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	<title>Medic Madness &#187; Opinion</title>
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		<title>Privatizing Detroit EMS</title>
		<link>http://medicmadness.com/2012/02/privatizing-detroit-ems/</link>
		<comments>http://medicmadness.com/2012/02/privatizing-detroit-ems/#comments</comments>
		<pubDate>Fri, 10 Feb 2012 13:49:11 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
		<category><![CDATA[News]]></category>
		<category><![CDATA[Opinion]]></category>
		<category><![CDATA[detroit ems]]></category>
		<category><![CDATA[ems news]]></category>
		<category><![CDATA[ems politics]]></category>
		<category><![CDATA[fire based ems]]></category>
		<category><![CDATA[private ems]]></category>
		<category><![CDATA[privatization detroit]]></category>
		<category><![CDATA[public ems]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1750</guid>
		<description><![CDATA[The City of Detroit has been facing some serious financial issues over recent years, and now they are faced with running out of cash before their fiscal year is over. It&#8217;s a pretty big deal. I&#8217;m not exactly sure how they got into this situation, but if I had to make a guess, I would [...]]]></description>
			<content:encoded><![CDATA[<p>The City of Detroit has been facing some serious financial issues over recent years, and now they are faced with running out of cash before their fiscal year is over. It&#8217;s a pretty big deal. I&#8217;m not exactly sure how they got into this situation, but if I had to make a guess, I would say they spent more money than they took in (as if there&#8217;s any other way?). One of the major side effects from their financial woes is a horribly broken EMS system. Ambulances sitting idle because they can&#8217;t afford to fix them, response times to critical calls exceeding an hour in some cases, poor employee morale, and a bad working environment are just a few problems that the public can see.</p>

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<p>With the state jumping in to fix the problem, city officials now have some serious changes to make. Privatizing the EMS system is now on the table as a big possibility. Personally, I think it should have been on the table a long time ago, but that&#8217;s neither here nor there at this point. The talking heads at City Hall say it will save money while the union heads say it will cost the city money. So which is it?</p>
<p>There are a lot of details I don&#8217;t know about Detroit&#8217;s EMS system so I can only speculate based on some assumptions, so if I&#8217;m wrong about something, please feel free to correct me.</p>
<p><img class="alignright size-medium wp-image-1754" src="http://medicmadness.com/files/2012/02/detroit-ems-300x225.jpg" alt="" width="300" height="225" />It&#8217;s pretty obvious at this point that Detroit EMS operates at a loss. This isn&#8217;t much of a surprise to me given the unemployment rate in Detroit and the fact that 911 simply isn&#8217;t a money-making enterprise. It&#8217;s very rare to find an EMS system that actually makes money on 911 calls alone. Where the money is usually made is event standbys and inter-facility transfers. Most private ambulance services use both to offset their losses from the 911 calls.</p>
<p>I&#8217;m not sure if Detroit EMS runs inter-facility or just 911, but I&#8217;m going to assume they only run 911. If I&#8217;m correct, then it is going to be virtually impossible for any service &#8211; whether it be public or private &#8211; to operate without a subsidy. So what can they do? Well 2 viable options exist. They can either pay a private service a fixed subsidy to run the 911 calls, or they can pay them no subsidy and give them exclusive rights to the inter-facility transfers and 911 calls. Personally, I think the second option is better at this point.</p>
<p>They can set performance requirements as a condition of the contract. These might include response times, minimum staffing, complaint resolution, etc. The service that wins the bid is required to operate within their budget and meet the requirements of the contract. I have seen this type of exclusive operating contract work very well in several areas, including a few that I have personally worked in. Where things usually go wrong, is when the city decides to start over-regulating the ambulance service to the point that they can&#8217;t afford to operate without a subsidy. At that point your right back to square one.</p>
<p>If the City of Detroit goes through with this decision, then my advice to the city is this:</p>
<blockquote><p>Pick a good company with a good reputation. There are plenty of them out there. Give that company exclusive rights to all emergency and non-emergency responses within the city limits. Set reasonable requirements and hold them to it. After you do all that, stay the hell out of their way. Don&#8217;t start trying to fix something that isn&#8217;t broke.</p></blockquote>
<p>I&#8217;m sure plenty people will disagree with me on privatization, but we do know that the public system isn&#8217;t working for them. The city has proven itself incapable of keeping a balanced budget, so why not wash their hands of it and allow someone else to manage the EMS operations? I really hope the best for the EMT&#8217;s and Paramedics working in Detroit. We&#8217;ll see what happens in the next couple months.</p>
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		<item>
		<title>And That&#8217;s Why We Lock Our Ambulances</title>
		<link>http://medicmadness.com/2012/02/and-thats-why-we-lock-our-ambulances/</link>
		<comments>http://medicmadness.com/2012/02/and-thats-why-we-lock-our-ambulances/#comments</comments>
		<pubDate>Fri, 03 Feb 2012 05:40:30 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
		<category><![CDATA[News]]></category>
		<category><![CDATA[Opinion]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1729</guid>
		<description><![CDATA[MT. JULIET, Tenn.&#8211;A man hopped into a Wilson County ambulance that was blocking his car and tried to move it while paramedics were loading a patient. http://www.jems.com/article/news/blocked-tenn-man-tries-move-ambulance Ambulances get stolen all the time, and yet many of us still think it&#8217;s OK to leave them unlocked. If someone truly wants inside your ambulance &#8211; or [...]]]></description>
			<content:encoded><![CDATA[<blockquote><p>MT. JULIET, Tenn.&#8211;A man hopped into a Wilson County ambulance that was blocking his car and tried to move it while paramedics were loading a patient.</p>
<p><a href="http://www.jems.com/article/news/blocked-tenn-man-tries-move-ambulance">http://www.jems.com/article/news/blocked-tenn-man-tries-move-ambulance</a></p></blockquote>
<p><img class="alignright size-medium wp-image-1731" src="http://medicmadness.com/files/2012/02/stolen-ambulance-300x225.jpg" alt="" width="300" height="225" />Ambulances get stolen all the time, and yet many of us still think it&#8217;s OK to leave them unlocked. If someone truly wants inside your ambulance &#8211; or any vehicle for that matter &#8211; they will get inside. What locks do, is keep the honest people honest.</p>
<p>Locking your vehicles doesn&#8217;t just stop people from joy-riding, it also keeps idiots like the one mentioned above from damaging your equipment. Take for example, my story:</p>
<blockquote><p>We were on scene of a 2-vehicle collision in the middle of the highway. I had parked my ambulance on the pavement as it had just finished raining and the shoulder was muddy and most likely too unstable to drive a large vehicle on. We were caring for 4 patients, 3 of which were critical.</p>
<p>We had a total of 2 ambulances, and 2 fire engines on scene. All vehicles were parked on the pavement (there&#8217;s really no coincidence here). Everything was going fine until a battalion chief rolled up on our scene and decided that the spot where my ambulance sat would be a perfect parking location for his bat-mobile. Never mind the fact that it was intentionally parked in it&#8217;s current location for quick and easy access.</p>
<p>So, Mr. Bat Chief (AKA Batman) decides that he is going to hop inside my ambulance and pull it over on the shoulder to make room for the bat-mobile. The ambulance did exactly what I was afraid of, and it slid about 5 feet into the mud and got stuck. So now we had the pleasure of sitting on scene with a critical patient for 35 minutes while we waited for another ambulance to arrive. And I got the pleasure of sitting on the side of the road for the next hour waiting for a tow-truck while I came up a good story to explain to my boss why I hadn&#8217;t locked the doors.</p></blockquote>
<p>Obviously the morons in both stories weren&#8217;t trying to steal the ambulances, but I guarantee a locked door would have stopped them in their tracks.</p>
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		<title>The Best Healthcare Delivery Model</title>
		<link>http://medicmadness.com/2012/01/the-best-healthcare-delivery-model/</link>
		<comments>http://medicmadness.com/2012/01/the-best-healthcare-delivery-model/#comments</comments>
		<pubDate>Tue, 17 Jan 2012 14:00:24 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
		<category><![CDATA[Opinion]]></category>
		<category><![CDATA[Politics]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1666</guid>
		<description><![CDATA[I&#8217;m constantly finding myself in debates over which healthcare delivery model is &#8220;the best&#8221;. Many people argue in favor of government-based healthcare, while many others stand by private / for-profit delivery models. The truth is, they all suck. Money controls the care. Bottom line, no arguing, it&#8217;s just the hard truth. You can&#8217;t sustain any [...]]]></description>
			<content:encoded><![CDATA[<p><img class="alignright size-medium wp-image-1673" src="http://medicmadness.com/files/2012/01/Hospital-entrance-sign-259x300.jpg" alt="" width="259" height="300" />I&#8217;m constantly finding myself in debates over which healthcare delivery model is &#8220;the best&#8221;. Many people argue in favor of government-based healthcare, while many others stand by private / for-profit delivery models. The truth is, they all suck. Money controls the care. Bottom line, no arguing, it&#8217;s just the hard truth. You can&#8217;t sustain any form of practice without a source of income, there&#8217;s just no way around that. So where the real argument lies, is where the money comes from.</p>
<p>Everybody has a budget and has to live within that budget to stay in business. This is no different between any of the delivery models. When the money runs low in a socialized system, income is increased by raising taxes while the private sector raises prices. Either way, the poor bastard working paycheck to paycheck winds up being the only one really affected.</p>
<p><strong>So which one is better?</strong></p>
<p>It&#8217;s no secret that I&#8217;m not a huge fan of government-ran healthcare, but that doesn&#8217;t mean I think the private-sector is without fault. My issue with government being in control of healthcare is their lack of ability to balance a budget. It just seems like healthcare would be yet another thing on the chopping block when it comes time to reduce the deficit. Instead of the sob stories telling us that &#8220;we will have to lay off police officers, firefighters and teachers if we don&#8217;t raise these taxes&#8221;, we will have the pleasure of having nurses and doctors added to that list. Plus, there is just too much red-tape and BS that goes into getting anything done.</p>
<p>Now I meant it when I said the private-sector isn&#8217;t perfect. As a matter of fact, they are far from it. Profit margins and favors to share-holders certainly do their share to affect patient care. Now let me set the record straight. I&#8217;m OK with someone making a profit off healthcare. That&#8217;s what drives growth and creates jobs. What&#8217;s troubling is some of the measures that are often taken to increase those profits.</p>
<p>Throughout my experience in healthcare, I would have to say that non-profit is my favorite delivery model. Like I said, there is still a budget but not so much of a profit margin to compete with. You tend to see things actually being done to benefit the patients that we serve. It&#8217;s just a different mentality. I currently work for 2 non-profit entities and I can say that we do a lot of things to benefit our patients that aren&#8217;t covered by medicare or probably any insurance agency. It&#8217;s just done because it&#8217;s the right thing to do.</p>
<p>Of course, there are always exceptions. For example, my last employer was a for-profit ambulance service. While we were in business to turn a profit, we did a ton of things to improve patient comfort, safety, crew comfort, etc. None of which was required. I know that there are a lot of government-based services that do the same as well, it&#8217;s just not the norm.</p>
<p>That&#8217;s just my opinion, ableit a biased one.</p>
<p><strong>The real problems</strong></p>
<p>The issues around our healthcare problems in the U.S. aren&#8217;t a matter of delivery methods. It&#8217;s a matter of reimbursement, abuse and lawsuits and all 3 are directly related to each other. It&#8217;s like that movie &#8220;Human Centipede&#8221; with lawsuits being on the front of the of the chain, abuse right behind and reimbursement on the tail end.</p>
<p><em>Side note &#8211; If you haven&#8217;t seen Human Centipede, consider yourself lucky. Whatever you do, DON&#8217;T watch that movie, it will scar you for life. If you have seen it &#8211; god forbid &#8211; then you should get the humor in the reference. </em></p>
<p>Lawsuits by themselves aren&#8217;t necessarily raising the cost of healthcare, but what they do is encourage defensive medicine. Doctors start ordering tests that they know aren&#8217;t necessary only to be &#8220;safe&#8221; <em>just in case </em>it&#8217;s actually something serious. So the 19-year-old with a headache and no other symptoms gets a CT scan and the frequent flyer who comes with the same complaint of chest pain every week gets a full cardiac workup. Those are just a couple examples of what the ER&#8217;s see on a regular basis.</p>
<p>A system that encourages defensive medicine also encourages abuse. The frequent-flyer previously mentioned will continue to come in on a regular basis, because he knows that nobody is going to just do a medical screening exam and send him away. Whether it&#8217;s food or attention he&#8217;s after, he knows he&#8217;s going to get it and so he continues to come back. Once again, that&#8217;s just one example.</p>
<p>So now comes the problem of reimbursement. Every time our frequent-flyer uses emergency services generates a bill. A bill that&#8217;s not going to get paid. Even if he is covered by Medicaid / Medicare, they are only going to cover a fraction of the cost. So what happens to the uncovered portion of the bill? Well, prices for these services just continue to increase in order to make up for the lost revenue. See: <a title="Cost Shifting – An EMS Fight for Survival" href="http://medicmadness.com/2010/10/cost-shifting-an-ems-fight-for-survival/">COST SHIFTING</a></p>
<p><strong>Solutions, anyone?</strong></p>
<p>Throwing money at the problem or changing our delivery model does nothing without addressing the core issues that got us here in the first place. As it currently stands, the people who pay for their insurance are essentially paying for those that don&#8217;t. Switching to a single-payer system or socialized system doesn&#8217;t change that. That problem with never go away.</p>
<p>What we need is better access to primary care providers and incentives for seeking appropriate levels of care. There isn&#8217;t much incentive for a primary-care physician to see Medicaid or Medicare patients because the reimbursement is terrible. Something has to be done about that. But not in the way that you might think. A trip to the family doctor or urgent care is going to be far less than a full-blown work-up at the ER. If more people were seeing their doctors instead of using emergency services to address their problems, then our insurance providers &#8211; both private and public &#8211; would have more money to spend on things like reimbursement.</p>
<p>Now this sounds fine and dandy, but getting people to seek appropriate levels of care isn&#8217;t going to happen by asking them nicely. There has to be serious incentives. For me, such incentives already exist. For me or my family to visit the ER, we pay a $100 co-pay unless we are admitted. In that case, the co-pay is waived. So every time me or a member of my family gets sick, we have to decide what will be the best way to seek medical attention. Obviously I&#8217;m not going to pay $100 for a sore throat, I&#8217;m going to pay $25 to see a PCP. Why can&#8217;t we use a similar system for Medicaid?</p>
<p>Like I said, asking nicely isn&#8217;t going to do the trick and neither will sending a bill. I think most would agree that people that habitually abuse emergency services aren&#8217;t going to willingly fork over the cash for a co-pay. And nobody is going to turn them away for lack of ability to pay, and that&#8217;s perfectly OK. But what we can do is deduct that co-pay from other benefits, like welfare. I would even go as far as saying that a $30 ER co-pay would substantially reduce the abuse.</p>
<p>If you set out a box of free donuts, people will naturally over-consume. If you charge even 50 cents people will most likely only take one, if even any. When people are visiting ER&#8217;s because they don&#8217;t have enough money for Tylenol, then we know we have a huge problem. Nobody is held accountable, so why would they act any different?</p>
<p>People abuse the system because it&#8217;s not only allowed, it&#8217;s encouraged. Until we actually get serious about addressing the high cost of healthcare, nothing is going to change. It doesn&#8217;t matter how much money we throw at it or who&#8217;s running the show.</p>
<p>&nbsp;</p>
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		<title>My 3 Favorite EMS Tribute Songs</title>
		<link>http://medicmadness.com/2012/01/my-3-favorite-ems-tribute-songs/</link>
		<comments>http://medicmadness.com/2012/01/my-3-favorite-ems-tribute-songs/#comments</comments>
		<pubDate>Mon, 16 Jan 2012 14:00:22 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
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		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1635</guid>
		<description><![CDATA[I absolutely love music. It&#8217;s a big passion of mine that I have had since I was a child watching my parents play in bands. Growing up, I really looked up to them and wanted to play music, just like then. I eventually followed in their footsteps and became a professional musician, playing the local [...]]]></description>
			<content:encoded><![CDATA[<p>I absolutely love music. It&#8217;s a big passion of mine that I have had since I was a child watching my parents play in bands. Growing up, I really looked up to them and wanted to play music, just like then. I eventually followed in their footsteps and became a professional musician, playing the local music scene, shortly after high school. My father is an amazing song writer, a talent that I have never possessed. I tried my hand at writing music sometime late in high school, and for a while I actually thought I was good at it. That is, until I recorded myself singing one of my songs. My songs were forever locked away and to this day, I have yet to try and write again. Instead, I look for music that I can relate to.</p>
<p>Having been through a lot in my life, I have often considered trying to put my feelings and experiences into a song, but for some reason I can&#8217;t bring myself to try.  Who knows, maybe someday I&#8217;ll break through my barriers and put something together, but for now I&#8217;ll stick to playing my instruments and playing / singing the songs that I love.</p>
<p>The following 3 songs are all ones that I have stumbled across over the past few years. I enjoy them because I can relate to all of them. I have had these songs saved on my YouTube &#8220;favorites&#8221; list for a while now and I have been itching to share them. They aren&#8217;t very popular songs, but I happen to enjoy them. It&#8217;s also no coincidence that they are all country, being that it&#8217;s my music of choice <img src='http://medicmadness.com/wp-includes/images/smilies/icon_smile.gif' alt=':)' class='wp-smiley' /> </p>
<p><strong>The Call: </strong>Cory Young</p>
<p><a href="http://www.youtube.com/watch?v=aTLM6QGLQFE"><img src="http://img.youtube.com/vi/aTLM6QGLQFE/2.jpg"></a></p>
<p><a href="http://www.youtube.com/watch?v=aTLM6QGLQFE">Click here</a> to view the video on YouTube.</p>

<p>I found this song on YouTube recently and really enjoyed it. Cory Young is a singer / songwriter from Nashville who also happens to be a Paramedic / Firefighter. The video looks like it was taken from a iPhone, so the quality isn&#8217;t all that great. However, you can visit his <a href="http://www.reverbnation.com/coryyoungmusic">Reverb Nation page</a> and listen to the studio version of the song.</p>
<p><strong>Think of Me: </strong>Tracy Lawrence</p>
<p><a href="http://www.youtube.com/watch?v=PpPqBtDy2jQ"><img src="http://img.youtube.com/vi/PpPqBtDy2jQ/2.jpg"></a></p>
<p><a href="http://www.youtube.com/watch?v=PpPqBtDy2jQ">Click here</a> to view the video on YouTube.</p>

<p>This obviously isn&#8217;t the official music video. I&#8217;m fairly certain that he never produced one. I like this song because it serves as a tribute to everyone in public safety and the military. You can find it on his &#8220;<a href="http://www.amazon.com/gp/product/B000W12AUK/ref=as_li_ss_tl?ie=UTF8&amp;tag=medimadn-20&amp;linkCode=as2&amp;camp=1789&amp;creative=390957&amp;creativeASIN=B000W12AUK">Strong</a>&#8221; album.</p>
<p><strong>I Hope They Get to Me In Time: </strong>Darius Rucker</p>
<p><a href="http://www.youtube.com/watch?v=Q_4diWW-k5Y"><img src="http://img.youtube.com/vi/Q_4diWW-k5Y/2.jpg"></a></p>
<p><a href="http://www.youtube.com/watch?v=Q_4diWW-k5Y">Click here</a> to view the video on YouTube.</p>

<p>This isn&#8217;t the original music video. It&#8217;s something that somebody put together, but I still think it&#8217;s cool. This is more of a tribute from a patient&#8217;s perspective, which makes it unique from most EMS / Public Safety tributes. You can find this on his &#8220;<a href="http://www.amazon.com/gp/product/B001FJ2IX2/ref=as_li_ss_tl?ie=UTF8&amp;tag=medimadn-20&amp;linkCode=as2&amp;camp=1789&amp;creative=390957&amp;creativeASIN=B001FJ2IX2">Learn to Live</a>&#8221; album.</p>
<p>If anyone knows of any other good EMS tribute songs, please let me know. I would love to hear anything from any style.</p>
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		<title>Those Pesky Ambulance Chasers</title>
		<link>http://medicmadness.com/2012/01/those-pesky-ambulance-chasers/</link>
		<comments>http://medicmadness.com/2012/01/those-pesky-ambulance-chasers/#comments</comments>
		<pubDate>Sun, 15 Jan 2012 14:00:46 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
		<category><![CDATA[Field Medicine]]></category>
		<category><![CDATA[Opinion]]></category>
		<category><![CDATA[ambulance chasers]]></category>
		<category><![CDATA[ask mc]]></category>
		<category><![CDATA[safe ambulance operation]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1627</guid>
		<description><![CDATA[&#8230;.and not the kind you are imagining. If you don&#8217;t read the Motor Cop Blog, you should. MC has a great column called &#8220;Ask MC&#8221; where he takes questions from readers about anything related to law enforcement. I can appreciate this column as I have been the recipient of his advice on more than one [...]]]></description>
			<content:encoded><![CDATA[<p><img class="alignright size-medium wp-image-1628" src="http://medicmadness.com/files/2012/01/ambulance-chaser_1407-300x198.jpg" alt="" width="300" height="198" />&#8230;.and not the kind you are imagining.</p>
<p>If you don&#8217;t read the <a href="http://motorcopblog.com/">Motor Cop Blog</a>, you should. MC has a great column called &#8220;<a href="http://motorcopblog.com/category/ask-mc/">Ask MC</a>&#8221; where he takes questions from readers about anything related to law enforcement. I can appreciate this column as I have been the recipient of his advice on more than one occasion. Thanks again, MC!</p>
<p>Anyway, on to the story.</p>
<p>MC had a reader submit a question about family members following ambulances at a dangerously close distance during emergency transports. Rather than try and re-create the reader&#8217;s scenario, I will paste the question here:</p>
<blockquote><p>I recently assisted in transporting a baby to a city hospital after he was brought to our ER after an arrest. It was a roll of the dice as to whether he’d make it there, we had 4 adults in the back keeping eyes on him and praying. Stressful, to say the least. Before we left the family was told NOT to try to keep up with the ambulance, and the last thing anyone needed was a car wreck on the way. Every family has been told this, on every transport I’ve been on, and to date none have listened. This morning we were trying to part traffic in the city during rush hour, and the family car was on our butts all the way. About 1 foot off the bumper, in spite of getting floodlighted from the ambulance and the doc making “Get away!!” gestures from the back window.</p>
<p>Do you have any suggestions…our hospital frowns on firing warning shots out the back window. What could be more convincing, and within the law as far as instructions before the transport, and what are officers able to do to help. Obviously we went through several towns fairly fast, and a police chase after a speeding ambulance is darned disruptive and dangerous, so I was at a loss at the time.</p></blockquote>
<p>MC had a great response to the reader&#8217;s question. Do yourself a favor and <a href="http://motorcopblog.com/2012/01/14/ask-mc-follow-that-ambulance-or-dont/">read the article</a> to see his response before continuing on.</p>
<p><a href="http://motorcopblog.com/2012/01/14/ask-mc-follow-that-ambulance-or-dont/">http://motorcopblog.com/2012/01/14/ask-mc-follow-that-ambulance-or-dont/</a></p>
<p>He really hit the nail on the head when he said that you can&#8217;t control other people&#8217;s actions. This is especially true during a state of panic. What you CAN control, is your actions.</p>
<p>All of us in EMS have experienced situations like this, probably on a fairly regular basis. I personally have been rear-ended twice by following family during a transport. On both occasions, we had to stop and wait for another ambulance to show up and continue patient care and transport. It&#8217;s a bad situation for everybody.</p>
<p>Now, back to controlling the things that we can control, like our actions. MC pointed out that we should communicate with the family and explain what&#8217;s going on and explain why following the ambulance is a bad idea. I can&#8217;t agree more. Keeping family in the loop is key. I have made a practice of taking down family member&#8217;s phone numbers before leaving, so that I can call them once we arrive at the ER to either update them on the situation, or allow the hospital staff to contact them. I have found that taking the time to make sure they know what&#8217;s going on goes a long way towards bringing them down off their state of panic.</p>
<p>There will be occasions where nothing you say or do works. A wise man once said that &#8220;you can&#8217;t fix stupid&#8221;. Well, Mr. White couldn&#8217;t be more correct, and in these cases you just have to do what&#8217;s right for yourself and the patient. On some occasions I have elected to discontinue a code-3 (lights and sirens) transport and continue in &#8220;cold&#8221; due to a vehicle following too close. Every time I have done this the family got upset and complained, and management has always backed me. You have a responsibility to protect yourself and those around you. If a following vehicle is compromising your safety during a code-3 transport, then you have to do whatever it takes to be safe.</p>
<p>One of the best quotes of MC&#8217;s response:</p>
<blockquote><p>One of the great things about an ambulance is the medic in the back.  While you are headed to the hospital, you are receiving the appropriate medical care you need.  There is less need to drive with imprudence…at least theoretically.</p></blockquote>
<p>Took the words right out of my mouth. We are no longer &#8220;gurney jockeys&#8221;. The scoop-and-run mentality is slowly dying and we are starting to be looked at more like a mobile ER, as we should. There are only a few scenarios where rapid transport is warranted, much less beneficial. I&#8217;m sure a bunch of people disagree with me, but trust me when I say that we will never advance in our field if we keep hauling ass to the ER&#8217;s instead of actually treating our patients.</p>
<p>Now back to the topic on hand&#8230;&#8230;(see <a title="EMS and ADD" href="http://medicmadness.com/2011/11/ems-and-add/">EMS and ADD</a>)</p>
<p>The bottom line is, don&#8217;t compromise your safety. Driving an ambulance is a lot like riding a motorcycle. Everybody is either aiming for you or ignoring you. As professional drivers, we have to do our jobs and everyone else&#8217;s as well. Be aware of your surroundings. Try to avoid putting yourself in these positions by communicating with the family. If all else fails, drive slow.</p>
<p>&nbsp;</p>
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		<title>You Idiot</title>
		<link>http://medicmadness.com/2012/01/you-idiot/</link>
		<comments>http://medicmadness.com/2012/01/you-idiot/#comments</comments>
		<pubDate>Tue, 10 Jan 2012 17:21:20 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
		<category><![CDATA[News]]></category>
		<category><![CDATA[Opinion]]></category>
		<category><![CDATA[mark powell]]></category>
		<category><![CDATA[paramedic accused of raping patient]]></category>
		<category><![CDATA[sexual assault]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1571</guid>
		<description><![CDATA[You probably read yesterday&#8217;s post about the paramedic that was accused of raping a patient. I was very upset with the media&#8217;s one-sided reporting of the story as they can easily destroy someone&#8217;s reputation if they turn out to be innocent. Well as it turns out, the paramedic in question tarnished his own reputation. The [...]]]></description>
			<content:encoded><![CDATA[<p><img class="alignright size-medium wp-image-1572" src="http://medicmadness.com/files/2012/01/doc4f0b325a4180c238579975-300x225.jpg" alt="" width="300" height="225" />You probably read <a title="Guilty Until Proven Innocent" href="http://medicmadness.com/2012/01/guilty-until-proven-innocent/">yesterday&#8217;s post about the paramedic that was accused of raping a patient</a>. I was very upset with the media&#8217;s one-sided reporting of the story as they can easily destroy someone&#8217;s reputation if they turn out to be innocent. Well as it turns out, <a href="http://www.newhavenregister.com/articles/2012/01/09/news/metro/doc4f0b325a4180c238579975.txt?viewmode=default">the paramedic in question tarnished his own reputation</a>.</p>
<blockquote><p>The warrant says Powell at first denied any inappropriate contact but then said he touched the woman&#8217;s breasts and genitals &#8220;to elicit a response from or awake the female.&#8221; The warrant says he expressed remorse to police.</p></blockquote>
<p>Sorry dude, that&#8217;s never appropriate and you just made yourself and your peers look that much worse to the general public. I still stand by my dislike for one-sided journalism, they just happened to get lucky this time.</p>
<p>It&#8217;s always hard for me to imagine that my peers would consider doing things like this, which generally causes me to assume the best in cases like these. I hold EMS professionals to a high standard and I have a lot of respect for what we all do on a daily basis. Crap like this just reminds me that there are bad eggs everywhere.</p>
<p>For more details on the confession check out the local article:<br />
<a href="http://www.newhavenregister.com/articles/2012/01/09/news/metro/doc4f0b325a4180c238579975.txt?viewmode=default">http://www.newhavenregister.com/articles/2012/01/09/news/metro/doc4f0b325a4180c238579975.txt?viewmode=default</a></p>
<p>You can also download and read the arrest warrant that has details of the accusation and the statements from the paramedic admitting the allegations. Just be warned, it contains some potentially offensive material.</p>
<p>Download: <a href="http://medicmadness.com/files/2012/01/77689916-Powell-Warrant.pdf">77689916-Powell-Warrant</a></p>
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		<title>Guilty Until Proven Innocent</title>
		<link>http://medicmadness.com/2012/01/guilty-until-proven-innocent/</link>
		<comments>http://medicmadness.com/2012/01/guilty-until-proven-innocent/#comments</comments>
		<pubDate>Mon, 09 Jan 2012 20:12:41 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
		<category><![CDATA[News]]></category>
		<category><![CDATA[Opinion]]></category>
		<category><![CDATA[amr paramedic arrested]]></category>
		<category><![CDATA[conn paramedic accused of sexual assault]]></category>
		<category><![CDATA[ems news]]></category>
		<category><![CDATA[paramedic accused of rape]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1558</guid>
		<description><![CDATA[ A paramedic raped a woman as she lay unconscious and strapped to a stretcher in the back of an ambulance on the way to a hospital, police said Friday. If you haven&#8217;t read the story of a Conn. Paramedic Accused of Sexual Assault you should. The article published by the Associated Press leaves a bit to [...]]]></description>
			<content:encoded><![CDATA[<blockquote><p> A paramedic raped a woman as she lay unconscious and strapped to a stretcher in the back of an ambulance on the way to a hospital, police said Friday.</p></blockquote>
<p>If you haven&#8217;t read the story of a <a href="http://www.jems.com/article/news/conn-paramedic-accused-ambulance-sex-ass">Conn. Paramedic Accused of Sexual Assault</a> you should. The article published by the Associated Press leaves a bit to be desired, but the <a href="http://hamden.patch.com/articles/amr-paramedic-allegedly-sexually-assaults-patient">article found on a local news source</a> paints a little bit of a better picture and has video of the interview with police officials.</p>
<p>I&#8217;m not particularly pleased with the reporting of this story as pretty much every news outlet involved has tried and found this paramedic to be guilty. But then again, objective reporting is rarity these days so I shouldn&#8217;t be all that surprised.  What&#8217;s more upsetting, is the comments provided by the local police department and his own employer:</p>
<blockquote><p>“The allegations in this case represent outrageous and horrifying conduct by an emergency medical professional,&#8221; Wydra said. &#8220;Our society places the greatest level of trust and confidence in its public safety providers, and the circumstances in this case reflect a tremendous breach of that faith.</p></blockquote>
<p>This quote from the police chief is something that I would expect AFTER a guilty verdict. In the event that new evidence clears this medics name or if he is found to be not-guilty, will the police chief issue an apology? Probably not. The problem with this kind of reporting is that it essentially destroys his reputation, whether or not he is guilty. He may very well be innocent and have his charges dropped, but these articles will remain and will ultimately cause trouble for him when he applies for jobs, school, etc.</p>
<p>Having worked as a supervisor for a rather large ambulance service, I fielded more complaints than I can count. Some of them were legitimate and many were bogus. On several occasions, I had employees accused of assault, battery, theft, and even sexual assault. In fact, I even know of one paramedic that was arrested due to allegations of sexual assault on a minor. His name was dragged around through the mud until the charges were dropped due to several inconsistencies in the &#8220;victim&#8217;s&#8221; stories. He was cleared back to work, but the allegations haunted him for years later.</p>
<p>I try to look at cases like this with an open mind. I know that while the over-whelming majority of EMS professionals are honest people, we still have a few bad eggs circulating out there. However, I can&#8217;t ignore the fact that we often transport less-than-honest individuals. I&#8217;m not saying the accuser in this situation isn&#8217;t honest. For all I know, she may be telling to truth. From my personal experience, allegations of illegal activity are more often than not found to be bogus. I&#8217;m very curious as to what evidence was sufficient enough to issue an arrest warrant.</p>
<p>There are several questions that aren&#8217;t being answered, and probably won&#8217;t be until the case reaches trial. Allegations alone aren&#8217;t enough for me to formulate an opinion on what happened.</p>
<p>A few things I want know:</p>
<ul>
<li><strong>What was the transport time?</strong><br />
-Was there enough time for this to actually take place?</li>
<li><strong>Did the partner witness anything?<br />
-</strong>I can&#8217;t imagine that a woman waking up to being raped would go unnoticed by the paramedic&#8217;s partner.</li>
<li><strong>Was the patient under the influence of alcohol or drugs?<br />
</strong>-This alone doesn&#8217;t prove innocence or guilt, but it&#8217;s an important thing to evaluate when investigating these cases.</li>
<li><strong>Does the paramedic in question have any prior complaints or reprimands for similar incidents?<br />
</strong>-When things like this come to light (assuming it&#8217;s true), it&#8217;s rarely the first time.</li>
</ul>
<div>There are a few things mentioned in the article that raise an eyebrow. For example:</div>
<blockquote>
<div>&#8220;While being transported to the hospital, she awoke in the ambulance to find an AMR employee sexually assaulting her,&#8221; Smith said. Because the woman was strapped to the stretcher, she could neither move nor speak, he said. &#8220;She was helpless at the time of the assault,&#8221; he said.</div>
</blockquote>
<div>Strapped to the stretcher? The article claimed that she was transported for a head injury, so was she in c-spine or actual restraints? If she was in restraints, was there an indication for it like combativeness? Were the restraints placed on scene or in the ambulance?</div>
<div>Unable to move or speak? I&#8217;m not exactly sure how this would be possible. Was she chemically restrained? Is it even possible to perform said acts with someone who is in c-spine and / or placed in 4-point restraints on an ambulance gurney? These are all things that I can only hope the prosecution looks at.</div>
<div>I certainly hope that these accusations are false, and if the paramedic in question is actually guilty, then I hope justice is served. Likewise, I hope the accuser faces serious consequences if it turns out that the allegations are false. What&#8217;s most important here is that we don&#8217;t jump to conclusions before we know all the facts.</div>
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		<slash:comments>9</slash:comments>
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		<title>He&#8217;s Right, Nothing is Absolute</title>
		<link>http://medicmadness.com/2012/01/hes-right-nothing-is-absolute/</link>
		<comments>http://medicmadness.com/2012/01/hes-right-nothing-is-absolute/#comments</comments>
		<pubDate>Wed, 04 Jan 2012 05:24:36 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
		<category><![CDATA[Field Medicine]]></category>
		<category><![CDATA[Opinion]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1553</guid>
		<description><![CDATA[I’ve burned the rulebook/protocols, both physically and metaphorically, probably more times than I can count. There were times when what I did was right, and there were times when what I did was wrong. Either way I learned from the experience, and right or wrong I always owned it and did it knowing there would [...]]]></description>
			<content:encoded><![CDATA[<blockquote><p>I’ve burned the rulebook/protocols, both physically and metaphorically, probably more times than I can count. There were times when what I did was right, and there were times when what I did was wrong. Either way I learned from the experience, and right or wrong I always owned it and did it knowing there would be repercussions.</p></blockquote>
<p>Reading the article &#8220;<a href="http://thesocialmedic.net/2012/01/on-nothing-being-absolute-except-death-and-taxes/trackback/">Nothing being absolute except death&#8230;.. and taxes</a>&#8221; from <a href="http://thesocialmedic.net/">The Social Medic</a> brought back some unfortunate memories of when doing the right thing, wasn&#8217;t the right thing. His article was sparked by some debate over a <a href="http://www.emsworld.com/news/10576812/md-responders-broke-rules-to-save-girl">story of firefighters that transported a pediatric patient on their fire engine, rather than waiting for the ambulance</a>. I&#8217;m not going to come out and say whether or not what they did was &#8220;right&#8221;. Instead, I&#8217;m going to share my own story of &#8220;right vs wrong&#8221;. I&#8217;m pretty sure it will give you a good idea of how I would react if I was in their shoes.</p>
<p>We were dispatched to a doctors office for a younger female that had suffered a pneumothorax as a result of a medical procedure that had gone bad. Her doctor had requested that we transport to a hospital that his group contracts with. At the time, that hospital was on ED closure. I informed him of said closure only to be informed that he had contacted the receiving physician and that he had accepted this patient.</p>
<p><em>This is something that I have encountered MANY times. Every other time, I would have just transport to the hospital and call them en route to inform them of the situation. NO BIG DEAL&#8230;..right?</em></p>
<p>We loaded the patient without delay and did what me or any other paramedic in our system would have done. We started towards the ER of choice. When I called in report, I was instructed to divert. I called them on a land-line to speak with the charge nurse to inform him of why I was continuing to their facility. He still refused the patient. The accepting physician had already gone home and they were not going to accept this patient.</p>
<p>This was a first for me. I informed the patient of the hospital&#8217;s refusal and was immediately met with a demand to stop the ambulance and let her out. She was adamant that she would not receive care at any other hospital and was willing to take her chances with death.</p>
<p>Sure, I had informed her of the risks and she COULD have signed AMA and walked off to die somewhere, but I&#8217;m not OK with letting someone go, knowing what&#8217;s about to happen. I re-contacted the hospital and explained that the patient was attempting to sign AMA and go home. They didn&#8217;t care. Their suggestion was to allow her to do so.</p>
<p>I instructed my partner to divert to another hospital while I attempted to convince our patient to allow another hospital to treat her. We finally had no choice but to pull over before getting to any hospital and call someone to pick her up. I couldn&#8217; legally keep her any more. I called my supervisor for help and he showed up to ultimately receive the same resistance. She was stubborn and she knew her rights. By now her work of breathing had increased and I had to increase her oxygen to maintain a decent Sp02. Not a good time to sign AMA.</p>
<p>Being that transporting was out of the question, we were able to convince her to let her family drive her to the original ER of choice. I told her that we would follow her to make sure she made it OK. She agreed.</p>
<p>My supervisor called the ER one more time to inform them that she was going to be arriving via private vehicle. He asked them to do the right thing and just accept the patient so she didn&#8217;t have to resort to such measures. They finally agreed and accepted the patient. We arrived at the ER and the patient was transferred over with no issues.</p>
<p>Later that night &#8211; 10 minutes after clearing that hospital, to be exact &#8211; the charge nurse filed a formal complaint with our governing EMS agency. I was investigated and found to be in violation of the county&#8217;s transport destination policy. I had an infraction placed against my paramedic license and it remains until this day. The EMSA director said obtaining the AMA would have been the right thing to do.</p>
<p>If I had it to do over again, I would do the exact same thing, in the exact same way I did it. I don&#8217;t care how stubborn that patient was, it was my responsibility to make sure she received the care she needed.</p>
<p>Sometimes we get confused about what&#8217;s right, but I know for sure it&#8217;s not always what&#8217;s on paper.</p>
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		<title>Define Discrimination&#8230;.</title>
		<link>http://medicmadness.com/2011/12/define-discrimination/</link>
		<comments>http://medicmadness.com/2011/12/define-discrimination/#comments</comments>
		<pubDate>Thu, 22 Dec 2011 19:32:44 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
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		<category><![CDATA[fired for smoking]]></category>
		<category><![CDATA[fired for violating smoking policy]]></category>

		<guid isPermaLink="false">http://emsblogs.com/medicmadness/?p=1533</guid>
		<description><![CDATA[The jobs of three EVAC employees with more than 30 years of combined experience are up in smoke after they were found in violation of the county&#8217;s nicotine policy, a county spokesman confirmed Saturday. If you haven&#8217;t read the article, read it here: http://www.news-journalonline.com/news/local/west-volusia/2011/12/18/volusia-paramedics-fired-for-smoking.html I&#8217;ll start off by saying that legally, the terminations are valid and [...]]]></description>
			<content:encoded><![CDATA[<blockquote><p>The jobs of three EVAC employees with more than 30 years of combined experience are up in smoke after they were found in violation of the county&#8217;s nicotine policy, a county spokesman confirmed Saturday.</p></blockquote>
<p><img class="alignright size-medium wp-image-1537" src="http://medicmadness.com/files/2011/12/tobacco-nicotine-cigarettes-300x200.jpg" alt="" width="300" height="200" />If you haven&#8217;t read the article, read it here: <a href="http://www.news-journalonline.com/news/local/west-volusia/2011/12/18/volusia-paramedics-fired-for-smoking.html">http://www.news-journalonline.com/news/local/west-volusia/2011/12/18/volusia-paramedics-fired-for-smoking.html</a></p>
<p>I&#8217;ll start off by saying that legally, the terminations are valid and will most likely not be overturned. Whether you agree with the policy or not, it&#8217;s still written policy with clear language for what happens if you violate said policy. So yes, I think it&#8217;s sad that these experienced paramedics lost their jobs, but you can&#8217;t knowingly violate the rules and not expect to suffer the consequences.</p>
<p>Now, having said that, I must say that I think the policy is 100% BS.</p>
<blockquote><p>&#8220;I was terminated for something I do at home and is perfectly legal,&#8221; said Mike Stone, who had worked as a paramedic for EVAC for 5 1/2 years.</p></blockquote>
<p>I completely agree. As of right now, smoking is still legal and it doesn&#8217;t impair your ability to think rationally or function in the workplace. If they don&#8217;t want their employees smoking while on duty, then that&#8217;s OK. They have that right. But to try and dictate what their employees do in their personal lives is plain wrong.</p>
<p>For many of us, a nicotine-free policy wouldn&#8217;t have any affect, but what&#8217;s important is that the employer has already demonstrated that they are willing to tell you what you can and can&#8217;t do in your own time. Sure, it might not affect me now, but what happens when they decide that they don&#8217;t want to hire anyone that consumes caffeine or alcohol on their days off?</p>
<p>Smokers may not be a &#8220;protected classification&#8221; but I still view policies like this as discriminatory. Regardless of how much they spin this as an attempt to improve the health and well-being of their employees, it still comes down to them determining employment eligibility based on lifestyle choices. Of course, they won&#8217;t put people with high cholesterol on the chopping block, because that would most likely eliminate all of management. Eliminating people because they have bad habits seems fine and well until it&#8217;s THEIR bad habit that makes the hit list.</p>
<p>Maybe I&#8217;m just old-school, but I would think they would be better off addressing things like work performance or attendance. Then again, I&#8217;m just a dumb-ass paramedic, what do I know?</p>
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		<title>Not to piss off my conservative friends&#8230;.</title>
		<link>http://medicmadness.com/2011/11/not-to-piss-off-my-conservative-friends/</link>
		<comments>http://medicmadness.com/2011/11/not-to-piss-off-my-conservative-friends/#comments</comments>
		<pubDate>Tue, 08 Nov 2011 12:00:27 +0000</pubDate>
		<dc:creator>Sean Eddy</dc:creator>
				<category><![CDATA[Featured]]></category>
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		<description><![CDATA[I have somewhat refrained from posting political rants on this blog for a little while now, but there has been a lot going on in the political world and I gotta get some stuff off my chest. Most of you know where I stand with my beliefs. I tend to be very conservative on most [...]]]></description>
			<content:encoded><![CDATA[<p>I have somewhat refrained from posting political rants on this blog for a little while now, but there has been a lot going on in the political world and I gotta get some stuff off my chest.</p>
<p>Most of you know where I stand with my beliefs. I tend to be very conservative on most things, sometimes moderate with others. I respect other people&#8217;s opinions and beliefs and I can only wish for the same in return. Obviously we don&#8217;t always get what we wish for.</p>
<p>Unfortunately I&#8217;m going to have to go “Hannibal” on some of my fellow conservatives and “eat my own” for a post. I&#8217;m sure as a result, the hate-mail folder will probably get a few extra hits this time around.</p>
<p>I have come to a crossroads with my beliefs and I find myself having to choose between values that I stand for. I have realized that many of my beliefs contradict each other, and I feel that it is a direct result from the problems that the 2-party system has created. I hate having to choose sides because frankly, I don&#8217;t believe in everything either party stands for. Yes, I consider my beliefs to be conservative, but that doesn&#8217;t mean I think the Republicans are always right.</p>
<p>A wise man once told me that the constitution protects not only the rights that I like, but it also protects your rights that I don&#8217;t. For the most part, I have accepted that. I may firmly believe in my right to keep and bear arms, but I would never support forcing people to own and carry firearms. I certainly disagree with just about everything that comes out of Michael Moore&#8217;s mouth, but I would stand side-by-side with him to defend his right to free speech.</p>
<p>So why haven&#8217;t I done the same with things like gay marriage and abortion?</p>
<p>I asked myself this recently and I had a really hard time answering it. The truth is, neither issue really affects me. I&#8217;m not homosexual and I wouldn&#8217;t consider having an abortion (not that it&#8217;s physically possible, but you get the point). If the federal government decided to allow gay marriage nation-wide, it really wouldn&#8217;t affect me. Nobody is forcing me to marry another man and nobody is demanding that my wife and I have an abortion next time she gets pregnant.</p>
<p>So I guess where I am going with this, is that I have had to figure out what&#8217;s important to me. We can&#8217;t sit here and say that we don&#8217;t want our rights taken away, but then turn around and hack away at the rights of the people we don&#8217;t agree with. Yes, I still believe that abortion is wrong, but I still have the choice not to get one. The same goes for drinking and driving. I think it&#8217;s wrong to get plowed and then get behind the wheel of a car, but I&#8217;m not about to rally to outlaw bars or alcohol.</p>
<p>My political beliefs are actually quite simple. I don&#8217;t want government telling me that I have to or can&#8217;t do anything. As long as it doesn&#8217;t affect anyone else, let me make the decision on what&#8217;s right or wrong.</p>
<p>Where the Republican Party has gone wrong is they seem to spend all their time addressing the issues that don&#8217;t really affect anyone. What DOES matter are things like the economy, taxes, war, and defending our god-given rights&#8230;..all of them. The beauty of this country is that we don&#8217;t have to follow a single belief system. We are still free to practice the religion of our choice. We can work any job we want, live anywhere we want, talk anyway we want, and most importantly, we still have the right and the means to protect it all.</p>
<p>What we need to do, is worry about the issues that really matter right now so that we still have the ability to debate over the little things that we don&#8217;t agree with.</p>
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