Our Commitment to Education

EMS professionals require focused training that prepares them to provide emergency care in the pre-hospital and hospital environments. For EMS professionals, MedCare Ambulance is the best choice for beginning, or enhancing, your EMS career. Our technicians often go on to work in municipal fire departments, public safety departments, and hospitals. Some have even furthered their education, becoming nurses and doctors.

Education and training for the individual affects each and every one of us who will ever need emergency medical service. Whether you are an emergency professional, a health care provider or a safety-minded citizen, having the proper training and skills could help people or even save lives someday. MedCare Ambulance is committed to providing our community with the best emergency education, and we fully support continuing education of our employees.

Community Education

MedCare Ambulance would like to offer the following information as a basic guideline for some of the most common emergencies. Although these guidelines may assist when no other help is available, it is always recommended to call 9-1-1 in the event of an emergency.


 

Heart Attack

Chest Pain / Heart Attack Symptoms

What is a heart attack (myocardial infarction or MI)?

A heart attack, or myocardial infarction, occurs when one of more regions of the heart muscle experience a severe or prolonged decrease in oxygen supply caused by blocked blood flow to the heart muscle.

The blockage is often a result of atherosclerosis - a buildup of plaque, known as cholesterol, other fatty substances, and a blood clot. Plaque inhibits and obstructs the flow of blood and oxygen to the heart, thus reducing the flow to the rest of the body.

If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer severe and devastating damage and die. The result is damage or death to the area of the heart that became affected by reduced blood supply.

What are the risk factors for heart attack?

There are two types of risk factors for heart attack, including the following:

Inherited (or genetic):

Acquired:

Inherited or genetic risk factors are risk factors you are born with that cannot be changed, but can be improved with medical management and lifestyle changes.

Acquired risk factors are caused by activities that we choose to include in our lives that can be managed through lifestyle changes and clinical care.

Who is most at risk - inherited (genetic) factors?

  • Persons with inherited hypertension (high blood pressure)
  • Persons with inherited low levels of HDL (high-density lipoproteins), triglycerides, or high levels of LDL (low-density lipoprotein) blood cholesterol
  • Persons with a family history of heart disease (especially with onset before age 55)
  • Aging men and women
  • Persons with type 1 diabetes
  • Women, after the onset of menopause (generally, men are at risk at an earlier age than women, but after the onset of menopause, women are equally at risk)

Who is most at risk - acquired risk factors?

  • Persons with acquired hypertension (high blood pressure)
  • Persons with acquired low levels of HDL (high-density lipoproteins), triglycerides, or high levels of LDL (low-density lipoprotein) blood cholesterol
  • Cigarette smokers
  • People who are under a lot of stress
  • People who drink too much alcohol
  • Individuals who lead a sedentary lifestyle
  • Persons overweight by 30 percent or more
  • Persons who eat a diet high in saturated fat
  • Persons with Type II diabetes

A heart attack can happen to anyone - it is only when we take the time to learn which of the risk factors apply to us, specifically, can we then take steps to eliminate or reduce them.

Managing heart attack risk factors:

Managing your risks for a heart attack begins with:

  • Examining which of the risk factors apply to you, and then taking steps to eliminate or reduce them.
  • Becoming aware of conditions like hypertension or abnormal cholesterol levels, which may be "silent killers."
  • Modifying risk factors that are acquired (not inherited) through lifestyle changes. Consult your physician as the first step in starting right away to make these changes.
  • Consulting your physician soon to determine if you have risk factors that are genetic or inherited and cannot be changed, but can be managed medically and through lifestyle changes.

What are the warning signs of a heart attack?

The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently. Symptoms may include:

Indigestion, also known as upset stomach or dyspepsia, is a painful or burning feeling in the upper abdomen that may be accompanied by nausea; abdominal bloating; belching; vomiting; severe pain in the upper right abdomen; discomfort unrelated to eating; or indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or arm.

The symptoms of indigestion may resemble other medical conditions, such as chest pain. Always consult your physician for a diagnosis.

  • Severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
  • Pain or discomfort that spreads to the shoulders, neck, arms, or jaw
  • Chest pain that increases in intensity
  • Chest pain that is not relieved by rest or by taking cardiac prescription medication
  • Chest pain that occurs with any/all of the following (additional) symptoms:
    • Sweating, cool, clammy skin, and/or paleness
    • Shortness of breath
    • Nausea or vomiting
    • Dizziness or fainting
    • Unexplained weakness or fatigue
    • Rapid or irregular pulse

Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.

The symptoms of a heart attack may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Responding to heart attack warning signs:

If you or someone you know exhibits any of the above warning signs, act immediately. Call 911, or your local emergency number.

Treatment for a heart attack:

The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death.
Treatment in the emergency department may include:

  • Intravenous therapy
  • Continuous monitoring of the heart and vital signs
  • Oxygen therapy (to improve oxygenation to the damaged heart muscle)
  • Pain medication (by decreasing pain, the workload of the heart decreases, thus the oxygen demand of the heart decreases)
  • Cardiac medication (to promote blood flow to the heart, prevent blood clotting, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure)
  • Thrombolytic therapy (intravenous infusion of a medication which dissolves the blockage, thus restoring blood flow)

Once the condition has been diagnosed and the patient stabilized, additional procedures to restore coronary blood flow may be utilized, including the following:

  • Coronary angioplasty - With this procedure, a catheter is used to create a larger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels, percutaneous transluminal coronary angioplasty (PTCA) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. There are several types of PTCA procedures, including the following:
    • Balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area.
    • Atherectomy - the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter.
    • Laser angioplasty - a laser used to "vaporize" the blockage in the artery.
    • Coronary artery stent - a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
  • Coronary artery bypass - Most commonly referred to as simply "bypass surgery," this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest may also be used to create a bypass graft.
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Stroke

Stroke / Brain Attack

What is stroke?

Stroke, also called brain attack, occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. The area of dead cells in tissues is called an infarct. Due to both the physical and chemical changes that occur in the brain with stroke, damage can continue to occur for several days. This is called a stroke-in-evolution.

A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in only minor problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.

According to the National Stroke Association (NSA), it is important to learn the three R's of stroke:

  • Reduce the risk.
  • Recognize the symptoms.
  • Respond by calling 911 (or your local ambulance service).

Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediately.

Stroke is the third largest cause of death, ranking behind diseases of the heart and all forms of cancer. Strokes kill more than 158,000 Americans each year. About 5.5 million US adults live today with the effects of a stroke.

What are the most common symptoms of stroke?

The following are the most common symptoms of stroke. However, each individual may experience symptoms differently. If any of these symptoms are present, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately.
Symptoms may be sudden and include:

  • Weakness or numbness of the face, arm, or leg, especially on one side of the body
  • Confusion or difficulty speaking or understanding
  • Problems with vision such as dimness or loss of vision in one or both eyes
  • Dizziness or problems with balance or coordination
  • Problems with movement or walking
  • Severe headaches with no other known cause

All of the above warning signs may not occur with each stroke. Do not ignore any of the warning signs, even if they go away - take action immediately. The symptoms of stroke may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

What are some other symptoms of stroke?

Other, less common, symptoms of stroke may include the following:

  • Sudden nausea, vomiting, or fever not caused by a viral illness
  • Brief loss or change of consciousness such as fainting, confusion, seizures, or coma
  • Transient ischemic attack (TIA), or "mini-stroke"

    A TIA can cause many of the same symptoms as a stroke, but TIA symptoms are transient and last for a few minutes or up to 24 hours. Call for medical help immediately if you suspect a person is having a TIA, as it may be a warning sign that a stroke is about to occur. Not all strokes, however, are preceded by TIAs.

Risk factors for stroke:

Evaluating the risk for stroke is based on heredity, natural processes, and lifestyle. Many risk factors for stroke can be changed or managed, while others that relate to hereditary or natural processes cannot be changed.

Risk factors for stroke that can be changed, treated, or medically managed:
  • High blood pressure
    The most important controllable risk factor for brain attack is controlling high blood pressure.
  • Diabetes mellitus
    Diabetes is treatable, but having it increases the risk for stroke.
  • Heart disease
    Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke.
  • Cigarette smoking
    The use of oral contraceptives, especially when combined with cigarette smoking, greatly increases stroke risk.
  • History of transient ischemic attacks (TIAs)
    A person who has had one (or more) TIA is almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.
  • High red blood cell count
    A moderate increase in the number of red blood cells thickens the blood and makes clots more likely, thus increasing the risk for stroke.
  • High blood cholesterol and lipids
    High blood cholesterol and lipids increase the risk for stroke.
  • Lack of exercise, physical inactivity
    Lack of exercise and physical inactivity increases the risk for stroke.
  • Obesity
    Excess weight increases the risk for stroke.
  • Excessive alcohol use
    More than two drinks per day raises blood pressure, and binge drinking can lead to stroke.
  • Drug abuse (certain kinds)
    Intravenous drug abuse carries a high risk of stroke from cerebral embolisms (blood clots). Cocaine use has been closely related to strokes, heart attacks, and a variety of other cardiovascular complications. Some of them, even among first-time cocaine users, have been fatal.
  • Abnormal heart rhythm
    Various cardiac diseases have been shown to increase the risk of stroke. Atrial fibrillation is the most powerful and treatable cardiac precursor of stroke.
  • Cardiac structural abnormalities
    New evidence shows that cardiac structure abnormalities including patent foramen ovale and atrial septal defect increase risk for embolic stroke.

Risk factors for stroke that cannot be changed:

  • Age
    For each decade of life after age 55, the chance of having a stroke more than doubles.
  • Gender
    Men have about a 19 percent greater chance of stroke than women.
  • Race
    African-Americans have a much higher risk of death and disability from a stroke than Caucasians, in part because the African-American population has a greater incidence of high blood pressure.
  • Diabetes
    Diabetes is strongly linked with high blood pressure and, although diabetes is a treatable condition, increases a person's risk for stroke.
  • History of prior stroke
    The risk of stroke for someone who has already had one is many times that of a person who has not had a stroke.
  • Heredity/genetics
    The chance of stroke is greater in people who have a family history of stroke.

Other risk factors of stroke to consider:

  • Where a person lives
    Strokes are more common among people living in the southeastern United States than in other areas. This may be due to regional differences in lifestyle, race, cigarette smoking, and diet.
  • Temperature, season, and climate
    Stroke deaths occur more often during periods of extreme temperatures.
  • Socioeconomic factors
    There is some evidence that strokes are more common among low-income people than among more affluent people.

What are the different types of stroke?

Strokes can be classified into two main categories:

  • 88 percent are ischemic strokes - strokes caused by blockage of an artery.
  • 12 percent are hemorrhagic strokes - strokes caused by bleeding.

What is an ischemic stroke?

An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked or "clogged" and impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen and nutrients. The area of tissue death is called an infarct. About 80 percent of strokes fall into this category. Ischemic strokes are further divided into two groups, including the following:

  • Thrombotic strokes - caused by a blood clot that develops in the blood vessels inside the brain.
  • Embolic strokes - caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain via the bloodstream.

What is a thrombotic stroke?

Thrombotic strokes are strokes caused by a thrombus (blood clot) that develops in the arteries supplying blood to the brain. This type of stroke is usually seen in older persons, especially those with high-cholesterol levels and atherosclerosis (a build-up of fat and lipids inside the walls of blood vessels).

Sometimes, symptoms of a thrombotic stroke can occur suddenly and often during sleep or in the early morning. At other times, it may occur gradually over a period of hours or even days. This is called a stroke-in-evolution.

Thrombotic strokes may be preceded by one or more "mini-strokes," called transient ischemic attacks, or TIAs. TIAs may last from a few minutes to a few days and are often a warning sign that a stroke may occur. Although usually mild and transient, the symptoms caused by a TIA are similar to those caused by a stroke.

Another type of stroke that occurs in the small blood vessels in the brain is called a lacunar infarct. The word lacunar comes from the Latin word meaning "hole" or "cavity." Lacunar infarctions are often found in people who have diabetes or hypertension (high blood pressure).

What is an embolic stroke?

Embolic strokes are usually caused by an embolus (a blood clot that forms elsewhere in the body and travels through the bloodstream to the brain). Embolic strokes often result from heart disease or heart surgery and occur rapidly and without any warning signs. About 15 percent of embolic strokes occur in people with atrial fibrillation, a type of abnormal heart rhythm in which the upper chambers of the heart do not beat effectively.

What is a hemorrhagic stroke?

Hemorrhagic strokes occur when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds up in surrounding tissues and irritation and swelling occur. About 20 percent of strokes are caused by hemorrhage. Hemorrhagic strokes are divided into two main categories, including the following:

  • Intracerebral hemorrhage - bleeding from the blood vessels within the brain.
  • Subarachnoid hemorrhage - bleeding in the subarachnoid space (the space between the brain and the membranes that cover the brain).

What is an intracerebral hemorrhage?

Intracerebral hemorrhage is usually caused by hypertension (high blood pressure), and bleeding occurs suddenly and rapidly. There are usually no warning signs and bleeding can be severe enough to cause coma or death.

What is a subarachnoid hemorrhage?

Subarachnoid hemorrhage results when bleeding occurs between the brain and the meninges (the membranes that covers the brain) in the subarachnoid space. This type of hemorrhage is often due to an aneurysm or an arteriovenous malformation (AVM).

  • An aneurysm is a weakened, ballooned area on an artery wall and has a risk for rupturing. Aneurysms may be congenital (present at birth), or may develop later in life due to such factors as hypertension or atherosclerosis.
  • An AVM is a congenital disorder that consists of a disorderly tangled web of arteries and veins. The cause of AVM is unknown.

What are recurrent strokes?

Recurrent strokes occur in about 25 percent of stroke victims within five years after a first stroke. The risk is greatest right after a stroke and decreases over time. The likelihood of severe disability and death increases with each recurrent stroke. About 3 percent of stroke patients have a second stroke within 30 days of their first stroke, and about one-third have a second stroke within two years.

Emergency treatments for stroke:

Treatment is most effective when started immediately. Emergency treatment following a stroke may include the following:

  • Medications used to the dissolve blood clot(s) that cause an ischemic stroke. Medications that dissolve clots are called thrombolytic agents and are commonly known as "clot busters." These drugs have the ability to help reduce the damage to brain cells caused by the stroke. In order to be most effective, these agents must be given within several hours of a stroke's onset.
  • Medications and therapy to reduce or control brain swelling
    Corticosteroids and special types of intravenous (IV) fluids are often used to help reduce or control brain swelling, especially after a hemorrhagic stroke (a stroke caused by bleeding into the brain).
  • Medications that help protect the brain from damage and ischemia (lack of oxygen)
    Medications of this type are called neuroprotective agents, with some still under investigation in clinical trials.
  • Life support measures including such treatments as ventilators (machines to assist with breathing), IV fluids, adequate nutrition, blood pressure control, and prevention of complications

Other medications used to treat or prevent a stroke:

Other medications that may help with recovery following a stroke, or may help to prevent a stroke from occurring, include the following:

  • Medications to help prevent more blood clots from forming
    Medications that help to prevent additional blood clots from forming are called anticoagulants, as they prevent the coagulation of the blood. Medications of this type include, for example, heparin and warfarin (Coumadin®).
  • Medications that reduce the chance of blood clots by preventing platelets (a type of blood cell) from sticking together
    Examples of this type of medication include aspirin and dipyridamole (Persantine®).
  • Medications to treat existing medical conditions such as diabetes, heart, or blood pressure problems

Types of surgery to treat or prevent a stroke:

Several types of surgery may be performed to help treat a stroke, or help to prevent a stroke from occurring, including the following:

  • Carotid endarterectomy
    Carotid endarterectomy is a procedure used to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help prevent a stroke from occurring.
  • Craniotomy
    A craniotomy is a type of surgery in the brain itself to remove blood clots or repair bleeding in the brain.
  • Surgery to repair aneurysms and arteriovenous malformations (AVMs)

An aneurysm is a weakened, ballooned area on an artery wall that has a risk for rupturing and bleeding into the brain. An AVM is a congenital (present at birth) or acquired disorder that consists of a disorderly, tangled web of arteries and veins. An AVM also has a risk for rupturing and bleeding into the brain. Surgery may be helpful, in this case, to help prevent a stroke from occurring.

Constraint-Induced Therapy (CIT) for arm and hand paralysis after stroke:

Many individuals who have a stroke are left with paralysis of the upper extremities. CIT is a treatment that encourages the use of the stroke-affected limb by constraining the non-affected limb in a mitt, sling, splint or glove. Intense exercises are done using the stroke-affected arm or hand.

  • CIT restraints are worn for up to 90 percent of the waking hours.
  • Restraints can be removed for activities such as bathing.
  • Small steps are used to break down complex tasks such as making a phone call.
  • Verbal and written feedback is used to help motivate and inform persons undergoing CIT.
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Food Poisoning

Food Poisoning

What is food poisoning?

Food-borne illnesses affect millions of Americans each year. Many persons who think they have the flu or a virus are really victims of mild cases of food poisoning, caused by bacteria and viruses found in food. Particularly vulnerable to these infections are young children, the elderly, pregnant women (because of the risk to the fetus), and persons with chronic or serious illnesses, whose immune systems are already weakened.

What causes food poisoning?

Most food-borne illnesses are caused by eating food containing certain types of bacteria or viruses. After a person has eaten these foods, the microorganisms continue to grow, causing an infection. Foods can also cause illness if they contain a toxin or poison produced by bacteria growing in food.

Several different kinds of bacteria can cause food poisoning. Some of the common bacteria include the following:

  • Salmonella and Campylobacter - normally found in warm-blooded animals such as cattle, poultry, and swine and may be present in raw meat, poultry, eggs, or unpasteurized dairy products.
  • Clostridium perfringens - may be present in raw meat, poultry, eggs, or unpasteurized dairy products, as well as in vegetables and crops that come into contact with soil. Infection may occur when soups, stew, and gravies made with meat, fish, or poultry are stored improperly or left unrefrigerated for several hours.
  • Listeria - mainly associated with raw foods of animal origins.
  • Staphylococci - occur normally on human skin and in the nose and throat. These bacteria are transmitted to food when handled.
  • Escherichia coli (E. coli) - found in the intestines of healthy cattle. An infection is caused by eating undercooked beef (especially ground beef) or unpasteurized milk.

Hepatitis A and other viral diseases may be passed through the hands of infected persons onto the hands of food handlers or into sewage. Shellfish and other foods which may have been exposed to sewage-contaminated water can transmit these viral diseases.

Botulism is a rare but deadly form of food poisoning caused by Clostridium botulinum, which is found almost everywhere, including in soil and water. Low acid foods, such as meat, fish, poultry, or vegetables, that are improperly canned may be breeding grounds for this bacteria.

What are the symptoms of food poisoning?

Unfortunately, most cases of food poisoning mimic gastroenteritis, and many people with mild cases of food poisoning think they have the "stomach flu." However, the onset of symptoms is usually very sudden and abrupt, often within hours of eating the contaminated food. The following are the most common symptoms of food poisoning. However, each individual may experience symptoms differently. Symptoms may include:

  • Abdominal cramps
  • Watery and/or bloody diarrhea
  • Nausea and vomiting
  • Headache
  • Fever
  • Abdominal distention and gas

The symptoms of food poisoning may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Treatment for food poisoning:

Mild cases of food poisoning are often treated as gastroenteritis, with fluid replacement and control of nausea and vomiting being the primary focus. However, in serious cases of food poisoning, hospitalization may be necessary.

How can food poisoning be prevented?

  • Thoroughly wash hands before handling food.
  • Wash hands after using the toilet, changing diapers, smoking, blowing your nose, coughing, or sneezing.
  • Wash hands after touching raw meat, seafood, poultry, or eggs before working with any other foods.
  • Do not use wooden cutting boards for cutting raw fish, poultry, or meat. Plastic boards are easier to sanitize.
  • Thoroughly clean any surface or utensil after each use.
  • Cook poultry, beef, and eggs thoroughly before eating.
  • Do not eat or drink foods made from raw or undercooked eggs, poultry, meat, or unpasteurized milk, or other dairy products made from unpasteurized milk.
  • Wash all produce thoroughly before eating.
  • Avoid cross-contamination of foods by keeping produce, cooked foods, and ready-to-eat foods separate from uncooked meats and raw eggs.
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Toy Safety

Toy Safety

Billions of toys to amuse children of all ages are sold each year in the US. Unfortunately, toys also are associated with thousands of injuries each year, some of which result in death. Children under age 3 are especially at risk for injury from toys. Injuries can range from falling, choking, strangulation, burning, drowning, and even poisoning. However, the leading cause of toy-related death is choking, usually on latex balloons.

Injury often results when a toy is misused or used by children who are too young for that particular toy. An example is a toy with small parts, designed for older children, which can cause choking when those small parts are ingested by a curious toddler.

Knowing what dangers are associated with certain toys and age groups can help you better protect your child from toy injuries. When selecting toys for your child, consider the following recommendations:

  • Choose toys that are age-appropriate and meet your child's skill level and interest (read the toy's labeling).
  • Avoid using latex balloons as much as possible and use mylar balloons instead.
  • Make sure toys are used in safe environments, such as keeping a riding toy away from stairs.
  • Be involved in your child's play.
  • Store toys intended for older children separately from toys used by younger children.
  • Use a small parts tester to determine which small toys or parts are a choking hazard to children under age 3. A small parts tester allows for small objects to be inserted - if the object fits, it is a choking hazard.
  • Check toys regularly for damage and other hazards.
  • Stay up-to-date on toy recalls through the US Consumer Product Safety Commission website.

Supervising your child's play, in addition to following the recommendations made by toy manufactures could save lives. Listed in the directory below is additional information related to toy safety

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