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Now ye're talking - to an Intermediate Care Operative

  • 04-10-2019 9:25am
    #1
    Boards.ie Employee Posts: 12,597 ✭✭✭✭✭
    Boards.ie Community Manager


    Our next guest is an Intermediate Care Operative for the HSE National Ambulance Service. He has been working with them for 4 years now and has been working on ambulances in total for nearly 8 years as an Emergency Medical Technician (EMT). He will explain himself what an Intermediate Care Operative is when he logs on but if you have any questions, feel free to ask them now.


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Comments

  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    Good morning folks, Happy Friday.
    As Niamh has said, I've been working for the ICO service with the National Ambulance Service for 4 years now.

    I'm sure some of you are thinking what in the name of god is an Intermediate Care Operative?

    We're a small branch of NAS with approximately 200 staff and 50 vehicles nationwide.

    Our primary roll is to transport patients between hospitals and other care facilities.
    This includes hospitals to nursing homes, between regional and university hospitals, or often just to bring people home.

    A large amount of our work involves palliative and end of life care, but also things such as Neonatal transport of incubators, and transport of unwell patients of all ages to a more acute setting.
    We also act as a backup to the NAS emergency fleet, and respond to 112/999 calls if we are the closest available resource.

    Overall it's very varied work and takes us all over the country.
    I'm sure some of you have seen our vehicles chugging around the place.
    FKJ2m9p.jpg



    So AMA!


  • Registered Users Posts: 2,579 ✭✭✭charlietheminxx


    No questions for you, just want to say thanks for the work that you do.


  • Registered Users Posts: 2,339 ✭✭✭The One Doctor


    Thank you as well. You and your colleagues do fantastic work.


  • Registered Users Posts: 6,643 ✭✭✭Wanderer2010


    Do you have to be a certain type of person to be able to see so much death or near-death on a daily basis? Does any of it ever upset you? You mention that you do palliative care work too which must expose you to sensitive and upsetting family situations like tears, last conversations, old people who are suffering etc- how do you just switch off from that at the end of your shift?

    And as a follow-up to that, what made you want to do this work in the first place? Thanks in advance!


  • Moderators, Social & Fun Moderators, Regional East Moderators, Regional North West Moderators Posts: 11,918 Mod ✭✭✭✭miamee


    Thanks for doing this AMA. I'm curious how your working day is set up. Are you based in a specific hospital taking their patients wherever they need to be or based in maybe just a specific area and you get a list of runs/pick ups at the start of a shift?

    Do you do shift work or are you more of a day time worker?

    How far in advance would you know how your day or week is going to look?


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  • Closed Accounts Posts: 1,111 ✭✭✭SirChenjin


    Thanks for doing this AMA.

    What kind of training did you have to do for this role?

    As a previous poster mentioned, it must be difficult dealing with some situations. Is there good support for you, some kind of debriefing to help when you have had to deal with a particularly distressing situation?


  • Registered Users Posts: 9,630 ✭✭✭hynesie08


    Do you feel its a waste of resources when you get called out for something trivial, A broken ankle or wrist that could be a taxi instead? How do you feel when someones own stupidity causes them to tie up an ambulance on a busy Friday/Saturday night?

    Thank you for all you do as well.


  • Registered Users Posts: 6,162 ✭✭✭Damien360


    Do the crews draw straws to avoid Halloween night and Paddy’s weekend. Both look to be an absolute drain on people’s patience in the HSE services and well-being of those working those nights.


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    Do you have to be a certain type of person to be able to see so much death or near-death on a daily basis? Does any of it ever upset you? You mention that you do palliative care work too which must expose you to sensitive and upsetting family situations like tears, last conversations, old people who are suffering etc- how do you just switch off from that at the end of your shift?

    And as a follow-up to that, what made you want to do this work in the first place? Thanks in advance!

    Tough question.

    I think you definitely have to have some kind of caring aspect about you. Initially most staff will find the end of life aspect of it sad or uncomfortable, this goes for any care job be it a nurse or care assistant, but you learn to deal with it professionally over time.

    It's sad when you have to deal with end of life or difficult situations but I find it helps to know you do everything you can to make the person comfortable and support the family.
    Most patients and family are very appreciative and very thankful. That in itself is rewarding.

    I don't really take it home with me. Sometimes you think back about the really sad cases of course, but that's only human. It helps to talk with your colleagues about it.
    There are supports available to us if we ever feel overwhelmed by the work.

    To answer your second question: Simply put it's rewarding and interesting work. I wanted a job where I felt like I could make a difference and care for people. I was going to join the guards but I thought the ambulance service would be less hassle and more caring.


    miamee wrote: »
    Thanks for doing this AMA. I'm curious how your working day is set up. Are you based in a specific hospital taking their patients wherever they need to be or based in maybe just a specific area and you get a list of runs/pick ups at the start of a shift?

    Do you do shift work or are you more of a day time worker?

    How far in advance would you know how your day or week is going to look?

    The ICS is a day time only service. Shift times widely vary depending on what station you work in but usually these are 8-10 hour shifts. Like 9-7 or 12-10.
    There are intermediate care crews at both the university and general hospitals. They're based at the NAS hub stations. Near hospitals essentially. The more rural and small town stations don't tend to have ICV's.

    Relief workers know their roster 1-2 weeks in advanced which can be difficult if you have a family and need to organise childcare. But once you get on a full timer line you'll know your roster for the year.


  • Registered Users Posts: 24,647 ✭✭✭✭punisher5112


    Do you find the intermediate section easier then the normal call out type of work?

    What's the worst case you had to deal with and how do you find de-stress afterwards as in what's the best you find to unwind after a difficult day.

    When you were on the normal service were you ever attacked?

    Did you get tired of seeing the same people day after day especially with drugs and that....

    How many babies did you help bring into the world?

    Is there a such position as an ambulance driver that isn't a paramedic?

    I would love to be able to drive those around on the blues and twos....

    What's the best day you've had?


    Well done for all your service and thanks for coming on here.


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  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    SirChenjin wrote: »
    Thanks for doing this AMA.

    What kind of training did you have to do for this role?

    To join the intermediate care service you need to be a qualified Emergency Medical Technician. You can do the course privately which takes a few months at a cost, or like many of us we got our qualifications by working with voluntary services like the Red Cross or Civil Defense.

    Once you have your EMT licence, and C1 lorry licence you can apply for the job.
    If accepted you go to the national ambulance service college. You spend 3 weeks there doing some basic training and exams in the Ballinasloe college. Then do another 3 weeks advanced driving in the Tallaght college.
    They're basically just making sure you're a competent EMT and showing you the ropes. A lot of what you learn won't be until you actually get on the road.
    As a previous poster mentioned, it must be difficult dealing with some situations. Is there good support for you, some kind of debriefing to help when you have had to deal with a particularly distressing situation?


    There's a whats know as "Critical Incident Management System". This is basically nominated peer support workers you can go to if you're having a hard time after a call. If needs be you can go to the occupational health department, and get further help organised. But thankfully I've never had to avail of it.
    For most of us, I think the best support after a bad call is to just have a talk with your colleagues. Get a good 3-4 of ye together, have a chat and a laugh or a sigh. It's like an informal debriefing.

    Unlike the emergency ambulance service with paramedics, the real traumatic calls aren't as common and the type of work is slightly different in the ICS. But they do happen from time to time.

    I remember after one particularly bad emergency, our station ORM (manager) stood the crews down, got a few plates of sandwiches from the hospital catering. And we all went back to the station, and had a big debrief in the kitchen while having a tea and food.


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    hynesie08 wrote: »
    Do you feel its a waste of resources when you get called out for something trivial, A broken ankle or wrist that could be a taxi instead? How do you feel when someones own stupidity causes them to tie up an ambulance on a busy Friday/Saturday night?

    Thank you for all you do as well.

    Well in the ICS our work is more pre-booked transfers than emergencies. But we do respond to 999's or do emergency transfers also but most of it you're looking after stable non urgent patients.
    Some staff do get very bothered by the seemingly trivial calls. That includes transfers.

    Some days can be very routine and you're simply providing transport from A to B with no interventions required. You can spend the day hopping from nursing home to nursing home, or either bringing people to specialist appointments. Has to be done too.
    We're there to free up the frontline paramedics so they're able to respond to 999 calls.



    The next person asks something similar to your second question.

    Damien360 wrote: »
    Do the crews draw straws to avoid Halloween night and Paddy’s weekend. Both look to be an absolute drain on people’s patience in the HSE services and well-being of those working those nights.

    The likes of Halloween and St Patricks day don't bother us too much. We're tipping away between hospitals and aren't too effected by the hassle. Not to say it won't happen, but we're safer than the emergency ambulances. It's when they start to get strained that we'll be used.
    Some things can feel like a total waste of time but we still have to motor on and treat the person and bring them to hospital. When that radio rings you never know what's going to come through :D just don't get too complacent.
    I have dealt with plenty of hassle but it's usually far and few between thank god.

    The thing that drives most staff up the wall is calls where the person or family is fit, mobile, and theres 2 cars in the drive.
    The job is what you make of it. I don't see the point in getting mad about these things. You can't blame a lot of the general public, a lot of them ring their GP or the ambulance unsure and in need of advice. They'll be sent an ambulance no matter how minor so most are quite happy to wait when the voice on the phone tells them to.
    There are cases of people taking the total mick however. Doesn't happen too much.


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    Do you find the intermediate section easier then the normal call out type of work?

    What's the worst case you had to deal with and how do you find de-stress afterwards as in what's the best you find to unwind after a difficult day.

    When you were on the normal service were you ever attacked?

    Did you get tired of seeing the same people day after day especially with drugs and that....

    How many babies did you help bring into the world?

    Is there a such position as an ambulance driver that isn't a paramedic?

    I would love to be able to drive those around on the blues and twos....

    What's the best day you've had?


    Well done for all your service and thanks for coming on here.


    1.For the most part, the intermediate work is far more relaxed than the emergency ambulances. There are so many paramedics that would love to drop back for a change of pace and less hassle.

    But the ICV service has its cons too. You spend less time in the station, and more time on the road.

    2. I'd rather not go into explicit details about the bad things, due to patient privacy, and it's just not something that we in the service like to talk openly about as such.
    From the ICV perspective the thing that upsets me most is sick kids. I've had a lot of very unwell children over the years, cancer, accidents, mistreatment. It breaks my heart.


    3. I've had a couple of scuffles with agitated, or aggressive patients. I've never been seriously assaulted but some patients can be very difficult. Often it's not their fault either if they are post-ictal, or have serious mental health problems or have vascular dementia.

    4. You'll see a lot of the same faces. There are a very select few that take the mick and yeah it's a bit tiring but as long as they don't give me any grief I don't mind. I just get on with it. Drug addicts aren't the worst in my books, I have a lot of sympathy for them. A lot of my colleagues are fed up with them though. The public perception of drug addicts/alcoholism can be similar.

    5. No babies delivered and I hope it stays that way!

    What we do get a lot of is post-partum hemmorhage mothers that need to be transferred to a university hospital. We also get a lot of babies and neonates 1-4 weeks old. Incubator transports or retrievals. Believe it or not the babies are usually the quietest patients we have. I think the movement of the vehicle keeps them asleep.
    But to be fair it's largely down to the wonderful nurses and doctors in Special Care Baby Units that have them so well prepped and comfortable for a journey.

    6. Well ICO's are mostly EMT's. There's no Ambulance Driver role as such anymore. There's a few minibus drivers still working with NAS. The EMT's that drive the Neonatal Intensive Care and Critical Care ambulances are solely in a driving roll, but they're still trained EMT's at the end of the day.

    7. Driving on blues is always a bit of fun, but it takes a lot of concentration and energy. It's also risky and you need to be very clued in and use your training. Still we try avoid it unless absolutely necessary.

    8. My best day... hmm I'll have to think about that one and come back to you.


  • Registered Users Posts: 24,647 ✭✭✭✭punisher5112


    Very informative and much appreciated...

    I understand on patients confidentiality and all that so fully get that and respect that.

    What's the best ambulance to drive in your opinion?
    Ford or Mercedes-Benz.

    How hard did you find the training?

    I'd like to know why better working shifts can't be in place as I'll be blunt you see many overweight and this is a lot down to the shifts and unpredictability of the shift pattern...

    I've suffered terrible from this in shift work I do myself so fully understand how difficult it is....

    Do you see yourself sticking it out or would you like to move on from the driving part.


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    Very informative and much appreciated...

    I understand on patients confidentiality and all that so fully get that and respect that.

    What's the best ambulance to drive in your opinion?
    Ford or Mercedes-Benz.

    How hard did you find the training?

    I'd like to know why better working shifts can't be in place as I'll be blunt you see many overweight and this is a lot down to the shifts and unpredictability of the shift pattern...

    I've suffered terrible from this in shift work I do myself so fully understand how difficult it is....

    Do you see yourself sticking it out or would you like to move on from the driving part.


    1. The Merc Sprinters are great vans imo. Very versatile and speedy little yokes. Great workhorse, and they run the round of the clock. some of the vehicles have over 400,000km on them and are still chugging away.

    The fords are fully retired since about 2017 or 18 I think. I've heard paramedics refer to them as "tractors" before. Only driven them a hand few times. Not the nicest.

    But I see the privates in Renault Masters and I'm just glad we don't have those.



    2. The EMT course varies in difficulty depending on who you do it with.

    The ICV training in the NAS college is intense enough. They don't go easy on you. You're examined weekly, written and practical. Then the advanced driving for 3 weeks is tough going wtih weekly exams. It's stressful to say the least and the way you learned to drive for your car test goes out the window.

    3. The shift work sucks the life out of you, some times our rosters can have you working 8 or 9days straight with maybe 1 day off in between. But the plus side is depending on your roster you regularly get 3-4 days off too which is great. 2 days holidays can get you a week off if planned right.
    Why better shifts can't be in place? Not sure. a lot of stations have made their own roster but I think we can't have better shifts because of staffing. We would need a lot more to pad out the roster and provide cover.

    It was said to us in the college that most staff gain 1-2 stone in the first year of the job. The problem is we spend a large time sitting down. Sitting driving, sitting in the back, sitting in the station. Aside from walking in and out of hospitals/peoples houses it's not a very active job.
    Also, the fact we're on the road all day makes it hard to eat healthy when you rely on petrol station delis and fast food. Deli's are much better these days though and eating healthy is easier but it's still just another side effect of the shift work and job. It's a worldwide problem for EMS.
    I do a lot of sport and exercise to keep fit but not everyone is as good and active.

    I see myself doing this for the foreseeable future. Pay could be better though. :D


  • Registered Users Posts: 24,647 ✭✭✭✭punisher5112


    Does it be frustrating how bad drivers react as in constantly getting in the way and just stopping instead of getting out of the way safely..

    Nice to see what it's like from someone like yourself.


  • Registered Users Posts: 2,645 ✭✭✭krissovo


    Thanks for your service!

    Back in the 90’s i trained as combat medic in the British army and after a couple of years gained a UK paramedic qualification. I remember how rewarding my training was and my first patient that I clumsily stabilized before getting to them hospital. I always regret that it was a secondary trade for me and only worked full time for a year to get experience before going back to my primary trade.

    Are there any options for mature (late 40’s) entrants to the service?

    Who does your blue light training course and how long is it?

    Do you have annual skills assessments? How many days a year do you have refresher or additional training? Driving tests?

    What are the limits of treatments you can provide to patients? Can you intubate, give controlled medicines, emergency tracheostomies etc.


  • Moderators, Sports Moderators Posts: 14,599 Mod ✭✭✭✭CIARAN_BOYLE


    As the driver of an intermediate care ambulance have you ever felt under resourced when sent on a call (I presume emergency ambulances have different kit).


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    Does it be frustrating how bad drivers react as in constantly getting in the way and just stopping instead of getting out of the way safely..

    Nice to see what it's like from someone like yourself.

    Ah a bit I suppose, you'll always get a few drivers who panic and slam on the brakes but you'll get around them. Most drivers are good to react.
    krissovo wrote: »
    Thanks for your service!

    Back in the 90’s i trained as combat medic in the British army and after a couple of years gained a UK paramedic qualification. I remember how rewarding my training was and my first patient that I clumsily stabilized before getting to them hospital. I always regret that it was a secondary trade for me and only worked full time for a year to get experience before going back to my primary trade.

    Are there any options for mature (late 40’s) entrants to the service?

    Who does your blue light training course and how long is it?

    Do you have annual skills assessments? How many days a year do you have refresher or additional training? Driving tests?

    What are the limits of treatments you can provide to patients? Can you intubate, give controlled medicines, emergency tracheostomies etc.


    I think you'd have to join NAS the same way as everyone else. i.e get your EMT and driving cert and apply to the ICO panel, or apply direct to the 3 year paramedic degree. If you still hold a paramedic license in the UK the Pre Hospital Emergency Care council (PHECC) might review your qualifications and issue you an Irish license but I'd imagine it would have to be a recent enough and unskilled qualification if you haven't been practicing.

    When I did my blue light training it was done by retired guards working for a company called IATA but that's since changed. I know NAS were looking to recruit their own instructors and I hear there's still some ex-guards and UK police involved in it. The course was 3 weeks.
    Week 1 was all introduction to the advanced techniques.
    Week 2 was about perfecting those techniques and cutting any bad habits.
    Week 3 was blue light training.

    In terms of annual assessments, not much. We do yearly Cardiac First Responder training, and every second year we'll do things like manual handling, self defense, child protection and other little online things.

    Treatments: EMT's have 15 drugs.

    HVCFD13.png
    Paramedics have much more and Advanced paramedicas have something like 60 drugs in their skillset.

    We can do all the usual assessments, bar 12 lead ECG's and things like ruling out spinal injuries. For airways we have basic OPA's and SGA's, igels/king LT's. No intubation. or anything wild like criceostomy.

    The paramedics and advanced paramedics are trained in those sort of things.

    EMT CPG's are available to read on the PHECC website


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    As the driver of an intermediate care ambulance have you ever felt under resourced when sent on a call (I presume emergency ambulances have different kit).
    The age old controversy in the service. ICV's have some different kit to the frontline vehicles and at times it can leave us unable to do everything but for the vast majority of calls we manage.

    Because day to day it's routine and pre-booked work so we don't tend to require a lot of the equipment used on the paramedic vehicles.
    I've also found that each station has their vehicles kitted out slightly differently.

    We manage with what we, drugs, AED's, airway kit, diagnostics, splints, maternity, burns and trauma kit etc.
    What we lack however is things like pat slides, combi boards and vacuum mattress for spinal immobilisation. So when we are sent to calls that require them we end up assessing the patient, stabilizing them, and waiting for the paramedics to come out and assist.
    That sort of requirement is far and few between, so we can make do and have everything we need for most of the frontline calls.


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  • Registered Users Posts: 196 ✭✭Scienceless


    Are all new entrants to the ICO service starting off in relief positions? Does this mean working out of different bases in one region for the first few years?

    Very worthwhile work you do.. fair play.


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    Are all new entrants to the ICO service starting off in relief positions? Does this mean working out of different bases in one region for the first few years?

    Very worthwhile work you do.. fair play.


    When you receive a job offer you'll accept it for a certain region or hub station. Usually you'll just be left in that hub to work relief but from time to time you might be asked to cover shifts in other stations.

    You might be on relief for 1-4 years until a line is free. Some people find it very hard not knowing their roster more than a couple weeks in advanced but you just need to put up with it unfortunately.


  • Registered Users Posts: 196 ✭✭Scienceless


    You might be on relief for 1-4 years until a line is free. Some people find it very hard not knowing their roster more than a couple weeks in advanced but you just need to put up with it unfortunately.

    Seems fair enough for new entrants that are genuinely interested in doing the job, like anywhere else really, you have to work for it.

    Is most of the planned patient transport work local, I mean within one region or HSE operational area?
    Do you get many longer runs away from base?


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    rk local, I mean within one region or HSE operational area?
    Do you get many longer runs away from base?


    Vast majority of it is in your region but we do go outside the region and do plenty of runs to/from Dublin and the other cities.

    When you log in in the morning, you could have calls pending at your local hospital, or you could be sent 2 counties over to the next hospital. Some days I've travelled 5+ counties.

    Depending on how busy the day is you could average around 100-400km driving per shift.

    On some of my more busier days I've clocked 500-700km driving, and often these days you could get a late call to the city, which means going a few hours over finish time.

    We'd easily burn through €120 worth of diesel.





    I said it in an earlier reply but driving all day is so exhausting. We're lucky that there's two people per vehicle so we can swap. There's been plenty of times I've had to pull in and say to my partner we need to swap because the drowsiness sets in so fast.


  • Moderators, Entertainment Moderators Posts: 10,432 Mod ✭✭✭✭xzanti


    No question. Just wanted to thank you for all you do.


  • Registered Users Posts: 195 ✭✭grazer


    No question here either, but just want to say thank you. All my experiences of ambulances (elderly parents!) have been just excellent. Really professional calm nice people who know their stuff. It’s a tough job in all sorts of ways (I imagine both boring routine and critical chaos are stressful) and I’m very grateful to those who do it.


  • Registered Users Posts: 6 craggyjack


    What's the story with the PNA wanting to represent Ambulance staff?


  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    craggyjack wrote: »
    What's the story with the PNA wanting to represent Ambulance staff?


    I have to try frame this impartially.
    Essentially the ambulance service is very divided in terms of unions. There are 4 of them: SIPTU, Impact, Unite and NASRA/PNA.

    SIPTU being the largest union in the service holds about half of the 1800 or so staff, while the rest are fragmented across the 3 others.
    NASRA which is a branch of the PNA were setup up many years because staff felt the need for the ambulance service to have their own specific union solely for ambulance service workers. Much like the Gardai having the GRA or Nurses having the INMO.

    Because NAS is such a small branch of the HSE, many staff felt like SIPTU werent devoting enough time /attention to the issues within the ambulance service. Many felt that SIPTU and management have a stronger relationship with each other than with the staff on the ground, and don't listen to the issues we raise time and time again.


    Management (having a good relationship with the other unions) want absolutely nothing to do with NASRA and are refusing to recognise them. They're largely using stonewalling tactics and hoping NASRA will just fade away and fail.
    Staff are disgruntled over it because over the years there's a lot of issues that have built up within NAS that haven't been addressed by the main unions. There's also some stories of alleged deals been done between management/big unions.


    Most staff don't want to leave the other unions because they're officially recognised and will be able to represent them for personal issues they're having.
    NASRA have no negotiating rights so you won't get the same kind of representation from them. But many staff feel like NASRA have fought harder for wider issues

    It's messy and to be blunt, workplace morale in NAS is low. We're divided in terms of union membership but it's caused no conflict amongst the workers or anything.


  • Registered Users Posts: 10,633 ✭✭✭✭Widdershins


    Hello
    I was wondering if intermediate care operatives receive training specific to patients with Alzheimer's disease & dementia, eg. handling episodes of confusion and distress? Or does this come under a broader heading such as agitated patients?


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  • Company Representative Posts: 19 Verified rep I'm an intermediate care operative, AMA


    Hello
    I was wondering if intermediate care operatives receive training specific to patients with Alzheimer's disease & dementia, eg. handling episodes of confusion and distress? Or does this come under a broader heading such as agitated patients?


    Ah there's no real training like that unfortunately. You just have to learn most of that on the job. There's some online courses you can voluntarily do but most don't unless they're compulsory. It's something I think should be 100% brought in at the college.


This discussion has been closed.
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