This invention relates to devices and methods for detecting and monitoring heart rate and breathing, for example in battlefield environments.
The battlefield environment presents special problems for dealing with casualties. Triage is essential to identify the cohort of casualties who will benefit most from the correct medical treatment. Patient physiological monitoring is available for civilian settings but suitable equipment is not yet available for the battlefield. The battlefield itself is a noisy, dirty and chaotic environment and, more generally, can be subjected to extremes of temperature, humidity and the like.
Interviews with medical and other military personnel have identified a number of unmet needs including the need for fast, reliable measurement of respiratory rate, real time monitoring and display of vital signs, and access to vital signs trend data over time.
According to a first aspect the invention provided a device, in particular a medical device such as a battlefield triage device, configured to be attached to and carried by a person, in particular a patient/casualty, the device comprising: an attachable sensor module, to attach to or in the vicinity of a person's face, the module having a respiratory sensing region comprising an air temperature sensor and a humidity sensor arranged such that, when the module is attached, airflow in and out of the person's lungs flows over said respiratory sensing region, the module further bearing an optical heart sensor arranged, when the module is attached, derive to an optical heart rate sensing signal from flesh of the person; a signal processing system, coupled to said sensor module, to process and combine signals from said temperature sensor and said humidity sensor to determine a respiration rate for said person and to process signals from said optical heart rate sensor to determine a heart rate of said person; a data output system, coupled to said signal processing system, to output data indicating one or both of said respiration rate and said heart rate.
Embodiments of the device are small, light, very quick to attach and may be cheap enough to be disposable. In some preferred embodiments the sensor is arranged to attach to the person's nose and/or mouth—tests have shown good results for both. In one embodiment the sensor module is configured to clip onto the person. It may thus have a pair of jaws, in particular sprung jaws, or other means to clip partially within a nostril (although it may additionally or alternatively be clipped onto the mouth). The respiratory sensing region is arranged such that, when the module is clipped or otherwise attached partially within the nostril, airflow in and out of the person's lungs via the nostril flows over the respiratory sensing region. Other attachment methods which may be employed for this arrangement include a sticker, over-centre/cam clip, and a use-once ratchet system (akin to a cable tie). In still other approaches the sensor may be carried by another item attached to the person/patient/casualty, such as an oxygen mask. The general objective is to locate the sensing region in the vicinity of the mouth or nose.
Clipping the sensor onto the nose allows the respiratory rate to be monitored accurately without significantly impeding airflow. Preferably the respiratory sensing region is located at the base of one of the jaws adjacent the articulating (hinging) region so that it sits just outside the nostril in use. This allows the sensor also to respond to a degree to airflow through the mouth (and, if necessary, this device configuration also allows the device to be clipped onto a lip rather than a nostril). Preferably the optical heart rate sensor mounted on the outer jaw, to avoid obstructing airflow within the nostril. Preferably this sensor is shielded from external sunlight (which may be very bright) by an opaque region of the jaw and/or a dedicated light shield. Alternatively light transmission through the flesh of the nose may be employed with a light source on one of the jaws and a light detector on the other, preferably the internal jaw. This works better but the portion of the sensor inside the nostril needs to be relatively small.
Thus in embodiments the sensor module comprises a single, clip-on unit which senses both temperature and humidity or the respiration rate and which includes an optical sensor for the heart rate. As explained in more detail below, sensing both temperature and humidity is important for reliable operation in a wide range of environments—for example a jungle environment may be extremely humid with little change in humidity between air flowing into the lungs and air flowing out of the lungs, and in such a situation the temperature change may be relied upon to determine the respiration rate.
As previously mentioned, in some preferred embodiments at least the sensor module is cheap, light and disposable. A medical officer can be reluctant to leave kit with a casualty because they may need it for others and thus it is preferable for the device to be potentially issued to each soldier (or other user) individually, for example as part of a med-pouch. In embodiments, therefore, the sensor module is fabricated from moulded plastic and the jaws may be joined by a curved, resilient plastic connector acting as both a hinge and a spring. In principle the plastic sprung jaws/housing of the sensor module may therefore be one-piece mouldable.
In embodiments of the device the sensor module may also incorporate the signal processing system and data output system in a single, self-contained unit which simply clips onto the person's/patient's/casualty's nose. In such an arrangement a display may be provided on the outer most jaw, that is the jaw on the outside of the nostril when the device is attached. In other configurations a separate processing module, preferably a clip-on or strap-on module is provided incorporating the signal processing system and data output system. With such an arrangement the signal processing system may be automatically activated (switched on or woken from a sleep state) by connecting the sensor module to the processing module. The connection may be wired or wireless although automatic switch on is more straightforward with a wired connection since physical connection can activate the processing module.
The data output system preferably comprises a display of both the respiration rate and heart rate of the person/patient/casualty, although a visual and/or audible alert may additionally or alternatively be provided responsive to detection of a deteriorating respiration and/or heart rate (for example less/greater than a threshold and/or less/greater than a threshold change over time). The display may be an (organic) light emitting diode display which is advantageous because it is physically thin and power efficient, or an LCD or electronic paper (electrophoretic) display both of which are more easily visible under high ambient light conditions, the latter being also very thin and power efficient.
Further additionally or alternatively the data output system may include a wired or wireless communication system, for example PRR (personnel role radio) communications. Preferred embodiments of the system include a non-volatile memory configured to store a user-accessible log of historical data for the respiration rate and heart rate. Preferably this is incorporated into the signal processing system and travels with the person/patient/casualty although, potentially, it may be provided on a removable memory module. Again this data may be accessed either directly using the processing module or indirectly via wired or wireless communications including, for example, near field communications. Optionally the processing module may be provided with a system to enable a medic to record MIST (mechanism, injury, signs, treatment) data, again to follow the person/patient/casualty (it can be very difficult to communicate such information in a noisy helicopter were verbal communication is difficult or impossible). Such a system may comprise, for example, an analogue or digital recording system. Optionally the above-described device, and the methods/devices described later, may monitor additional vital signs, for example oxygen saturation (SpO2 or other measure) and/or blood pressure and/or skin temperature.
As previously mentioned preferred embodiments of the signal processing system combines signals from both the temperature sensor and humidity sensor to determine a respiration rate for the person/patient/casualty. In embodiments these may be combined with a weighting dependent on a measure of fidelity or quality of the respective signal, for example a signal-to-noise ratio of the signal. In embodiments a respiration rate is determined from each of the temperature sensor and humidity sensor and these are combined as a weighted average, weighted by a fidelity measure of the signals from which each rate is derived.
In one preferred signal processing technique a signal from one or both of the temperature sensor and the humidity sensor is differentiated to identify changes in temperature/humidity to establish a respiration rate. This is advantageous because of the wide temperature/humidity ranges over which the device may have to operate. The differentiated signal may then be averaged and thresholded to provide a digital signal whose pulse rate determines the respiration rate.
When processing the signal from the heart rate sensor preferably the signal is filtered to inhibit dicrotic noise (some cardiac injuries can produce a dicrotic pulse). In embodiments this may be achieved by inhibiting detection of a pulse/transition in the heart rate sensor signal until a threshold duration from a previous pulse has elapsed, preferably a predetermined fraction of a measured inter-beat interval.
The invention also provides a (preferably clip-on) sensor module as described above; and a signal processing module comprising a signal processing system as described above.
In a related aspect the invention a method of monitoring a person, for example a patient or casualty for battlefield triage, the method comprising; monitoring both heart rate and respiration rate of said person with a combined sensor module by: attaching said sensor module in or adjacent to a nostril or mouth of said person such that one or both of a temperature sensor and humidity sensor is located in an airflow in and out of the person's lungs via said nostril and/or mouth; monitoring a respiration rate of said person using said temperature and/or humidity sensor; and monitoring heart rate of said person using an optical heart rate sensor mounted on said sensor module.
As previously described, preferably in use the temperature/humidity sensors hang just underneath the nose and, preferably, the respiration rate is determined from a combination of signals from both the temperature sensor and humidity sensor. Alternatively, however the sensor may be attached to the mouth—some preferred embodiments can be attached in either position or elsewhere on the face in the vicinity of the nose or mouth. Preferably the sensor module is a clip-on sensor module.
In a further related aspect the invention provides a clip-on sensor module for a monitoring both heart rate and respiration rate of a person, the sensor module comprising one or both of a temperature sensor and humidity sensor arranged such that they are located in an airflow in and out of the person's lungs via said nostril when the module is clipped partially within said nostril; and an optical heart sensor arranged, when the module is clipped partially within said nostril, to derive an optical heart rate sensing signal from flesh of said nostril.
In use the module is attached to or held in the vicinity of the nose and/or mouth.
The invention contemplates employing a device/method/module as described above in scenarios other than a battlefield. Thus aspects and embodiments of the invention provide a medical device/method/module as described above which may be used for battlefield triage but also devices for use, for example, in a general hospital environment.
More particularly there is a general need for accurate electronic respiration rate measurement systems for activities such as triage, activity monitoring, health monitoring, breathing monitoring and the like, and tests have established that embodiments of the inventions are able to produce accurate breathing rate determinations.
Thus in a further aspect the invention provides a device configured to be attached to and carried by a person, the device comprising: a respiration rate sensor comprising an air temperature sensor and a humidity sensor; a signal processing system to process and combine signals from said temperature sensor and said humidity sensor to determine a respiration rate for said person; and a data output system, coupled to said signal processing system, to output data indicating said respiration rate for monitoring said person.
In some preferred embodiments the device further comprises a heart rate sensor, and the signal processing system is additionally configured to process signals from the heart rate sensor to determine a heart rate of the person.
The skilled person will appreciate that features of the above described aspects and embodiments of the invention may be combined in any permutation.
The invention is diagrammatically illustrated, by way of example, in the accompanying drawings in which:
In the drawings, the following reference numerals are used:
10=battlefield triage device
12=nose clip sensor module
13=hinge
14=connecting wire
16=latching connector
18=processing module with display device/interface
20=display
22=external battery
24=clip
26=power button
28=packaging
30=casualty (patient) nose
32=casualty's/patient's clothing
34=sound alarm
36=light alarm
38=medic's display device
40=latching connector
42=headband-based device
44=sucker-based device
46=combined display and sensor
48=respiration sensor region
50=heart monitor
51=light shield
52=light
54=air-flow
56=combined temperature/humidity sensor
58=trend graph
60=critical information
62=icons
64=personal role radio (“PRR”)
The nose clip 12 contains sensors to measure respiratory rate and heart rate. The nose clip may be disposable, which removes the risk of contamination transfer between patients. In the embodiment of the invention shown in
In
As described in more detail below, the respiratory rate is measured by sensing differences in temperature and humidity between inhaled and exhaled air, converting this into a measurement of breaths per minute. By locating the sensor as illustrated in
In embodiments the heart rate is detected by illuminating the flesh of the nose with light (which may be green light), for example from an LED, and sensing either the light transmitted through the nose or the level of light reflected back. The level of transmitted/reflected light is modulated according to blood flow into the nose. The nose has a good supply of subcutaneous blood vessels which alternately expand and contract in time with the heart rate, which can be detected as a small variation in the transmitted and/or reflected light. To avoid impeding the air flow within the nose preferably a reflectance sensor mounted on the outer jaw 12b is employed.
In the illustrated prototype the nose clip was fabricated from translucent plastic, which was coloured black 51 to shield the sensor from sunlight. The sensor was tested under a wide range of lighting conditions and reliability was reduced under high direct sunlight levels (90,000 lux). To address this sufficient shielding is employed for the sensor not to be saturated, optionally also arranging the readout electronics accordingly; an additional light shield (not shown) may also be employed.
Referring next to
Processor control code running on processor 100 reads and calculates sensor values, logs data to storage 106, drives the display 104, and allows the logged data to be downloaded via communications 110. The software provides a common framework for monitoring raw sensor data; in embodiments the sensor values are updated at 500 Hz, which allows noise to be rejected and improves sensor accuracy. Sensor algorithms detect fluctuations in the raw sensor data to identify a regular pattern, identifying and timing peaks to calculate the rate of the measured parameter, which is then displayed/stored/otherwise processed.
For the heart rate sensing chain, the maximum and minimum sensor signals are recorded and a threshold is set midway between the two. The software then monitors the point at which the recorded signal crosses this threshold. This value is then checked to determine that it lies within physically realistic limits and is therefore a genuine measurement (noise reduction) and the value is also filtered to suppress dicrotic noise, in embodiments by delaying by 0.6 of the previous inter-beat interval. The inter-beat interval is then calculated by determining the period of time which has lapsed between pulses, and this is then fed into a ten point rolling average filter to suppress the effect of false readings. The filtered inter-beat interval is then used as the heart rate variable for the subsequent processing.
Referring to
As previously described, additional functions performed by the processing module 18 include logging data to the internal memory and updating the display, for example every second. In one embodiment the onscreen history graph comprised 30 values and each time the buffer filled the data was compressed in half (and smoothed) and the time base of the graph increased. With this approach only 30 data points needed to be stored, substantially reducing the amount of memory required. To download data a button may be pressed on the unit or the external communications 110 may automatically connect, for example via nearfield coupling. A serial interface may be provided to access the stored data via one or both of a wired and wireless link. Regular or continuous monitoring may be provided if desired.
Although we have described example embodiments and applications of a medical/battlefield device for monitoring casualties for battlefield triage it will be appreciated that applications of the technology are not limited to this scenario. Thus the technology we have described is also useful in a hospital or ambulance environment. More generally applications may also include, for example, activity monitoring, health monitoring, breathing monitoring and the like. Still more generally, the technology may even be applied to suitable animals as well to people.
Thus in embodiments the invention also provides a device as described previously according to aspects/embodiments of the invention for use with non-patients, for example for: fitness purposes, recreational purposes, health monitoring purposes, wellness monitoring purposes, anxiety monitoring purposes, monitoring respiration rate during the practice of sport/activity/yoga and the like, managing stress and anxiety, and so forth. In further embodiments the invention provides a device to provides an alert when one or more vital signs deteriorates beyond a healthy norm, for example a norm in line with triage and/or medical procedures. Broadly speaking embodiments the invention have applications whenever monitoring breathing rate and heart rate using a sensor in the vicinity of the face can be employed. The sensor may be attached directly using clips, stickers and the like, or emplaced within another product which holds it in the correct vicinity, such as an oxygen supply mask.
No doubt many other effective alternatives will occur to the skilled person. It will be understood that the invention is not limited to the described embodiments and encompasses modifications apparent to those skilled in the art lying within the spirit and scope of the claims appended hereto.
Number | Date | Country | Kind |
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1312630.5 | Jul 2013 | GB | national |
Filing Document | Filing Date | Country | Kind |
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PCT/GB2014/052140 | 7/14/2014 | WO | 00 |