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Steep terrain and adverse weather are common in mountainous environments. Under these conditions, relatively minor injuries may require evacuation. The evacuation technique chosen is determined by the type of injury, distance to be moved, terrain, and existing installations. Air evacuation is preferred; however, the weather, tactical situation, or operational ceiling of the aircraft may make this impossible. It is, therefore, imperative that all personnel are trained in mountain evacuation techniques and are self-sufficient. Casualties should be triaged before evacuation. Triage is performed by the most experienced medical personnel available (physician, physician's assistant, medic).

Performing a rescue operation can be a significant emotional event. Rescue scenarios must be practiced and rehearsed until rescue party members are proficient in the many tasks required to execute a rescue. To perform most of the high-angle rescues, Level I and Level II mountaineers are required with a Level III supervising.


The techniques of evacuation are proven techniques. They are, however, all subject to improvement and should be discarded or modified as better methods of handling victims are developed.

a. When evacuating a victim from mountainous areas keep in mind that the purpose of a rescue operation is to save a life, and physical risk to the rescuers must be weighed against this purpose. However, there is no excuse for failing to make the maximum effort within this limitation. Work and expense should be no deterrent when a life is at stake.

b. Rescues will be unplanned (improvised) or planned rescue operations. For a planned rescue, equipment that is especially suited and designed for rescue should be used. For training missions always have a medical plan developed before an emergency arises (plan for the worst and hope for the best). Ensure that the MEDEVAC plan is a comprehensive plan and must be thought out and understood by all that may be involved in a potential rescue.

c. The following actions will be done immediately at the rescue scene.

(1) Assume command. One person, and one person only, is overall in charge at all times.

(2) Prevent further injuries to the victim and to others. Use reasonable care in reaching the victim.

(3) Immediately ensure the victim has an open airway, resume victim's breathing, control serious bleeding, and maintain moderate body warmth. If the victim is unconscious, continually monitor pulse. Protect the patient from environmental hazards.

(4) Do not move the victim until you have ascertained the extent of injuries, unless it is necessary to prevent further injuries or the victim is located in a dangerous location (for example, avalanche run-out zone, hanging glacier, possibility of falling rocks).

(5) Do nothing more until you have thoroughly considered the situation. Resist the urge for action. Speed is less important than correct action.

(6) Decide whether to evacuate with available facilities or to send for help. Speed in getting to a hospital must be balanced against the probability of further injury if working with inexperienced people, lack of equipment or wrong equipment, and terrain at hand.

(7) When the evacuation route is long and arduous, a series of litter relay points or stations should be established. These stations must be staffed with the minimum medical personnel to provide proper emergency treatment. When a victim develops signs of shock or worsens while being evacuated, he should be treated and retained at one of these stations until his condition allows evacuation.

(8) Helicopters or heated vehicles, if available, should be used for evacuation. While the use of aircraft or vehicles is preferred and can expedite a rescue operation, evacuation of a seriously wounded soldier should never be delayed to await aircraft, vehicle, or a change in weather.


Every commander should have a medical evacuation plan before undertaking an operation. This plan should have contingencies included so as not to rely on a single asset.

a. When rescuing a casualty (victim) threatened by hostile action, environmental hazard, or any other immediate hazard, the rescuer should not take action without first determining the extent of the hazard and his ability to handle the situation. THE RESCUER MUST NOT BECOME A CASUALTY.

b. The rescue team leader must evaluate the situation and analyze the factors involved. This evaluation can be divided into three major steps:

  • Identify the task.

  • Evaluate the circumstances of the rescue.

  • Plan the action.

c. The task must be identified. In planning a rescue, the rescuer tries to obtain the following information:

  • Who, what, where, when, why, and how the situation happened.

  • Number of casualties by precedence (urgent, priority, routine, tactical immediate),

  • number of casualties by type (litter or ambulatory), and the nature of their injuries.

  • Terrain features and location of the casualties.

  • Tactical situation.

  • If adequate assistance is available to aid in security, rescue, treatment, and evacuation.

  • If treatment can be provided at the scene; if the victims require movement to a safer location.

  • Equipment required for the rescue operation.

d. Circumstances of the rescue are as follows:

(1) After identifying the task, relate it to the circumstances of the situation.

  • Are additional personnel, security, medical, or special rescue equipment needed?

  • Are there circumstances, such as aircraft accidents (mass casualties), that may require specialized skills?

  • What is the weather condition?

  • Is the terrain hazardous?

  • How much time is available?

(2) The time element may cause a rescuer to compromise planning stages or treatment (beyond first aid). Make a realistic estimate of time available as quickly as possible to determine the action time remaining. The key elements are the casualty's condition and environment.

(3) Mass casualties are to be expected on the modern battlefield. All problems or complexities of rescue are now multiplied by the number of casualties. Time becomes the critical element.

(4) Considerations for the main rescue group for a planned rescue are as follows:

(a) Carry all needed equipment, hot food and drinks, stove, sleeping bags, tents, bivouac sacks, warm clothes, ropes, and stretchers.

(b) Prepare the evacuation route (ground transport to hospital, walking trails, fixed lines, lowering lines, anchor points, and rescue belay points). If the victim is airlifted out, attach a paper with the medical actions that were performed on the ground (for example, blood pressure, pulse rate, drugs started, and so on).

(c) When performing all rescues, the rescuers are always tied in for safety. With all rescue techniques, remember to think things through logically for safety and to prevent the rescuer from accidentally untying himself or the fallen climber.

(d) Constantly inform the casualty (if they are conscious) as to what you are doing and what he must do.

e. The rescue plan should proceed as follows:

(1) In estimating time available, the casualties' ability to endure is of primary importance. Age and physical condition may vary. Time available is a balance of the endurance time of the casualty, the situation, and the personnel and equipment available.

(2) Consider altitude and visibility. Maximum use of secure, reliable trails or roads is essential.

(3) Ensure that blankets and rain gear are available. Even a mild rain can complicate a normally simple rescue. In high altitudes, extreme cold, or gusting winds, available time is drastically reduced.

(4) High altitudes and gusting winds reduce the ability of fixed-wing or rotary-wing aircraft to assist in operations. Rotary-wing aircraft may be available to remove casualties from cliffs or inaccessible sites, and to quickly transport casualties to a medical treatment facility. Relying on aircraft or specialized equipment is a poor substitute for careful planning.


When there are mass casualties, an orderly rescue may involve further planning.

a. To manage a mass casualty rescue or evacuation, separate stages are taken.

  • FIRST STAGE: Remove personnel who are not trapped among debris or who can be easily evacuated.

  • SECOND STAGE: Remove personnel who may be trapped by debris, but whose extraction only requires the equipment on hand and little time.

  • THIRD STAGE: Remove the remaining personnel who are trapped in extremely difficult or time-consuming situations, such as moving large amounts of debris or cutting through a wall.

  • FOURTH STAGE: Remove dead personnel.

b. Evacuation of wounded personnel is based on the victim's condition and is prioritized as follows:

  • PRIORITY ONE: Personnel with life-threatening injuries that require immediate emergency care to survive; first aid and stabilization are accomplished before evacuation.

  • PRIORITY TWO: Personnel with injuries that require medical care but speed of evacuation is not essential.

  • PRIORITY THREE: Injured personnel who can evacuate themselves with minimal assistance.

  • PRIORITY FOUR: The logistics removal of dead personnel.


Before receiving training in basic mountain evacuation, litter teams should receive instruction in military mountaineering and basic first aid. Litter bearers and medics must know the use and care of rope as an item of equipment. The members of litter teams must be proficient in the techniques of belaying and choosing belay points. Proper support and protection must be given to victims and litter bearers when evacuating over steep, difficult terrain.


Although the wounded soldier's life may have been saved by applying first aid, it can be lost through carelessness, rough handling, or inadequate protection from the elements. Therefore, before trying to move the wounded soldier, the type and extent of his injury must be evaluated. Dressings over wounds must be reinforced, and fractured bones must be properly immobilized and supported. Based upon the evaluation of the type and extent of the soldier's injury, the best method of manual transportation is selected.


Personnel who are not seriously injured but cannot evacuate themselves may be assisted by fellow soldiers. Personnel who are injured and require prompt evacuation should not be forced to wait for mobile evacuation or special equipment.

a. One-Man Carries. The basic carries taught in the Soldier's Manual of Common Tasks (fireman's carry, two-hand, four-hand, saddleback, piggyback, pistol belt, and poncho litter) are viable means of transporting injured personnel; however, the mountainous terrain lends itself to several other techniques. One-man carries include the sling-rope carry and the rope coil carry.

(1) Sling-Rope Carry. The sling-rope carry (Figure 11-1) requires a 4.5-meter sling rope and two men—one as the bearer and the other as an assistant to help secure the casualty to the bearer's back. Conscious or unconscious casualties may be transported this way.

(a) The bearer kneels on all fours.

(b) The assistant places the casualty face down on the bearer's back ensuring the casualty's armpits are even with the bearer's shoulders.

(c) The assistant then finds the middle of the sling rope and places it between the casualty's shoulders.

(d) The assistant runs the ends of the sling rope under the casualty's armpits, crosses the ends, and runs the ends over the bearer's shoulders and back under the bearer's arms.

(e) The assistant runs the ends of the rope between the casualty's legs, around the casualty's thighs, and back around to the front of the bearer. The rope is tied with a square knot with two overhand knots just above the bearer's belt buckle.

(f) The rope must be tight. Padding, when available, should be placed where the rope passes over the bearer's shoulders and under the casualty's thighs.

Figure 11-1. Sling-rope carry.

Figure 11-1. Sling-rope carry.

(2) Rope Coil Carry. The rope coil carry requires a bearer and a 36 1/2-meter coiled rope. It can be used to transport a conscious or unconscious victim.

(a) Place the casualty on his back.

(b) Separate the loops on one end of the coil, forming two almost equal groups.

(c) Slide one group of loops over the casualty's left leg and the other group over the right leg. The wraps holding the coil should be in the casualty's crotch with the loops on the other end of the coil extending upward toward the armpits.

(d) The bearer lies on his back between the casualty's legs and slides his arms through the loops. He then moves forward until the coil is extended.

(e) Grasping the casualty's arm, the bearer rolls over (toward the casualty's uninjured side), pulling the casualty onto his back.

(f) Holding the casualty's wrists, the bearer carefully stands, using his legs to lift up and keeping his back as straight as possible.

(g) A sling rope around both the casualty and bearer, tied with a joining knot at chest level, aids in keeping an unconscious victim upright. This also prevents the coils from slipping off the carrier's chest.


The length of the coils on the rope coil and the height of the bearer must be considered. If the coils are too long and the bearer is shorter, the rope must be uncoiled and recoiled with smaller coils. If this is not done, the casualty will hang too low on the bearer's back and make it a cumbersome evacuation. A sling-rope harness can be used around the victim's back and bearer's chest, which frees the bearer's hands.

b. Buddy Rappel. The carrier can also conduct a seat-hip rappel with a victim secured to his back. In this case, the rappeller faces the cliff and assumes a modified L-shape body position to compensate for the weight of the victim on his back. The victim is top-rope belayed from above, which provides the victim with a point of attachment to a secured rope. The methods for securing a victim to a rappeller's back are described below.

(1) To secure the victim to the carrier's back with a rope, the carrier ties a standard rappel seat (brake hand of choice, depending on the injury) and rests his hands on his knees while the victim straddles his back.

(2) A 4.2-meter sling rope is used. A 45-centimeter tail of the sling is placed on the victim's left hip. (This method describes the procedure for a seat-hip rappel with right-hand brake.)

(3) The remaining long end of the sling rope is routed under the victim's buttocks, and passed over the victim's and carrier's right hip. The rope is run diagonally, from right to left, across the carrier's chest, over his left shoulder, and back under the victim's left armpit.

(4) The rope is then run horizontally, from left to right, across the victim's back. The rope is passed under the victim's right armpit and over the carrier's right shoulder.

(5) The rope is run diagonally, from right to left, across the carrier's chest and back across the carrier's and victim's left hip.

(6) The two rope ends should now meet. The two ends are tied together with a square knot and overhand knots.

(7) The knot is positioned on the victim's left hip. The carrier's shoulders may need to be padded to prevent cutting by the rope.

(8) An alternate method is to use two pistol belts hooked together and draped over the carrier's shoulders. The victim straddles the carrier, and the belay man secures the loose ends of the pistol belts under the victim's buttocks. Slack in the pistol belt sling should be avoided, since the carrier is most comfortable when the victim rests high on his back (see FM 8-35).

(9) A large rucksack can be slit on the sides near the bottom so that the victim can step into it. The victim is belayed from the top with the carrier conducting a standard rappel. The carrier wears the rucksack with the victim inside.

(10) A casualty secured to a carrier, as described above, can be rappelled down a steep cliff using a seat-shoulder or seat-hip rappel. The casualty's and rappeller's shoulders should be padded where the sling rope and rappel lines cross if a seat-shoulder rappel is used. The buddy team should be belayed from above with a bowline tied around the victim's chest under his armpits. The belay rope must run over the rappeller's guide hand shoulder.


Many types of litters are available for evacuating casualties in rough mountain terrain. Casualties may be secured to litters in many different ways, depending on the terrain, nature of injuries, and equipment available. All casualties must be secured. This should be done under medical supervision after stabilization. It is also important to render psychological support to any victim awaiting evacuation.

If the litter must be carried, belayed, and then carried again, a sling rope should be wound around the litter end and tied off in a l-meter-long loop. This enables the carriers to hook and unhook the litter from the belay. Slings are available to aid the soldiers with litter carrying. Utility rope or webbing 6 meters long may be used. The rope is folded in half, and the loose ends are tied together with an overhand knot. These slings are attached to the litter rails (two or three to a side, depending on the number of litter bearers) by a girth hitch, and then routed up along the handling arm, over the shoulder, behind the neck, and then down along the other arm. The knot can be adjusted to help the outside arm grip the webbing. These slings help distribute the load more evenly, which is important if a great distance must be traveled.

a. Manufactured Litters. The following litters are readily available to mountaineering units.

(1) The poleless, nonrigid litter (NSN 6530-00-783-7510) is best issued for company medics since it is lightweight, easy to carry, and readily available. Casualties should be secured with the chest strap and pelvic straps, which are sewn on one side. This litter may be used when rappelling, on traverse lines, and on hauling lines in the vertical or horizontal position. It can be improvised with poles.

(2) The poleless semi-rigid litter (NSN 6530-00-783-7600) may be used the same as the nonrigid litter. It offers more victim protection and back support because of the wooden slats sewn into it.

(3) The mountain basket-type rigid litter (NSN 6530-00-181-7767) is best suited for areas where several casualties are to be transported. All other litters may be placed inside this litter basket and transported across traverse lines. This litter is rectangular and has no vertical leg divider so that it will accommodate other litters. It is also known as a modified Stokes litter.

(4) The Stokes metal litter (NSN 6530-00-042-8131) is suited for situations as above; however, the casualty must be moved in and out of the litter since no other litter will fit inside it. Some Stokes litter frames have a central weld on the frame end, which is a potential breaking point. Winding the rope around the frame end will distribute the force over a wider area and stabilize the system. (See FM 8-10-6 or USAF TO 00-75-5 for additional information on the Stokes litter.)

(5) The standard collapsible litter (NSN 6530-00-783-7905) (rigid pole folding litter) is most readily available in all units and, although heavy and unsuited to forward deployment, may be rigged for movement over rough or mountainous terrain. The folding aluminum litter (NSN 6530-00-783-7205) is a compact version of the pole litter and is better suited for forward deployment.

(6) The UT 2000 is manufactured in Austria and is specifically designed for mountaineering operations. The litter consists of two parts that join together to form a rigid litter. Each part has shoulder and waist straps that can be used to man-pack the litter making it extremely light and portable. When joined together the shoulder and waist straps are used to secure the casualty to the litter. Strapping is also provided to make a secure hoist point for aircraft extraction and high-angle rescues. Wheel sets are another accessory to the UT 2000 litter (either two wheels or one); they attach to the litter for use during a low-angle rescue.

(7) The patient rescue and recovery system (NSN 6530-01-260-1222) provides excellent patient support and protection (Figure 11-2). However, it is not a spinal immobilization device. A backboard must be used with this system for patients who have injuries to the shoulder area. This system will accommodate long and short backboards, scoop stretchers, and most other immobilization equipment.

Figure 11-2. Rescue and recovery system (NSN 6530-01-260-1222).

Figure 11-2. Rescue and recovery system (NSN 6530-01-260-1222).

b. Field-Expedient Litters. A litter can be improvised from many different things. Most flat-surface objects of suitable size can be used as litters. Such objects include boards, doors, window shutters, benches, ladders, cots, and poles. Some may need to be tied together to obtain the required size. If possible, these objects should be padded.

(1) Litters can also be made by securing poles inside blankets, ponchos, shelter halves, tarpaulin, jackets, shirts, sacks, bags, or mattress covers. Poles can be improvised from strong branches, tent supports, skis, and other similar items.

(2) If poles cannot be found, a large item, such as a blanket, can be rolled from both sides toward the center. Then the rolls can be used to obtain a firm grip to carry the victim. If a poncho is used, the hood must be up and under the victim, not dragging on the ground.

(3) A rope litter is prepared using one rope (Figure 11-3). It requires 20 to 30 minutes to prepare and should be used only when other materials are not available. Four to six bearers are required to carry the litter. The rope litter is the most commonly used field-expedient litter.


Above the tree line, little material exists to construct litters.

Figure 11-3. Rope litter.

Figure 11-3. Rope litter.

(a) Make 24 bights about 45 to 61 centimeters long, starting in the middle of the rope so that two people can work on the litter at one time.

(b) With the remainder of the rope, make a clove hitch over each bight. Each clove hitch should be about 15 centimeters from the closed end of the bight when the litter is complete.

(c) Pass the remainder of the rope through the bights outside of the clove hitches. Dress the clove hitches down toward the closed end of the bight to secure the litter and tie off the ends of the rope with clove hitches.

(d) Line the litter with padding such as clothing, sleeping bags, empty boxes.

(e) Make the rope litter more stable by making it about 6 inches wider. After placing the clove hitches over the bights, slide them in (away from the closed end) about 15 centimeters. Take two 3- to 4-meter poles, 8 centimeters in diameter at the butt ends, and slide each pole down through the bights on each side. Dress down the clove hitches against the poles. Take two 1-meter poles, and tie them off across the head and foot of the litter with the remaining tails of the climbing rope.


The above measurements may have to be altered to suit the overall length of rope available.


Rescue systems are indispensable when conducting rescue operations. A large number of soldiers will not always be available to help with a rescue. Using a mechanical advantage rescue system allows a minimal amount of rescuers to perform tasks that would take a larger number of people without it.

a. Belay Assist. This system is used to bring a climber over a section that he is unable to climb, but will continue climbing once he is past the difficult section.

(1) First, tie off the following climber at the belay with a mule knot.

(2) Tie a Prusik knot with short Prusik cord about 12 inches below the mule knot, and place a carabiner into the loop. Place the tail from the mule knot into the carabiner in the Prusik cord.

(3) Untie the mule knot without letting the following climber descend any more than necessary. Do not remove the belay.

(4) Maintain control of the brake side of the rope and pull all of the slack through the carabiner in the Prusik cord.

(5) Pull up on the rope. The rope will automatically feed through the belay.

(6) If the leader has to pull for a distance he can tie another mule knot at the belay to secure the second climber before sliding the Prusik down to get more pulling distance.

(7) After the climber can continue climbing, the leader secures the belay with a mule knot.

(8) Remove the Prusik cord and carabiner, then untie the mule knot and continue belaying normally.

Notes: With all rescue techniques make sure that you always think everything through, and double check all systems to ensure that you don't accidentally untie the fallen climber or find yourself without back-up safety. Do not compound the problem! When doing any rescue work the rescuers will always be tied in for safety.

b. Belay Escape. The belay escape is used when a climber has taken a serious fall and cannot continue. The belayer is anchored and is performing an indirect belay, and must assist the injured climber or go for assistance. To accomplish this he must escape the belay system. The belayer will remain secured to an anchor at all times.

(1) After a climber has been injured, tie off the belay device on your body using a mule knot. To improve this system, clip a nonlocking carabiner through the loop in the overhand knot and clip it over the rope.

(2) Attach a short Prusik cord to the load rope and secure it to the anchor with a releasable knot.

(3) Using a guard knot or Munter mule, attach the climbing rope from the belay device.

(4) Untie the mule knot in the belay device attached to the harness and slowly lower the climber, transferring the weight of the climber onto the Prusik.

(5) Remove the climbing rope from the belay device attached to the harness.

(6) Release the mule knot securing the Prusik, transferring the weight to the anchor.

(7) At this point the climber is secured by the rope to the anchor system and the belayer can now assist the injured climber.


Cliffs and ridges, which must be surmounted, are often encountered along the evacuation path. Raising operations place a greater load on all elements of the system than do lowering operations. Since all means of raising a victim (pulley systems, hand winches, and power winches) depend on mechanical advantage, it becomes easy to overstress and break anchors and hand ropes. Using mechanical raising systems tends to reduce the soldier's sensitivity to the size of the load. It becomes important to monitor the system and to understand the forces involved.

a. Raising Systems, Belays, and Backup Safeties. Raising systems, belays, and backup safeties are of special importance in any raising operation. The primary raising system used is the Z-pulley system, which theoretically gives three pounds of lift for each pound of force expended. In practice, these numbers decrease due to rope-pulley friction, rope-edge friction, and other variables. A separate belay rope is attached to the litter and belayed from a separate anchor. Backup Prusik safeties should be installed in case any part of the pulley system fails.

(1) Raising System. When considering a raising system for evacuations, the Z-pulley system is the most adaptable. It can be rigged with the equipment on hand, and can be modified and augmented to handle heavier loads. Although the vertical or horizontal hauling lines can also be used, the Z-pulley system offers a mechanical advantage that requires less exertion by the transport team.

(2) Belays. Whenever ropes are used for an evacuation operation, the overriding safety concern is damage to the ropes. This is the main reason for two-rope raising systems (raising rope and belay rope).

(3) Backup Safeties. Because the stresses generated by the Z-pulley system can cause anchors to fail, backup safety Prusiks are used to safeguard the system. These should be attached to alternate anchor points, if possible.

b. Raising the Litter. The litter is prepared as already described.

(1) The raising ropes and belay ropes are secured to top anchors and are thrown down to the litter crew.

(2) Padding is placed at the cliff edge and over any protrusions to protect the ropes from abrasion.

(3) The litter attendants secure the ropes to the litter.

(4) The raising crew sets up the Z-pulley system.

(5) One member of the crew secures himself to an anchor and moves to the edge of the cliff to transmit signals and directions. (This is the signalman or relay man.)


If the load is too heavy at this time, another pulley is added to the system to increase the mechanical advantage.

(6) Attendants guide the litter around obstacles while the crew continues to raise the system.

(7) As the litter nears the cliff edge, the signalman assists the attendant in moving the litter over the edge and onto the loading platform, taking care not to jar the casualty.

c. Descending Slopes. When descending a moderately steep slope that can be down-climbed, the litter and victim are prepared as described earlier (Figure 11-4).

(1) One man serves as the belay man and another takes his position on the rope in front of the belay man, assisting him in lowering the litter. The litter bearers take their positions and move the litter down with the speed of descent controlled by the belay man.

Figure 11-4. Low-angle evacuation—descending.

Figure 11-4. Low-angle evacuation—descending.

(2) The extra man may assist with the litter or precede the team to select a trail, clearing away shrubs and vines. He reconnoiters so that the team need not retrace its steps if a cliff is encountered.

(3) The most direct, practical passage should be taken utilizing available natural anchors as belay positions.


Evacuation down cliffs should be used only when absolutely necessary and only by experienced personnel. The cliffs with the smoothest faces are chosen for the route. Site selection should have the following features: suitable anchor points, good loading and unloading platforms, clearance for the casualty along the route, and anchor points for the A-frame, if used. There are many ways to lower a casualty down a steep slope. As long as safety principals are followed, many different techniques can be used. One of the easiest and safest techniques is as follows (Figure 11-5):

a. Use multiple anchors for the litter and litter tenders.

b. Secure the litter to the lowering rope with a minimum of four tie-in points (one at each corner of the litter). Lengths of sling rope or 7-millimeter cordage work best. Make the attached ropes adjustable with Prussik knots so that each corner of the litter can be raised or lowered to keep the litter stable during descent. Tie the top of the ropes with loops and attach to the lowering rope with a pear shaped locking carabiner.

c. Two litter tenders will descend with the litter to control the descent and to monitor the casualty. They can be attached to separate anchors and either self-belay themselves or be lowered by belayers.

d. Once the steep slope has been negotiated, continue the rescue with a low-angle evacuation.

Figure 11-5. Cliff evacuation descent.

Figure 11-5. Cliff evacuation descent.

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