u/philpo

Yeah

We had one foreign Tourist do this per month on average.mostly not that dramatic,but still.

As someone who is German and lived in (urban) West Australia for a while and worked in its emergency services as a career paramedic:

People have no idea how fucking large Western Australia is and how fucking empty it is.

There are stations (farms) larger than a fair share of German states.

And yes, my dear Americans, it's even large by your standards - WA straight across is roughly the distance from SF to St.Louis and if you need an actual road it's basically the distance from SF to the east coast. With the difference that only 2.9 Million people live there - not even a third of greater SF and almost all of them live in the Perth metro region.

Outside of that there are very few population hotspots - after the 2.3 Millions in Perth the second largest town, Bunbury doesn't even have 100k.

Anyway, the area she got lost in is actually "that remote", to be honest. The nature reserve is only slightly larger than Luxembourg but fairly "close" to civilization as it's a nature reserve that is basically defining the end of the civilization in that area. To the west it's all farms and such. To the east? The big nothing. You only cross one road after 300km and only two more for the next 2000km..

The question I have is what she was doing there.

Because it's not an area you visit spontaneously, not an area you travel through or make a quick detour when going east.

Really strange.

Yeah, but please rely on them. An iPhone needs a working display basically to use it - and is far less "rugged" than a proper sat beacon. People tend to have their phones lying somewhere in their car, drop it when they try to get their car out of the sand, or simply forget to charge them.

There is a reason sat beacons are as rugged as they are.

(And btw, they don't work everywhere and not at all latitudes)

West Australia is huge. Like really really huge.

You can for weeks - with a car- without meeting someone.

Please don't, though. That really requires experience and a lot of equipment. (Amongst others a sat beacon for emergencies)

But read up on the Gunbarrel highway or the Canning Stock road.

I guess they couldn't get hold of someone in the US DoD after the budget cuts to approve the reboot?

Well, just Privateer for a non signing faction or nation then

You could simply go to Austria and do that.

Palatschinken is acceptable for any meal and delicious.

You are welcome - this is basically one of my specialities, even though my work focuses more on the prehospital fields.

Yeah,but can we please leave Venice intact doing that?

Without the tourists it's a nice little city to be honest, and its inhabitants have suffered enough.

Maybe Marghera?

Sorry for the late reply.

Here are some leads - not all of these studies are truely "rockstars", but they will lead you into the right direction if you follow their citations.

**Myocardial Infarction:**

Searcy R, Patel R, Drossopoulos P, Arora S, Stouffer GA. Rural-urban disparity in survival and use of PCI in patients who develop STEMI while hospitalized for a non-cardiac condition. Curr Probl Cardiol. 2025 Mar;50(3):102979. doi: 10.1016/j.cpcardiol.2025.102979. Epub 2025 Jan 10. PMID: 39800089

Sasaki K, Koeda Y, Yoshizawa R, Ishikawa Y, Ishida M, Itoh T, Morino Y, Saitoh H, Onodera H, Nozaki T, Maegawa Y, Nishiyama O, Ozawa M, Osaki T, Nakamura A. Comparing In-Hospital Outcomes for Acute Myocardial Infarction Patients in High-Volume Hospitals Performing Primary Percutaneous Coronary Intervention vs. Regional General Hospitals. Circ J. 2023 Sep 25;87(10):1347-1355. doi: 10.1253/circj.CJ-23-0188. Epub 2023 Aug 10. PMID: 37558468.

**Stroke/Traumatic brain injury:**

Quantifying Improved Outcomes, Cost Savings, and Hospital Volume Changes From Optimized Emergency Stroke Transport. (2022). Stroke,53 (12), 3644–3651. https://doi.org/10.1161/strokeaha.122.039172

Tepas JJ 3rd, Pracht EE, Orban BL, Flint LM. High-volume trauma centers have better outcomes treating traumatic brain injury. J Trauma Acute Care Surg. 2013 Jan;74(1):143-7; discussion 147-8. doi: 10.1097/TA.0b013e3182788b5a. PMID: 23271089.

Saposnik G, Baibergenova A, O'Donnell M, Hill MD, Kapral MK, Hachinski V; Stroke Outcome Research Canada (SORCan) Working Group. Hospital volume and stroke outcome: does it matter? Neurology. 2007 Sep 11;69(11):1142-51. doi: 10.1212/01.wnl.0000268485.93349.58. Epub 2007 Jul 18. PMID: 17634420.

Tsai SHL, Goyal A, Alvi MA, Kerezoudis P, Yolcu YU, Wahood W, Habermann EB, Burns TC, Bydon M. Hospital volume-outcome relationship in severe traumatic brain injury: stratified analysis by level of trauma center. J Neurosurg. 2020 Mar 13;134(3):1303-1315. doi: 10.3171/2020.1.JNS192115. PMID: 32168482.

Trauma:

Tang A, Chehab M, Ditillo M, Asmar S, Khurrum M, Douglas M, Bible L, Kulvatunyou N, Joseph B. Regionalization of trauma care by operative experience: Does the volume of emergent laparotomy matter? J Trauma Acute Care Surg. 2021 Jan 1;90(1):11-20. doi: 10.1097/TA.0000000000002911. PMID: 32925573.

Nathens AB, Jurkovich GJ, Maier RV, Grossman DC, MacKenzie EJ, Moore M, Rivara FP. Relationship between trauma center volume and outcomes. JAMA. 2001 Mar 7;285(9):1164-71. doi: 10.1001/jama.285.9.1164. PMID: 11231745.

Let me know if you need more info on a specific field.

Currently at a conference, but will do. Remind me in two days if I forget it.

Hello fellow Black Forestian! (Neustadt? It has 150 beds, doesn't it? I hope you don't mean Oberndorf,Stockach or Wolfach..In these cases I have a lot of bad news for you...but they don't fit your description)

• Imaging: In cases like this, angiography is an imaging option to see which can be used (even though it's much rarer these days).Germany is also pretty much alone with it's common use of MRIs - these machines are expensive to run and are only that widespread because we use them far more than clinically indicated-this is why they are often outsourced to a radiology clinic(in Neustadt to a Freiburg one...their afterhour availability...is varying). Additionally even these machines often cannot perform all necessary imaging options (e.g. perfusion MRI for stroke)

• Blood means a blood bank. These cases need blood transfusions urgently. Currently none of the smaller Black Forest hospitals has more than a few emergency blood products. Everything else needs to be delivered - which is a problem if shit hits the fan

• Stroke is a nice example actually: We have a nice system of telestroke care,indeed. And medical development will kill it within the next few years. Because by now we have more and more evidence that thrombolysis (dissolves the blockage with a drug) has worse results than thrombectomy(removal of the cloth - in these cases with a catheter similar to a cardiac cath lab). And that even if it takes longer (lysis has a timeframe of 4.5 hours, cath can often be performed up to 24h after the incident) it shows better results. Even before that was it was a game of numbers as "bloody strokes" as in vascular damage strokes - the vessel is not blocked but ruptured- always couldn't be treated in telestroke units as fhey required neurosurgical intervention and we knew from the beginning that the telestroke concept did them more damage than good,but as they were rarer it was acceptable.

The cath-based thrombectomy has one major downside, though - it is an extremely advanced (both skill and equipment wise)and delicate process. In the black forest region only Freiburg Uniklinik, Villingen (rather recently) and Basel currently are able to do so.

• A myocardial infarction is another very good example. The state-of-the-art treatment for an MI is a catheter intervention. Period. Anything else is not even remotely as good. We also know, that interventionists need a certain quantity of interventions to do so reliably,fast and with a good quality. This already makes it hard to impossible for a small hospital to provide good outcomes. Even medium sized hospitals like Tuttlingen(450 beds )fail to provide these, especially in urgent cases. There is already an abundance (fucking Waldshut has one but does not provide urgent care 24/7)of cath labs in Germany - which by a "euros needed to treat" perspective is a total waste of money but as cath interventions are a good way to make money for a hospital it is acceptable for some reason. Most other countries in the world cannot afford this luxury (and we can't either, tbh)

Anyway. In your case the MI wouldn't even be transported to the small hospital right now. The ambulance service does a 12 lead. If this confirms a STEMI (MI with urgent cath lab need-the most urgent one) it will be transported to a cathlab right away(currently Villingen,Krozingen, Freiburg Uni and Josefshaus, Freudenstadt, Singen, Basel,sometimes Waldshut, sadly Lörrach).

And no, we don't measure outcomes just for the cases which arrive at the hospital alive - all major studies factor in transport times and even then the results are absolutely staggering in favour of a concentration of facilities. (And even if we would follow international standards and remove the Cath labs from Waldshut, Lörrach and Tuttlingen the patients would benefit). There is only one very small subgroup of patients this doesn't apply to: Patients who either already have an cardiac arrest at the time the ambulance arrives or within the first 10min of treatment and in theory could be catheterised with ongoing CPR - but these are rare, even then have a horrible outcome and the evidence even in an urban setting simply is inconclusive.

Don't get me wrong, I do agree with you on some points:

• Our secretary of health is..a dimwit. As a Bavarian reingeschmeckter here I really really feel ashamed. We didn't want him and then he became a secretary of health here. (And I've met him personally. The only good thing I can say about him: He is not as bad as Karl Lauterbach or Jens Spahn)

• The uni hospital fucked up,yes. But at the moment of "shit hit the fan" the patients survivability would have been better in a uni hospital - even considering the driving distance. (Hungary has an excellent ambulance system that surpasses ours in some areas)

And don't get me wrong: The way we "concentrate" hospitals in Germany is a scam. We actually simply close hospitals without extending the amount of beds and capabilities in the centres.

Which then of course leads to overcrowding, etc.

From a healthcare economist's perspective you would need to build up 1.2 beds in a centre per bed closed as people normally would need to stay a bit longer there due to various reasons. Only then it works properly.

There is also the option to retain some beds in a step down approach, with primary and urgent care being delivered in the centre and the patient later being transferred to the "smaller" facility but treatment is still being controlled by the centre, as well as using the smaller facility as an urgent care clinic, e.g. in partnership with external medical offices. As it is done in the UK,Australia, Hungary (sic!), Italy,Australia, etc.

But for the later we would need a centralised healthcare management and not a rag rug of different providers.

Oh damn. Here we go again.

We have a mountain of evidence, that small hospitals are providing far worse outcomes, even if you factor in transport times to larger facilities.

They don't have the equipment(from blood, to imaging, interventional radiology, etc.), the qualification(you won't find a interdisciplinary surgical team like you find in a larger centre)and the experience(you need to have a certain case load to keep your skills up) to handle cases with higher severity.

Of course people feel like the "good old hospital" close by would "save their life", but the times where a small surgeon saves a life are long gone. (And realistically they fucked up more than enough cases back then as well. We have started to gather evidence about that since the 50ies).

In that case multiple people fucked up. There is zero evidence that the uterus rupture wouldn't have happened if she was an inpatient - or that she would have survived if she was an inpatient in that small hospital.

Yeah, a friend of mine literally told them "I'd rather let you fire me than end up in El Salvador".

They didn't fire him. The US client was infuriated, but now they meet in Canada or London.

Neofascists doing neofascists things

Especially as his brother was with him on the flight.

That is another level of gruesomeness.

Yeah, absolutely, AI has issues- that's why I narrowed my "Boeings fa**ult" down to electronics/software. There isn't too much maintenance they can fuck up in that department that can kill both engines(afaik).

In other parts like fuel,fuel distribution,etc? Totally different.

My bet is still on sometimes with the fuel, though. Maybe water in the fuel.

No.

Faults often don't get detected early,need certain circumstances (swiss cheese model) or quite simply, are caused by replacement parts.

There is a long chain of things that could fall into Boeing responsibility - and even if it doesn't the market does not always react reasonably.

Wake turbulence requires something to cause the wake - usually another aircraft. Additionally wake turbulences autoregulate themselves - they don't stay "in the air" but rather disperse rather fast, especially close to the ground.

VAAH is a pretty small airport that has no continual taxiway(which they once had,for some strange reason) so aircraft need to backtrack(Basically go in the wrong direction on the RW, then do a U-Turn) at the end of the runway if they go for a take-off runway of RW23.This leads to a long time for any wake turbulence to disperse.

Additionally the 787 is a mighty big aircraft and mostly wake turbulences affect aircraft that are smaller than the ones which caused it. (This is of course not fully accurate,but it gets complicated then) And the 787 is absolutely powerful enough to power through basically any wake turbulence.

Last but not least there was not a starting aircraft directly before the flight but a (very small) landing one - so even more time for any wake to disperse.

So in the end I would be pretty damn sure it wasn't that.

Yeah,I am not sure if there is a safety interlock with Boeing RATs(and the video is really bad)...so it might be intentional.

It's strange.

Personally I currently go with water in the fuel system as the "most likely guess by a armchair pilot"(me),but wouldn't also be surprised being it an electronic error. When that would be the case Boeing would be fucked beyond repair,imho.