Transcription
Matt: I don’t have anything. No, I don’t have anywhere to… I’ll just swallow it.
Devin: Do not swallow it.
Matt: Too late.
Devin: That’s gross.
Erik: Gross? Why is that gross to you, Devin?
Devin: It’s gonna sit there forever.
Erik: No, it’s not.
The whole thing about…
Matt: Seven years!
Erik: No, that’s an old wives tale.
Matt: Is it? That’s not true?
Erik: No, no, it’s not true at all. Oh, there we go. You’ll pass that. It’s not a problem. If you want to dig through your poop, you can find your, your, your gum. Even if a patient swallows a safety pin or something, you’ll pass that. Yeah. Or a quarter.
Matt: Well, that’s what you tell parents when you go on the kid.
My kid swallowed a penny. He’ll poop it out in a week.
Erik: Now you’d be a little more sensitive because the parents are spending a lot of money bringing their kid in.
Matt: Well, no, I just tell them pre hospital that. Yeah. Your kid doesn’t need to go to the emergency room. They’ll poop it out in a week.
Erik: Well, one of the reasons we do it, though, is we want to make sure that it’s not…
Matt: A battery.
Erik: Well, it’s not a battery, and it’s not in the trachea. Would be nice to see that penny below the diaphragm. Correct. In the stomach. Yes. Yeah. Anyway. Fun facts. But as far as gum goes, the… You’re gonna poop it out. Swallow your gum. It’s gonna come out with everything else. It’s not like you got this, like, this gum compartment in your stomach that holds the gum for seven years or whatever.
Matt: Maybe it’s the gum compartment.
Erik: Yeah. Well, the, so, well, we, we do on Ace talk a lot about the medicine of yesteryear. Yeah. You know. Vitality. I can’t, I mean, they treat STDs, venereal diseases, with, with saltpeter.
Saltpeter. Saltpeter. Component of. Of gunpowder. That’s how they treat, you know.
Matt: Treated. Treated.
Erik: Yeah, past tense. Yes, or sore throats in kids. What are these? The gargled kerosene? Can you imagine?
Matt: When in syncable turpentine, it’s turpentine. You pour hot cold, ice cold water on their face?
Erik: Yeah, and how do they, how do, there was the other one Oh yeah, GI bleeding, they, they would inject chicken broth in your rectum.
I mean, these are the ways that we used to treat people a hundred years ago.
Matt: Well, but this is crazy, you just said a statistic. That the mod, the emergency room, the first emergency department was when?
Erik: Well, the emergency room has existed a long time. A long time. It was it was, because emergencies have always happened. It’s not like emergencies only happen when they built the ER, you know that. Right, right. So, so, historically the way that they used to have an emergency room was literally a room in the hospital for emergencies. Right. And it would be staffed by a resident. An intern. These are two different low level physicians who would kind of run things.
And then they would be overseen by a duty physician in the hospital, maybe from home. It could be a psychiatrist or a pathologist or a radiologist. Just a physician who would oversee the intern and the resident. Now, the models may vary a little bit depending upon where the hospital was, but this was in, you know, pre 1960, this is the way that hospitals ran their ERs.
It was literally a room dedicated to emergencies. That’s where the word emergency room came from. And then in 1961, I think his name was Dr. Stills started the first ER with four physicians in Alexandria, Virginia. That was the first er.
Matt: That’s crazy to think that the first ER was just a little over 50 years ago.
Yeah. That’s crazy.
Erik: It’s changed a lot now. Yeah. Fast forward to today. Our healthcare system has exploded and, and our largest, the largest gross domestic product in our country is our healthcare. And half of the care that we deliver, half of the medical care delivered in our system is in the er. Yeah.
ER’s huge. That’s enormous.
Matt: And since COVID, it has gotten even more huger. Yes. It’s crazy.
Erik: And I think, I think what COVID did is they illuminated the significance of pre hospital medicine really. Because to me, the, one of the problems with the perspective most people have of medicine is that it starts with the doctor in the ER.
It starts with the doctor’s office in the clinic and maybe they get transferred to the hospital to get admitted. You go to the hospital to see the surgeon to get a surgery done or right. There’s a lot of different ways you can engage the healthcare system. But half of the ER is delivered from, oh excuse half of half of he care.
Half of healthcare, yeah. Is delivered from the er. Yeah, ER care. And a large portion of the ER patients. And actually the majority of the patients who get admitted to the healthcare system come from. The pre hospital environment come from an ambulance, whether it’s a fire department with a med unit or a private ambulance company or, yeah, right, exactly.
So, the the significance of the pre hospital environment was really highlighted by COVID. People realized during COVID how important the pre hospital environment is to care.
Matt: Which, like we talked about, used to be… The pre hospital, the ambulances were run by the morticians. The funeral homes of the area.
Yeah, because basically that’s all they were doing was taking transporting dead bodies in the hearse. Yes, exactly. And then they kind of went to ambulance drivers and we still have some of those today that they just kind of go.
Erik: Yeah, give
Matt: them a dose of diesel and don’t actually do anything. But it’s evolved.
Erik: Let’s park back there for just a moment. Yeah. On the way that it used to be. Because that’s really all it was, was a transport service. Yeah,
Matt: you were literally just an ambulance driver. That’s right. Somebody riding in the back with you, but they weren’t really doing any care.
Erik: And over time, we’ve added medications, we’ve improved the technology on the ambulance itself.
And now we’re coordinating with hospitals for amputation teams and ECMO teams. We have really come a long way. When
Matt: I went to paramedic school, what, 18, 19 years ago? Yeah. We didn’t activate code STEMIs. We didn’t activate code strokes. Mm hmm. We certainly didn’t do anything sepsis. Mm hmm. 15 years ago, you know.
We didn’t do any of that when I went to paramedic school. RSI There were some departments that had it. It was certainly out there pre hospitally. Super controversial, and it still kind of is. But it’s a lot more, we didn’t have paralytics and those kind of things when I went to paramedic school, we didn’t do any of that.
You only intubated dead people.
Erik: Well, I’m going to tick some medical directors off by saying this, but as a medical director, we need to be more progressive. Because the pre hospital environment is changing, and we need to train up our pre hospital environment. Whether you’re a paramedic or an EMT, we’ve got to maximize.
the care they can deliver. Because what we’re seeing right now is the tremendous impact that the pre hospital environment can have. On the continuum of care of a patient. Yeah. One minute saved in stroke care is seven and a half miles of nerve fibers in the brain.
Matt: Yeah, it’s just like traumas and heart attacks.
This morning,
Erik: we were meeting with a cardiologist and what did he
Matt: say? Yeah, he said that time is muscle. That’s right. And the quicker you start perfusing that muscle, the quicker you get them to the appropriate facility. And that’s all based on identification. If you identify that this patient’s having a STEMI, you take them to the appropriate care, you activate early enough.
You’re literally saving that muscle.
Erik: Can you remember that quote you read to me today? That kind of inspired some of what we’re talking about today. It was a quote you read about comparing like what’s better. You know what, I think I have
Matt: it right here. Yeah, it was a quote on an article and basically a guy who was looking into basically what was better was which one’s better, fire based EMS or private EMS and he asked a local private EMS provider.
What he thought was better, and he said, was it I posed the question, fire or private? Which is superior delivery system? And his answer was so simple, yet so obvious, that it made questions seem superfluous. It doesn’t matter. He said that any EMS system can only be measured one provider at a time. In the end, the delivery system is nothing more than a means of transportation.
It is the commitment. And dedication of the individual provider that matters. If the provider doesn’t want to be there, it doesn’t matter what the patch says on their arm, the patient suffers either way. And you said doctors, that’s same with some doctors can be that way.
Erik: I think it’s probably in any field you have some people who really care about their job, and some people who just maybe have a bad attitude.
Life is tough sometimes, and people have bad days, or maybe they’re at the end of their career, and they don’t care anymore.
Matt: Well, and like you said, you might take some medical directors off, I’ll probably make some firefighters mad by saying this, that, you know, a lot of times fire, there’s people that get into the fire service, and they think that it’s gonna be rescue me, and back draft, and Chicago fire, and every call’s gonna be bunker gear, and kicking in doors, and doing all the cool stuff.
And. The reality is those calls have decreased, you know, the advancers in fire science have gotten much safer. But our protocols and the amount of things that they’re requiring paramedics to do has become more and more complicated. And so, in my mind, I think it needs to be even. I’m not trying to negate the importance of being an effective firefighter, rescue, whatever, but you need to be just as capable as a paramedic because at the end of the day, like we’ve talked about, What’s it matter if you pull, let’s say a fireman, what’s it matter if you pull that fireman that was involved in a mayday, a structural collapse, or had a cardiac event while fighting a fire, most common leading cause of death in firefighters, right?
And you pull that guy out of a building and then you hand him off to two sub paramedics that don’t know what to do and they just want to give him a dose of diesel and that guy either suffers major damage or maybe doesn’t make it because of it. We have a firefighter in my department. that suffered a significant cardiac event while on duty.
And had he not had people there that were capable and knew exactly what to do, he probably would not have survived that. And as a direct result of paramedics being capable paramedics. And that’s why we do what we do at ACE is we want to make, I mean, that is why you and I think are so much on the same page.
We’re so passionate. You from the medical director standpoint of improving our knowledge of things and me from the provider, pre hospital provider standpoint of, of letting people know how important this is and can directly, this isn’t a joke, you can directly impact whether a patient lives or dies. I like
Erik: this morning with our interview with the cardiologist, we talked about the chain, we’re all links in this chain.
And we’re all providing care. We’re all, it’s all about patient care, right? Yes. So the patient will call dispatch and will enter the pre hospital environment to get to the ER or to definitive care. Yeah. Any delay in that, that process or that link, any, any link they’re not performing to their optimum capacity.
Yeah. Is hurting patients. Yep. And, and I think that. And, and again, to be positive, that’s what our mission statement is, is to improve the care we deliver, improving the health of our communities, saving minutes in transport time is huge. When you imagine it being your wife or, or your, your parents or your kids or whoever it might be, your neighbor we, we, we are imagining our family members being treated.
And by optimizing pre hospital care, we save lives, right? So, you’re right, that’s really what it’s all about. And, and the ER care has changed a lot, like we talked about, and Dr. Mills, in 1961, in Alexandria, Virginia, with four other doctors. That’s, that was the birthplace of emergency medicine. That’s crazy.
Some people, some people in Ohio might be getting angry with me right now, but, but that’s a different issue. But the point is, back in the 60s it was born and it was pretty, pretty, you know, prehistoric back then, right? Yeah. And then through the different, like in Afghanistan we learned a ton with, with Pre hospital care.
Pre hospital care. Trauma care. So we’ve learned a lot in the ER, but the same thing is true, and I would actually argue that in the pre hospital environment I think we’re a little more up to date.
Matt: Well, I know, like, trauma wise, like, the military, they’re the experts on trauma. Like, we get… Like, when I started, we didn’t have tourniquets.
It was a no no to put a tourniquet on anybody. You didn’t do that. And then Afghanistan, that, you know, the war came up. The
Erik: Boston bombing. Boston bombing. We learned from these things, yeah.
Matt: Military teaches us a lot, and now pre hospital, I know, like… One of the things we’ve talked about, Entitle. Yeah. Like, pre hospitally, at least in my system, and in the Dallas Fort Worth area, I mean, we use Entitle for a lot of things.
And I’ve even brought up Entitle as far as a diagnostic tool with sepsis, and I’ve been looked at like I’m crazy from an ER physician. Yeah, I know. Like, you know, but I know that we’re, it’s just not used that much.
Erik: Well, I think in the ER world, we rely a lot on some other tests that you don’t have access to.
True. So, a lactic acid… would correlate with an end title of less than, I think it was 25. An elevated lactic acid might be the metric that an ER doctor would use. And you can get a point of care lactic acid pretty quick, but nothing’s faster than getting an end title.
Matt: Well, and when you get that information, it’s just like you said, it’s that link in the chain.
When I’m communicating, that’s another… Criteria we can use, you know, like, Hey, they’re in titles 19 and it hasn’t gone up and they’re showing the blood sugars. Hi. Yeah. I’ll be DK. Exactly.
Erik: Yeah. You don’t need to wait for the labs to come back.
Matt: Yeah. If it’s just start treating. Yeah, exactly. Exactly. Yeah.
It’s really interesting to see how much it’s evolved and And it’s amazing to me, I mean, you went to school for a long time to be a physician. Way too long.
Erik: Way too long. Big waste of time. Okay. I’m kidding. No.
Matt: He said it, I didn’t know. But I mean, like, my
Erik: paramedic class was I sacrificed, I sacrificed a decade of my life to train for that job.
Matt: My paramedic, the classroom portion was not even four months. Not even four months. And then you have clinicals, hospital rotations, and then you’re, you know, your ride out’s on an ambulance. And then, you know, I’m RSI ing people and criking people and, you know, finger core costumies. I mean, dude, it’s amazing to me the things that we’re allowed to do.
Totally different than, like, my nursing background.
Erik: Well, you know, and I’ll, you know, you’re giving yourself you’re beating yourself down a little bit. You’re so much more capable than the way you’re making it sound.
Matt: I’m just saying from the standpoint of… The amount of education, yeah, training that we get compared to a physician.
Erik: Well, let me, I mean, a lot of our training and, and listen, I love my training where I trained. I think it’s the best medical school around in my residency program. I really think that we train ER doctors better than anybody. Yeah. I really believe that. But in training, you’d initially It’s like, you don’t know what you’re going to become.
So, and we’ll talk, maybe we’ll do a podcast on this some other time, but you’re kind of drinking from a fire hose, getting everything. And so as an ER doctor, I probably didn’t need a lot of the biochemistry and a lot of the pathology or pathology is pretty important, but we learn a lot of things we never use in medicine.
Matt: That’s the one thing I love about paramedic school is it is down and dirty. Look, for the most part, down and dirty look. You don’t need to know all the biology of why this is happening. I mean, they get into a little bit of it, but it is down and dirty. This is what you need to know. This is what you need to look for.
Erik: And we are, we do focus on that at ACE. We try to make what we teach something that’s practical. But I, I do like to geek out a little bit because I think there’s value. Yeah. In, in understanding why things happen a certain way. For sure. And, and that’s cool. Cause like when you’re reading a book, you’re not thinking about your kindergarten teacher teaching you the alphabet.
Right. But that was really instrumental in you knowing how to read a book, right? For sure. So there are some foundational things that are really good to know that you learn in your training. Yeah. But then there are cool things that we do. And in the pre hospital environment, medications we use, where I like to answer the why.
Why does that, why does magnesium relax smooth muscle? Well, obviously that’s going to help with this, but why does it stop seizures? It’s really interesting, when pregnant women, you know, it clamps you. So there’s a whole lot of really cool stuff to learn.
Matt: But that’s what I tell, like, the students is, Before I went to paramedic school, And I was told this, and I have told several people this.
I went to the other paramedics, I was at EMT. I went to the paramedics I worked with, and I was like, Hey, what do I need to be studying, what do I need to, and they said, Ball, just go to school, pass the test, come out, and we’ll show you how to be a paramedic. Because there really is a difference between, I’ve had valedictorians of paramedic school come out and not do well in the field.
Because there’s a disconnect there. And… There really is some truth to that, because a lot of it is dealing with people and reading body language. But then you learn that that book knowledge is super important. That short amount of time that you spend in school, it’s super important to understand that stuff.
Because then as you come out and you’re in the field and you’re trying to apply it to patients, if you continue to study and learn, it will all start coming together. You know, and the, the human side compared with the school side compared with the practical side will all start to tie in and that’s where experience comes in, you know, which is.
Erik: In my opinion, the best teacher experience, I think is the best teacher. I think that, you know, you learn a lot in your training with books, right? That’s important foundational knowledge. And, and I’ll say on a side note, if you’re, if you’re in school and you’re, you are studying books, listening to this podcast right now, it’s those books aren’t going to teach you enough.
If you’ve really got to be assertive and get stuff out of your training, ask questions, you know, maximize every little bit of information you can from every, every. Part of your training, and then when you get out there, you can apply more and learn, like you said, from the experiences. That’s, that’s the key.
I learned so much more in residency than I did from books.
Matt: Yeah. And you know, what’s funny is like, we have a big problem with, you know, when I got done with paramedic school is 10 shifts. So I had 10, 24 hour shifts that I had. To be checked off or be whatever. Okay, you’re good to go as a paramedic now.
The clinical portion? Well, no, I’m saying like, I did the 24 hours, or excuse me, I did the 240 hours on an ambulance as part of my school requirement. Oh, yeah, yeah, yeah. But then once I finished with my department, I had to ride for 10 more shifts to our medical director to say, Okay, you know, I got my national registry, okay, you’re checked off by the state and whatever.
But now the medical director… Is going to make sure, but we didn’t do mega codes back then. It was just kind of like you went through and okay, you did your time. You’re good to go. We use the same standard now. It’s 10 shifts. And it’s like these kids nowadays, the amount of stuff that they’re
Erik: What if your department’s not busy?
10 shifts may not get you near as much as you would.
Matt: Exactly. If you’re not running enough calls, and so every department’s different. Some, some departments say you have to run a minimum number of calls. My department, we have shifts, we base off of shifts, but a lot of people that maybe got into the fire service like I did 20 years ago or whatever, they’re like, well, I don’t understand, this guy can’t be checked off in 10 shifts.
Dude, what we were learning 20 years ago compared to what they’re learning now, it’s completely, not necessarily different, they’re learning so much more. So much
Erik: more stuff. Well, medicine’s dynamic. It’s changing all the time. If you’re practicing medicine like it was practiced 20 years ago, You’re a little behind.
You’re way behind. We’re doing things now that… We know some providers
Matt: like that. A little archaic.
Erik: You know, you got to stay up to date and that’s another thing that we try to do here is to stay up to date with ACE. You know, if we’re going to follow the CAP CE guidelines, we’ve got to update our, our content every three years.
Even three years, things could change a lot.
Matt: Absolutely. Look at COVID. We’re just three years out from COVID and the whole world has changed. And we talked about that, the busyness, our call volume, your volume in the ER has like, what doubled, would you say? Yeah.
Erik: Yeah. Yeah. Yeah. We normally was a busy day.
Pre COVID, you know, maybe five, six years ago. Yeah. Is the average now and we are breaking records right and left. Yeah. So, so there, there is definitely something about. COVID, something, something happened. Now it’s, it’s not just the change in COVID. There’s also some staffing stuff that’s going on.
Yep. A lot of, a lot of doctors are leaving medicine.
Matt: Yep. Nurses are too. Lots of nurses. Yeah.
Erik: And there’s, there’s a staffing issues.
Matt: And then you even, I mean, lots of paramedics, you know, the paramedic is a tough position because really the highest pay you’re going to get as a paramedic is fire based.
Because you’re going to be a firefighter paramedic, that’s going to be by far higher salary base than private EMS, even flight. I was amazed because I mean, you and I know flight medics are very, very capable providers, super smart, very, very capable. And their compensation is not at par with what their skilled level is, not even close.
And like private ambulance, I mean, it’s because it’s a for profit company. I mean, it’s almost laughable what… These people get compensated for what they’re asked to do.
Erik: I’ve been a medical director in all these environments. Yes. And I think one, to answer the question in the quote you read earlier it, I, I love it.
It doesn’t really matter. Yeah. And what’s better. Yep.
Matt: Right? Yeah, it doesn’t matter if it’s private, it’s about who is doing
Erik: it. Right, and how seriously they take their job. Yep. And, and I think to get back to the, the progression and the evolution of the emergency room and the pre hospital environment there’s a, there’s something, there’s something to be said now about what is happening in this environment.
Matt: Yes. And I think it might have to change. Like pre hospital, I mean, like they’re having… A lot of places have nurse practitioners and PAs and even physicians. I know over in Europe, it’s very common to have physicians on helicopters flying out. We saw that picture in the Louvre of the ECMO, them doing ECMO in the middle of the Louvre.
And we’re just kind of catching up to that. But a lot of systems, I know Travis County down in Austin, they have physicians assistants, maybe even nurse practitioners that come out. Trying to keep patients out of the ER to keep these numbers down.
Erik: I’m training my tactical medics how to suture. Yeah.
And we’re, we’re going to the cadaver lab at our local medical school to train up on some procedures that a lot of agencies are doing. Finger thrower costumes. Yeah, but these things save lives. Yes. And these are the types of things that I hope become more common. Yeah. And I think as you and I continue to spread the, the, the good news, the good word about, about EMS education, I think that I think that We’re going to be part of the progression of this, this field.
Yeah. And Tim, you know, right now after COVID people are taking it so much more serious. I mean, during COVID who’s coming to your house.
Matt: Exactly. And a lot of it was literally the first responders making decisions. I mean, I remember the first call I went on that it was a potential COVID patient. And I was like, almost terrified because I’m like, we don’t know what this is yet.
You know? And I mean, we’re in all the stuff and I’ve got EMS supervisors and we’re donning and doffing gear. Like I went into a hazardous materials area and you know, all that stuff.
Erik: It’s as a medical director was so stressful during COVID because I had my and at that time I had multiple medical directorships.
So a lot of agencies, cities, departments, EMS companies calling, asking for new directives or advice on how to handle COVID. And then at the same time as a medical director within the ER, planning the tents in the parking line and working with you know, FEMA nurses, and there was, there was the ER and the EMS community.
Really took the blood, took it to the, took it in the teeth with, with Covid. Yeah. A hundred percent. I talked to the cardiologists and the orthopedists and, and whatever they, they’re, they’re twiddling their thumbs. Yeah. There was just nobody in the hospital.
Matt: No. Cuz they cut shut down day surgery. Yeah. And everything else.
Right. But the ERs and the ICUs were getting hammered and pre-hospital, we were getting hammered. But I think that seeing, acknowledging the importance of. You know, again, good triage, which I mean, that’s what we’re good at pre hospital is, is, you know, looking at a patient and, and, you know, before you never refuse transport on a patient, you know, never did that.
If they call, they’re going and now they’re starting to look at like, maybe we don’t need to take every single person that calls nine one, one to the ER, you know, because like we’ve talked about people, unfortunately abused nine one, one, you know. And then, but these ERs are absolutely packed and wait times for medics, wait times for patients are through the roof because everybody’s going to the ER for every little thing, you know, and it’s just crazy.
So utilizing EMS to maybe triage and maybe, you know, do telemedicine, you know, is a new thing that’s come along.
Erik: You are, what you’re saying right now is so progressive. Yeah. There’s, there’s a lot of the ER care that, that we do is unnecessary. Yeah. And here in Texas, we get paid for what we do, so the the executives within the Bring them.
Right. Yeah. Right. They don’t want to hear me say this. But in, in most areas of the country EMS, sorry medical systems, payers, hospital systems are working together to take on risk. Yeah. And what that means is… is that they’re, they’re taking the risk for the care they deliver in projecting utilization and then trying to direct utilization.
Here in Texas… There’s no risk. Yeah, the ER groups the hospitals will just pay for whatever we do. Yep, and it’s called fee for service Yep, but that’s changing That is changing because the system isn’t going to keep working that way and Texas will just be one of the last ones to change But when they do there’s going to be increased accountability in the pre hospital environment Our paramedics are going to be held to a higher standard because the government’s going to be watching the data closer Because in one municipality where you’re doing ECMO and saving these lives, the other communities are going to say, well, why aren’t we doing it?
Exactly. And then that medical director is going to be like, well I better start training up my guys. Oh, I better start, you know, and then, you know, EMS education becomes more important. And that’s hopefully something we can do to serve them. Yeah.
Matt: Yeah, it’s an interesting conversation, that’s for sure.
And it’s only going to get, EMS is only going to become more involved, more complicated. We’re going to be asked to do more things ET3?
Erik: Are you familiar with ET3? ET3. ET3. I don’t know how much time we have, but I will quickly tell you. We’ve got about two minutes. Two minutes. Emergency, treat, triage, and transport.
We can use Medicare dollars to reimburse your department if you don’t go to the ER. Oh, yes. Okay. Yeah, I haven’t heard that. Traditionally, you only get money if you transport to the ER. Right. If you don’t transport to the ER, no money to you. Yeah, since
Matt: COVID, that’s changed,
Erik: right? Well, that’s the CARES Act, and along with the COVID, a bunch of, you know, money that came from the government.
But, this is separate. This is ET3. And that money from Medicare can actually reimburse you. for treating that patient in place or maybe taking them to an urgent care or to their primary care doctor. Yep. Not necessarily the ER. Right. This is very interesting. Point is, the government’s pumping money into the EMS environment.
Matt: Which is going to bring a lot more attention onto the EMS.
Erik: It sure is. You better make sure you got your shoes tied up nice And you got your hair combed.
Matt: I don’t have to comb my hair much.
Erik: Well, this has been interesting. It’s changed a lot and it’s going to continue to change. We’ve got to keep up with it.
A lot of it has to do with
Matt: education. Yeah, for sure. Yeah, you’re more comfortable doing things if you know what to do.
Erik: That’s right. This is a good topic. This is good, Matt.