Emergency Medical Preparedness: Prepare Yourself for a Medical Emergency

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Editor’s Note: This post is another entry in the Prepper Writing Contest from Suzanne S.. If you have information for Preppers that you would like to share and possibly win a $300 Amazon Gift Card to purchase your own prepping supplies, enter today.

When it comes to prepping, there is a lot of talk about what material needs we should have on hand. A bug-out bag, freeze-dried food, water, transportation, first-aid kit, weapons for protection and a place to bug-out to. The idea is to have the basic needs of food, water and shelter readily available. The problem is; when the SHTF not everyone gets to just go merrily about their way, to easily head out and get gone. In fact, it is quite likely that many of us will sustain significant injuries that need to be tended to. Whether it is ourselves, our loved ones, or the friends who will be with us, we will need to know how to take care of each others injuries and illnesses.

I am an Emergency Medicine Physician Assistant with more than 20 years of Emergency Room experience, the majority of it in Level I Trauma centers (where the most severe cases…crashes, gunshots, severe work injuries, falls from heights, etc. go). Prior to becoming a PA, I was an EMT. I have a great deal of experience dealing with trauma victims and worked in an ER where we saw multiple gunshots daily. I have lectured at several colleges in the Chicago area as well as being responsible for teaching EMT, Physician Assistant, Medical and Podiatry students. I have also been an instructor for the American Red Cross teaching First Aid, CPR and Advanced Cardiac Life Support (ACLS) classes.

There is a lot of information out there about what makes up a good medical kit for your bug-out bag. Everything you need can be either assembled by you or purchased as anyone of a variety of pre-stocked kits. While the kit you have with you when you bug out is obviously important, it is also completely useless if you have not taken the time to learn how to use it. The truth is you can stop most bleeding with direct pressure. Sometimes you need a torn shirt, some duct tape and a pair of trauma scissors. You don’t have to be MacGyver to do it. You do need proper training.

Pamela Rauseo, 37, performs CPR on her nephew, 5-month-old Sebastian de la Cruz, after pulling her SUV to the side of the road. The baby was rushed to Jackson Memorial Hospital, where he is reportedly doing OK.

That said; EVERYONE who expects to deal with the aftermath of when the SHTF needs to know basic CPR and at least basic Trauma First Aid. That means taking classes and practicing what you learn. I can tell you stories about people attempting to administer first aid who had no training, but I won’t. Suffice it to say the outcomes were less than desirable.

The Survival Medicine Handbook: A Guide for When Help is Not on the Way

Let’s think about some injuries you can expect in the woods, hiking or running to find cover. Or for that matter, just being in a place where help is not going to come anytime soon. Falls are very common and can result in anything from a scrape to sprains to more serious injuries like fractures and head injuries. So ask yourself; do I really know how to treat a sprain? What about a fracture? Do I know how to stop bleeding and properly clean a wound? Have I ever done those things? Would I be able to actually do the job the right way should I need to? What if it was something life threatening? Could I save a person’s life?

If the answer to any of the above is NO, then you can have all the gear in the world at the ready, but YOU are not ready to bug-out!

I’m going to give an example of injury event that can be a tragedy if you are not properly trained to treat it. Remember, this is about knowing: both what TO do and what NOT TO do.

You and your companion are moving quickly through a heavily wooded area and your companion falls. When you reach them, you see a branch has impaled their arm. They are essentially stuck to a tree because of a branch sticking all the way through their arm. Your companion is in shock and not even aware of the extent of the injury. They are confused. There is blood coming from their arm and also from a gash on the right side of their head which is bleeding profusely. You think you see bone exposed through the head laceration and it seems that one of their legs has something wrong. Closer examination shows you that the ankle is sitting at a strange angle. What do you do now?

If you are like most people, you freak out, try to compose yourself so you don’t freak out your companion, get really pale and nearly pass out and then reach for your cellphone to call 911. Oops, no connectivity, so no help coming. So what now? The first aid kit! You have a first aid kit with a manual in it to walk you through caring for these injuries. You dig out the kit, open and it and check the book only to find it’s great for small cuts and bruises and simple things, but it has nothing remotely close to what you’re dealing with now.

Suddenly, you realize that maybe it wasn’t such a good idea to cancel that first aid class you had signed up for but decided you were too busy/tired to take. Besides, someone else will know what to do or I’ll call 911 anyway, I’ll never need to use it.

WOW! Talk about contrary to prepper philosophy. Or is it? It would seem that Emergency Medical preparedness training is a no-brainer, but in reality, most prepper sites and stores that cater to preppers are focused on the medical equipment you need rather than the training required to use it.

So anyway, I can’t teach you the how to do it in this article. I can give you a good idea of what good, accurate care and treatment of this fall will require. And yes, you can look all these things up on the internet. However, unless you learn from a real, live person who can guide you and correct mistakes you will surely make as you learn, you are never going to be able to really address the problems this very real scenario depicts.


The very first thing required in any trauma/accident situation is an evaluation of the site of the accident. Stop, take a breath and look at where you are about to go. Is it a safe place to enter? In the urban world this is akin to a Paramedic called to the scene of a gunshot victim. In that situation, the Paramedic cannot help the victim until the Police have arrived and determined that the Paramedic is safe from the danger of being shot herself when she goes to help. At that point the scene is declared “safe” and the Paramedics can get to work.

In the wilderness or woods, the dangers are different but still just as potentially deadly. Is the ground stable? Are there dangerous branches or rocks that could fall onto you as you make your way to your companion? Will you slip and fall as well if you attempt to help? Do you need to take time to tie off before going to the person? What about wildlife? Are you in danger of animal or insect attack when you go to help? Can you find a way to make the scene safe?

Only after you treat the area as if it were a busy street corner will you be safe. You have to STOP, LOOK, and LISTEN.

Once the scene is determined safe, or made safe the next thing is to get to the injured person and take stock of the situation by doing an initial survey of them. This is done by looking and speaking to them without touching them. Encouragement to stay still is recommended at this point. Usually saying “Hold on, try not to move, I’ll be right there,” is a good start.

Look carefully at the person and where they are lying. Do you see any blood? Where is it coming from? What about limb deformities? If so, which ones. Are there any objects that will cause difficulty in treating the injuries? Can they be cleared or do you need to find a way to work around them.

Now it’s time to your ABCDE’s: Airway/Head and Neck, Breathing, Circulation, Disability/Deformity, and Exposure assessment.

Airway: If the person is conscious and talking, then they have a clear airway, but they might have a neck injury which will require stabilization. In the case of any significant fall, or one with an accompanying head injury, be sure that the cervical (neck) spine is stabilized. If the person is unconscious or can’t talk, be sure that the airway is clear of obstruction before going further. Gently lowering the jaw while holding the forehead steady will allow you to see if anything is causing an obstruction. Look for broken teeth, blood, dirt or some foreign body causing an obstruction. Remove any obstruction you can see. Do not blindly probe their mouth. You could push an unseen object backward and cause an obstruction where none had previously existed.

Breathing: Is the person breathing on their own? If they can talk, they are breathing. Is there any reason to suspect a possible lung injury? Do they have any evidence of a chest injury that could have broken a rib? A broken rib can puncture a lung and lead to air in the chest collapsing the lung on that side. You can check this several ways. One is to watch the rise and fall of the chest and see if both sides rise equally. Another is to put your ear on one side of the chest, then the other and listen for breath sounds to be equal on both sides. If you notice that the trachea, the tube that runs down the middle of your neck, is pushed to one side; that is a clear sign of a lung injury. The best case scenario is that you have a stethoscope in your kit that will allow you to hear the actual breath sounds easily. If there is a lung injury, this is a true emergency and will need to be treated quickly, but that is a procedure that requires specialized training.

Circulation: Check for obvious bleeding, but also in the case of extremity injury, is there good blood flow to the far portions of the extremity? Is the color of distal (far) limb pink or pale/bluish? Is it warm to the touch or cool/cold? Pink and warm = good. Anything else indicates blocked blood flow which may be due to arterial injury or compression. Arterial injury needs repair soon. Compression can often be correct by adjusting the limb to an appropriate angle.

Disability/Deformity: Is neurologic function intact or are they confused, unable to answer questions or showing other signs of significant head injury? Are there limb deformities, obvious chest or facial depressions indicating broken bones? Depending on what you find, a variety of things may be needed from re-evaluation of the airway, to splinting or bandaging.

Exposure: How long has it been since the injury took place? Are they becoming chilled or hypothermic? Cold =shock. Putting a warm cover over an injured party ASAP is essential even in hot weather.

The important thing to do now is stay calm and determine what needs to be treated first. If there is copious bleeding indicating probable arterial involvement (this can also be characterized by blood that sprays with each pump of the heart) apply direct pressure and if necessary a tourniquet that can be tightened and released easily. If there is no major bleeding issue, then recheck the airway and breathing. If there is chest deformity and/or other evidence of a collapsed lung, that is the next thing to deal with unless there is now evidence of airway obstruction or the person is not breathing on their own. The former requires clearing the airway, the latter requires rescue breathing. The collapsed lung requires specialized training you can’t get from the internet or a book. Any other injuries can wait. Remember; the brain starts to die after 3 minutes without oxygen. Airway is first unless bleeding is so profuse that not stopping it would mean there would not be enough blood to circulate oxygen.

Back to our fall victim; we have bleeding, limb deformity, confusion and a fall. The fall means we have to have high suspicion of a neck injury and the confusion could be shock or it could indicate a more serious injury such as concussion or a brain bleed. We also have a penetrating injury which may have been an insult to a major artery. This person is seriously injured and qualifies as a trauma patient. Ideally, we would get this person stabilized and out of there ASAP, but that is not an option. Instead, we have to stabilize and create a sheltered space as close to where we area as possible so we can begin to treat the various injuries.

Assuming there are no immediate life threats (Excessive bleeding or collapsed lung/blocked airway) we begin by stabilizing the neck. A towel, shirt or thick cloth of some kind can be rolled and taped carefully in place to accomplish this. Next stabilize and splint any limb deformities so that we can move the victim with the least amount of discomfort to them. Continue to talk to them to assess their mental status. At this point, things get tricky…

People’s first instinct when presented with something sticking out of or through a body part is to remove it. STOP! Don’t do it! Not only is it exactly the wrong thing to do, it could quite possibly be the thing that kills the person. I know it is scary looking and seems like the danger comes from it being stuck in the person, but at this point the person is alive and has survived impalement. Leaving the object embedded is not dangerous at this point; it is actually the safest thing to do. As long as the object is left in place, it is acting to tamponade (stop) the bleeding. That is, it is putting pressure on any lacerated vessels and preventing any major bleeding. Yes there will be some oozing around the injury site, but it will be minimal as compared to what happens should the object be removed. NEVER REMOVE AN IMPALED OR IMBEDDED OBJECT FROM A PUNCTURE WOUND unless you have been trained to handle this procedure. This is another procedure that requires specialized training courses.

But what about infection, you ask? Yes, infection risk is high, but it is not a life threatening problem at this time. A neck injury or brain injury will need prior attention as will the bleeding from the head wound. Antibiotics are something you can give, but not at this time because the victim has a decreased mental status and it is not clear if they can swallow a pill without causing an airway obstruction or aspirating it into a lung.

For the time being, the safest and most efficacious thing to do is to cut both ends of the branch so that your companion can be maneuvered to the sheltered spot. Start with the end of the branch still attached to the tree and try to keep the arm as immobile as you can while doing so to minimize pain. You can then trim the protruding opposite side.

Don’t cut the ends short. Leave enough to be able to grasp both ends firmly to assist removal when it is time. Use your gauze or Ace wrap to secure the branch so that it moves as little as possible during transport to avoid causing undo pain.

Continue to monitor the ABC’s and mental status and address what need to be done ASAP. Once you have done as much as you can, find a way to get this person out of there and to an emergency care center as quickly as possible otherwise, they will likely not survive for very long.

This all started out as a fall but resulted in multiple injuries placing your companion in danger of dying. With the proper training, you could swing the odds much more in favor of a good outcome. So before you buy that cool medical kit, or put one together on your own, get out there and get trained. If you know someone who has been trained and can teach you the emergency survival techniques you’ll need, ask them to teach you. Meanwhile there are a multitude of courses in first aid, tactical lifesaving, wilderness emergency medicine, survival medicine and CPR. Don’t forget to look into classes that teach herbal remedies. Know what plants can ease pain or prevent infection, they may be the only medications you’ll have available.

So go out and get prepared. Learn.


  1. FRANK

    December 20, 2016 at 9:59 pm

    A self serving article for an overpriced book that lacks a great deal of information you can get from books costing one fourth the price of this book.

    These are much better resources available on Amazon

    Wilderness Medicine
    by Doctor William Forgey
    excellent book written by a medical doctor with illustrations, detailed instructions and sources to help the average person cope with a medical emergency

    Where There Is No Doctor
    by Hesperian Health Guide
    A book written for third world nations where doctors are rare, so the average person has a guide for medical care

    The author is correct in that a person should get as much experience as possible. Join a volunteer fire department, take a Red Cross First Aid class, EMT class, or any number of Emergency Management Classes that you can take for free through your state emergency management department or FEMA. The more knowledge you have the better. Hey if you have the extra $40 to spend on this book great but I sent it back for a refund, I found it did not offer enough information for the price, YMMV.

    • Huples

      December 21, 2016 at 12:12 pm

      Frank my articles have most picture things added by Pat. It might be Pat not the author who placed that book picture there. The entire article is get training, not get books

      • FRANK

        December 21, 2016 at 4:20 pm

        If the purpose of the article was to promote training why didn’t you include the available training that people can obtain for free through their state emergency management agencies, the National Fire Academy, The Emergency Management Institute, FEMA and I’m sure there are other resources that are out there to help people get training. It is difficult for full time EMT and Paramedics to keep up with the training hours required to keep their certification and work full time jobs. A quick look at Amazon has over a hundred emergency medicine titles yet you promote one book out of all the available titles. Why not include several titles if your purose is not to promote this book
        I own well over a hundred medical books and this is the only book I have ever returned, it is poorly written and lacks a lot of information available in less expensive books.

        • Huples

          December 22, 2016 at 4:09 pm

          The article has nothing to do with me

          • Mike

            January 3, 2017 at 1:43 pm

            My God people give it a rest. He is just pointed out you may want to educate yourself on some basic first aid. I myself was a working EMT, its a good read. Don’t read into more than he is trying to get across. Good read Thanks

    • Pat Henry

      December 21, 2016 at 2:22 pm

      Huples is exactly right. I add almost every photo and in this case, the link to Survival Medicine. The author didn’t recommend it, I did.

      I don’t personally think that WTIND is as good as Survival Medicine at least not for the average American. Yes, if you are living in a remote village and the people you are treating think demons are what is causing illnesses, don’t have above a 5th grade education, yes that book is pretty good. You can even download a free copy here: http://piero.com/piero.www/documents/1e2ed28ed1224cfeef33860a375f5a05.pdf

      Regardless, printed medical resources are great to have. Choose whichever you believe is best and make sure you have hard copies.

      • FRANK

        December 21, 2016 at 4:37 pm

        I’m not sure what “think demons” are in your mind but the information in Where There Is No Doctor could benefit anyone who does not have any formal medical training which is exactly what it was written for. The manual is used world wide since 1970 I believe and has undergone several revisions.
        In the British Medical Journal, a 1998 review said: “Chances are that if you visited a remote district hospital in a developing country you would find a well thumbed copy of Where There is No Doctor in its library. The book is intended primarily for village health workers, but generations of doctors and medical missionaries who have worked in under-resourced communities globally will vouch for its value in providing concise reliable information”
        Where There Is No Doctor is simply a book written to help people save lives the world over that has been translated into multiple languages and reviewed by multiple medical journals and agencies. And as you pointed out is also offered for free as a download, instead of forty dollars.

  2. Huples

    December 20, 2016 at 10:46 pm

    Excellent advice but in shtf I’d not be so quick to start spinal precautions in this scenario. Limbs move, head moves, and they are talking so cut the branch and move them to a safe place ASAP. Consider a tourniquet, definitely split the limb, and definitely pack around both entry and exit point. Note the entry point. To remove the branch it will be likely easier to pull it back out rather than push it forward.
    Pour a lot of hydrogen peroxide into the debranched wound. Consider deep probing for residual twigs

  3. christopher

    December 21, 2016 at 7:00 am

    I was hoping i could just shout “Medic” and someone would come running out of the shadows to save the day!:> i have to admit, this is one of my weak points I have to strive & push myself to learn. its is a really important topic and not just in SHTF, but everyday use. Although i have had CPR/AED courses & wilderness first responder course, this is a subject that isnt my fav but necessary.. i had a excellent instructor on my wilderness first responder course and learned alot.

    • Huples

      December 21, 2016 at 12:17 pm

      Get going on it Christopher or the medic might be me and I’ll black tag most serious wounds in shtf. Better to help yourself than hope a bored and overworked medic will work hard in shtf dealing with a major wound

  4. The Deplorable Cruella DeVille

    December 21, 2016 at 10:29 am

    This subject is a weak link in virtually everyone’s SHTF plans.
    Personally I’ve take as much training as I can get. Boy Scouts, to USCG, to rural vol FD, and CERT. EMT/AEMT/wilderness first responder. But there is never enough, and worse – never enough real practice to stay competent.
    That noted, some is infinitely better than none.
    I do take exception to one thing mentioned in the article: “Start with the end of the branch still attached to the tree” – I would do the end protruding from the victim first: the branch/object remaining attached to the tree or whatever will help stabilize distant end has you cut it. If you cut the near end first you will be tasked with stabilizing a chunk of wood supported partially by the victims body.

    • Huples

      December 21, 2016 at 12:16 pm

      Yes. Actually I’d cut that protruding side before basically doing anything else. Placing a strain through the entire wound.
      In reality an unlikely injury from a branch unless you jump down into the tre. A metal impalement is more likely.
      I thought on this on and amputation later on and death 79% or more is likely in shtf. You need surgical debridement of the entire wound, are there bone fragments? Basically go slow, go carefully, and prevent injuries

      • The Deplorable Cruella DeVille

        December 21, 2016 at 12:41 pm

        Re the impalement possibility: I was trekking one of my GH routes a couple weekends ago, and lo and behold! A family of beavers had laid claim to one of the streams. No problems since I actually like to see wildlife expanding their terrain, although I had to walk an additional half mile to get around the pond that was once a nice meadow.
        But the spikes these guys leave sticking up where they took out saplings! A trip and fall onto one of more of them would be something Vlad the Impaler could appreciate! And everywhere with 50 yards of the original stream course. Something I had never considered…

        The survival implications would be quite grave in my opinion – no debridement would be practical, and any amputation outside the realm of modern surgical suites would revert back to 2000 BC: chop it off as quickly as possible, and seal it via fire. Excruciatingly painful, and shock alone could be lethal.

        And now that nice bubbling stream water is a source of Giardiasis and Leptospirosis if not boiled extensively.

        • Huples

          December 21, 2016 at 2:53 pm

          Yup. Avoid major injury, illness, and trauma in shtf. Care options will be limited and mortality at best as good as post Nightingale Crimea War. Pre her it was 50% death rate for soldiers from all injuries, illness. I think just Washington well and basic care dropped it to 4% but many died on the battlefront anyhow.
          I have a few bone saws in my kit. Surgeons are only good if they are really fast 🙁

          • The Deplorable Cruella DeVille

            December 21, 2016 at 3:05 pm

            Hmmm. Only bone saw I have is in my cooking gear. Used to dismantle edibls for the freezer…
            Easily sterilized, although that could be a waste of time in SHTF…
            One crude amputation procedure I saw demonstrated on a dead hog, (prepped for slaughter anyways), was to use a ligature type tourniquet, ie; thin wire, fishing line, para-cord, pulled super tight, the cut made immediately adjacent with a knife and saw, if available, and the stump dipped into melted pine pitch. Effective I suppose, but…..
            Penetrating wounds of the thorax = dead.

            • Huples

              December 22, 2016 at 4:12 pm

              Shock kills so do it as fast as possible and then cauterize wound with heat. Yes, a tourniquet is needed. Not sure the death rate from this in civil war but had to be over 50%

              • FRANK

                December 23, 2016 at 12:29 am

                Disease killed more than 400,000 soldiers in the Civil War, according to the University of Houston’s Digital History website. Dysentery was the most common fatal disease, according to the Civil War Preservation Trust. Soldiers also died from typhoid fever, a bacterial disease transmitted by lice, as well as malaria, pneumonia, smallpox and yellow fever. Several factors contributed to the spread of disease, including poor hygiene, spoiled food, impure water, lack of medical knowledge and lack of surgeons.
                Battle wounds killed about 200,000 soldiers in the Civil War. Most battle deaths were caused by rifle bullets, especially from the percussion rifle, according to Georgia Perimeter College. Infection and gangrene also caused many amputations and casualties.
                A good article on caterization follows and is shared for your thoughts and information.
                Cauterization is tricky, and should be left to the experts.
                Cauterizing tools came in our field medical packs in the military, and the only thing I used them for was lighting cigarettes when we couldn’t find dry matches in the jungle. Cauterizing like you see in the movies doesn’t exist.
                You stick a hot poker on a bullet hole, and all you are going to do is burn away the healthy skin around the hole and cause pain and more trauma to the victim! Cautery is usually used INTERNALLY,
                With pin point accuracy,
                To stop bleeders that are too short, too torn up or too inaccessible to clamp or stitch off. For instance, there is no way to stitch a liver that has been cut and is bleeding. A liver is like tying to put stiches in Jello, and every needle prick will cause that much more bleeding. Enzymes in the liver keep it from clotting, so it will ooze blood until it repairs it’s self no matter what you do, and you might not have enough blood to allow it to ooze for two or three weeks… In comes the Cautery tool, and you simply ‘Sear’ the surface of that liver closed so it isn’t leaking as much.
                (You will NEVER get a liver to stop seeping blood, only internal repair can do that) Remember, a bunch of your internal organs are VERY soft and delicate, so sticking a hot poker in there and rooting around is a BAD idea!
                And like the old ‘John Wayne’ movies, if you stick a hot poker in a bullet hole, all you are going to do is succeed in doing is making a nice tunnel for infectious materials, and make it MUCH harder to get the bullet out…
                Heat Seared tissue DOES NOT stitch it’s self together.
                It will replace it’s self from below, but it will not stitch together with the ‘Far’ side of the hole or wound. Large, gaping flesh wounds are sometimes cauterized when help is a LONG way off…The idea is to control bleeding, without much regard to sanitation or what it will do to surrounding tissue. I remember seeing a guy in Central America that was shark bit in the thigh about 48 hours from shore, and the crew ‘Cauterized’ the gaping hole to keep him from bleeding out since they had no medical kit and no way to control the hemorrhage…It was a HORRENDOUS Wound!
                What the shark hadn’t taken, the cauterizing had destroyed!
                I just couldn’t believe he survived it! Most of the upper thigh next to the hip joint was gone, and the thin layer of scar tissue that had formed since the attack by shark and boat mates, you could actually see the two parts of the hip ball & socket work through the scar tissue…

                Anyway, cautery is best left to the professionals…

  5. Huples

    December 23, 2016 at 8:58 am

    Thanks for the info. I’ve been looking at using a 12 volt battery for cautery in shtf but those sort of wounds are none survivable in shtf anyhow.
    One thing no one has mentioned is cautery is only used really for small vessels outside specialist operating rooms. If a large vessel is bleeding you have to sew it shut. Then if blood flow below is not good gangrene and death. Dismal really.
    Of note America did not use Nightingale’s ideas in the civil war. One book a lot of people should get is her Notes on Nursing. Designed for none nurses and pregerm theory but very useful on basic sanitation.
    Anaesthesia is a good idea before doing anything as drastic as described by us in the comments section and a bottle of rye and a twig to bite won’t work. I have a few vials of stuff for in extremis care.

    • FRANK

      December 23, 2016 at 6:57 pm

      Agree with you whole heartedly on anaesthesia before trying any of the things discussed here. That is the value of the book Wilderness Medicine, Dr Forgey recommends including both Lidocaine and Katamine in your kit. I purchaed Lidocaine from my vet for years by telling him I wanted to suture my dogs, goats, cows etc myself. He usually charged me ten dollars for a bottle but it was worth it to have it in my kit. When I found the book Wilderness Medicine I did what the author suggested and took the book to my doctors office on my next visit. I purchased a copy of the book to give to him and explained I wanted to compile a complete medical kit including Lidocaine and Katamine. Over a period of several months he wrote prescriptions for all the medications listed in the book. If you have a good relationship with your doctor, take a copy of the book, Wilderness Medicine with you and discuss your needs with them. The book not only has a list of medications but explains what to use them to treat and explains normal dosages. Overall the best advice for ten bucks you could possibly buy and if you have an understanding doctor could open the door to having a fully stocked medical kit.

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