Archive | Rural Resilience

Is there a Sandpiper Responder near you?

Spot the Sandpiper responder? They work with all other emergency personnel, including ambulance, fire, police, lifeboat and mountain rescue teams. (Staged simulation - pic by Chris Hogge).

Spot the Sandpiper responder? They work with all other emergency personnel, including ambulance, fire, police, lifeboat and mountain rescue teams. There are actually two in this photo.  (Staged simulation – pic by Chris Hogge).

Have you heard of the Sandpiper Trust?  If you are a rural GP or nurse in Scotland, you are very likely sitting there thinking ‘yeah, of course’!  You probably don’t have to look far in your home/car/work to find a familiar blue Sandpiper Bag – over £2000 worth of emergency life-saving kit brought together into a neat, organised package, ready to go at a moment’s notice.

Sandpiper Bag - in this case there's a BASICS Scotland teaching exercise being carried out in the background.

Sandpiper Bag – in this photo there’s a BASICS Scotland teaching exercise being delivered in the background.

There are over 1000 such bags in Scotland, mainly in rural and remote areas.  They enable rural clinicians to support the Scottish Ambulance Service in providing emergency care when there isn’t an ambulance easily available, or sometimes as there is more than one casualty, or the skills of a doctor are required to augment those of an ambulance paramedic.

One thousand bags.  That’s over £2,000,000 (2 million) worth of kit – funded purely from public donations over the last fifteen years.  And that’s before considering that responders who are on islands or make themselves trackable by the ambulance service, are provided with even more resource, from EZIO needles and pelvic slings, to defibrillators and technology to plug themselves into the national responder system.

Bags are provided to rural clinicians who have successfully completed the excellent BASICS Scotland courses in emergency care.  From advanced paediatric life support, to trauma care, to ongoing teleconference sessions to share best practice… the system works because of this integrated approach between BASICS Scotland – who provide the training and support – and the Sandpiper Trust – who provide the kit and training resources.

What started the Sandpiper Trust?

The Sandpiper Trust Logo - inspired by 'a light hearted, cheeky bird who plays by streams and on the seashore' - just like Sandy Dickson, whose tragic death inspired the charity to be founded.

The Sandpiper Trust Logo – inspired by ‘a light hearted, cheeky bird who plays by streams and on the seashore’ – just like Sandy Dickson, whose tragic death inspired the charity to be founded.

The Trust was formed shortly after the tragic death of Sandy Dickson in 2000 – at the age of 14 years as a result of a swimming accident in rural Canada.  His parents, Penny and Aly asked the question ‘What would have happened if this had occurred in Scotland?’.  Penny’s sister Claire and brother-in-law Robin Maitland supported them on a journey that would soon provide rural Scotland with an integrated system of emergency care and resource that has become the envy of many other countries.

Their work has inspired others to provide advice and expertise – such as when Chris Tiso of the outdoor sports company Tisos came across the Mark 1 Sandpiper Bag by chance, and provided his support to enable the Mark 2 Bag to incorporate much improved fabrics, layout and carrying harness.

More background to the Trust can be found here.

Who funds the Sandpiper Trust?

Sandpiper Bags are designed to keep equipment laid out in a logical and helpful way (Pic from simulation training at recent BASICS Scotland course).

Sandpiper Bags are designed to keep equipment laid out in a logical and helpful way (Pic from simulation training at recent BASICS Scotland course).

The Sandpiper Trust exists entirely on personal donations.  If you visit the Sandpiper Trust facebook page, you’ll see a range of budding cyclists, iron men, stall holders, bakers, auctioneers and other inspired volunteers who give their time to fund the Trust’s activities.

Unfortunately the nature of the work that the Sandpiper Trust supports, means that there are often sensitivities in reporting this at the time.  Patient confidentiality remains a paramount aspect of healthcare, and so responders have to be careful when highlighting the work that they have carried out at the time.  Inevitably, responding to emergencies can result in contact with adversity, tragedy, and changed or lost lives.  However, where possible, work is publicised to give Sandpiper supporters an idea of how donations are used.

The Sandpiper Trust is keen to hear from Sandpiper Responders about where their kit has helped.  It helps to keep the energy going behind the colossal fundraising efforts behind the scenes.

How does the system work?

Bags and jackets like this are provided to responders across rural Scotland - here's mine (Pic: Chris Hogge).

Bags and jackets like this are provided to responders across rural Scotland – here’s mine (Pic: Chris Hogge).

I am one of many Sandpiper Responders across Scotland.  I offer my situation as a typical example of why the Sandpiper Trust works so well to support us rural GPs in Scotland.  On Arran we have one ambulance available at any one time, and it is used for emergency and non-emergency patient transport.  It takes two hours to drive round Arran, and our population rises from 5,000 to 25,000 over seasonal periods such as Easter, Summer and Christmas.  We see lots of outdoor activity enthusiasts on Arran – cyclists, hillwalkers, paragliders – and like many parts of Scotland, we are seeing our population become more elderly and medically complex.

Our full team of GPs – along with one of our Practice Nurses with expertise in emergency care – are equipped with Sandpiper Kit.  Being island responders, we are given extra resources which means typical kit will cost more than £3000 per responder.  Three of us are mapped onto the Scottish Ambulance Service (SAS) system.  I carry an airwave radio and a smartphone that allows me to be tracked wherever my car goes – and to book on and off depending on other commitments.

If SAS require support – if Arran’s only ambulance is busy with another call, if there are multiple casualties, or if the crew have requested medical support – they will contact us by phone or radio, often using the map to see if anyone is closest and available.  Failing that, SAS will tend to call our community hospital to see if a response can be co-ordinated from there.  BASICS Scotland training includes not only advanced emergency medical care, but considerations about driving safely, providing a ‘sitrep’ back to ambulance control and keeping the initial scene as safe as possible.  Our personal protective equipment includes very high quality hi-vis jackets, which are extremely useful for road accidents and incidents in the open.

Sandpiper Responders can provide vital information back to ambulance control to help identify patients who need urgent evacuation for specialist medical care.

Sandpiper Responders can provide vital information back to ambulance control to help identify patients who need urgent evacuation for specialist medical care.

The job of a SAS call handler is very difficult, and sometimes it’s tricky to decide how urgently someone needs medical attention.  There are occasions when we are asked to assist with someone suspected of being very ill or injured, but being the first ‘eyes on scene’ we can further triage the call.  Being volunteers – and that emergency calls can take us away from a busy surgery, family life or time off – SAS tend to be careful and respectful on when we are asked to attend emergencies.  However, there’s no doubt that there are occasions when our early attendance can help to stand down limited resources – or indeed scale up a response for patients requiring emergency evacuation by helicopter.

Each year, across Scotland, Sandpiper responders attend thousands of calls.  These all depend on voluntary time, along with replacement of items which are used or which expire.  We continue to receive fantastic support from the Sandpiper Trust, who remain committed to providing us with great quality and often cutting-edge equipment.  Sometimes our ambulance colleagues are envious about the quality of the kit we are provided with!

What sort of calls do you attend?

Technology, funded by the Sandpiper Trust, enables some responders to link directly into the Ambulance Service responder system.

Technology, funded by the Sandpiper Trust, enables some responders to link directly into the Ambulance Service responder system.

I recently attended my 117th call in the last six years on Arran.  Without providing dates or specifics, here’s a look back at my last ten calls:

  • sudden heart failure, helicopter evacuation after stabilisation – SAS crew request for assistance
  • motorbike crash, thankfully only minor injuries – SAS crew busy with another call
  • fall off a ladder, serious injuries, helicopter evacuation from scene – SAS crew request for assistance
  • cardiac arrest, unfortunately fatal – ‘dual response’ requested
  • cardiac arrest, unfortunately fatal – ‘dual response’ requested
  • haematemesis (vomiting blood) – SAS crew busy with another call
  • mountain bike crash, teenager with chest and head injuries – SAS crew busy with another call
  • unresponsive 2 week old baby – ‘dual response’ requested
  • chest pain, suspected heart attack – SAS crew busy with another call
  • 35 week old baby with breathing problems – SAS crew delayed response due to location

What about WildCat?

wildcatWildCat is an impressive programme to trial a co -ordinated system of response to cardiac arrests in rural Aberdeenshire.  Building on the lessons of TOPCAT – a project in Edinburgh which has revolutionised how medics respond to cardiac arrests – WildCat aims to translate those lessons into a useful system for rural areas.  It builds on the response already provided by Sandpiper responders, and aims to train folk from much wider backgrounds to get early defibrillation and quality CPR to patients in cardiac arrest.  You can read more about WildCat here.

Sounds amazing.  Can I help?

Donations are particularly necessary to enable the Sandpiper Trust’s work to continue.  You can find out more about how to donate here.  If you live in a rural area of Scotland, ask your GP or practice nurse if they have a Sandpiper Bag next time you’re in.  If you feel able and inspired to help with local fundraising, your local responders and the Sandpiper Trust will be keen to support you with that.

Over the next few months, we hope to raise awareness about the amount of Sandpiper Kit in rural Scotland.  You can post messages to the Sandpiper Trust Facebook Page – and also there will be some twitter activity including the hashtag #spkit.

You can also use the comments section below to chip in your experience of using or benefitting from Sandpiper-funded equipment.

Her Majesty The Queen recently presented the 1000th Sandpiper Bag to a responder.

Her Majesty The Queen recently presented the 1000th Sandpiper Bag on behalf of the Sandpiper Trust to another responder in Scotland.

 

 

splogo

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New number for Scotland’s Retrieval Services

News just out which will be relevant to all Scottish rural GPs and healthcare practitioners…

scotstar

Download a poster for your unit (2.2MB)

From 11 July 2016 the telephone number to access a transport team for advice or retrieval will be 0333 990 222.

This number will connect you to the new Specialist Service Desk in the Glasgow Ambulance Control Centre.

The Scottish Ambulance Service are making this change to deliver the following improvements to service users;

  • Provide a single point of contact for advice or retrieval for all age groups
  • Provide real time updates on transport availability at the time of call
  • Utilise multi-party voice conferencing when required/requested for pre-transfer advice or planning
  • Call recording for audit and governance
  • Provide a single point of contact for mission progress updates

To report any issues with this new activation process, please contact the Specialist Service Desk Supervisor on scotamb.ssdsupervisor@nhs.net

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New Lifeline courses for volunteer responders

basicsIt is acknowledged that stress and psychological distress is a common reaction to the sorts of incidents that emergency responders encounter in the course of their duties.  This includes volunteer responder teams who have another ‘day job’ but who provide vital emergency services to their communities.

The effect of stress – and the importance of personal resilience – is recognised as an important consideration of overseeing an emergency care system.  So we’re pleased to hear about a new organisation – funded by Scottish and UK Governments from the proceeds of LIBOR fines – that aims to improve awareness of the stresses involved with, and offer a mechanism of support for emergency responders.

Across Scotland there are thousands of people who give emergency assistance to their fellow citizens. They provide a vital service to our communities, but their jobs can be emotionally and physically demanding. The Lifelines Scotland project supports the health and wellbeing of all emergency responders, and provides information for family and friends.

Lifelines Scotland is running a number of courses across Scotland to help teams and leaders support team-members and responders more effectively in dealing with traumatic and difficult events.  BASICS Scotland is one of several organisations who are promoting this initiative, and they are keen to increase awareness of it amongst the responders who they support.

For more information, see the flyer below, or visit the website at www.lifelinesscotland.org.

lifeline

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Scotland OOH Care Report now out

IMG_1166

Rural OOH presents specific challenges

The widely anticipated report into safeguarding the future of Scottish out-of-hours care is now available.

Led by Prof Sir Lewis Ritchie, the report – commissioned by the Scottish Government – offers a comprehensive assessment of the challenges and opportunities into providing sustainable, quality out-of-hours care across Scotland.  The challenge of recruiting GPs (amongst other health professionals too), the rising demand from comorbidity and our ageing population, as well as rising expectations generally… make for a tricky landscape for which to design a strategy like this.

However, the opportunities in more co-ordinated working, building on the strengths of integrated teams and more effective (and efficient) approaches to unscheduled care – appear to be a cornerstone of the report, which was published yesterday.

In addition, it makes clear that the service needs to seize more benefits offered by technology – for example in remote assessment and co-ordination of service providers.  Technology cannot offer all the solutions, but we need to be better connected.  It is apt that another story ran yesterday about the scale of the lack of connectivity in rural parts of the UK – and that’s just on the roads.  The need for high-level pressure on connectivity providers is clear, if the recommendations of the OOH report are to be realised.

Another welcome observation is that OOH can be a stimulating area of practice, and a useful learning environment – for students, GP trainees and other practitioners wanting to increase their experience of unscheduled care.  There is also a hint towards the fact that current OOH centres often struggle to offer appropriate rest/catering facilities for their staff.

There is regular consideration throughout the report of the ways in which services have to consider local geography and other service provision.  It appears to be a great example of a rural-proofed document, that takes Scotland’s rural populations well into account in its recommendations.  There is a lot to digest, and of course the challenge will be in implementation.  However, as a major stepping stone towards a more sustainable OOH service, it appears to hit the mark.

The report is available in full here: http://www.gov.scot/Publications/2015/11/8463/downloads

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Community Hospital Major Trauma: CPD by VC

basicsEverything about major trauma is now about getting the patient to the right place, first time.  For rural areas this means that often the rural community hospital is bypassed, so that a patient can be transported – often by helicopter – to one of Scotland’s major trauma centres.

This, of course, makes sense.  Combining early effective response, often involving EMRS/ambulance service colleagues as well as early callout of BASICS Scotland responders to begin treatment on scene – along with definitive care including early imaging and restorative surgery where necessary – is optimum patient care.

However, there are occasions when a community hospital – or a protracted local rural practitioner response – will be required to stabilise casualties e.g. in multiple casualty incidents or when air transfer is not available.

So how does rural Scotland – and the role of the rural GP/nurse/paramedic – fit into ongoing development of Scotland’s Major Trauma Network?

This is the question which will be addressed at the next meeting of the RRHEAL Rural GP VC Education Network.  Held on Tuesday 24th November – 1230-1400 – the event is free for rural practitioners to sign up to across rural Scotland.

Chaired by Dr Charlie Siderfin (GP – Balfour Hospital, Orkney) and with input from EMRS colleagues, this meeting will consider what community hospitals can do to provide an effective response to the major trauma patient; and how this fits in with ‘best practice’ and the major trauma network.

Programme:
  • Introductions
  • Spotlight: Background to the Scottish Major Trauma Network
  • Case & Arran Major Trauma Pathway
  • EMRS: Scotland Major Trauma Network and You
  • Discussion

To sign up, please complete the application form available from RRHEAL here.  You can link in from any NHS Scotland VC site, or via your personal NHS Scotland VC account (Jabber).  There are however limited places so please contact RRHEAL as soon as possible.

We hope to see you there.

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Belford 50:150 Conference: 22-25 October 2015

belfordhospital‘Tis the season it seems, to start looking at what events are happening over the autumn and winter months.  Here’s a new one, which looks exciting and a great chance to join a wide range of fellow clinicians from rural medicine across Scotland and beyond.

The Belford 50:150 Conference will mark the 150th anniversary of the opening of the Belford Hospital in Fort William, and the 50th anniversary of being on its present site.

The Belford Hospital serves a large area of rural Scotland, and as a result has been responsible for producing innovative approaches – and some fantastic characters! – in the provision of rural healthcare.  The conference is aimed at a wide range of attendees – and there is an impressive line-up of speakers from Scotland and beyond covering a stimulating and interesting range of topics – including mountain rescue, difficult ‘oncall’ scenarios,  international perspectives, and reflections from Belford alumni on what their Belford training has done for them in their subsequent careers.

Some of the most recent 'graduates' of the Belford Hospital

Some of the most recent ‘graduates’ of the Belford Hospital

There’s also a social programme, featuring a ceilidh on the Saturday night, and I suspect there will be lots of reunions happening too.

Kudos to current Belford consultants Patrick Byrne and Sarah Prince for putting together such an attractive programme.  I’m booked and hope to see you there.

NB. Closing date for abstract submissions is Friday 28th August – full details on the website.

> Belford 50:150 Conference Website
Belford Hospital image used under Creative Commons licence: N Chadwick
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Our experience of simulation training on Arran

splogoIn September 2014 we took delivery of three Laerdal mannequins to support the work of emergency responder groups on the Isle of Arran.  These were funded by the kind support of the Sandpiper Trust.  Spurred on by the work of the TOPCAT study – identifying that quality early CPR, along with effective clinical teamwork and leadership results in considerable improvement in survival from cardiac arrest – we sought to provide an island based resource to allow professionals and the public to improve their resuscitation skills.

This project was named ‘caiRRn’ – the Cardiac Arrest Integrated Rural Responder Network.  You can read more about the project at http://www.cairrn.org.uk.

Or watch this presentation from Richard Lyon, one of the stalwart researchers at the Resuscitation Research Group in Edinburgh.  If you need any convincing that this is worthwhile work, just watch this.

Earlier this year, the Scottish Government published the document ‘Out of Hospital Cardiac Arrest – A Strategy for Scotland‘.  We are particularly enthused that it gives several specific consideration to the challenges and opportunities of improving cardiac arrest survival in rural areas.

Community

After discussing our caiRRn project proposal with the Sandpiper Trust, we received two Laerdal QCPR mannequins for focussed CPR practice with our First Responder groups, emergency teams and the wider public.  To date they have been used to help train over 100 members of the public on Arran, and feature regularly in the training of our three First Responder Groups.

We will report on our experience of these mannequins in a separate article.

Professionals

We were also delighted to take delivery of a Resusci Anne Simulator for use with more qualified responders, particularly those who manage more complex arrest and peri-arrest scenarios as part of their voluntary or professional duties.  Over the last year, we have integrated its features into increasingly regular training – including GPs, hospital nurses, practice staff of Arran Medical Group and paramedics & technicians of the Scottish Ambulance Service.

It has been a steep learning curve, and after a year, we feel that it is now an integral part of regular training.  We have built simulation sessions into our weekly GP meetings; and we use the simulator on an ad-hoc basis when the hospital workload allows.  Our ambulance colleagues have found it particularly useful to practice scenarios as well as a teaching aid for trainee paramedics learning about patient assessment: breath sounds, heart sounds, advanced airway management and more.

We are grateful to the Sandpiper Trust for their considerable generosity in facilitating these resources to be available locally to Arran teams.  Already there are patients who have benefited from the training allowed – including some who have experienced and survived cardiac arrest on Arran.  We are keen to share the lessons learned, and have produced the following video clips as a way of doing this.

If you have any questions about our experience of the simulators, please contact us.  Dr David Hogg (GP) has been leading this project, and you can contact him at: david.hogg@nhs.net .

Conflicts of Interest: I am one of the Clinical Governance Leads at BASICS Scotland, which receives lots of support from the Sandpiper Trust.  I do not have any links with Laerdal, and I’m not on any commission! 

Introduction

Why Simulation?

Tour of Features

What about defibrillation?

Tour continued…

Any tips?

A brief demonstration

Acknowledgements

 

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Must-watch video from @KangarooBeach

When was the last time you watched something that you felt simply had to have a wider audience?

For me that was last night.  Tim Leeuwenburg of Kangaroo Island, Australia had already presented this talk to the wide community of SMACC in Chicago, but by sharing his story and reflections on video, it makes for compulsive viewing by all clinicians, from those about to hit the wards and experience ‘grown up’ clinical responsibility, to those who are approaching burnout – or who are keen to identify burnout in others.

As a rural GP I found Tim’s story compelling and relevant, and I think others will too.  If you can tolerate the graphic nudity (it’s worth it), take or make 30 minutes in your life to watch this.  And share.

 

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Inside the rural NHS: Steve McCabe

Portree

Portree, Isle of Skye

This podcast interview from Bateman Broadcasting was published just last week, and I think gives a real insight into the present challenges and highlights of working as a GP on the Isle of Skye.

Dr Steve McCabe, of the Portree practice, gives his views on what needs to happen to make rural practice more attractive and sustainable.

A recommended listen!

[podcast]http://tvi-media.com/batemanpodcasts/McCabe_McKenna_230315.mp3[/podcast]

Photo by Jack Torcello, Creative Commons
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Major Trauma – a free resource for community hospitals

photo-28Major trauma seems to have become the ‘sepsis’ of prehospital care: with more attention than ever being placed on setting up networks of care, specifically defined responses and considerable resource to get patients to centres of expertise as quickly as possible.  It makes sense, and I understand that it’s firmly based on evidence, including the impressively game-changing and solidly learned lessons that came out of the military hospital at Camp Bastion, Afghanistan.  The Scottish Ambulance report on major trauma services is available here.

What’s the need?

The main aim is to get those patients with significant injuries – particularly head, internal and polytraumatic injuries – to a centre that can offer immediate cardiothoracic, abdominal, orthopaedic and neurosurgical input, and surrounded by 24/7 radiology, dedicated trauma teams and intensivists.  It relies on recognition of serious trauma from the outset, by ambulance call takers and subsequent call interrogation at Ambulance Control.  It relies on appropriate trauma teams/paramedic/aeromedical resources being requested.  On focussed roadside treatment, but rapid transfer to a ‘Level 4’ major trauma centre.  And on an accurate standby call and team configuration being effected at the receiving hospital.

Teamwork

photo-26When it works it works well.  However, in rural areas it can present particular dilemmas.  Helicopters can make transfer to these centres possible from scene, but those of us working in these environments quickly learn that helicopters don’t always fly… or seldom have room for more than one casualty.  If you are unable to get immediate transfer of your patient, at what point should you stay at scene, or take your patient back to a community hospital for in-house stabilisation with more light and tools to hand?  There is no easy answer: the factors are hugely dynamic.

A recent road accident involving two casualties, that I attended as a BASICS GP responder on Arran, got me thinking and discussing with colleagues who had also been involved.  Despite significant injuries, immediate air transfer was not available, and we brought both patients back to our community hospital for further stabilisation and treatment, before transfer later in the evening.

What can we do better?

For some time we’ve wondered if it would be possible to draw up a checklist, or at least some sort of guide to give us ready access to a structured, systematic process of treating major trauma casualties.  Despite excellent BASICS Scotland training, and ongoing local refresher training – the fact is that we don’t see these cases very often.  A&E forms a frequent part of our rural GP workload, but we probably each see 4-10 cases of serious trauma per year.

We were particularly keen to develop a resource for use at our community hospital.  So I asked the question on Twitter:

And within hours, responses included the following:

… as well as this from the ever-helpful Bangor GP/ED superdoc, Linda Dykes (see their website here):

Working together

Linda sent me her department’s trauma pathway (and many others, but I’ll leave that to another article!).  She is happy for their work to be shared to others who might be able to benefit.  As a small community hospital, it’s difficult for us as GPs to find the time and expertise to draw up pathways like this from scratch, so it was hugely appreciated that we had this starting point.

photo-11As with our other emergency care work, we were quick to enlist input from our Emergency Medical Retrieval Service.  Dr Drew Inglis helped us to make it more specific to our situation, and tie-in with EMRS protocols as they are likely to be involved in the transfer of most of our major trauma patients.

So, keeping in the spirit of the help that Linda first offered us, you can download the PDF version of our major trauma pathway.  We’ve had to strip out some ‘sensitive’ contact information, but this can be easily added back in for your own department.

We’re aware that there are likely to be many revisions to follow.  We’ll keep this page updated with relevant changes.  At some point, we probably need to move from text boxes to tables, and that will help if you have any problems printing the documents below.  It will look text-heavy, but this reflects the desire for an aide-memoire to a systematic approach.

However, most importantly, please feel free to share and modify this pathway for your own use.  Please let me know if you have found this helpful, and in return I’ll email whenever we have useful changes to make.  Thanks again to Linda for allowing all this to germinate in the first place.

The Pathway

Generic Major Trauma Pathway v0.7 (PDF)

For the word document please contact me directly, so we can monitor interest in this.  My email address is included at the bottom of the PDF document.

 

Photos by Chris Hogge, taken from simulated exercises with Arran Resilience.  Upside down car by David Hogg with permission.

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