# Why Do It?



## VentMonkey (Nov 24, 2017)

So, it’s pretty evident the the HEMS industry has quickly, and unfortunately become notorious for an all too common theme: crashes.

Having been the paramedic that “wanted to fly” so bad that I applied for multiple bases within a reasonable driving radius it does make sense to ask if the risk is worth the reward. I know when I was still in search of that position it seemed as though it was, or certainly “couldn’t be that dangerous”. In all honesty it very much can be, and is.

While I haven’t been flying too long, the older crowd remembers a time without NVG’s, and “flying blind”, yet still, HEMS crashes aren’t uncommon. For what it’s worth, the most recent crash was felt at our base personally by one of our pilots who had done some work overs with the actual crew members.

A lot of bright-eyed students will come by our base and gawk at the helicopter like it’s some sort of pin-up girl. The reality is, it’s more often than not a faster air ambulance, which is what I typically tell them.

Personally, I find words like “hero”, or “heroism” heardly appealing when it comes to this line of work, be it ground or air. When I think of (let alone dying doing it) doing something I truly love, it surely isn’t at work. So at this point for me I do it because I do enjoy it, but that doesn’t mean I don’t realize one day may not allow me to return to the next.

Is it a sad reality? Well it depends on how you look at it. I certainly don’t want to leave my wife, and two girls alone in this world by any means. The flip side being the inevitable.

What if there were more campaigns, funding, money put into saftey of the HEMS industry? Would it really drive away greed and it’s desire to push weather, or stop bases from popping up over night next to one another like Wal-Marts?

Would it decrease the frequency of HEMS crashes to an astonishing point, or are these events bound to happen/ are happening at an unfortunately alarming rate because of such an over saturated market?

Back to my question. And it’s directed at even the students sitting in classes hoping one day to do it:

Why fly? Is it really worth it to you? If so, why is it worth a seemingly inherent risk?


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## mgr22 (Nov 24, 2017)

If I were doing HEMS, I think the question that would trouble me the most would be, "To what extent can its use be justified?"


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## EpiEMS (Nov 24, 2017)

VentMonkey said:


> over saturated market


I'd be very interested to see if the for-profit operations are better/worse than the not-for-profit or government operations in terms of crash rates. That said, I bet it gets complicated because some of the not-for-profits probably outsource the actual helicoptering side of things (aircraft + pilot)...?


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## GMCmedic (Nov 24, 2017)

EpiEMS said:


> I'd be very interested to see if the for-profit operations are better/worse than the not-for-profit or government operations in terms of crash rates. That said, I bet it gets complicated because some of the not-for-profits probably outsource the actual helicoptering side of things (aircraft + pilot)...?


That's what my employer did for 30 years till just this month when we went to statflight branded PHI. We were accident free for 30 years if that hel0s any lol


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## EpiEMS (Nov 24, 2017)

GMCmedic said:


> That's what my employer did for 30 years till just this month when we went to statflight branded PHI. We were accident free for 30 years if that hel0s any lol



Interesting - have you noticed any differences?


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## SandpitMedic (Nov 24, 2017)

If I had kids I wouldn't do this job.


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## GMCmedic (Nov 24, 2017)

EpiEMS said:


> Interesting - have you noticed any differences?


I havent had enough interaction. Same crews, same pilots but one. They new helo is IFR capable so may not be a good comparison.


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## EpiEMS (Nov 24, 2017)

GMCmedic said:


> They new helo is IFR capable so may not be a good comparison.



That'll change the dynamics, indeed.


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## VentMonkey (Nov 24, 2017)

GMCmedic said:


> The new helo is IFR capable so may not be a good comparison.





EpiEMS said:


> That'll change the dynamics, indeed.


How so? The Duke HEMS crash this past summer was an IFR ship, and by all accounts caused by mechanical failure. 


SandpitMedic said:


> If I had kids I wouldn't do this job.


Why not?


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## TXmed (Nov 24, 2017)

Ive been in situations in houses of patients, wrecks on roadways, and going interior in structure fires where i have felt we took full safety precautions and suddenly the dynamics change and suddenly i am no longer safe. And while yes HEMS gets alot of publicity for crashes, ive accepted that no matter what job i do as a first responder i am never 100% safe. Having said that i will never work with someone who just blatantly violates any safety procedure, Hems, ground ems or fire. 

At this point i do this job because i believe what i do helps both patients and other first responders.


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## GMCmedic (Nov 24, 2017)

VentMonkey said:


> How so? The Duke HEMS crash this past summer was an IFR ship, and by all accounts caused by mechanical failure.



I would think because the IFR private helo would take flights that the VFR not for profit would otherwise decline. IFR vs VFR would have to be taken into consideration when comparing not for profit vs for profit.


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## VentMonkey (Nov 24, 2017)

GMCmedic said:


> I would think because the IFR private helo would take flights that the VFR not for profit would otherwise decline. IFR vs VFR would have to be taken into consideration when comparing not for profit vs for profit.


TMK, IFR flight planning isn’t this simple. They don’t just accept missions VFR ships won’t, especially RW. FW is a whole nother animal.


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## GMCmedic (Nov 24, 2017)

To answer the original question....because the more I learn the more I start to dislike the way ground transport medics operate. I'm an advocate of change and it's fought tooth and nail at every turn. We still have a medic that leaves patients on backboards cause "Ive been doing this for 35 years and those doctors don't know what theyre talking about". After a while, be surrounded by this mindset eats at you.

I don't know why I expect critical care to be different, maybe it won't be. 

I still go into burning structures, but for some reason HEMS scares me. I worry mostly for my daughter, I certainly want to see her grow up, but thinking "it will never happen to me" only works for so long.


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## VFlutter (Nov 24, 2017)

I will admit my initial interest in the profession was because of the "cool" factor. I always thought of Flight Nursing as the top of the mountain and that only the best got to fly. When it came time to apply it was the appeal of increased autonomy, more education, and a new challenge. I knew there were risks however I was young, single, and did not put all that much thought into it. I read online forums and talked to some people and made sure to look for a program with NVG, good safety record, etc. 

I will say that I truly enjoy my job and do not regret it for a minute. Even with a few incidents close to home I feel comfortable with my program, aircraft, and crew. I do think we serve a purpose and do good in many cases albeit probably not as much as I would hope to think. We bring critical care to the patients whom otherwise would not have it. 

I am really not sure how to quantify the risk vs benefits. There are programs that have flown for decades without fatal incidents while others do not. Many accidents seem to be avoidable. 

HEMS is not perfect. It is overused, abused, and over-saturated but I do think it serves a purpose. 

I do think that medicaid/medicare reform would help some of the billing issues / profit issues. With some places having 70% medicare/medicad flights that do not even pay for fuel it really drives the profit push elsewhere.


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## CALEMT (Nov 25, 2017)

VentMonkey said:


> Why fly? Is it really worth it to you? If so, why is it worth a seemingly inherent risk?



My personal preference I would jump at the opportunity for a helitack gig. Granted this is a topic for a different forum but I feel the concept applies. I have no real interest in HEMS. In all reality they're the same as a ground rig the only difference being a RN and the method of transportation. They run a higher acuity of calls and transfers, but the same in the aspect of ground vs HEMS. With that in consideration theres a big difference between a engine vs helitack. I mean who wouldn't want to IA (initial attack) a fire and then fly back to base without having to mop-up? Thats every wildland firefighters dream...

Theres an inherent risk with every aspect of this profession wether its HEMS vs ground. With that in mind, I'd wager my chances of dying in a ambulance collision vs a helicopter crash.


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## Carlos Danger (Nov 25, 2017)

When I got into HEMS I wasn't yet 25 and I'd only been a paramedic for about 1.5 years, but I was in a very busy urban 911 system and was already bordering on being burned out, largely because I saw little future for myself professionally. Flying was a step up clinically and professionally and no question that the sheer cool factor was a big part of the attraction. I had a military aviation background and literally would get goosebumps seeing the helicopter slowly and noisily touching down at the trauma center. I was really lucky to get into it as early in my career as I did. We practiced on airway trainers or smoked cigars under the open hanger door overlooking the lake as the sun went down after a busy day of scene calls, or slept in private rooms between calls instead of sitting on street corners in the ghetto. We didn't get called to pick up drunks or hysterical 15 year old girls faking seizures. We didn't go to minor MVC's and have to KED everyone in the minivan "just in case". We were actually expected to know our ****, and treated as though we did. We had one helicopter that covered a huge area and there was something humbling and awe-inspiring and exciting about being "THE" duty flight paramedic covering thousands of square miles and dozens of small rural hospitals. A 45 minute flight out into the middle of nowhere for a MVC with entrapment gives you plenty of time to think about the gravity of what you are doing, especially when you know it's the same distance back to the trauma center and that patient will be no one's responsibility but yours, no matter what is going on with them. My program was great at PR and we were pretty much treated like gods everywhere that we went. Even aside from those superficial perks, I genuinely enjoyed the work. I spent the next 12 years doing it at a few different programs and it was not easy to walk away from even when it became clear that it was time to move on

So, I really do get it. I loved HEMS and I'd be a massive hypocrite if I told others that they shouldn't pursue similar satisfaction in their career.

All that said, though……the industry has changed dramatically since the mid-1990's, and is a greedy, parasitic mess these days. Knowing what I know now - even keeping in mind how much I loved it - I honestly would not start a career in HEMS at this point. HEMS programs literally support themselves on lies (the "golden hour", "higher level of care", etc) and their parent companies make their shareholders rich by sending huge bills to unfortunate victims who never got to make an informed decision about their transport, and who statistically would have done just as well being transported by ground. HEMS crews are sent out to complete as many transports as possibly in marginal equipment and with minimal training. This situation doesn't fly (no pun intended) anywhere else in the developed world, and there are obvious reasons for that.


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## CANMAN (Nov 25, 2017)

Remi said:


> When I got into HEMS I wasn't yet 25 and I'd only been a paramedic for about 1.5 years, but I was in a very busy urban 911 system and was already bordering on being burned out, largely because I saw little future for myself professionally. Flying was a step up clinically and professionally and no question that the sheer cool factor was a big part of the attraction. I had a military aviation background and literally would get goosebumps seeing the helicopter slowly and noisily touching down at the trauma center. I was really lucky to get into it as early in my career as I did. We practiced on airway trainers or smoked cigars under the open hanger door overlooking the lake as the sun went down after a busy day of scene calls, or slept in private rooms between calls instead of sitting on street corners in the ghetto. We didn't get called to pick up drunks or hysterical 15 year old girls faking seizures. We didn't go to minor MVC's and have to KED everyone in the minivan "just in case". We were actually expected to know our ****, and treated as though we did. We had one helicopter that covered a huge area and there was something humbling and awe-inspiring and exciting about being "THE" duty flight paramedic covering thousands of square miles and dozens of small rural hospitals. A 45 minute flight out into the middle of nowhere for a MVC with entrapment gives you plenty of time to think about the gravity of what you are doing, especially when you know it's the same distance back to the trauma center and that patient will be no one's responsibility but yours, no matter what is going on with them. My program was great at PR and we were pretty much treated like gods everywhere that we went. Even aside from those superficial perks, I genuinely enjoyed the work. I spent the next 12 years doing it at a few different programs and it was not easy to walk away from even when it became clear that it was time to move on
> 
> So, I really do get it. I loved HEMS and I'd be a massive hypocrite if I told others that they shouldn't pursue similar satisfaction in their career.
> 
> All that said, though……the industry has changed dramatically since the mid-1990's, and is a greedy, parasitic mess these days. Knowing what I know now - even keeping in mind how much I loved it - I honestly would not start a career in HEMS at this point. HEMS programs literally support themselves on lies (the "golden hour", "higher level of care", etc) and their parent companies make their shareholders rich by sending huge bills to unfortunate victims who never got to make an informed decision about their transport, and who statistically would have done just as well being transported by ground. HEMS crews are sent out to complete as many transports as possibly in marginal equipment and with minimal training. This situation doesn't fly (no pun intended) anywhere else in the developed world, and there are obvious reasons for that.



I think there are programs out there which break every mold you described in your last paragraph, it's just a matter of provider's searching for them, and refusing to jump into the industry for anything less. I guess I am lucky that I have been flying now for 8 years and at two programs, neither fit into any of the definitions above, which plays into my considerations to keep flying. That being said I realize that is not the industry norm, and I completely agree with everything you hammered home in said paragraph. 

At the end of the day, and this is only my opinion, I think non for profit and either hospital based, or health system supported/community based is the best model out there and eliminates some of those issues. Knowing what I know about the industry, regardless of my love for flying, you would not catch me flying for a for profit community based program in a non IFR rated ship/quarterly trained pilot/pilots. That's a personal decision as I realize some people do chose to work at places like that, but if that were my only option locally I would no longer be flying.


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## DrParasite (Nov 25, 2017)

Remi said:


> We didn't get called to pick up drunks or hysterical 15 year old girls faking seizures. We didn't go to minor MVC's and have to KED everyone in the minivan "just in case".


That is pretty much it.  Most ground EMTs and paramedic deal with a ton of BS and minor calls... flight medics only deal with sick patients.  They are the ultimate paramedic fly car system.  And when the weather is bad, they don't fly, but they do continue to get paid.

Before I relocated to NC, it I had any desire to make a career of EMS, being on a helicopters would be my career goal.  And then a friend of mine and former coworker's helicopter crashed into the side of a mountain in New Mexico, at the age of 29.  It made everything very real. And recently the Duke helicopter crashed, with 0 survivors.

Call me selfish, but I have a family now, and I want to go home at the end of every shift and make sure I can give my son a hug.  I'll run into a burning building, i'll cut someone out of a car on a highway, and I'll willingly help a person with who-knows-what type of communicable disease, because I have some ways to mitigate the risk.  It's very hard to mitigate the risk of your helicopter crashing, and lately it happens to be all too common.

And true story: in 2002ish, I remember hearing two supervisors discussing how the biggest risk to EMS personnel was dying in helicopters crashes.... they said what about car accidents? Maybe they article was right after all...


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## CANMAN (Nov 25, 2017)

DrParasite said:


> That is pretty much it.  Most ground EMTs and paramedic deal with a ton of BS and minor calls... flight medics only deal with sick patients.  They are the ultimate paramedic fly car system.  And when the weather is bad, they don't fly, but they do continue to get paid.
> 
> Before I relocated to NC, it I had any desire to make a career of EMS, being on a helicopters would be my career goal.  And then a friend of mine and former coworker's helicopter crashed into the side of a mountain in New Mexico, at the age of 29.  It made everything very real. And recently the Duke helicopter crashed, with 0 survivors.
> 
> ...



When the weather is bad at my program we get shuffled into a private ambulance to complete most of the missions for critical patients by ground......This is due to a lack of legit critical care transport in the area, so there isn't many times we get paid to sit around in crappy weather. 

That being said I guess I don't really see a difference with being willing to risk your life fighting a fire vs. flying in a helicopter. I do both, and don't think one is riskier then another. I worry just as much about being struck on the side of the highway while working an MVC. I also think about how far I drive to get to my HEMS base x number of times a week and think about how many miles I am logging on the road and my risk of a serious MVC over a HEMS accident. Like TxMed said, my wife and I have come to terms with the fact that whatever I do for a career will likely have some level of inherent danger to it. I participate as part of my crew making sound decisions about the aircraft, weather, everyone's level of restfulness, etc and wear my PPE 100% of the time and wear it correctly. We drill on the ground and in the air on emergencies and IIMC procedures as a crew. I make it a point to do as much as I can to mitigate as many dangers as possible of any job/position I am in. Overall, given the level of risk, I feel pretty damn comfortable at work. I respect the dangers, but also know my wife would be well taken care of if something were to ever happen to me. Outside of that I am not willing to leave a career I love based off of "what if's" when those also exist in other jobs and everyday normal life. I refuse to live my life in fear.


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## grumpy1 (Nov 27, 2017)

Most crashes are result of "pilot" error and flying in weather that isn't suitable.  Personally, proper crew resource management, crew members who are not afraid to speak up and management support make the environment better.  Some companies maintain their aircraft well and others do not but mechanical problems happen at times no matter which company.

A culture of safety that allows crew members and pilots to speak up without retribution and good relationships in addition to safe aircraft are a must.


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## limavictor (Nov 29, 2017)

The answer I most often give when people ask me about the risks associated with HEMS is- of course the job involves risk, so we as a company, as a crew, and I personally, take the appropriate measures to mitigate as much of that risk as we can. This involves regular training, education, and open communication between all crew members. Sure, you can not mitigate all of the risk away, but I believe we do as much as we can, and the remaining risk is acceptable. The moment that risk level rises above an acceptable level, we turn around, go home, land somewhere in between if we have to, or stay on the ground in the first place.

As far as the question of why fly? I simply can not think of any other profession that allows me to work with such a diverse group of professionals and provides the kind of opportunity to fly in the kind of equipment we do, while still allowing me to provide for my family and maintain a lifestyle that I enjoy.


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## SeeNoMore (Feb 7, 2018)

Even knowing the risks of the job I would have a hard time giving it up. I like my 911 job, but I would miss the opportunity to take care of critically ill patients with a high degree of autonomy. I think I would be just as happy pursuing Nursing and eventually advanced practice / CRNA , but that's never going to happen for financial reasons so basically it's flight or a lifetime of 911 only. I've made my choice but I do understand that over a career there is good chance I'll be killed. I try to be open about this with my family and put as much money away so that there will be some financial stability when I die.


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## Old Tracker (Feb 7, 2018)

I'm too old these days for adventures or even investing the time and money to shoot for paramedic, but if I were 20 years younger... That being said, I suspect people do it as part of a self drive to be the best, to be at the pinnacle, so to speak, of the profession. You see it in folks that go on submarines, fighter pilots, swat guys, door kickers, etc. And it isn't limited to testosterone overflowing males.


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## VentMonkey (Feb 7, 2018)

Old Tracker said:


> I suspect people do it as part of a self drive to be the best, to be at the pinnacle, so to speak, of the profession.


Certainly holding yourself to that standard is a driving force, but I think a lot of guys and gals don’t really possess consistent motivation once they get here.

In other words, just like many things it becomes a “show and tell”, which I find quite pitiful.

I would never consider what I do as a pinnacle only because that sounds too arrogantly defining (IMO). Maybe the highest level of paramedic field care, but then that means constant drive. But again, constant drive is hardly innate with most people though.


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## MSDeltaFlt (Feb 19, 2018)

Why fly...

That is a very good question.  The first time I ever flew was because I wanted to fly.  So I did whatever it took to land that flight job.  I focused on that so much I overlooked the one thing I needed most:  self confidence.  I was overwhelmed and was unable to come off of orientation.  So back home I went with my tail tucked between my legs.

The second time I flew I had gotten the desire to simply be in the air out of my system and my desire was to be able to do the job I wanted: to have the autonomy, protocols, and the equipment to do what the patient needed.

I don't fly anymore.  Not because of the crash, not because of the injuries, not because of the pain and suffering during the 8 months of physical therapy and the emotional healing that inevitably came with it.  But because of what happened AFTER I came back.  Because of what happened AFTER I climbed back into the left seat.

The industry is over saturated... WAY over saturated.  And ground EMS isn't nearly as advanced as it needs to be.  The only time a helicopter should be utilized is if time is the ONLY thing that ground EMS cannot provide.  But those birds are constantly in the air.  They are flying more and more stable patients.  Why?  Simple.  Flight volume.  PR.  The almighty dollar.  When hospitals and ground crews call these companies for whatever reason, if they don't fly these amazingly stable patients then the requesting agency with get their feelings hurt and call another service.  So they'll say, "Oh, just call us for your airmedical needs."

See, at 6 months into my 8 month intensive PT to get back on the line I discovered that the patient I almost died pinking up got drunk again and wrecked the car in almost the same spot.  Then after I returned to the line I found that there were several flights that I was unable to take because my aircraft was already enroute to a PR and we were loaded down with pizzas and t-shirts.  I held out for a few years hoping it would improve but it never did and I had had enough.  I got tired of feeling dirty and wanting to vomit over some of the business practices.  And it wasn't with just one service.  I tried another one.  And it was even worse.  I was having to fly patients as a flight medic that I wouldn't even start an IV on as ground medic.  And I was told to smile and thank them for the flight.

HEMS definitely has a place.  It is needed.  But not to the current extent that it is being used.

The only time a ground paramedic should use HEMS, IMHO, is if your patient needs to get there a h3ll of a lot faster than your highway gear can get them there.

The only reason I ever became a paramedic in the first place was so I could become a flight paramedic.  Now you couldn't pay me to do that again.


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## VFlutter (Feb 20, 2018)

MSDeltaFlt said:


> The only time a ground paramedic should use HEMS, IMHO, is if your patient needs to get there a h3ll of a lot faster than your highway gear can get them there.



I agree, to an extent, in a perfect world. But do you really think that HEMS does not offer anything over ground EMS in most places in the US? Blood, Txa, RSI, etc


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## DrParasite (Feb 20, 2018)

A couple of months ago, I was speaking to a retired Baltimore (MD) County medic supervisor, and he said they used to call for medevac all the time; not because they needed the bird, but rather for the flight medic; ground medics couldn't RSI, while flight medics could. and this was 15 years ago.

Once you throw in for profit agencies into the HEMS 911 world, things got a lot shadier.... especially if the ground EMS and the HEMS were the same agency.  HEMS usage increased, because there is big money to be made in HEMS.  And there are plenty of stories about shady stuff happening involving for profit companies when they were trying to secure a new contract, or make the existing contract holders happy.

20 years ago, there were 2 helicopters covering all of NJ.  Now there are 10 or so, with all but 2 being for profit entities (and one of them shut down due to lack of call volume due to over saturation).

I once had a dream of becoming a flight medic... but learning that a former coworker died in a medevac crash, and then the duke life flight crash, made me think that maybe it's better for me to not take that risk, because I want to go home to my family at the end of every shift.


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## MSDeltaFlt (Feb 20, 2018)

If your patient actually requires blood or Txa then your patient is in a serious time sensitive situation that only two things can fix: hot lights and cold steel.

As far as RSI goes, there are ground crews that can RSI.  And there still others that can DAI.  If blood pressure is a concern then start pouring the fluids to them as you are getting the DAI drugs ready to push.

If the blood pressure is too low for DAI then that is why God created pressors.  If the pressors don't work then they are in a serious time crunch that my aforementioned highway gear can't fix.


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## Cameron S (May 6, 2018)

Is it worth the risk? No.
Is there anything else to do in life? No.


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