During medical emergencies, teams face complex tasks and decisions, predicated on memory of complex algorithms. Smartphone-based advanced life support apps, such as the Resus Council UK’s iRESUS[1], have been shown to reduce the cognitive burden of stressful situations during simulation, thus improving their performance[1]. The “National Tracheostomy Safety Project”(NTSP) app[2], provides an interactive approach to tracheostomy emergencies, designed to guide the user through management steps. We propose the next logical step in assistive technology is to enable voice control, which can recognise unfolding emergencies and guide and users through the algorithm. Our feasibility study explores challenges in deploying voice recognition software for simulated airway emergencies.

Methods
i-Trache integrates the NTSP emergency guidelines with voice recognition technology. Testing the app occurred in standardised simulation scenarios. A manikin deteriorated physiologically to prompt actions from consenting participants. We collected frequency of failed voice commands, measured background noise and debriefed candidates using a standardised proforma.

Results
Participants completed scenarios using the i-Trache app. We identified several hurdles to app development:
1. Voice recognition cannot be continuously active to avoid wrongly triggering commands. A command keyword known to participants minimises the risk, but can reduce usability.
        
2. Background noise can interfere with the accuracy of the app.

3. Participants can become too focused on the app, neglecting the simulated patient. 

Conclusion
We have identified key improvements required for app developemnt. Voice-guided resuscitation using mobile technologies carried universally by healthcare professionals is an important area for future innovations.

References
1. D. Low, N. Clark, J. Soar, et al. Anaesthesia, 66(4):255-62, 2011 
2. NTSP app, 2016, BOXSAIL LTD, Version 1.1. Mobile app

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