IEC technical committee 62: Electrical equipment in medical practice, and ISO subcommittee
SC3: Lung ventilators and related devices of ISO technical committee 121: Anaesthetic and
respiratory equipment.
It is published as double logo standard.
This first edition constitutes a collateral standard to IEC 60601-1: Medical electrical
equipment – Part 1: General requirements for safety, hereinafter referred to as the general
standard.
60601-1-8  IEC:2003(E) – 5 –
This standard replaces the following standards:

ISO 9703-1 Anesthesia and respiratory care alarm signals – Part 1: Visual alarm signals

ISO 9703-2 Anesthesia and respiratory care alarm signals – Part 2: Auditory alarm signals

ISO 9703-3 Anesthesia and respiratory care alarm signals – Part 3: Guidance on

application of alarms
The text of this collateral standard is based on the following documents:

FDIS Report on voting
62A/424/FDIS 62A/432/RVD
Full information on the voting for the approval of this standard can be found in the report on
voting indicated in the above table. In ISO, the standard has been approved by 16 P-members
out of 18 having cast a vote.
In the 60601 series of publications, collateral standards specify general requirements for
safety applicable to:
– a subgroup of MEDICAL ELECTRICAL EQUIPMENT (e.g. radiological equipment); or
– a specific characteristic of all MEDICAL ELECTRICAL EQUIPMENT, not fully addressed in the
general standard (e.g. alarm systems).
The numbering of sections, clauses and subclauses of this collateral standard corresponds
with that of the general standard.
Clauses, subclauses, tables, and figures which are additional to those of the general standard
are numbered starting from 201; additional annexes are lettered AAA, BBB, etc., and
additional items aaa), bbb), etc.
In this collateral standard, the following print types are used:
– requirements and definitions: roman type;
– notes, examples, explanations, advice, introductions, general statements and references: smaller roman type;
– test specifications and guidance in Annex AAA: italic type; and
– TERMS DEFINED IN CLAUSE 2 OF THE GENERAL STANDARD, IN THIS COLLATERAL STANDARD OR AS
NOTED: SMALL CAPITALS.
The requirements are followed by specifications for the relevant tests.

Clauses and subclauses for which a rationale is provided in informative Annex AAA are
marked with an asterisk (*).
The committee has decided that the contents of this publication will remain unchanged until
2008. At this date, the publication will be
− reconfirmed;
− withdrawn;
− replaced by a revised edition, or
− amended.
– 6 – 60601-1-8  IEC:2003(E)
INTRODUCTION
MEDICAL ELECTRICAL EQUIPMENT and MEDICAL ELECTRICAL SYSTEMS are increasingly used in

medical practice. ALARM SIGNALS are frequently used to indicate unsatisfactory physiological

PATIENT states, unsatisfactory functional states of the MEDICAL ELECTRICAL EQUIPMENT or

MEDICAL ELECTRICAL SYSTEM or to warn the OPERATOR of potential hazards to the PATIENT or

OPERATOR due to the MEDICAL ELECTRICAL EQUIPMENT or MEDICAL ELECTRICAL SYSTEM.

INFORMATION SIGNALS convey information that is independent of an ALARM CONDITION.

Surveys of healthcare personnel have indicated significant discontent with ALARM SIGNALS.

Problems include difficulty in identifying the source of an ALARM SIGNAL, loud and distracting

ALARM SIGNALS, and the high incidence of FALSE POSITIVE or NEGATIVE ALARM CONDITIONS [16] .
Surveys of manufacturers of medical monitors demonstrated a wide variety of DEFAULT ALARM
PRESETS. The leading reason for disabling ALARM SIGNALS is the large number of ALARM
SIGNALS associated with FALSE POSITIVE ALARM CONDITIONS. See also bibliography.
Safety of PATIENTS depends on the ability of the OPERATOR to correctly discern the
characteristics of ALARM SIGNALS. Usability is an important element in the design of ALARM
SIGNALS that are readily discernible without being unnecessarily distracting or disturbing. This
approach is intended to rationalize the current situation, to reduce confusion by limiting
proliferation of ALARM SIGNALS and their control states, and to minimize distraction for other
people. This collateral standard was developed with contributions from clinicians, engineers
and applied psychologists.
The terminology, requirements, general recommendations and guidance of this collateral
standard are intended to be useful for manufacturers of MEDICAL ELECTRICAL EQUIPMENT and
MEDICAL ELECTRICAL SYSTEMS and for technical committees responsible for particular
standards.
The effectiveness of any ALARM SYSTEM depends critically on its implementation by the USER.
It is important that the USER configure the ALARM SYSTEM so that an OPERATOR is not able to
compromise it.
___________
1)
Figures in brackets refer to the bibliography.

60601-1-8  IEC:2003(E) – 7 –
MEDICAL ELECTRICAL EQUIPMENT –

Part 1-8: General requirements for safety –

Collateral Standard:
General requirements, tests and guidance for alarm systems

in medical electrical equipment and medical electrical systems

SECTION ONE – GENERAL
1 * Scope and object
1.201 Scope
This collateral standard specifies requirements for ALARM SYSTEMS and ALARM SIGNALS in
MEDICAL ELECTRICAL EQUIPMENT and MEDICAL ELECTRICAL SYSTEMS.
It also provides guidance for the application of ALARM SYSTEMS.
1.202 Object
The object of this collateral standard is to specify basic safety and essential performance
requirements and tests for ALARM SYSTEMS in MEDICAL ELECTRICAL EQUIPMENT and MEDICAL
ELECTRICAL SYSTEMS and to provide guidance for their application. This is accomplished by
defining alarm categories (priorities) by degree of urgency, consistent ALARM SIGNALS and
consistent control states and their marking for all ALARM SYSTEMS.
NOTE See IEC 60513:1994 [4] for a description of basic safety and essential performance.
This collateral standard does not specify:
– whether any particular MEDICAL ELECTRICAL EQUIPMENT or MEDICAL ELECTRICAL SYSTEM is
required to be provided with ALARM SYSTEMS;
– the particular circumstances which initiate an ALARM CONDITION;
– the allocation of priorities to a particular ALARM CONDITION; or
– the means of generating ALARM SIGNALS.
1.203 Relationship to other standards
1.203.1 IEC 60601-1
For MEDICAL ELECTRICAL EQUIPMENT, this collateral standard complements IEC 60601-1.
When referring to IEC 60601-1 or to this collateral standard, either individually or in
combination, the following conventions are used:
– "the general standard" designates IEC 60601-1 alone;
– "this collateral standard" designates IEC 60601-1-8 alone;
– "this standard" designates the combination of the general standard and this collateral
standard.
1.203.2 Particular standards
A requirement in a particular standard takes priority over the corresponding requirement in
this collateral standard.
– 8 – 60601-1-8  IEC:2003(E)
1.203.3 Normative references
The following referenced documents are indispensable for the application of this document.

For dated references, only the edition cited applies. For undated references, the latest edition

of the referenced document (including any amendments) applies.

2)
IEC 60417-DB:2000-10 , Graphical symbols for use on equipment

IEC 60601-1:1988 Medical electrical equipment – Part 1: General requirements for safety
Amendment 1 (1991)
Amendment 2 (1995)
IEC 60601-1-1:2000, Medical electrical equipment – Part 1-1: General requirements for safety
– Collateral standard: Safety requirements for medical electrical systems
3)
IEC 60601-1-6:― , Medical electrical equipment – Part 1-6: General requirements for safety
– Collateral standard: Usability
4)
IEC 60651:1979 , Sound level meters
Amendment 1 (1993)
Amendment 2 (2000)
ISO 3744:1994, Acoustics – Determination of sound power levels of noise sources using
sound pressure – Engineering method in an essentially free field over a reflecting plane
ISO 7000:1989, Graphical symbols for use on equipment – Index and synopsis
2 Terminology and definitions
5)
For the purposes of this collateral standard, the following definitions apply.
NOTE This collateral standard uses the term “equipment” to mean MEDICAL ELECTRICAL EQUIPMENT or non-MEDICAL
ELECTRICAL EQUIPMENT in the context of a MEDICAL ELECTRICAL SYSTEM.
2.201
* ALARM CONDITION
state of the ALARM SYSTEM when it has determined that a potential or actual hazard exists
NOTE 1 An ALARM CONDITION can be invalid, i.e. a FALSE POSTIVE ALARM CONDITION.
NOTE 2 An ALARM CONDITION can be missed, i.e. a FALSE NEGATIVE ALARM CONDITION.
2.202
* ALARM CONDITION DELAY
time from the occurrence of a triggering event either in the PATIENT, for PHYSIOLOGICAL ALARM
CONDITIONS, or in the equipment, for TECHNICAL ALARM CONDITIONS, to when the ALARM SYSTEM
determines that an ALARM CONDITION exists
2.203
* ALARM LIMIT
threshold used by an ALARM SYSTEM to determine an ALARM CONDITION
___________
2)
“DB” refers to the IEC on-line database.
3)
To be published
4)
A consolidated edition (1.2) exists including IEC 60651 (1997) and its Amendment 1 (1993) and Amendment 2
(2000)
5)
An index of defined terms is found beginning on page 70.

60601-1-8  IEC:2003(E) – 9 –
2.204
ALARM OFF
state of indefinite duration in which an ALARM SYSTEM or part of an ALARM SYSTEM does not

generate ALARM SIGNALS
2.205
* ALARM PAUSED
state of limited duration in which the ALARM SYSTEM or part of the ALARM SYSTEM does not

generate ALARM SIGNALS
2.206
ALARM PRESET
set of stored configuration parameters, including selection of algorithms and initial values for
use by algorithms, which affect or modify the performance of the ALARM SYSTEM
2.207
ALARM RESET
OPERATOR action that causes the cessation of an ALARM SIGNAL for which no associated ALARM
CONDITION currently exists
2.208
ALARM SETTINGS
ALARM SYSTEM configuration, including but not limited to:
– ALARM LIMITS;
– the characteristics of any ALARM SIGNAL inactivation states; and
– the values of variables or parameters that determine the function of the ALARM SYSTEM.
NOTE Some algorithmically determined ALARM SETTINGS can require time to be determined or re-determined.
2.209
ALARM SIGNAL
type of signal generated by the ALARM SYSTEM to indicate the presence (or occurrence) of an
ALARM CONDITION
2.210
* ALARM SIGNAL GENERATION DELAY
time from the onset of an ALARM CONDITION to the generation of its ALARM SIGNALS
2.211
ALARM SYSTEM
parts of MEDICAL ELECTRICAL EQUIPMENT or a MEDICAL ELECTRICAL SYSTEM that detect ALARM

CONDITIONS and, as appropriate, generate ALARM SIGNALS
2.212
AUDIO OFF
state of indefinite duration in which the ALARM SYSTEM or part of the ALARM SYSTEM does not
generate an auditory ALARM SIGNAL
2.213
AUDIO PAUSED
state of limited duration in which the ALARM SYSTEM or part of the ALARM SYSTEM does not
generate an auditory ALARM SIGNAL
2.214
BURST
group of PULSES with a distinctive rhythm or pattern

– 10 – 60601-1-8  IEC:2003(E)

2.215
DE-ESCALATION
process by which an ALARM SYSTEM decreases the priority of an ALARM CONDITION or decreases

the sense of urgency of an ALARM SIGNAL

2.216
DEFAULT ALARM PRESET
ALARM PRESET that can be activated by the ALARM SYSTEM without OPERATOR action

NOTE Manufacturer- or USER-configured ALARM PRESETS are possible types of DEFAULT ALARM PRESETS.

2.217
* DISTRIBUTED ALARM SYSTEM
ALARM SYSTEM that involves more than one item of equipment of a MEDICAL ELECTRICAL SYSTEM
NOTE The parts of a DISTRIBUTED ALARM SYSTEM can be widely separated in distance.
2.218
ESCALATION
process by which an ALARM SYSTEM increases the priority of an ALARM CONDITION or increases
the sense of urgency of an ALARM SIGNAL
2.219
FALL TIME
t
f
interval over which the PULSE amplitude decreases from 90 % to 10 % of its maximum (see
Figure 201)
2.220
FALSE NEGATIVE ALARM CONDITION
absence of an ALARM CONDITION when a valid triggering event has occurred in the PATIENT, the
equipment or the ALARM SYSTEM
NOTE An ALARM CONDITION can be rejected or missed because of spurious information produced by the PATIENT,
the PATIENT-equipment interface, other equipment or the equipment itself.
2.221
FALSE POSITIVE ALARM CONDITION
presence of an ALARM CONDITION when no valid triggering event has occurred in the PATIENT,
the equipment or the ALARM SYSTEM
NOTE A FALSE POSITIVE ALARM CONDITION can be caused by spurious information produced by the PATIENT, the
PATIENT-equipment interface, other equipment or the ALARM SYSTEM itself.
2.222
HIGH PRIORITY
indicating that immediate OPERATOR response is required
NOTE The priority is assigned through risk analysis.
2.223
* INFORMATION SIGNAL
any signal that is not an ALARM SIGNAL or a REMINDER SIGNAL
EXAMPLE 1 ECG waveform
EXAMPLE 2 SpO tone
EXAMPLE 3 Fluoroscopy beam-on indication
2.224
* INTELLIGENT ALARM SYSTEM
ALARM SYSTEM that makes logical decisions based on monitored information without OPERATOR
intervention
EXAMPLE 1 An ALARM SYSTEM that changes priority based on the rate of change of a monitored variable.

60601-1-8  IEC:2003(E) – 11 –

EXAMPLE 2 An ALARM SYSTEM that suppresses an ALARM CONDITION when a related ALARM CONDITION of higher

priority has recently generated an ALARM SIGNAL.

2.225
INTERBURST INTERVAL
t
b
period of time between the end of the last PULSE of a BURST and the start of the first PULSE of
the next BURST of the same ALARM SIGNAL (see Figure 201)

2.226
LATCHING ALARM SIGNAL
ALARM SIGNAL that continues to be generated after its triggering event no longer exists until
stopped by deliberate OPERATOR action
2.227
LOW PRIORITY
indicating that OPERATOR awareness is required
NOTE The priority is assigned through risk analysis.
2.228
MEDIUM PRIORITY
indicating that prompt OPERATOR response is required
NOTE The priority is assigned through risk analysis.
2.229
NON-LATCHING ALARM SIGNAL
ALARM SIGNAL that automatically stops being generated when its associated triggering event
no longer exists
2.230
OPERATOR'S POSITION
intended position of the OPERATOR with respect to the ALARM SIGNAL generating part of the
ALARM SYSTEM
NOTE A DISTRIBUTED ALARM SYSTEM can have multiple OPERATOR’S POSITIONS.
2.231
PHYSIOLOGICAL ALARM CONDITION
ALARM CONDITION arising from a monitored PATIENT-related variable
EXAMPLE 1 High exhaled anesthetic agent concentration.
EXAMPLE 2 Low exhaled tidal volume.

EXAMPLE 3 Low oxygen saturation measured by pulse oximetry.
EXAMPLE 4 High arterial pressure.
EXAMPLE 5 High heart rate.
2.232
PULSE
brief continuous sound having a specific spectral content
2.233
PULSE FREQUENCY
f
o
fundamental frequency (first harmonic) of a PULSE
2.234
* REMINDER SIGNAL
periodic signal that reminds the OPERATOR that the ALARM SYSTEM is in an ALARM SIGNAL-
inactivation state
– 12 – 60601-1-8  IEC:2003(E)

2.235
RISE TIME
t
r
interval over which the PULSE increases from 10% to 90% of its maximum amplitude (see

Figure 201)
2.236
TECHNICAL ALARM CONDITION
ALARM CONDITION arising from a monitored equipment-related or ALARM SYSTEM-related

variable
EXAMPLE 1 An electrical, mechanical or other failure.

EXAMPLE 2 A failure of a sensor or component (unsafe voltage, high impedance, signal impedance, artifact,
noisy signal, disconnection, calibration error, tubing obstruction, etc.).
EXAMPLE 3 An algorithm that cannot classify or resolve the available data.
6 Identification, marking and documents
6.3 Marking of controls and instruments
Addition:
NOTE Additional requirements for the marking on controls and instruments are specified in this collateral
standard, together with the technical requirements, giving rise to requirements on markings. These requirements
are also listed in BBB.1.
6.7 Indicator lights and push-buttons
a) Colors of indicator lights
Addition, after the first sentence:
See also 201.3.2.2.
Addition, after the second sentence:
See also 201.3.2.2.
6.8.1 ACCOMPANYING DOCUMENTS
Addition:
NOTE Additional requirements on ACCOMPANYING DOCUMENTS are specified in this collateral standard, together
with the technical requirements, giving rise to requirements on ACCOMPANYING DOCUMENTS. These requirements are
also listed in Table BBB.2.
6.8.2 Instructions for use
Addition:
aaa) ALARM SYSTEMS
Instructions for use shall:
− * provide an overview of the ALARM SYSTEM, including a listing and description of every
possible ALARM CONDITION and, as appropriate for the intended OPERATOR, a summary of
how it is determined;
− indicate any delay inherent in the determination of an ALARM CONDITION;
− disclose the OPERATOR'S POSITION; and
− * include how and when to verify the functionality of the ALARM SYSTEM.
As applicable, the instructions for use shall:
− caution against setting ALARM LIMITS to extreme values that can render the ALARM SYSTEM
useless.
NOTE Additional requirements on instructions for use are specified in this collateral standard, together with the
technical requirements, giving rise to requirements on instructions for use. These requirements are also listed in
Table BBB.3.
60601-1-8  IEC:2003(E) – 13 –

6.8.3 Technical description
Addition:
NOTE Additional requirements on technical description are specified in this collateral standard, together with the

technical requirements, giving rise to requirements on technical description. These requirements are also listed in

Table BBB.4.
SECTION TWO TO TEN – NOT USED
Addition:
201 ALARM SYSTEMS
201.1 * ALARM CONDITION
201.1.1 * General
If ALARM CONDITIONS are grouped into PHYSIOLOGICAL ALARM CONDITIONS, TECHNICAL ALARM
CONDITIONS or other ALARM CONDITION groups by the manufacturer, this shall be disclosed in
the instructions for use.
Compliance is checked by inspection of the instructions for use.
201.1.2 * ALARM CONDITION priority
ALARM CONDITIONS shall be assigned to one or more of the following priorities: HIGH PRIORITY,
MEDIUM PRIORITY, or LOW PRIORITY. Unless a particular ALARM CONDITION priority is specified in
a relevant particular standard, the assignment of priorities is part of the risk management
process and shall be based on Table 201. The priority of each ALARM CONDITION shall be
disclosed in the instructions for use. Priorities may be identified in groups.
NOTE A risk management process for medical devices is given in ISO 14971.
Compliance is checked by inspection of the instructions for use and risk management file.
Table 201 – ALARM CONDITION priorities
a
Potential result of failure Onset of potential harm
to respond to the cause
b c d
Immediate Prompt Delayed
of ALARM CONDITION
e
Death or irreversible injury HIGH PRIORITY HIGH PRIORITY MEDIUM PRIORITY

Reversible injury HIGH PRIORITY MEDIUM PRIORITY LOW PRIORITY
Minor injury or discomfort MEDIUM PRIORITY LOW PRIORITY LOW PRIORITY
or no ALARM SIGNAL
An INFORMATION SIGNAL may also be used to indicate the potential for delayed minor injury or discomfort.
a
Onset of potential harm refers to when an injury occurs and not to when it is manifested.
b
Having the potential for the event to develop within a period of time not usually sufficient for manual corrective
action.
c
Having the potential for the event to develop within a period of time usually sufficient for manual corrective
action.
d
Having the potential for the event to develop within an unspecified time greater than that given under “prompt”.
e
MEDICAL ELECTRICAL EQUIPMENT with a therapeutic function is usually designed to prevent immediate death or
irreversible injury by automatic safety mechanisms.

– 14 – 60601-1-8  IEC:2003(E)

201.2 * Disclosures for INTELLIGENT ALARM SYSTEM

If an INTELLIGENT ALARM SYSTEM is provided, the instructions for use shall include, as

applicable, an overview of how the ALARM SYSTEM:

a) determines an ALARM CONDITION on the basis of time, weightings, multiple variables, or

other advanced processing (including, but not limited to, algorithms, neural networks,

fuzzy logic, etc.);
b) generates ALARM SIGNALS for two or more ALARM CONDITIONS of equal priority (including,

but not limited to, internal ranking, effect on generation of ALARM SIGNALS);

c) changes the previously-assigned priority or relative prioritization of a particular ALARM

CONDITION (e.g., ESCALATION or DE-ESCALATION);
d) changes the ALARM SIGNAL GENERATION DELAY or ALARM CONDITION DELAY; and
e) changes the characteristics of the generated ALARM SIGNALS (for example, volume, pitch,
tempo, urgency).
Compliance is checked by inspection of the instructions for use.
201.3 Generation of ALARM SIGNALS
201.3.1 General
Each ALARM CONDITION shall cause the generation of visual ALARM SIGNALS as specified in this
collateral standard. If deemed necessary by risk assessment regarding the environment in
which the ALARM SYSTEM is intended to be used, additional ALARM SIGNALS shall be generated.
These additional ALARM SIGNALS may be auditory, verbal, vibratory or produced by other
means.
EXAMPLE ALARM SYSTEMS with HIGH or MEDIUM PRIORITY ALARM CONDITIONS that are intended not to be
continuously attended by an OPERATOR in NORMAL USE should generate additional auditory ALARM SIGNALS.
Compliance is checked by inspection of the ALARM SYSTEM.
201.3.2 * Visual ALARM SIGNALS
201.3.2.1 General
ALARM SYSTEMS shall generate visual ALARM SIGNALS to indicate the presence of ALARM
CONDITIONS, their priority and each specific ALARM CONDITION.
201.3.2.2 * Characteristics of visual ALARM SIGNALS
If a visual indicator is necessary for the OPERATOR to identify the equipment or part of the

equipment that requires OPERATOR response or awareness, at least one visual ALARM SIGNAL
shall be provided that:
a) indicates the priority of the highest priority ALARM CONDITION; and
b) can be perceived correctly at a distance of 4 m from the ALARM SYSTEM.
If an alarm indicator light or graphical simulation of an indicator light is used for these
purposes, it shall comply with the color and flashing requirements given in Table 202.
Alternatively, this indication may be generated by some other type of visual display or device.
ALARM SYSTEMS that do not contain HIGH PRIORITY or MEDIUM PRIORITY ALARM CONDITIONS are
exempt from this requirement if their visual indication cannot be confused with a HIGH PRIORITY
or MEDIUM PRIORITY alarm indicator light complying with Table 202.
NOTE 1 This visual indicator is necessary for ALARM SYSTEMS that are intended to be located in the proximity of
other ALARM SYSTEMS.
NOTE 2 This visual indicator is not necessary for ALARM SYSTEMS that are worn, e.g., a paging receiver.

60601-1-8  IEC:2003(E) – 15 –

NOTE 3 An indicator light can be simulated, e.g. by a graphical display.

Table 202 – Characteristics of alarm indicator lights

Alarm Indicator Flashing Duty
category color frequency cycle

HIGH
Red 1,4 Hz to 2,8 Hz 20 % to 60 % on
PRIORITY
MEDIUM
Yellow 0,4 Hz to 0,8 Hz 20 % to 60 % on
PRIORITY
LOW Cyan or
Constant (on) 100 % on
PRIORITY yellow
At least one visual ALARM SIGNAL shall be provided that identifies the specific ALARM CONDITION
and its priority. This signal shall be perceived correctly (be legible) at a distance of 1 m from
the equipment or part of the equipment or from the OPERATOR’S POSITION. This visual
indication may be text placed beside an indicator light or text on a display. The presence of
an ALARM CONDITION may be visually indicated (marked) with symbol IEC 60417-5307 (see
Symbol 1 of Table D.201). The priority may be indicated by adding one, two or three optional
elements, (e.g., ! for LOW PRIORITY, !! for MEDIUM PRIORITY, and !!! for HIGH PRIORITY).
NOTE 4 Factors affecting the legibility of a visual indication include the nature and characteristics of the visual
indication itself, ambient lighting in the intended environment of use, and viewing angle and distance.
NOTE 5 The use of text that flashes on and off is discouraged because it is often difficult to read. Flashing text
that alternates between normal and reverse video or another color is acceptable.
NOTE 6 Multiple-purpose computer-generated graphic displays should be designed in accordance with modern
6)
human interface design principles. Attention is drawn to IEC 60601-1-6 .
NOTE 7 The identification of the ALARM CONDITION is intended to convey information necessary for PATIENT safety
and safe use of the equipment.
If multiple ALARM CONDITIONS occur at the same time, each individual ALARM CONDITION shall
be visually indicated, either automatically or by OPERATOR action, unless an INTELLIGENT ALARM
SYSTEM is provided that prevents a lower internal rank ALARM CONDITION from generating
ALARM SIGNALS when a higher internal rank ALARM CONDITION is generating or has recently
generated ALARM SIGNALS (see 201.2).
Visual INFORMATION SIGNALS, if provided, shall be correctly perceived as different from visual
ALARM SIGNALS at a distance of 1 m from the ALARM SYSTEM or from the OPERATOR’S POSITION.
Compliance is checked by inspection of the visual ALARM SIGNAL under the following
conditions:
− the OPERATOR has a visual acuity of 0 on the logMAR [17] scale or 6-6 (20/20) vision

(corrected if necessary),
− the viewpoint is at the OPERATOR'S POSITION or at any point within the base of a cone
subtended by an angle of 30° to the axis horizontal to or normal to the center of the plane
of display of the monitoring display or visual indication, and
− the ambient illuminance in the range [21] of 100 lx to 1 500 lx.
201.3.3 * Auditory ALARM SIGNALS
201.3.3.1 * Characteristics of auditory ALARM SIGNALS
An ALARM SYSTEM provided with auditory ALARM SIGNALS shall have at least one set of ALARM
SIGNALS that:
___________
6)
To be published
– 16 – 60601-1-8  IEC:2003(E)

a) is priority encoded and meets the requirements of Tables 203 and 204; or

b) is generated by means of different technology (e.g., voice synthesizing of verbal ALARM

SIGNALS) and is validated (e.g., by clinical or simulated clinical usability testing).

Table 203 – * Characteristics of the BURST of auditory ALARM SIGNALS

HIGH PRIORITY MEDIUM PRIORITY LOW PRIORITY
Characteristic
d
ALARM SIGNAL ALARM SIGNAL ALARM SIGNAL

a, e
Number of PULSES in BURST 10 3 1 or 2

PULSE spacing (t ) (see figure 201)
s
st nd
between 1 and 2 PULSE x y y
nd rd
between 2 and 3 PULSE x y not applicable
rd th
between 3 and 4 PULSE 2x + t not applicable not applicable
d
th th
x
between 4 and 5 PULSE not applicable not applicable
th th
between 5 and 6 PULSE 0,35 s to 1,30 s not applicable not applicable
th th
between 6 and 7 PULSE x not applicable not applicable
th th
between 7 and 8 PULSE x not applicable not applicable
th th
between 8 and 9 PULSE 2x + t not applicable not applicable
d
th th
x not applicable not applicable
between 9 and 10 PULSE
b, c
INTERBURST INTERVAL (t )
b 2,5 s to 15,0 s 2,5 s to 30,0 s >15 s
or no repeat
Difference in amplitude between any two PULSES Maximum 10 dB Maximum 10 dB Maximum 10 dB
Where x shall be a value between 50 ms and 125 ms.
Where y shall be a value between 125 ms and 250 ms.
The variation of x and y within a BURST shall be ± 5 %.
MEDIUM PRIORITY t + y shall be greater than or equal to HIGH PRIORITY t + x.
d d
a
See also Table 204 for characteristics of the PULSE.
b
Unless otherwise specified in a particular standard for a particular MEDICAL ELECTRICAL EQUIPMENT.
c
Manufacturers are encouraged to use the longest INTERBURST INTERVAL consistent with the risk analysis.
Writers of particular standards are encouraged to consider the longest appropriate INTERBURST INTERVAL of
the auditory ALARM SIGNAL for the particular ALARM SYSTEM application. Long INTERBURST INTERVALS can under
certain conditions negatively affect the ability to correctly discern, in a timely manner, the source of the
ALARM CONDITION.
d
The generation of the auditory component of a LOW PRIORITY ALARM CONDITION is optional.
e
Unless inactivated by the OPERATOR, MEDIUM PRIORITY and LOW PRIORITY auditory ALARM SIGNALS shall
complete at least one BURST, an
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