Wednesday, 13 February 2013

A Real Emergency


Let me paint you a little a picture. We had just taken a 97 year old to hospital. This 97 year old had just fallen down 17 stairs from top to bottom. She had a head injury, she had a broken wrist and she had broken ribs. She didn't want to go to hospital. She didn't want to call an ambulance. She did, because she couldn't get herself up. She apologised 12 times whilst in our presence for getting us out and wasting our time when we could be dealing with REAL emergencies. It took a lot of convincing to get her to agree to hospital and despite the pain she was in she felt she was burden. She had lived through 2 world wars. She had been employed full time from the age of 14 to 75. That's 61 years of taxes and national insurance since its inception. She has no carers at all and still does her own shopping. She costs the country her Freedom Pass and her medication which consisted of a daily Aspirin. She really was an inspiration. We left her at hospital to go and do a REAL emergency.

"25 year old female, pain in back after carrying baby and changing nappy"

What is there to say? I could rant about this for 10, 000 for even needing a breath, but I won't. I will not pass judgment, I will not share my thought. I was just explain what happened, what was said and what we did. Then, I will open it to the floor!

We arrived on scene at the patients flat. It was a council flat. 3 bedrooms. Nice kitchen. HUGE TV in the living room. Ashtray on the coffee table full of fag buts. Childs dummy 6" away. We had let ourselves in as the door was ajar. Sitting on the reclining black leather sofa was our patient. She had a pain'd expression across her face. Jeremy Kyle was on the TV (I'm being serious).

"Hello my dear, what's the problem today?"

"My back hurts."

"Where about?"

"Right here" she said, rubbing her lower back.

"When did it start?"

"About half an hour ago?"

"And what were you doing when it came on?"

"I'd been carrying me baby round and then put her down to change her and as I leaned down it started hurting real bad."

"Do you suffer with back problems?"

"Nah"

"Have you taken any painkillers?"

"Nah"

"It sounds muscular, you may have strained it slightly, what would you like to do today?"

"Go up hospital to get it checked out."

"I don't think hospital is necessary. You can probably treat it at home with pain killers and rest. Hospitals aren't the best place for babies, especially as they will probably tell you what i'm suggesting."

"Nah, i'd sooner go up there and get it checked out."

So that's what we did. She got all her stuff together and we headed out to the ambulance. As we were walking down the stairs her boyfriend / partner arrived. He followed us up to hospital in his car. It was a 2011 BMW with a personalised number plate. He lived at the same address. 

In the ambulance I established she was normally fit and well. No medical history to speak of. No allergies. She smokes 20-30 a day. She is unemployed. Her partner is also unemployed. We arrived at hospital, handed over to the nurse and were promptly sent to the waiting room.

So, for a change I will refrain from saying too much and leave it there!  That is for YOU, my readers to do! Thoughts on a postcard please! 

59 comments:

  1. I think this says a lot about today's 'Jeremy Kyle' generation. We've been brought up on the basis that convenience should rule over common sense.
    The world owes us, everything should be done for us.
    Had this been me, I would've taken pain killers, had a hot bath, used a hot water bottle and seen how it went. If it still didn't ease, I would've made a GP appointment, or visited an out of hours clinic, and expected my boyfriend to drive me in his BMW.
    Some people take laziness to an extreme.
    I can only hope that one day, either them or their loved ones REALLY need an ambulance, and that they have to wait due to other fools like them.

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    1. I love the term 'jeremy kyle generation'! I'll use that!

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    2. I wholeheartedly agree with you on this case Joanne. Well said and far more politely than i would have.

      Ella, i know it's your job but you were far kinder in this situation than i would have been. I would have told the lazy fu&*$r to take a paracetamol, suck it up and deal with it, and whilst she's at it, stop sponging off the tax payers and get a job. Have some damn pride, stop feeling like the world owes you, etc... Sorry but those kind of people really make my blood boil.

      Ella you must be a saint to deal with people like that on a daily basis and not smack 'em with an oxygen tank.

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  2. Once again boils down to we are owed services by society. No matter if we could treat ourselves, the ambulance service is there as a taxi service to hospital, which is used as a GP's. surgery. You are guaranteed to be seen without an appointment.

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  3. Gahhhhhh, it honestly makes my blood boil, how can it be that myself and my husband both work, but drive a ford cmax and probably don't have a telly as big as they do!!! I work in a Dr's surgery and the reason we don't have any appointments is because the surgery gets clogged up time and again with the same people who think it is their right to see a Dr when they demand, regardless of what it is for, I've even had people phone for an appointment, tell me it's an emergency and then when they come in its to get a prescription for nit treatment!!!!! And people wonder why us receptionists are moany haha the worlds gone mad! X

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  4. I just wish that the ambulance crews had the right to be able to walk out of jobs and charge people for their time, and that those charges would come out of their benefits if that were the case!!

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  5. The only job that has ever bought me to tears involved a little old woman who was badly injured post fall and was still finding it necessary to apologise constantly for disturbing us (in between gasping for breath). She had waited many hours for us as it was due to the low priority she was deemed to be by the system. If that was my nan I'd be fuming that the ambulance had been cancelled off going to her for a 19 year old 500m from hospital with current chest infection, coughing. We did that job only to find that the hour later when we were available again we got back our original job of the lady on the floor. As it happens we were the last ones to hold her hand whilst she was conscious. That haunts me to this day. People need to consider what an emergency actually is.

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    1. The whole idea of me not passing judgment was I wanted to see how many people would talk about the old lady! Thank you!

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  6. I think it is time we got more judgemental not less. My parents, who lived and fought in a world war, would have judged me if I made no effort to get a job, did not keep my house clean, spent money I didn't earn on luxuries and used services such as 999 inappropriately. I grew up without a television in the 70's because we couldn't afford one.
    I will judge my children the same way, it is time for people to take personal responsibility for their own health and for that of their children.
    I will go and work tonight, forgive me if I raise an eyebrow in a sceptical fashion when someone says they can't afford to buy paracetamol whilst staring at the huge TV and screeching down their top of the range mobile phone.

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    1. I like to judge but have been told that is naughty of me!

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  7. There's a whole generation on folk like this. Don't know what to do with themselves. Don't want to work - why should they when our taxes can pay for them? And live their lives with a sense of entitlement "because they can".

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  8. Fixed penalty fines for misuse. We need them

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  9. Crumbs, can afford all that on benefits but can't afford a taxi to a gp or doctors.

    Now I have got upset before about being told no for a "home visit"we were camping, my back went. History of problems with it. A disk had slipped and it had caused my legs to not respond. If I was alone I'd have phoned 999, but not for plain normal back ache. It took me over an hour to be able to get up, from face down in the mud.

    A little ouchy? Is she for frigging real? Arrrgggggggggggggggg

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    1. To clarify, I meant I phoned a gp asking for a home visit, not an ambulance.

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  10. Recently I have dispatched 8 min response ambulances to the following complaints : sore throat , nasty cough, bored, hiccups, cold like symptoms . All these calls originated from NHS Direct 111 service. Little hope for the general public to use the service correctly when a division of the NHS can't distinguish between life threatening emergencies & a complaint that needs nothing more than 'kissing better"

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    1. Im dreading it being introduced in our area!

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  11. Social welfare was intended for people that had fallen on hard times as a temporary measure until they get back on their feet. Unfortunately, nowadays we seem to be producing generations of families brought up on benefits with no incentive to study and or work hard as all they need to do is put out a grubby , nicotine stained hand for it to be filled with money from hard working tax payers. When people have no need to work to earn money, they don't appreciate the value of money.

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    Replies
    1. THANK YOU! Yes! Social housing should be for people who've last jobs, or can't work or single mums etc. Not just because its an easy way out!

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  12. Perhaps I'm going to buck the trend here, but people call 999 for many different reasons. Everyone has their own breaking point; the point at which they need to seek help. It is not their fault, or the ambulance service's fault that this happens. What needs to be done is for the wider NHS organisation as a whole to better educate people about the services available to them - patient transport, out of hours GP, MIU, WIC etc etc.

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    1. I know, but if your back is that bad, you wouldn't be able to continue carrying said child around the flat and to the ambulance. You wouldnt be able to walk! I offered GP and WIC and she refused!

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  13. Why couldn't her other half of driven her to the A&E as she was that determined to go? I'm sure you don't get seen any faster for minor/non existent problems just because you arrive by ambulance, or am I wrong?


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    1. That was my burning question!

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    2. She was probably operating under the false assumption that coming in by ambulance would result in her being seen before those who brought themselves in. That's common here in the States, and considering how much idiots in the UK have in common with idiots in the US, it wouldn't surprise me if the idiots across the pond bought into this delusion as well.

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  14. My Nan and Grandad didn't even call the GP when they felt unwell as they thought they'd be a burden. When my Nan had appendicitis it took a lot of persuasion to get her to go to hospital! When she was dying of lung cancer she kept worrying she was a burden and my Grandad stuggled for 3 weeks on his own caring for her without asking for any help because he didnt want to be a pain. I really think some people nowadays just don't have a clue how to look after themseleves (let alone any children they may have..!) and can't even have the common sense to take some paracetamol. They think they need someone to tell them all the time what to do, or how to do something. It's scary the lack of knowledge some people in society have about obvious day-to-day things such as health and diet. It makes me feel sad to read your post as its something we all know happens - its almost stereotypical - but at the same time it does happen in real life! Did this woman want the drama of saying she went to hospital? What did she think would happen there? One day she may really need some help and when she has to wait for it as other people are wasting time like she has, perhaps she'd think again! (but I doubt she would)

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    1. Different generation, different rules, greater respect and appreciation of others.

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  15. With the utmost respect : ROFLMFAO . In the near future , when the patient is charged to be taken to hospital ( if there are hospitals ) in an ambulance , there won't be many able to afford the payment . That time is not far off .

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  16. I've posted before about the fact that you cannot refuse transfer to ED. I dont understand it. Give her two paracetamol, complete the paperwork and leave! You are not saying she cannot go to hospital. You are sayong she doesnt need transport. That is a satisfactory ambulance response.

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    1. That would have been what I would have done but we cannot refuse if a patient wants to go to hospital.

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  17. I've posted before about the fact that you cannot refuse transfer to ED. I dont understand it. Give her two paracetamol, complete the paperwork and leave! You are not saying she cannot go to hospital. You are sayong she doesnt need transport. That is a satisfactory ambulance response.

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    1. We aren't aloud to act like registered medical professionals! That would be ridiculous!

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  18. First case. ESI level 2 High risk. Second ESI level 5. Second case is not an emergency and by definition it should not have been a response. The error happened before you were dispatched and lies in the triage process IMHO.

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    1. The triage system is NEW yet is so out of date!

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  19. Accurate pre EMS call triage systems need to be implemented across the board. Where used they have reduced medical costs tremendously and kept more ALS units available

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  20. i recently phoned nhs direct having fallen several hours earlier on a slippery path, all i wanted was some advice, was heat /cold best, anti inflamitaries or paracetamol after discribing the pain the nhs person was adament she was sending an ambulance - i pointed out it wasnt an emergancy and certainly didnt warrent one all it would do was scare my children, wouldnt listen and put me through to dispatch, refused it again and told them id make my own way to a&e if they agreed not to send it. husband drove me down, there less than 30 minutes, doctor basically treated me like the time waster i felt, my point with ths is with the Jeremy Kyle society we have this type of treatmentt isnt helping its draining a valuable resource.

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  21. It's about time the poor started actually looking & acting poor, eh? Having massive TVs really doesn't sit well with how I like to think of them. Like you, I'd be far more comfortable if people on unemployment benefit had no TV.

    Irritating she called an ambulance as well. She should have gone in the partner's BMW.

    How'd you know it was a council flat, btw? They have signs on them these days? I sure hope so! I like to know exactly where the poor live!

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    1. Haha! There are certain estates in my area which are all social housing. I will never get the huge TV thing! Bugs the hell out of me!

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    2. You expect those who have been made redundant (for example) to get rid of their TV because you think unemployed people shouldn't have one?

      If I recall correctly, St John Ambulance NZ charges $50 (NZ) for a call out, unless it's for an accident in which case it is covered by the Accident Compensation Corporation http://en.wikipedia.org/wiki/Accident_Compensation_Corporation.

      Very interesting blog. It leaves me hoping that the New Zealand health system doesn't go the way of the NHS!

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  22. How is the old lady? And just how the hell does a couple on benefits afford a huge tv and a year old BMW?

    I don't like the nasty party but the idea of making non-emergency transport or calls like these a pay-in-advance service or it'll be stopped out of your benefits sounds like one way to keep these timewasters out of ambulances.

    I read your blog and despair of vast chunks of modern society, if anything it is obvious that the 'judging' and 'ranting' that you do are part of a finely tuned system to ease your stress by venting rather than storing it up and hurting yourself or others.

    I saw a bloke with his push bike in a warm waiting room at the station this morning; him on one seat the bike up against a 4 seater bench - what moron thinks their bike needs to be kept warm!

    Sadly I suspect that the call-handlers at NHS Direct will benefit as much as the general public should someone at the top of the NHS & Ambulance trusts grow the balls to decide to educate the public on when a 999 call is justifed; then the makers of reality tv and the sports channels can do the world a favour and show the adverts for free in the ad-breaks in their schedules.

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    1. Oh I agree, stop their benefits. A fail safe way of ensuring they don't try this ridiculous trick again!

      We have to think of some sort of final solution to this mockery of our emergency services.

      Delete
  23. I'm an EMT in the US, and after reading a few of your posts, I am getting the impression that dispatchers can actually refuse to send an ambulance out? Here if someone requests an ambulance, they get one. Too bad an early triage system doesn't actually seem to work. We also can only transport to the hospital. It is possible to get an ambulance to take you to the doctor, but you have to have a form signed by a doctor stating there is a medical need for you to be transported by ambulance, and everything has to be arranged days (usually weeks) in advance. This is a totally different service, unrelated to 911. It would be interesting if we could transport to a doctor's office.

    It amazes me what people call an ambulance for. I can count on one hand the times I've called an ambulance. Twice was after falling and severely spraining my ankle (no one ever said I was graceful). The first time I was alone and hurt the foot I use to push the gas pedal, so didn't feel I could drive. The second time was after I slipped on some wet leaves and fell down a steep embankment in the mountains. I limped about halfway back to the trail leading to the car (with the assistance of my husband and a stranger who just happened to be down there with us), but the trail was so steep that even with two good ankles I would have had to get on all fours to climb up it. There was no way I was getting up that trail. It took 6 emergency workers and a stokes basket to get me out of there. I literally crawled into the house when I got home. The last time was when I started having back spasms so bad I couldn't get up from the sofa without blinding pain.

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  24. A potential solution....

    Send a car, not a truck, to initially assess patients. This way they can't be automatically transported....

    If they NEED a truck, ask for one as appropriate. (i.e. GET ONE NOW or please truck send a truck when you can)

    If they just WANT a truck, politely tell them you will ask for one but it may be some time - up to 4 hours (which could be true) as their condition is not life threatening. See if they still want one then or want to make their own way. If they still insist on a vehicle, ask control to get one, lowest possible priority, within 4 hours. Use the lowest qualified crew that your trust has (ideally PTS but most of that is private now!) so as to free up the more highly qualified crews for the work that requires their skills.

    It does work - I've been to people with a slight cut to the hand. Cleaned & dressed it so there is no immediate problem and then said it will be 3h for a truck as we are so busy (this was accurate!). They make their own way.

    If we keep sending them vehicles when they don't need them, they will never learn. If the system can be abused, they will abuse it.

    The above method does not give us that power to say "no" which would be nice, but it does give us the power to make sure those in need get the ambulances quickly and those who want an ambucab are made to wait. And who knows - perhaps they might start to just take them selves down the hospital if they know they have to wait so long!

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    1. I wonder how many other older people defer calling the ambulance as they consider themselves a nuisance? The Kyle Kids see paramedics alongside pizza deliveries and 'know their rights'. They live in a conscience free World, and it's sadly not getting better

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  25. As for the lady who fell down the stairs.. I would follow up on and buy her some flowers. :)

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  26. As for the lady who fell down the stairs.. I would follow up on and buy her some flowers. :)

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  27. All the education, leaflets, TV adverts etc etc in the world will not stop people from abusing the service. They consider it their right, the only way that a change would come about is if you hit their pocket and started charging. Quite how you go about that I dont know, also they would have the same old defence 'aint got no money'.

    I had suspected meningitis was delirious and weak enough that walking was difficult, my family was asked if they wanted an ambulance, no was the reply and they bundled me into the car literally. ( It was sepsis btw ).
    I have noticed that there are many people who do try and struggle with getting the pt to the hospital for whatever actual medical physical reason. Also I wonder how many people do in fact do that when an ambulance was appropriate, think of how many transfers youve done where the patient came in on their own and were proper poorly. We shouldnt forget those people.

    Its what makes me so mad about these other time wasters.

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  28. Am wading in too.
    It's really boring just having the facts presented and being expected to make up my own mind. Am a libran and perpetual second guessing is a nightmare to people like me. I WANT to say oh, sweet lady thinking she's being a burden, and oh, bad doleys with their big telly. I hope you go back soon to being true to yourself Ella, and not being influenced by a vocal minority of trolls.
    However.
    I worked in elderly care, and saw all too often the elderly who were an absolute pain in the arse (but still got full, courteous treatment) but didn't half turn on the charm when anyone in a medical or official capacity was around.
    I also see some oddness in the doley case. Maybe they had a terrible row and he wouldn't take her to the hospital and only turned up because someone told him there was an ambulance parked up outside their flat? She wouldn't be the first to make a show of being poorly for some attention.
    As a foil to both cases, one of my best friends is a headmistress of a small private school. She has a lovely lifestyle but seems addicted to A and E. She has visited Casualty as it should still be called no less than twice already this year. Once because she ran out of depression medication and this weekend because of some abcesses under her arm.
    Casualty gave a much needed definition to the place. You visited it with limbs hanging off, blood spurting or hearts stopping, and that was it. Now with it's renaming, which I sincerely believe is a marketing trick to actually get people to visit MORE frequently it seems to imply a much more vaguely welcoming place. I believe that is an issue that should be taken to task with the men in suits.
    I love this blog, it may vex me, or sadden me, or encourage me, but it always makes me think.
    Thank you Ella x

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  29. 111 is in our area already and the job volume has increased massively. Not always cause the caller wants an ambulance - I've been to loads where the caller hadn't wanted us and were embarrassed we had arrived. The call taker & the system interprets almost everything as an emergency e.g. a heavy cold = breathing difficulty, a sore chest from infection = chest pain, a 6 month back pain as a traumatic event. Their excuse is they can't assess over the phone. It's ridiculous

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  30. Sometimes I think 111 gets it right, even if it might not seem like it to start with. I'm in a VAS that does A&E support for the local ambulance trust.
    Recently, we got sent to someone with shooting pains down her arm - she thought it was probably a trapped nerve, and so did we. She had rung 111 to get an OOH GP appointment - she had been put on hold, then the call taker had come back to her and told her we were coming.
    She thought sending an ambulance was a bit much - but when we chatted about it we all realised that the GP would just have sent her to hospital anyway - so we'd saved time and a likely very painful double car journey.
    I think, if given the chance, in our Trust Control will send appropriate resources. RRVs are allowed to transport minor stuff, paramedics can book "urgents" - and decline transport or take to GP.
    Around here, your job above would probably get the comment - "I see your boyfriend's arrived. His car looks like it has much comfier seats than our ambulance, and you'll get seen as quickly if you go by car as by ambulance, maybe quicker as you don't have to wait for us to book you in, you can go straight to Reception and do it yourself. Why don't you go in the car?"

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  31. Erm, since when were we not allowed to refuse transport when its not appropriate, and this was not appropriate. Im defo sure you work in London because its become an LAS culture to just transport everything! I know a handful of colleagues who have the guts to refuse the resource and quite rightly! Offer a advice and leave at home. If they want checked tell her to get in her BMW and go to the WIC.
    I do it regularly on the FRU and can always justify it! yes be thorough, yes do all you can, draw the line at abuse of our service!

    On a personal note, My dad had an MI and there were no resources for over 10 min, finally got a crew (no car) after nearly 15 min (perhaps orcon was met because I was on scene with no kit, shitting bricks) Anyway, I knew fine well as I was watching my hero ebb away that my collegues were ferrying idiots like your back pain girl to A&E! So it actually angers me to see my fellow health care professionals allowing lay members of the public dictate to us what happens next! We aint taxis...stop acting like taxi drivers!

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