{"id":35131,"date":"2018-03-26T15:48:58","date_gmt":"2018-03-26T07:48:58","guid":{"rendered":"https:\/\/www.columbiaasia.com\/malaysia\/?post_type=health-article&#038;p=35131"},"modified":"2024-05-28T15:53:55","modified_gmt":"2024-05-28T07:53:55","slug":"chain-of-survival","status":"publish","type":"health-article","link":"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/","title":{"rendered":"Chain of Survival"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"35131\" class=\"elementor elementor-35131\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bd777f8 e-con-full e-flex e-con e-parent\" data-id=\"bd777f8\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5907a07 elementor-widget elementor-widget-text-editor\" data-id=\"5907a07\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Would you know what to do if a loved one collapsed in front of you and showed no sign of life? If you find yourself in such a situation, it could mean the person\u2019s heart has stopped beating and that he\/she could be experiencing what doctors call sudden cardiac arrest (SCA). If you think that\u2019s bad news, that\u2019s only the half of it. Before you can fully absorb what\u2019s happening, you have to spring into action because you have only four minutes to save the person\u2019s life by performing cardiopulmonary resuscitation (CPR).<br \/><br \/>Almost everyone has heard of CPR. You would have heard it being discussed in school or probably seen someone perform the procedure on crime shows on TV. But the question is, do you know what it takes to save someone\u2019s life with CPR?<br \/><br \/>In most SCA cases, proper application of this simple but vital skill could be the difference between life and death. Statistics indicate that about 80 per cent of SCA cases occur either at home or public spaces. In such a scenario, the person nearest to the victim is likely to be a relative, friend or passer-by with no medical expertise. But if the person present at the scene is able to perform CPR on the victim promptly, the latter\u2019s chance of survival is significantly increased. Indeed, learning how to effectively administer CPR means you could one day save the life of a loved one.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d034ca6 elementor-widget elementor-widget-spacer\" data-id=\"d034ca6\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-column .elementor-spacer-inner{height:var(--spacer-size)}.e-con{--container-widget-width:100%}.e-con-inner>.elementor-widget-spacer,.e-con>.elementor-widget-spacer{width:var(--container-widget-width,var(--spacer-size));--align-self:var(--container-widget-align-self,initial);--flex-shrink:0}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container,.e-con>.elementor-widget-spacer>.elementor-widget-container{height:100%;width:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer{height:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner{height:var(--container-widget-height,var(--spacer-size))}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty,.e-con>.elementor-widget-spacer.elementor-widget-empty{position:relative;min-height:22px;min-width:22px}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon,.e-con>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon{position:absolute;top:0;bottom:0;left:0;right:0;margin:auto;padding:0;width:22px;height:22px}<\/style>\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9e51842 elementor-widget elementor-widget-image\" data-id=\"9e51842\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 15-07-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"500\" height=\"293\" src=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-01-1.jpg\" class=\"attachment-large size-large wp-image-35152\" alt=\"\" srcset=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-01-1.jpg 500w, https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-01-1-300x176.jpg 300w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5cbd402 elementor-widget elementor-widget-text-editor\" data-id=\"5cbd402\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p style=\"text-align: center;\"><em>Position hands over sternum and begin chest compressions while the second-aider sets up the AED machine. It\u2019s always good to have someone on standby to take over chest compressions after two minutes.<\/em><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c3d3940 elementor-widget elementor-widget-spacer\" data-id=\"c3d3940\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0ec7992 elementor-widget elementor-widget-text-editor\" data-id=\"0ec7992\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Columbia Asia Hospital Malaysia consultant emergency physician and regional emergency services coordinator Dr Terence Leslie de Silva said SCA is a condition when the heart suddenly and unexpectedly stops beating. There are many causes of cardiac arrest, ranging from existing heart arrhythmia to being hit in the chest with a baseball. Regardless of the underlying condition, without CPR, most people experiencing SCA won\u2019t survive, and with every minute CPR is delayed, the survival rate declines.<br \/><br \/>\u201cCPR only works when the heart suddenly stops beating, most often because of a cardiac condition or heart attack. The heart\u2019s function is to pump blood into vital organs such as the brain and kidneys, and in the case of a cardiac arrest, CPR is urgently needed to restore blood flow from the heart to the vital organs,\u201d he continued.<br \/><br \/>By doing CPR, he added, the victim\u2019s heartbeat is stimulated, restoring blood flow and oxygenation to the body\u2019s system until medical professionals arrive at the scene. \u201cChest compressions force the heart to continue pumping, essentially serving as the electrical signal that keeps the heart beating.\u201d<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6bd6014 elementor-widget elementor-widget-spacer\" data-id=\"6bd6014\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a273fd8 elementor-widget elementor-widget-image\" data-id=\"a273fd8\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"500\" height=\"293\" src=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-02-1.jpg\" class=\"attachment-large size-large wp-image-35153\" alt=\"\" srcset=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-02-1.jpg 500w, https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-02-1-300x176.jpg 300w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e45d945 elementor-widget elementor-widget-text-editor\" data-id=\"e45d945\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p style=\"text-align: center;\"><em>De Silva says time is of the essence when treating a cardiac arrest victim. \u2014 Photo from Columbia Asia<\/em><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-96aedda elementor-widget elementor-widget-spacer\" data-id=\"96aedda\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bbbbd99 elementor-widget elementor-widget-text-editor\" data-id=\"bbbbd99\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>De Silva stressed that time is of the essence when treating a cardiac arrest victim. \u201cOnce the heart stops beating, the blood circulation stops and if not treated within four minutes, it will cause irreversible damage to the victim\u2019s brain cells shortly after oxygen deprivation.\u201d<br \/><br \/>Apart from that, de Silva said CPR helps to prolong any abnormal rhythm there is in the victim\u2019s heart. \u201cMost times, when people have a heart attack or SCA, the heart starts to brillate instead of beating in proper rhythm.\u201d<br \/><br \/>He also pointed out that it\u2019s because of this brillation that the Automatic External De brillator (AED) machine comes in handy when dealing with SCA cases.<br \/><br \/>\u201cIn many developed countries around the world, you can easily nd AED devices in airports, offices, shopping malls and public places all within a distance of four minutes,\u201d he added.<br \/><br \/>De Silva explained that the AED machine is a life-saving equipment that goes hand in hand with CPR; it is used to jumpstart the heart in the event of SCA. \u201cThese portable shock devices automatically detect the abnormal heart rhythm and treat it through de brillation.\u201d<br \/><br \/>Each machince is equipped with straightforward audio and visual commands, making it easy for any by stander to use.<br \/><br \/>Because SCA can occur to anyone at any time, de Silva said it is crucial for everyone to know how to correctly perform CPR.<br \/><br \/>In the past, some people were reluctant to perform CPR on a SCA victim because it involved mouth-to-mouth resuscitation, he noted. But the guideline for performing CPR changed in 2010, allowing those uncomfortable or who have not received proper training to attempt hands-only CPR until qualified paramedics arrive at the scene.<br \/><br \/>The sequence of basic life support as explained by de Silva<br \/><strong>1. Danger<\/strong><br \/>If someone appears to be unconscious, survey the area first and check for possible risks to the victim and yourself. Although it is best to begin CPR as quickly as possible, the first-aider needs to ensure that he will be safe while performing the procedure.<br \/><br \/><strong>2. Response<\/strong><br \/>Once you have approached the victim, determine if CPR is necessary by assessing the person\u2019s responses. Ask loudly if the person is okay or gently shake the person to examine responsiveness. If there is no response, check for signs of life by assessing the victim\u2019s pulse.<br \/><br \/>Place your finger two finger breadths away (either to the left or right) from the person\u2019s Adam\u2019s apple to feel the pulse. If there\u2019s no pulse, call 999 and you\u2019ll be directed to the medical emergency call centre where a doctor or paramedic will take you through the sequence of CPR while waiting for the ambulance to arrive. Meantime, ask if anyone in the area can provide you with an AED machine.<br \/><br \/><strong>3. Circulation<\/strong><br \/>Begin chest compressions. Place the heel of your dominant hand over sternum (the hard bone of the chest) \u2013 the midpoint between the epigastric region and the base of the neck \u2013 and put the other hand on top of the dominant hand. Keep arms straight and push the chest down about two inches deep. Try to do at least 120 compressions in two minutes.<br \/><br \/>Bear in mind that chest compression is a tiring procedure. Therefore, it\u2019s good to have someone on standby to take over after two minutes.<br \/><br \/>Once the AED has arrived, stop the chest compressions, switch on the device and attach the pads on the patient\u2019s chest.<br \/><br \/>The basic life support procedure also includes \u201cAirway\u201d and \u201cBreathing\u201d techniques which de Silva said are best left to qualified paramedics.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3605f23 elementor-widget elementor-widget-spacer\" data-id=\"3605f23\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1fe7872 elementor-widget elementor-widget-text-editor\" data-id=\"1fe7872\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"color: #999999;\"><em>This article first appeared in <a href=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival.pdf\">Malay Mail, 22 March 2018<\/a><\/em><\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Would you know what to do if a loved one collapsed in front of you and showed no sign of life? If you find yourself in such a situation, it could mean the person\u2019s heart has stopped beating and that he\/she could be experiencing what doctors call sudden cardiac arrest (SCA). If you think that\u2019s bad news, that\u2019s only the half of it. Before you can fully absorb what\u2019s happening, you have to spring into action because you have only four minutes to save the person\u2019s life by performing cardiopulmonary resuscitation (CPR).<\/p>\n","protected":false},"author":2,"featured_media":35106,"template":"","topic":[95],"language":[137],"class_list":["post-35131","health-article","type-health-article","status-publish","has-post-thumbnail","hentry","topic-general","language-en"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Chain of Survival - Columbia Asia Hospital I Private Hospital in Malaysia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chain of Survival - Columbia Asia Hospital I Private Hospital in Malaysia\" \/>\n<meta property=\"og:description\" content=\"Would you know what to do if a loved one collapsed in front of you and showed no sign of life? If you find yourself in such a situation, it could mean the person\u2019s heart has stopped beating and that he\/she could be experiencing what doctors call sudden cardiac arrest (SCA). If you think that\u2019s bad news, that\u2019s only the half of it. Before you can fully absorb what\u2019s happening, you have to spring into action because you have only four minutes to save the person\u2019s life by performing cardiopulmonary resuscitation (CPR).\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/\" \/>\n<meta property=\"og:site_name\" content=\"Columbia Asia Hospital I Private Hospital in Malaysia\" \/>\n<meta property=\"article:modified_time\" content=\"2024-05-28T07:53:55+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-banner.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1100\" \/>\n\t<meta property=\"og:image:height\" content=\"300\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/\",\"url\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/\",\"name\":\"Chain of Survival - Columbia Asia Hospital I Private Hospital in Malaysia\",\"isPartOf\":{\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-banner.jpg\",\"datePublished\":\"2018-03-26T07:48:58+00:00\",\"dateModified\":\"2024-05-28T07:53:55+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/#primaryimage\",\"url\":\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-banner.jpg\",\"contentUrl\":\"https:\/\/www.columbiaasia.com\/malaysia\/wp-content\/uploads\/2024\/05\/health-articles-chain-of-survival-banner.jpg\",\"width\":1100,\"height\":300},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.columbiaasia.com\/malaysia\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Health Articles\",\"item\":\"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Chain of Survival\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.columbiaasia.com\/malaysia\/#website\",\"url\":\"https:\/\/www.columbiaasia.com\/malaysia\/\",\"name\":\"Columbia Asia Hospital I Private Hospital in Malaysia\",\"description\":\"Surpassing two decades of providing private healthcare in Malaysia, we continue to bring reliable &amp; affordable medical services through our 13 hospitals.\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.columbiaasia.com\/malaysia\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Chain of Survival - Columbia Asia Hospital I Private Hospital in Malaysia","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.columbiaasia.com\/malaysia\/health-articles\/chain-of-survival\/","og_locale":"en_US","og_type":"article","og_title":"Chain of Survival - Columbia Asia Hospital I Private Hospital in Malaysia","og_description":"Would you know what to do if a loved one collapsed in front of you and showed no sign of life? If you find yourself in such a situation, it could mean the person\u2019s heart has stopped beating and that he\/she could be experiencing what doctors call sudden cardiac arrest (SCA). If you think that\u2019s bad news, that\u2019s only the half of it. 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