Patent Publication Number: US-11375936-B2

Title: Wearable medical system to monitor a patient parameter

Description:
CROSS REFERENCE TO RELATED PATENT APPLICATIONS 
     The present application is a continuation of U.S. application Ser. No. 16/011,794 filed Jun. 19, 2018 (pending), which in turn is a continuation of U.S. application Ser. No. 15/707,896 filed Sep. 18, 2017, now U.S. Pat. No. 10,022,551, which in turn is a continuation of U.S. application Ser. No. 13/906,327 filed on May 30, 2013, now U.S. Pat. No. 9,827,431. Said application Ser. No. 13/906,327 claims the benefit of U.S. Provisional Patent Application Ser. No. 61/807,453 filed on Apr. 2, 2013. Said application Ser. No. 16/011,794, said application Ser. No. 15/707,896, said application Ser. No. 13/906,327, and said Application No. 61/807,452 are hereby incorporated by reference in their entireties. 
    
    
     BACKGROUND 
     Some types of heart arrhythmia may result in lessening blood flow, thus reducing the amount of blood pumped to the various parts of the body. Some arrhythmias may even result in a Sudden Cardiac Arrest (SCA). SCA leads to death very quickly, unless treated in the interim. 
     People who have had a heart attack have an increased risk of SCA, and therefore it is recommended that they receive an Implantable Cardioverter Defibrillator (“ICD”). An ICD has electrodes that continuously monitor the person&#39;s electrocardiogram (“ECG”). If certain types of heart tachyarrhythmia are detected, then the ICD delivers electrical therapy through the heart. 
     People with increased risk of an SCA are sometimes given a wearable external defibrillator system. The recipients typically include those who have had a heart attack but have not yet had an ICD implanted. A wearable defibrillator system typically includes a vest or harness that is worn by the person. The system includes a defibrillator and electrodes that are attached to the vest or harness. Typically the system monitor the person&#39;s ECG via the electrodes continuously. If a heart tachyarrhythmia is detected, then the defibrillator delivers the appropriate electrical discharge through the heart. 
     A problem is that compliance by the person is often not full. While the person has the system, they often do not wear it because they find it cumbersome and uncomfortable. The issue of improving compliance has been addressed, for example in US Patent Application No. 2012/0283794. 
     A root of the discomfort is from the fact that the electrodes of the wearable system have to be making good electrical contact continuously with the person&#39;s skin, so that the person&#39;s ECG can be monitored continuously. The problem has been addressed, for example in U.S. Pat. No. 6,546,285, titled LONG TERM WEAR ELECTRODE FOR DEFIBRILLATION SYSTEM. The latter patent teaches, among other things, to move the electrodes to different places on the person&#39;s skin at different times, and/or to use a hydrogel for the electrodes that includes a therapeutic agent which promotes skin health. 
     BRIEF SUMMARY 
     The present description gives instances of wearable defibrillator systems and methods, the use of which may help overcome problems and limitations of the prior art. 
     In one embodiment, a wearable defibrillator system includes a support structure with one or more electrodes in an unbiased state. A monitoring device monitors, for the long term, a parameter of the person that is not the person&#39;s ECG; rather, the monitored parameter can be the person&#39;s motion, or a physiological parameter. When a value of the monitored parameter reaches a threshold, such as when the person is having an actionable episode, the electrode becomes mechanically biased against the person&#39;s body, for making good electrical contact. Then, if necessary, the person can be given electrical therapy, such as defibrillation. 
     An advantage over the prior art is that, while the wearable defibrillator system does require long-term wearing to protect the person, wearing itself does not require that one or more of its electrodes be making good electrical contact with the person&#39;s skin for the long term. The contact is made by the biasing, when the system otherwise detects that the person is having an actionable episode. Until then, however, the electrodes can be worn more loosely, sometimes similarly with how loose the other garments feel to the wearer. This can reduce the person&#39;s aversion to wearing the defibrillation system, who might in turn comply more with the instruction to wear it. 
     These and other features and advantages of this description will become more readily apparent from the following Detailed Description, which proceeds with reference to the drawings, in which: 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a diagram of components of a wearable defibrillator system, according to embodiments. 
         FIG. 2  is a diagram showing sample thresholds for making decisions according to embodiments. 
         FIG. 3  is a diagram showing components of an external defibrillator, such as the one shown in  FIG. 1 , which is made according to embodiments. 
         FIG. 4A  is a diagram showing an electrode, such as a possible embodiment of an electrode of  FIG. 1 , which is not being biased towards the body of the wearer according to embodiments. 
         FIG. 4B  is a diagram showing the electrode of  FIG. 4A , but in which the electrode is instead being biased towards the body of the wearer according to embodiments. 
         FIG. 5  is a flowchart for illustrating methods according to embodiments. 
         FIG. 6  is a flowchart segment for describing additional optional operations according to embodiments. 
         FIG. 7  is a flowchart segment for describing an additional optional operation according to embodiments. 
         FIG. 8  is a flowchart segment for describing additional optional operations according to embodiments. 
         FIG. 9  is another flowchart for illustrating methods according to embodiments. 
         FIG. 10  is one more flowchart for illustrating methods according to embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     As has been mentioned, the present description is about wearable defibrillator systems and methods. Embodiments are now described in more detail. 
     Embodiments include wearable defibrillator systems, which are configured to be worn by a person. The person is sometimes called also a patient and/or a wearer. The person wearing the system may be moving, for example during their daily activities. As they move, any garments they wear may shift with respect to their body. The wearable defibrillator systems of the embodiments are configured to defibrillate the person by delivering electrical charge to the person&#39;s body. 
     Systems according to embodiments may include a support structure, which is configured to be worn by the person. The support structure can be any structure suitable for wearing, such as a harness, a vest, a garment, and so on. The support structure can be implemented in a single component, or multiple components. For example, a support structure may have a top component resting on the shoulders, for ensuring that the defibrillation electrodes will be in the right place for defibrillating, and a bottom component resting on the hips, for carrying the weight of the defibrillator. 
       FIG. 1  is presented as an example of only some embodiments.  FIG. 1  is a diagram of components of a wearable defibrillator system. A generic support structure  170  is shown relative to the body of a person  82 . Structure  170  could be a harness, vest, garment, and so on. It could be implemented in a single component, or multiple components, as per the above. Structure  170  is wearable by person  82 , but the manner of wearing it is not depicted, as structure  170  is depicted only generically in  FIG. 1 . 
     Systems according to embodiments may also include a monitoring device, which can be used for determining whether intervention by the system will be necessary. By way of an example, a monitoring device  180  is also shown in  FIG. 1 . Optionally, the monitoring device is coupled to the support structure, physically and/or in terms of electrical communication with other elements coupled to the support structure, as will be deemed necessary by a person skilled in the art in view of this disclosure. 
     The monitoring device is configured to monitor at least one parameter of the person, which is not an electrocardiogram (“ECG”) of the person. The monitoring device generates a signal that encodes a value of the monitored parameter. The value of the parameter can be used by the system as will be deemed necessary by a person skilled in the art in view of this disclosure. 
     The value of the parameter, in turn, can be used to make a decision. The decision can be made when a threshold is reached or exceeded. The determination of whether the threshold is reached or exceeded can be made as is known in the art. For example, in embodiments where a value is encoded in a voltage level, the determination can be made by a comparator that is tripped when the voltage level exceeds the applicable threshold voltage level. In other embodiments, the system can optionally include a logic device, such as a processor, and the value is encoded in as a number. The logic device can be is configured to determine when the parameter has reached or exceeded the appropriate threshold. Different thresholds according to embodiments are now described, both for the parameter of the monitoring device, and other parameters. 
       FIG. 2  is a diagram showing possible thresholds  220 ,  250 ,  285  for making decisions according to embodiments. Examples of use of these thresholds are described later in this document, also in terms of flowcharts. It will be appreciated that not all of these thresholds are used in every embodiment. 
     Thresholds  220 ,  250 ,  285  are shown on a single scale, according to relative potential severity of the patient&#39;s condition. Even though shown in a single scale, it should be remembered that these thresholds may be established for the same or different patient parameters, for use by the same or different elements of embodiments. For example, the thresholds can be either for the parameter monitored by the monitoring device, or by another monitoring device, or for an ECG reading of the person obtained by electrodes, and so on. Moreover, there can be same or different results if the thresholds are reached or exceeded. 
     The thresholds of  FIG. 2  are shown in a scale. Embodiments escalate the checking and operations, such as along this scale, as they detect the patient&#39;s condition to be more severe, in ways that the system could address by administering electrical therapy. 
     These thresholds are now described in more detail. Threshold  220  is a response-check threshold, above which the decision can be that the person be asked to respond, in some manner, as to whether they are fine. A person who responds they are fine will likely not need electrical therapy at this time. Threshold  250  is an ECG-check threshold, above which the decision can be that an ECG reading of the person needs to be taken for certainty. If the person&#39;s ECG turns out to be a non-shockable rhythm, such as a normal sinus rhythm, then the system need not administer electrical therapy. Threshold  285  is a defibrillation advised threshold, above which a defibrillate decision is made, and the person is defibrillated. Below the lowest of thresholds, which in  FIG. 2  is threshold  220 , the patient can be presumed to be not in danger, and the decision can be that no action is taken, and there is no escalation. 
     Returning now to the monitoring device, its monitored parameters can be a motion of the person&#39;s body, in some embodiments. In these embodiments, the monitoring device may include a motion detector, which can be made in many ways as is known in the art. Or, the monitoring device could include a GPS, which informs of the location, and the rate of change of location over time. Many motion detectors output a motion signal that is indicative of the motion of the detector, and thus of the person&#39;s body. 
     It is known how to infer the activities and likely severity of the patient condition by interpreting the motion signals. For example, if the person stops moving at a time when they are expected to be moving or continue moving or exhibits other behavior that indicates that SCA may be taking place, that can be cause for escalation, as per the above. As such, the threshold can sometimes be adjusted according to an output of the motion detector itself. 
     The thresholds can be adjusted also with regard to additional parameters that can be monitored. One such additional parameter can be the time of day, which can be monitored by a clock in a processor of the system. For example, the person is expected to be sleeping during more of the night hours. 
     In other embodiments, the monitored parameter is a physiological parameter of the person. The physiological parameter can be anyone that would help detect whether the person is in need of electrotherapy by the wearable defibrillation system. Example such parameters include the person&#39;s blood oxygen level, blood flow, blood pressure, blood perfusion, pulsatile change in light transmission or reflection properties of perfused tissue, heart sounds, breathing sounds and pulse. Accordingly, the monitoring device could be a pulse oximeter, a Doppler device for detecting blood flow, a cuff for detecting blood pressure, illumination detectors and maybe sources for detecting color change in tissue, a device that can detect artery wall movement, a device with a microphone, and so on. Pulse detection is taught at least in Physio-Control&#39;s U.S. Pat. No. 8,135,462, which is hereby incorporated by reference in its entirety. In addition, a person skilled in the art may implement other ways of performing pulse detection. Similarly with motion, if the monitored physiological parameter indicates that SCA could be taking place, that can be cause for a decision to check further or defibrillate, and so on. 
     In yet other embodiments, both the person&#39;s physiological parameter and motion can be monitored in combination. The value of the physiological parameter becomes better informed from the motion profile, as is the appropriate threshold for determining whether an actionable episode is taking place so as to escalate. The threshold can be adjusted accordingly. For example, if the person is running then a somewhat higher pulse rate may be tolerated until a time after they stop, without needing to escalate, and so on. 
     Systems according to embodiments may also include a capacitor, which can be configured to store an electrical charge. Under certain circumstances, the charge is configured to be delivered to the person&#39;s body according to embodiments. Preferably the capacitor is coupled to the support structure, and the charge is delivered while the person is wearing the support structure. 
     In certain embodiments, the capacitor is implemented as part of a defibrillator, such as sample external defibrillator  100  in  FIG. 1 . In those cases, the defibrillator can be coupled to the support structure, such as defibrillator  100  is coupled to structure  170  in  FIG. 1 . In other embodiments, a full defibrillator may not be implemented, such as in instances where the capacitor charge is controlled to be delivered to the person remotely, and so on. 
       FIG. 3  is a diagram showing components of an external defibrillator  300  made according to embodiments. These components can be, for example, in external defibrillator  100  of  FIG. 1 , in the event that defibrillator components beyond the capacitor are provided. These components of  FIG. 3  can be provided in a housing  301 , which is also known as casing  301 . 
     External defibrillator  300  is intended for person  380  who would be the wearer, such as person  82  of  FIG. 1 . In some embodiments, defibrillator  300  includes the above described monitoring device  325 , which can include any one of a motion sensor, a physiological parameter motion, etc., as per the above. In other embodiments, the monitoring device is provided outside housing  301 , such as monitoring device  180  is shown in the example of  FIG. 1 . 
     Defibrillator  300  typically includes a defibrillation port  310 , such as a socket in housing  301 . Defibrillation port  310  includes nodes  314 ,  318 . Defibrillation electrodes  304 ,  308 , which will be described later in more detail, can be plugged in defibrillation port  310 , so as to make electrical contact with nodes  314 ,  318 , respectively. It is also possible that defibrillation electrodes can be connected continuously to defibrillation port  310 , instead. Either way, defibrillation port  310  can be used for guiding via electrodes to the wearer the electrical charge that has been stored in energy storage module  350 . 
     Defibrillator  300  may optionally also have an ECG port  319  in housing  301 , for plugging in ECG electrodes  309 , which are also known as ECG leads. It is also possible that ECG electrodes can be connected continuously to ECG port  319 , instead. ECG electrodes  309  can help sense an ECG signal, e.g. a 12-lead signal, or a signal from a different number of leads, as long as they make good electrical contact with the body of the patient. 
     Defibrillator  300  also includes a measurement circuit  320 . Measurement circuit  320  receives physiological signals from ECG port  319 , if provided. Even if defibrillator  300  lacks ECG port  319 , measurement circuit  320  can obtain physiological signals through nodes  314 ,  318  instead, when defibrillation electrodes  304 ,  308  are attached to the patient. In these cases, a person&#39;s ECG signal can be sensed as a voltage difference between electrodes  304 ,  308 . Plus, impedance between electrodes  304 ,  308  can be sensed for detecting, among other things, whether these electrodes  304 ,  308  are not making good electrical contact with the person&#39;s body. These physiological signals are sensed, and information about them is rendered by circuit  320  as data, or other signals, etc. 
     Defibrillator  300  also includes a processor  330 . Processor  330  may be implemented in any number of ways. Such ways include, by way of example and not of limitation, digital and/or analog processors such as microprocessors and digital-signal processors (DSPs); controllers such as microcontrollers; software running in a machine; programmable circuits such as Field Programmable Gate Arrays (FPGAs), Field-Programmable Analog Arrays (FPAAs), Programmable Logic Devices (PLDs), Application Specific Integrated Circuits (ASICs), any combination of one or more of these, and so on. 
     Processor  330  can be considered to have a number of modules. One such module can be a detection module  332 . Processor  330 , running detection module  332 , is a sample embodiment of a logic device configured to determine whether the above-described monitored parameter has reached a specific threshold. For example, the monitoring parameter can be input from monitoring device  325 , if provided. For another example, detection module  332  can include a ventricular fibrillation (“VF”) detector and the person&#39;s sensed ECG from measurement circuit  320  can be used to determine whether the person is experiencing VF. Detecting VF is useful, because VF is a precursor to SCA. 
     Another such module in processor  330  can be an advice module  334 , which arrives at advice, for example based on outputs of detection module  332 , and/or implements decisions. There can be many types of advice according to embodiments. As one example, a Shock Advisory Algorithm can render the advice to shock, as opposed to not shock the person. Such can be, for example, when the person&#39;s condition has reached or exceeded defibrillation advised threshold  285  of  FIG. 2 . Shocking can be for defibrillation, pacing, and so on. If the advice is to shock, some external defibrillator embodiments proceed with shocking, or may advise a remote attendant to do it, and so on. As another example, the advice can be to administer CPR, and defibrillator  300  may further issue prompts for it, and so on. 
     One more example of a decision that can be made is to bias one or more electrodes towards the person&#39;s body, as will be described later in this document. The decision can be communicated in some of these embodiments by generating a biasing signal BA. Defibrillator  300  optionally includes also a bias port  392  for exporting biasing signal BA from bias port  392  to a biasing mechanism of the system, which will also be described later. 
     Processor  330  can include additional modules, such as module  336 , for other functions. In addition, if monitoring device  325  is indeed provided, it may be operated in part by processor  330 , etc. 
     Defibrillator  300  optionally further includes a memory  338 , which can work together with processor  330 . Memory  338  may be implemented in any number of ways. Such ways include, by way of example and not of limitation, nonvolatile memories (NVM), read-only memories (ROM), random access memories (RAM), any combination of these, and so on. Memory  338 , if provided, can include programs for processor  330 , and so on. The programs can be operational for the inherent needs of processor  330  and can also include protocols and ways that decisions can be made by advice module  334 . In addition, memory  338  can store prompts for person  380 , if they are a local rescuer. Moreover, memory  338  can store patient data. 
     Defibrillator  300  may also include a power source  340 . To enable portability of defibrillator  300 , power source  340  typically includes a battery. Such a battery is typically implemented as a battery pack, which can be rechargeable or not. Sometimes, a combination is used, of rechargeable and non-rechargeable battery packs. Other embodiments of power source  340  can include AC power override, for where AC power will be available, and so on. In some embodiments, power source  340  is controlled by processor  330 . 
     Defibrillator  300  additionally includes an energy storage module  350 . Module  350  is where some electrical energy is stored, when preparing it for sudden discharge to administer a shock. Module  350  can be charged from power source  340  to the right amount of energy, as controlled by processor  330 . In typical implementations, module  350  includes a capacitor  352 , which can be a single capacitor or a system of capacitors, and so on. As described above, capacitor  352  can store the charge for delivering to the patient. 
     Defibrillator  300  moreover includes a discharge circuit  355 . Circuit  355  can be controlled to permit the energy stored in module  350  to be discharged to nodes  314 ,  318 , and thus also to defibrillation electrodes  304 ,  308 . Circuit  355  can include one or more switches  357 . Those can be made in a number of ways, such as by an H-bridge, and so on. 
     Defibrillator  300  further includes a user interface  370  for a user  380 . User  380  can be the wearer, if conscious, or a rescuer. The rescuer can be local, such as a bystander who might offer assistance, or a trained person who might arrive after the fact. Alternately the rescuer could be remote, such as a trained person in remote communication with a system according to embodiments, and/or with the wearer. 
     User interface  370  can be made in any number of ways. For example, interface  370  may include a screen, to display what is detected and measured, provide visual feedback to the rescuer for their resuscitation attempts, and so on. Interface  370  may also include a speaker, to issue voice prompts, etc. Interface  370  may additionally include various controls, such as pushbuttons, keyboards, touchscreens, a microphone, and so on. In addition, discharge circuit  355  can be controlled by processor  330 , or directly by user  380  via user interface  370 , and so on. 
     Defibrillator  300  can optionally include other components. For example, a communication module  390  may be provided for communicating with other machines or a remote rescuer  380 . Such communication can be performed wirelessly, or via wire, or by infrared communication, and so on. This way, data can be communicated, such as patient data, episode information, therapy attempted, CPR performance, and so on. 
     Embodiments of the system of the invention may additionally include defibrillation electrodes. It will be appreciated that the defibrillation electrodes of embodiments could both deliver a charge, and also serve for sensing the person&#39;s ECG. The defibrillation electrodes can deliver to the person electrical charge stored in the capacitor, for restoring their heart rhythm, when the defibrillation electrodes make good electrical contact with the body of the wearer. 
       FIG. 1  shows an example of defibrillation electrodes  104 ,  108 , which are coupled to external defibrillator  100  via electrode leads  105 . When defibrillation electrodes  104 ,  108  make good electrical contact with the body of person  82 , defibrillator  100  can administer, via electrodes  104 ,  108 , a brief, strong electric pulse  111  through the body. Pulse  111 , also known as a defibrillation shock, goes also through heart  85 , in an attempt to restart it, for saving the life of person  82 . 
     In the example of  FIG. 3 , defibrillation electrodes  304 ,  308  would plug into defibrillation port  310 , so as to make electrical contact with nodes  314 ,  318 , respectively. Defibrillation electrodes  304 ,  308  could be similar to defibrillation electrodes  104 ,  108  of  FIG. 1 . 
     Embodiments of the system of the invention may additionally include ECG electrodes. If provided, ECG electrodes could be electrically connected for example as seen in  FIG. 3  for ECG electrodes  309 . 
     As such, in many embodiments, either defibrillation electrodes are provided by themselves, or ECG electrodes are provided in addition to defibrillation electrodes. An ECG reading can be provided by either type of electrodes, preferably while they are making good electrical contact with the body of the person, and more particularly the skin. 
     In a number of embodiments, all the above mentioned electrodes are not always making good electrical contact with the person&#39;s skin. In fact, at least one of the above-mentioned electrodes, also known as a certain electrode, can be coupled to the support structure such that, while the support structure is worn by the person, the certain electrode is at a so-called unbiased state. When in the unbiased state, the certain electrode is moveable with respect to the person&#39;s body, for example as a result of the person&#39;s moving around. For example, the certain electrode could contact the person&#39;s skin as a regular garment does, for example as does a shirt that is not tightened around the person&#39;s body. As such the certain electrode could shift around the person&#39;s skin, and occasionally lose contact with it. In those occasional moments, the electrical impedance between the certain electrode and the patient&#39;s skin would become infinite. 
     As will be seen below, the certain electrode can be either one of the defibrillation electrodes, or one of the ECG electrodes, if provided. Of course, what is written about the certain electrode could also apply for a companion electrode that performs a similar function. 
     It is that lack of the certain electrode&#39;s making consistently good electrical contact with the skin that makes the support structure more comfortable to wear than the prior art for the long term. Of course, the certain electrode not necessarily making consistently good electrical contact for the long term is not desirable, but that will be addressed by the biasing mechanism that is now described. 
     Embodiments of the system of the invention may additionally include a first biasing mechanism. The first biasing mechanism can be configured to cause the certain electrode to transition from the above described unbiased state to a so-called biased state. When in the biased state, the certain electrode is biased towards the person&#39;s body against the support structure. The biasing, then, is by a force that causes the certain electrode to be less moveable with respect to the person&#39;s body than when in the unbiased state. As such, when in the biased state, the certain electrode makes better and/or more reliable electrical contact with the person&#39;s skin than in the unbiased state. The better electrical contact can be used for more reliable defibrillation and or receiving ECG signals, as the case may be for the certain electrode. 
     In preferred embodiments, the first biasing mechanism can cause the certain electrode to transition from the unbiased state to the biased state, responsive to a value of the monitored parameter reaching a threshold. As such, the first biasing mechanism can be configured to receive a biasing signal that signifies that the determination has been made that the value of the monitored parameter has reached the applicable threshold, and there will be escalation. For example, when a logic device has been provided to make that determination, the first biasing mechanism can be configured to receive the biasing signal from that logic device. An example was described above for biasing signal BA from the device of  FIG. 3 . 
     The transitioning from the biased state to the unbiased state is also called biasing and deployment of the certain electrode. Deployment is for the certain electrode, and possibly also other electrodes of the system. It will be appreciated that deployment in this sense might not necessarily change much the position of the certain electrode with respect to the patient&#39;s body, but it will change the force with which it is pushed or biased towards the body. 
     The first biasing mechanism can be made in any way so as to cause pressure to be applied to the certain electrode against the support structure, and therefore bias the certain electrode towards the person&#39;s body. Various embodiments of the first biasing mechanism include a spring that is released, causing the support structure to be tightened around the body, causing a balloon to be inflated, adding pressure to a hydraulic system, applying force such as with an electromagnet, and turning a screw gun arrangement so that turning result in a translation motion. The sample embodiment of  FIG. 1  shows also a biasing mechanism  194 . 
     A sample deployment is now described.  FIG. 4A  is a diagram according to an embodiment. A patient  482  is wearing a support structure  470 , of which two portions are shown. Support structure  470  is made according to embodiments and, as with  FIG. 1 , it is shown only generically. A certain electrode  408  could be either a defibrillation electrode or an ECG electrode and is coupled to support structure  470  in an unbiased state. In the instant of  FIG. 4A , certain electrode  408  does not even contact the skin of patient  482 . A biasing mechanism  494  is also coupled to support structure  470 . 
       FIG. 4B  is a diagram showing the same elements as  FIG. 4A , except that biasing mechanism  494  exerts a biasing force  496  due to which certain electrode  408  is biased towards patient  482  against support structure  470 . In the instant of  FIG. 4B , certain electrode  408  contacts the skin of patient  482 . Certain electrode  408  is less easily movable in  FIG. 4B  than in  FIG. 4A . 
     In a number of embodiments, the first biasing mechanism is preferably made so that it is further reversible, either by the wearer, or by a bystander, or by a remotely monitoring medical professional. Reversing would be upon verifying that there is no actionable episode to be addressed by the system, moves downwards in the scale of  FIG. 2 , and is the opposite of escalation. Reversing could be automatically enabled by further functionality. Or, reversing could be implemented by permitting the mechanically reverse motion of what deployed the certain electrode and any other electrodes. Care should be taken that reversing is not suggested prematurely, or by a person who does not understand the function of the system, such as a well-meaning by uninformed bystander. 
     It will be appreciated that, when the certain electrode is in the biased state, it can be counted on to make better electrical contact with the body. Accordingly, any ECG inputs received by the certain electrode preferably are trusted more when the certain electrode is in the biased state than in the unbiased state. Regardless, in a preferred embodiment, an additional, serendipitous check on the patient can be an ECG reading that is received incidentally while the certain electrode is in the unbiased state and whose content causes alarm. Such an ECG reading can be used in a number of ways, for tentative escalation. One example is for the biasing mechanism to cause the certain defibrillation electrode to transition to the biased state from the unbiased state responsive to an ECG reading of the person that is received incidentally while the certain electrode is in the unbiased state. 
     In most embodiments, the certain electrode makes good electrical contact while biased, i.e. while the biasing mechanism exerts a biasing force. In some embodiments, however, the certain electrode includes adhesive material. The adhesive material can be always there or be deployed right before the biasing. As the biasing mechanism causes the certain electrode to transition from the unbiased state to the biased state by exerting the biasing force, it in turn causes the certain electrode to adhere to the person due to the adhesive material. The electrode can remain adhered even if the biasing mechanism discontinues exerting the biasing force. 
     Embodiments of the system of the invention may additionally include a memory. The memory can be configured to record various aspects, such as values of the parameter being monitored, an event of a threshold having been reached by the monitored parameter, an event of the certain electrode transitioning to the biased state form the unbiased state, and so on. In embodiments where the defibrillator of  FIG. 3  is used, the memory can be memory  338 . 
     Embodiments of the system of the invention may further include a user interface. The user interface can include output devices, such as a speaker, a display, a vibration mechanism etc., plus input devices such as a microphone, buttons, keys, and other implements that a user can activate or deactivate. The user interface can be configured to issue a query to the person, to verify that they are conscious, and therefore confirm there is no cause for alarm from a detected value of the monitored parameter. Such can be, for example, when the person&#39;s condition has reached or exceeded response-check threshold  220  of  FIG. 2 . In those instances, embodiments permit the wearer to enter an input in response to the query within a certain time, before the certain electrode transitions from the unbiased state to the biased state. An example is a “live man switch”, which the wearer can push, to indicate they are fine. In such embodiments, the certain electrode can be configured to transition to the biased state only if a preset acceptable input has not been received in response to the query within a preset time after the query has been issued. In embodiments where the defibrillator of  FIG. 3  is used, the user interface can be user interface  370 . 
     If the option of querying the user is indeed provided, it can be further coupled with the advent of a serendipitous receipt of an ECG reading whose content causes alarm while the certain electrode is in the unbiased state. In such embodiments, the user query can be triggered as above. 
     As mentioned above, in some embodiments, the certain electrode is a defibrillation electrode. In these embodiments, the electrical charge stored in the capacitor of the system is configured to be delivered through the person&#39;s body via the certain electrode, and also via another defibrillation electrode. In the particular example of  FIG. 1 , defibrillation electrode  108  is the certain electrode, and defibrillation electrode  104  is the other defibrillation electrode, while no separate ECG electrodes are provided. Certain electrode  108  can become deployed, as can electrode  104  by a suitable biasing mechanism. 
     Moreover, in other embodiments, the certain electrode can be an ECG electrode. In these embodiments, one or more ECG electrodes are thus provided above and beyond defibrillation electrodes. The one or more ECG electrodes can become deployed, as per the above. 
     When ECG electrodes are also provided, there are a number of options about the defibrillation electrodes. One option is for the defibrillation electrodes to be always attached to the patient by how they are coupled to the support structure. This is not very advantageous, however, as the intent is to liberate the person from contact with electrodes for the long-term wear, so as to make compliance more palatable. 
     Another option is to have the defibrillation electrodes also be deployable. More particularly, the defibrillation electrodes can be coupled to the support structure. The coupling can be such that, while the support structure is worn by the person, at least a particular one of the defibrillation electrodes is either at an unbiased state or a biased state. Similarly, with the above, when the particular defibrillation electrode is in the unbiased state, it is moveable with respect to the person&#39;s body responsive to the person&#39;s moving. Moreover, when the particular defibrillation electrode is in the biased state, the particular defibrillation electrode is biased towards the person&#39;s body against the support structure so as to be less moveable with respect to the person&#39;s body than when in the unbiased state. 
     When the defibrillation electrodes are also deployable, an ECG reading can advantageously be received also from the particular electrode that is deployed. Moreover, it is preferred to configure the electrical charge to be delivered through the person&#39;s body when the particular defibrillation electrode is in the biased state, when defibrillation advised threshold  285  is exceeded. In fact, it is even more preferred to configure the electrical charge to be delivered through the person&#39;s body only when the particular defibrillation electrode is in the biased state, to avoid wasting energy, or misdirecting the electrical charge. 
     When the defibrillation electrodes are also deployable, there are a number of embodiments. An embodiment is for at least one of the ECG electrodes to be attached to at least one of the defibrillation electrodes. As such, deploying the certain ECG electrode by the first biasing mechanism also deploys the defibrillation electrode. Attachment can be implemented in any number of ways. For example, the ECG electrode can be formed integrally with one of the defibrillation electrodes. In a preferred embodiment, the ECG electrode can be formed as a segmented electrode with a defibrillation electrode. In this option, the certain electrode can also be considered to be the defibrillation electrode, which has the further feature of one or more ECG electrodes attached to it. 
     Another embodiment is for at least one of the defibrillation electrodes to be truly distinct from the ECG electrodes. This option has the advantage that certain types of false alarm will result in deploying only the ECG electrodes upon partial escalation, but not the usually larger defibrillation electrodes. This option also has the disadvantage that two deployments may be needed, which requires more biasing structures in the system. 
     In such embodiments, a second biasing mechanism can be provided for the system, which is distinct from the first biasing mechanism. The second biasing mechanism can be configured to cause the particular defibrillation electrode to transition from its unbiased state to its biased state. 
     Methods are now described, by using flowcharts. These methods may also be practiced with additional operations, and by embodiments described above. These methods are for a defibrillator system that is wearable by a person who may be moving, and which includes a support structure and electrodes coupled to the support structure. The electrodes are coupled such that, while the support structure is worn by the person, at least a certain one of the electrodes is moveable with respect to the person&#39;s body responsive to the person&#39;s moving. The certain electrode can be a defibrillation electrode, an ECG electrode, or a combination of the two. Moreover, these flowcharts may find more detailed explanations in what is written above. 
       FIG. 5  shows a flowchart  500  for describing methods according to embodiments. According to an operation  510 , at least one parameter of the person is monitored, while the person is wearing the support structure. The parameter is not an electrocardiogram (“ECG”) of the person. In some embodiments, the parameter is a motion of the person&#39;s body. In other embodiments, the parameter is a physiological parameter, which could be one of the person&#39;s blood perfusion, blood flow, blood pressure, blood oxygen level, pulsatile change in light transmission/reflection properties of perfused tissue, heart sounds and breathing sounds. 
     According to a next operation  545 , it is determined whether a threshold has been reached for the monitored parameter. If not, execution returns to operation  510 . 
     If yes, then according to a next operation  582 , the certain electrode becomes biased towards the person&#39;s body against the support structure. Accordingly, the certain electrode becomes less moveable with respect to the person&#39;s body than previously. Biasing can be by exerting force, with implements such as described above. 
       FIG. 6  shows a flowchart segment  600  for describing additional optional operations according to embodiments. The additional optional operations of flowchart segment  600  can be added to other flowcharts in this description. 
     According to an optional operation  684 , it is inquired whether a defibrillate decision has been made. If not, execution can return to a previous operation. If yes, then according to a next operation  690 , the person is defibrillated. 
       FIG. 7  shows a flowchart segment  700  for describing additional optional operations according to embodiments. The additional optional operations of flowchart segment  700  can be added to other flowcharts in this description. 
     According to an optional next operation  747 , an indication is recorded in a memory of an electrode becoming biased. This might have occurred, for example, per the previous operation  582  of  FIG. 5 . 
       FIG. 8  shows a flowchart segment  800  for describing additional optional operations according to embodiments. The additional optional operations of flowchart segment  800  can be added to other flowcharts in this description. 
     According to an optional operation  830 , a query is issued to the person. The query can be issued when a parameter has reached or exceeded response-check threshold  220  of  FIG. 2 . 
     According to a next operation  840 , it is inquired whether a preset acceptable input in response to the query has been received timely, for example within a preset time after the query has been issued. If yes, then the person can be presumed to not have had an SCA, and escalation of inquiry or perception of severity of their condition can be forestalled. If not, then further escalation is justified, and other measures can take place, such as biasing one or more electrodes, and so on. 
       FIG. 9  shows a flowchart  900  for describing a method according to embodiments. According to an operation  910 , a parameter is monitored that is not an ECG of the person. 
     According to a next operation  950 , it is determined whether an ECG-check threshold  250  has been reached for the parameter. If not, execution returns to operation  910 . 
     If yes, then according to a next operation  981 , the certain electrode becomes biased towards the person&#39;s body against the support structure. As such, the certain electrode becomes less moveable with respect to the person&#39;s body than previously. 
     According to a next operation  985 , it is inquired whether defibrillation is advised. If not, execution can return to operation  910 . If yes, then according to a next operation  990 , the person is defibrillated. 
       FIG. 10  shows a flowchart  1000  for describing a method according to embodiments. Flowchart  1000  is for a device that has distinct ECG electrodes from defibrillation electrodes, with distinct respective biasing mechanisms. Unlike the usually large defibrillation electrodes, ECG electrodes maybe harder to aim to suitable locations on the person&#39;s skin. 
     According to an operation  1010 , a parameter is monitored that is not an ECG of the person. According to a next operation  1050 , it is determined whether an ECG-check threshold  250  has been reached for the parameter. If not, execution returns to operation  1010 . 
     If yes, then according to a next operation  1060 , the ECG electrodes become biased towards the person&#39;s body against the support structure. As such, the ECG electrodes become less moveable with respect to the person&#39;s body than previously. 
     According to a next operation  1070 , it is first inquired whether defibrillation is likely advised. The first inquiry—also designated as “A” in the flowchart—of this operation  1070  is according to ECG readings received from the now biased ECG electrodes. The first inquiry of this operation  1070  can be more tentative than the upcoming inquiry. If not, execution can return to operation  1010 . 
     If yes, then according to a next operation  1080 , the defibrillation electrodes become biased towards the person&#39;s body against the support structure. 
     According to a next operation  1086 , it is again inquired whether defibrillation is advised. The second inquiry—also designated as “B” in the flowchart—of this operation  1086  is according to ECG readings received from the now biased defibrillation electrodes and can be to determine whether threshold  285  has been reached or exceeded. If not, execution can return to operation  1010 . If yes, then according to a next operation  1090 , the person is defibrillated. 
     In the above, the order of operations is not constrained to what is shown, and different orders may be possible according to different embodiments. In addition, in certain embodiments, new operations may be added, or individual operations may be modified or deleted. 
     A person skilled in the art will be able to practice the present invention in view of this description, which is to be taken as a whole. Details have been included to provide a thorough understanding. In other instances, well-known aspects have not been described, in order to not obscure unnecessarily the present invention. 
     This description includes one or more examples, but that does not limit how the invention may be practiced. Indeed, examples or embodiments of the invention may be practiced according to what is described, or yet differently, and also in conjunction with other present or future technologies. 
     One or more embodiments described herein may be implemented fully or partially in software and/or firmware. This software and/or firmware may take the form of instructions contained in or on a non-transitory computer-readable storage medium. Those instructions may then be read and executed by one or more processors to enable performance of the operations described herein. The instructions may be in any suitable form, such as but not limited to source code, compiled code, interpreted code, executable code, static code, dynamic code, and the like. Such a computer-readable medium may include any tangible non-transitory medium for storing information in a form readable by one or more computers, such as but not limited to read only memory (ROM); random access memory (RAM); magnetic disk storage media; optical storage media; a flash memory, etc. 
     The term “computer-readable media” includes computer-storage media. For example, computer-storage media may include, but are not limited to, magnetic storage devices (e.g., hard disk, floppy disk, and magnetic strips), optical disks (e.g., compact disk [CD] and digital versatile disk [DVD]), smart cards, flash memory devices (e.g., thumb drive, stick, key drive, and SD cards), and volatile and nonvolatile memory (e.g., RAM and ROM). 
     Other embodiments include combinations and sub-combinations of features described herein, including for example, embodiments that are equivalent to: providing or applying a feature in a different order than in a described embodiment, extracting an individual feature from one embodiment and inserting such feature into another embodiment; removing one or more features from an embodiment; or both removing a feature from an embodiment and adding a feature extracted from another embodiment, while providing the advantages of the features incorporated in such combinations and sub-combinations. 
     The following claims define certain combinations and subcombinations of elements, features and steps or operations, which are regarded as novel and non-obvious. Additional claims for other such combinations and subcombinations may be presented in this or a related document. 
     In the claims appended herein, the inventor invokes 35 U.S.C. § 112, paragraph 6 only when the words “means for” or “steps for” are used in the claim. If such words are not used in a claim, then the inventor does not intend for the claim to be construed to cover the corresponding structure, material, or acts described herein (and equivalents thereof) in accordance with 35 U.S.C. § 112, paragraph 6.