Interestingly, there was a recent study that indicated for penetrating trauma the patient had a much higher survival rate if they were taken to the ER by private car compared with waiting for EMS transport. Presumably because you are less likely to waste that golden hour.
There are a couple reasons why he might do this that I can think of.
1). He didn't know how many people were going to come in or how serious they would be. Triage in MCI does depend to a certain degree on what your facility is capable of and the expected volume and status of patients. If he underestimated the volume or criticality of the patients about to come in he might have put more into the red pod than he would have otherwise. Underestimating seems plausible in this case because this was the worst mass shooting in history in the US.
2). Medicolegally he might have a fear that he would be judged harshly if he didn't automatically try to save everyone.
This is not my understanding of how to triage in MCI. ATLS definitely does teach the importance of deprioritizing people that will be hard or impossible to resuscitate in favor of prioritizing people that leads to a roughly utilitarian greatest good.
That said, I have never heard "black tag = not breathing = don't try to help"[1]. I know for a fact that the boundary for who to try to save immediately and who to deprioritize is very grey in many cases (it is why you should have an experienced doctor doing it). A common example why that equivalency is not taught in ATLS is the case of a boat capsizing in frozen waters. There may be many frozen victims who are not breathing but could still be very salvageable medically. If you chose to not help those who are not breathing in that case you would plausibly be found negligent without some extraordinary situation to justify yourself with.
Another example would be mass overdose on fentanyl, many are saveable but none would be breathing when you first see them.
Yes, those are two special cases where respiratory statues would not map well to expected outcomes. As far as I know, there was no capsize or mass opioid overdose involved...
I'm not sure where your understanding of triage comes from, but you're mistaken if you think respiratory status isn't the primary determining factor in black/expectant classification (in the US, there may be differences in other international systems I'm not aware of).
The vast majority of triage in US is done using the START system (or START-derived systems, like SALT).
I am excited for the phone but I don't get having matrix as the messaging app. I don't see the value in matrix. Encryption is not on by default, which is unacceptable in a modern messaging app. It leaks metadata like a seive. None of my friends or co-workers on it. It isn't decentralized enough.
They should just use briar. It hides metadata, it's encrypted, it's peer to peer. It's biggest downsides are no file transfer, no iOS client, no offline messaging.
Or better yet someone should develop an app based on one of the newer concepts like vuvuzela/alpenhorn or loopix.
Encryption is only not on by default because it is still in (late) beta. Obviously by the time the Librem5 ships this will be on by default.
You’re right that metadata isn’t protected serverside: so use servers you trust. In future the plan is to move to a hybrid p2p approach to fix this, but usability and features are more important given you can pick the servers to trust. https://matrix.org/~matthew/2016-12-22%20Matrix%20Balancing%... has more details on the tradeoff.
I’d be shocked if your friends and coworkers aren’t accessible via Matrix, given bridges through to Gitter, IRC, Slack etc. And if you want them to be native Matrix users, just invite them :)
In terms of “not decentralised enough”... the only bits which aren’t decentralised are the node which hosts your account, and (currently) the mapping DB of email/msisdn to matrix IDs. The latter is being fixed by the community currently; the former is harder but due to be worked on next year (hopefully solved by the time the Librem5 ships).
In terms of briar: it’s a great project, and perhaps it will surpass Matrix in time. But right now the battery and bandwidth requirements of running a full p2p stack on the client - as well as all the missing features you list, are a showstopper. It’s also not really set up as an open protocol/specification; just a library and app.
So, Matrix is probably the best bet for now. And we’re counting on evolving at the current rate or faster over the next year in the lead up to the Librem5 shipping.
I'm a Matrix patreon supporter because I see it as one of the most important OSS projects currently and I have my entire extended family using it via a self-hosted server.
Push notifications via GCM or APN all also centralized, correct?
What do you see as taking the place of GCM or APN on the Librem 5 phone? I currently use Riot on a device with neither (5 minute polling) and the experience as an instant messaging application isn't as good as an Android/iOS device.
If matrix moved toward pond style metadata protection I would make the effort to move my social graph on to it and probably support it financially.
As is, I don't see the value proposition of matrix. I am genuinely curious what it is. An update to xmpp?
Is it that it is going to be encrypted AND federated? Many popular apps now support default encryption so that isn't much of a selling point. Conversations is federated and is not getting traction the way signal has. Being federated has benefits but they are sort of theoretical and aren't high on most people's list of concerns. Further the value proposition of federated systems is attenuated by it's downsides (slow evolution).
Meanwhile people get killed based on metadata. Seems like a more urgent problem to tackle.
An easy way to describe Matrix is as a decentralised database of realtime conversations, which are signed and replicated over the participating servers. The main novelty over XMPP MUCs is that conversations are replicated equally over the servers so there's no single point of control - it's really more a decentralised than federated model. And yes, it has (beta) E2E crypto too - albeit trying to take the best aspects of Signal (the double ratchet) whilst also making it usable for sharing conversation history when desired between devices, and actually clearly tracking which devices are participating in the conversation. The "slow evolution" criticism of federation/decentralisation is empirically fairly bogus, as long as you structure the layers of the protocol so they can all evolve independently without cross-cutting concerns.
You're right that people get killed based on metadata, which is why it's in our sights in the longer term. But our focus is first on features that make the system actually compete effectively with its centralised counterparts (encrypted decentralised Slack or WhatsApp style use cases), otherwise in practice nobody's seriously going to use it. And secondarily on protecting metadata, especially given there's stuff like Ricochet & Briar that you can use today if you're doing something where you really need the metadata protection today.
Because OWS explicitly don't want third party clients. It's a controversial decision, but IMO they have good reasons for it. This said, if there's a client that works on Debian, it should work on the Librem (perhaps with some UX work). Currently on desktop, Signal is an Electron app.
I suffered from depression pretty much my entire 20's, and looking back it felt like the long line of anti-depressants I was prescribed exacerbated the situation. Eventually I changed how I live my life and started making baby steps towards improving myself. And I magically stopped being depressed. I have no doubt there are people out there that need help with medication. But I think the only thing that could have helped me was someone reaching out and showing me how to get out of my rut. But even then it would have been on me to make some changes and find out what makes me happy.
There is no well done study I have heard of that supports your position. In general SSRIs have an effect size that is so low it is not clinically relevant. There are multiple meta analyses that demonstrate that.
I am a physician with training in neuroscience. There is no scientific consensus that stimulants help the problems you are talking about. There is some preliminary evidence that stimulants may make some problems worse (graduation rates).
