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Joined 2 years ago
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Cake day: June 24th, 2024

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  • The issue is not “oh, that will not do good”,but more “does the risk outweight the benefit or not”.

    Intubating a patient is always a delicate procedure, doing so with an emergency patient (who obviously has not fasted, has a acute reason for being intubated,etc.) is even more difficult and doing so prehospitally is even more risky. It’s dark, cramped, loud, there are other enviromental factors (I once failed because my hands were shaking to much from the cold), etc. And,in case of a medically assisted intubation before you can intubate you kick out the patients breathing reflexes so they will sure as hell die if you do not suceed. A so called “cannot oxygenate (=Cannot ventilate)/cannot intubate” situation is a nightmarish situation which gives seasoned anaesthesists nightmares. . This makes intubation a skill hard to master - you need around 100 intubations to learn it and 15 per year to keep that skill. Seperatly for adults and children. (The later is even hard to uphold for anaesthesists)

    While out tooling has improved and made it FAR easier and safer (videolaryngoskopy, capnography,etc.) than 20 years ago, it is still debatable how safe it is when performed prehospitally. (A recent German study showed a first pass rate - the rate how sucessful a intubation is on first try- of 60% for all professions,including paramedics, anaesthesists,etc.)

    Additionally it takes a lot of time - which will occupy a team. While in hospital more people can do other things at the same time. So it’s worth considering “hey,we take 10min of scene time to tube a patient. A hospital is 10 min away. Is jt worth to make a run there and tube then with a better enviroment, while other people can do labs,run blood,etc.?”

    The question therefore is more than valid and not as easy to answer - it is always a consideration of patient status, location, resources and enviromental factors. (How bad is the patient? How hard will he be to intubate? How far away from hospital am I? Do I have a intensely trained team I work with every day or am I a solo responder working with a EMT crew that is barely holding it together? How sure am I that I can intubate this patient? How up to the task am I really? How is the truck,the scene?) It’s often a very tough decision. And I saw countless patients die from providers developing a “tuberitis” - the tube needs to go in, no matter what.

    Don’t get me wrong - the UK for example has a lack of prehospitally available qualified providers who can properly intubate and I am a old fuck who in doubt will intubate the patient (unless it’s a child, no longer doing these). But I have far more training in that than the average provider. (Currently a high three digit count in the logbook, thanks to working in anaesthesia part time for years)

    Source: Am a critical care paramedic, for almost 25 in EMS, have done research on this.


  • Xwiki is missing.

    For me after a similar search it is the current winner. Even though it has it’d downsides. We came from Confluence and tested a LOT of systems. My spreadsheet of systems we considered has around 120 rows by now. (Not all pure wikis as we also moved away from jira and considered going down a “put the wiki into the servicedesk” route)

    Pro:

    • It is well tested in a enterprise enviromentand mighty

    • It has all the features I personally found important for a company wiki, e.g. approval, versioning, templates, collaboration, integration api,etc.

    • It is fairly easy to extend it yourself

    • It is easy to host subwikis within the same installation with a self defined grade of independence - which is great for customer facing things,large projects with externals,etc.

    • The development community is big and enterprise focus and release cycles are good. (Not like a certain .js) There is very little chance it will stall suddenly as the wiki has been adopted by a lot of large companies which seem to support it.

    • It’s truely free,no “pay to get custom fields” bullshit.

    • It’s truely self hosted.

    • it can be hosted system side, if you are not into docker.

    Contra:

    • It is written in bloody Java

    • (even though this sentence is redundant with the one above) It is a resource hog

    • The look and feel is a bit outdated unless you customise it yourself. Then it is reasonably good.But there are basically no paid templates,etc.

    • Paid support is only available through third parties it seems.

    • It can be, well, slow to update…like physically slow. It is not hard to update,not at all…press a few buttons…but sometimes it takes ages.


  • The main point would be: UK would need to follow the same rules everyone else has to.

    Because when the UK was still a member they had a shitton of special rules which they basically blackmailed the other members into. (E.g. London would have never gotten that big as a financial market without them ) They basically took all the benefits and only gave back as little as possible.

    So. Sure,the UK can apply to become a member. But no more special rules.

    Oh,that ends the privacy nightmare the UK has become? Well… Oh,that means you have to follow the same (very lenient and basic) rules in terms of taxation and tax evasion? Well… Oh,that means you have to take part in shared duties of ALL EU countries? Well…

    Romania can do it, Portugal can do it, Poland can do it.

    Well…


  • They had a helicopter overhead and he refused help and pushed upwards (which He had direct communications with a mountain policeman and turned help down.

    There are multiple warning signs to turn back if you haven’t passed this point by X time. They were multiple hours late AND in adhorent conditions.

    And yes, if there is a criminal law provision in Austrian (as well as German law), that gives people a duty to protect the ones with lesser ability to protect themselves in certain situations.

    So the sentencing is totally right







  • We kind of selfhost almost everything - while we operate a small server ourselves, the main burden is on a dedicated server setup. Basically a FreeIPA+Authentik+OpenCloud Stack as a base,with Redmine, Kimai, Zammad, Matrix, Jitsi and a few more apps. (Moodle, Seed DMS, Netbox, Zabbix, OPNsense, Vaultwarden, Forgejo, Ansible). Additionally we use a fair share of software remotely via RDP.

    Backups are done onsite and to three different offsites, including cold storage backups.

    As we all work fully remote this setup is also fairly adaptable and the switch to a (almost fully) Linux shop went far better than expected - my staff is fairly content with their setup (afaik).

    The only thing I refuse to selfhost are email and VoIP.





  • Zabbix is extremly nice.

    Why?

    • API Monitoring for Proxmox and Docker/Podman. Aka "you don’t need to setup monitoring for every container/LxC/VM. Do it once for the host,then everything gets autodiscovered.

    • Active and passive agents as well as SNMP, IPMI,etc. can be combined as you like. Also does Website/service/application/database monitoring, SSG/Telnet checks and nowadys can even do Prometheus and MQTT/Modbus

    • The proxy is really really worth it. It collects data from nodes you do not want exposed and relays them to the server. This includes all kind of inputs and is really easy to setup.

    • Due to it being around for two decades there are a shitton of templares for devices - and it’s fairly easy to do your own.

    • Unlike other systems (cough checkmk cough Grafana) there are no features that are only available to paying customers.

    The most major downsides are the fact that it’s moderately to fairly ressource intensive to run in a small setup(but does consume less than others in large Setups) and it’s far less flashy dashboards. (Which are still powerful,though)


  • Not a fan. Absolutely not.

    They had multiple security incidents which they kept under the rugs for a long time, they have the tendency to EOL devices without warning (which then means you need to replace your sometimes 9month old device or your whole enviroment can’t be updated), their lock-in into their ecosystem is much more complete as they can’t be used properly without their enviroment.(e.g. Omada devices can work without the Omada stuff, with Unifi you will always need a controller for some functions).

    So if you realy need SDN features like Unifi look at Omada,otherwise Mikrotik is a solid alternative. (And OPNsense for firewall)


  • philpo@feddit.orgtoSelfhosted@lemmy.worldSystem Redundancy
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    1 month ago

    My company is a part of critical infrastructure and we provide consulting in disasters (e.g. how to get a hospital back up and running). So we fall under European legislation to have certain precautions. And as I colocate in my companys rack…it’s easier. As the rack is in a room I rent to my company. (We are small and I am the founder,that makes it easier)

    But yeah, we put a bit of thought in it. Waiting for Iris2 finally materialise so I can get rid of LTE finally.


  • philpo@feddit.orgtoSelfhosted@lemmy.worldSystem Redundancy
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    1 month ago

    I have a LTE Backhaul,but admittedly if the firewall itself craps out I would also be offline - but I can at least reboot it via a plain old GSM power plug. That thing does not directly reboot the firewall,though, but brings up a old raspberry (usb boot,I don’t trust sdcards) which then checks if outside connectivity is still available (so if the GSM power plug gets compromised it’s not an issue) and if not tries a shutdown or,if that is unsucessful, a powercut of the firewall. If that also doesn’t work it triggers a dry contact in the GSM plug which leads to the plug sending out a SMS so I know I am fucked and need to get someone with a key to the rack.