Baby's Anaphylactic Reaction Triggers PTSD for Student Paramedic | Ambulance - BBC

[@LeahDino32]

I can't believe people are saying she isn't fit to be a paramedic. Did we watch the same video? Through the entire call she remained level headed and professional, and it wasn't until the child was safely at the hospital that she allowed herself a moment to process her feelings--which is way healthier, by the way, than if she had just ignored them and carried on. Smh

[@MsTinkerbelle87]

Right? You want that empathy from a medic!!!

[@brummyuk-d6f]

Life has taught me that you will always have people who judge you, no matter what. People who sit back, comfortable having never face the same issues as you, telling you what you should have done or could have done, or what you didn't do. It gets tiring. Those people wear thin on me.

[@MalenkayaLolle]

I think she did a amazing job with the family ❤

[@UKsystems]

I think poor people are mean it but getting across is that if it affects you too much? Don’t do the job however most people are affected by something in this job and that’s what they don’t realise

[@hgmb1705]

@@MalenkayaLolleshe truly did. It wasn’t until this aired that we even had a clue that she’d been through something like this. She was incredibly professional and empathetic.

[@jamesderamus6200]

As a former paramedic, the comments from folks talking bad about the paramedic are absolutely ignorant. She has the gift a lot of us don’t have. The ability to turn it off during the call and the ability to talk it out afterwards is whats going to help her have a long and successful career. Debriefs were a thing when I was doing it, but it wasnt required and very few times did we even go. Good on her for talking out how she felt immediately. The keyboard warrior syndrome is absolutely insane, especially since most of them havent seen anything traumatic. The emergency personnel who last are the ones that have the wherewithal to deal with what they saw and work through it. Unless you have done the job you have no idea what these folks have to see.

[@Irishrose5424]

this yes. If you know how to get thru and process things you will not only help others but yourself to continue on in a healthy manner Besides You are only human to react when another person gets scared. I used to be a CNA and I cried with families who lost their loved ones. WE are only human.

[@patkelly6349]

Yea is that right James. I worked at the highest level in this industry for longer than you mate so don’t get me started. This is total rubbish to go to you tube for your 15 mins of glory. She’s a Prima Donna.

[@patkelly6349]

Another James old boy from Pommy land. Don’t embark on a career if she feels she cannot cope.

[@usualdosage7287]

​@@patkelly6349wow seen your comment history you don't like anything

[@thehoneybadger1223]

@@patkelly6349 she did cope. She got help sent to the place and kept calm and collected while doing so, which in turn helped the caller to stay calm and collected.

[@hgmb1705]

Hello 👋🏻 as this has just popped up on my recommended videos 7 months after its first aired… this is my son Ruben. He was 1 year and 11 months when this was filmed and is now 3 years and 7 months old. Just to clear some thing up - Asher was incredible. She was empathetic and extremely professional throughout this experience and I had absolutely no idea she’d been through something like this with her own daughter until the show first aired. Her empathy and kindness kept me calm. I also work in the NHS, and our own personal experiences allow us to relate to our patients and actually help us to become better at our jobs in the long run. (Imagine that - human experiences allow us to empathise with other humans 🙄) Also - Ruben is fine! He has allergies to Milk and Eggs and has suffered 2 anaphylactic attacks in the past -both within a fortnight of each other - when he was around 6 months old. He’s still under the care of the allergy specialists. Thankfully, he hasn’t had an ambulance ride since this was filmed 😂

[@rachelfrater6623]

so good to know ruben is doing ok!❤️

[@Focusonbehind]

How can some child have allergies to Milk and Eggs, the thing that is the perfect breakfast? Talking about a birth defect, jesus. Hope you are all well and take care!

[@hgmb1705]

@ he was allergic to wheat as a baby too, but has thankfully grown out of it now 😂 scrambled egg on toast would have been game over for him, poor thing!

[@dynamo1796]

Can I just say - you did an AMAZING job of staying strong and keeping calm. Lots of people go to pieces when they see their precious babies struggling like this and understandably so. But you stayed calm for Reuben, got the help he needed and stayed strong for him. All the best for you and your family!

[@louiselincoln]

Wow. To everyone hating on the paramedic for this...excuse me. Check yourself. No wonder the NHS staff are ground into the floor with that attitude. Get yourself back in order. Compassion and empathy are what we need now, not toxic attacks from behind the comfort of a screen where you aren't even on the ground doing the job.

[@I_AM_NUM_3]

These first responders are wonderful and kind. Perfect examples of great EMS workers.

[@kathbrandon8023]

USA viewer here - so much empathy, kindness & professionalism from this team. In awe of the dedication of your NHS workers🥰 (and such lovely accents!!)

[@patkelly6349]

Pommy clowns

[@ambermarielewis9353]

@@patkelly6349that’s a rude comment

[@patkelly6349]

@@ambermarielewis9353 Hey if this had been a bloke would you have carried on. I’m betting no.

[@maggiemccauslin1084]

@ambermarielewis9353 She's mad at a human showing human emotions

[@Birdtoes]

I so understand this paramedic mom!! My son nearly died of asthma, and in o e hospital emergency room visit the doctor was yelling “we’re losing him, we’re losing him!!!!” I fainted, and spent the next 3 years in & out of hospitals with him. Now when I see or hear of others in this position, I just go right back to the “We’re losing him” moment and panic for them. There should be supportive help for parents of ill children.

[@Dorky_Ikea]

I hope he’s doing better, along with you. I’m a teen and cannot fathom the fear you and any parent must feel when the possibility of losing your child comes up. I’m sure there’s supportive groups online (Facebook, etc) and maybe there are local groups in your area? Again, hope you and your family are alright. You sound like an amazingly strong mother

[@toninatoli]

Excellent to debrief. Taking these moments to decompress helps keep first responders from burning out.

[@TiredSunflower]

exactly!

[@maggiemccauslin1084]

Pat in the comments seem to think paramedics shouldn't have emotions or express how they feel

[@rosyapplekitchen635]

Things hit differently when you personally go through situations as she did. Especially nearly losing a loved one. Well done to her. She was very professional and took a minute to let it out after. Every paramedic I encountered here in London was beyond amazing at their job.

[@skevimavride9584]

Go for it girl, you need to tell all sometimes to some people you are an angel and only a human one at that !!! Bravo ❤

[@sarahhenderson7417]

My Dad is a retired paramedic after 40 plus years. I can't imagine what he had witnessed

[@patkelly6349]

I can I did it for same time. This is disgusting the way this girl is behaving. Grow up or get another job. Can you see how the child was. Nothing wrong with the kid. People panic and carry on. Most of the time it’s just garbage.

[@otm011]

@@patkelly6349 A very ignorant statement. Don’t you dare judge her if you don’t work in this job. It’s a common phenomenon in EMS and the best medicine is talking to one‘s colleagues. No offense, but obviously don’t consider paramedics human beings.

[@patkelly6349]

@@otm011 lol. I’m sick of these woke gen z ambos. Get another job if you can’t control your emotions. No way would I go on you tube whilst on duty and display this weep for me attitude. I’ve seen 100 times more than this you tube glorified but I dint go carrying on. I feel much more admiration for the girls in aged care who get paid poorly and get no recognition for their hard work. Ambos are well cared for. I should know.

[@fabplays6559]

@@patkelly6349 No-one can control their emotions. All you do is bottle them up, and that does not make you stronger. It means that you have taken what is human about you and stuffed it so deep inside yourself that you will die an empty husk. You think you're stronger for it, but your fear of compassion has weakened you and whether you know it or not, your loved ones have and will suffer as a result.

[@xykane]

@@patkelly6349 Glad you're out of EMS now. I promise no one misses you being their provider if this is how you acted.

[@LS-fe4ob]

Wow what heroes. It’s great to show this that they’re humans and they do incredibly tough work. Blessings

[@tylociraptor8131]

Strong woman, this. Able to recognize her PTSD trigger and push through to do the job in front of her only to let herself feel it when the child is safe and out of danger.

[@hgmb1705]

Asher was incredible ❤

[@JaniceRNZ]

Thank you for all that the paramedics do. Take care.

[@cameronallan5624]

We are all human. And that is what makes us great!!!

[@maggiemccauslin1084]

Pat in the comments seems to think it's not okay to show human emotions

[@erinhall1025]

Her reaction was a PTSD reaction. Just because you or someone you know react that way doesn't mean anything. it is HER reaction. My kid was in a bike accident 8 years ago, split her liver in 1/2 and was in PICU for 5 days and missed 3 months of school. My friends kid had a seizure at school two weeks ago, and was admitted to hospital for observation. I went to visit (my friend and I are found family) and that evening, I had a episode of reliving everything that happened. And this wasnt going to ICU, it wasn't the same hospital and it was a completely different thing. It was still PTSD. How do you know she didn't go home and over analyze every second and get heart palpitations and scream and cry? This clip is short and shows her at the beginning of digesting this call.

[@Craftylisa69]

Bless that paramedic what a professional keeping calm and give ing the best care. Total hero’s our nhs staff all of them !

[@diaryofanotdgirl]

Sometimes people who have experienced things are the best people who can turn up to help you as they are able to understand more than others can

[@loudloveen]

That's perfectly understandable.

[@flourbvoy1269]

Thank you so much, Asher and Jared, for the amazing work you're doing. We need more people like you.

[@bipper7943]

Could see how good of a character the fella is at the end being empathetic and also lightening the mood with a bit of banter. Seems like a pleasure to work with.

[@maggiemccauslin1084]

Why are people hating on the paramedic? She did nothing wrong and kept strong in front of the mom and only vented to the other paramedic afterwards... they are aloud to express what they are feeling

[@sadib4782]

i feel for her. i’m currently doing my emergency medical responder training and the scenarios that involve high speed collisions and TBI’s have been really hard because of past events. it gets easier over time but it’s never fun.

[@Userhh-ix8si]

for those of you saying shes not fit to be a paramedic. why dont you step into her shoes?? doctors, nurses, practitioners, matron’s & paramedics are ALLOWED to experience trauma and feelings. they arent robots

[@tristanshannon-g4g]

I’m a professional mental health counselor and grew up with multiple traumas. I worked through them and have tons of coping skills now. It’d be absolutely mad for someone to tell me I shouldn’t do my job because occasionally I get triggered by a patient’s experience/story, etc.

[@Userhh-ix8si]

@@tristanshannon-g4g agreed, i applause all the healthcare workers! living with chronic illnesses means i rely on doctors to help a lot and in some circumstances, the hospital. most the time cannot fault them.

[@majkolsson7192]

He seems like an awesome trainer and she is going to be an awesome paramedic. Do people want paramedics without any empathy and self experienced trauma? Sorry, not people, children in the comment section. Do you homework and then go to bed.

[@mariejohansen1156]

The thing is, you think that everything is fine.. But your body remembers, so does a tiny place in your mind and soul. And all the memories, the pain you felt during the day, smell, sound.. Everything comes back in a flash! And sometimes just a tiny sentence spoken can trigger it, also sometimes something big can happen but your body doesn't react before later on. Cptsd & ptsd really sucks. So I'm sending my best regards and big hugs to this paramedic and her team, actually I send my best regards + lots of gratitude and hugs to all paramedics out there. Thank you for everything you do ❤

[@hgmb1705]

Both paramedics were wonderful with us and all of this is so true, Asher used her experiences to relate and empathise with the situation! That’s what a good paramedic does.

[@nuescht79]

In einen solchen Beruf ist ein so guter Partner, nicht mit Gold aufzuwiegen!

[@aliciaperry9439]

She has PTSD from a previous encounter. She's going to have days when she feels bad about what happened. For those who say she's unfit to be a paramedic, have you ever had to go through a traumatic experience like she has or like some have who have been mistreated? Until you do, you have absolutely no idea what these paramedics and EMTs, firefighters go through on a daily basis. Her own child passed away from SIDS. THAT is why she has PTSD and is having a challenging time coping with it.

[@chrisfilms8674]

Bless her 😢

[@thehoneybadger1223]

The day that seeing a child in distress doesn't affect you, is the day you need to change jobs. Once that compassion dries up, your quality of work will slip. Compassion doesn't mean breaking down and crying and being unable to fulfil your job.

[@ellis20022]

i lost my mom in november of 2023 and then my dad got really sick in january of 2024, and we both were having panic attacks in the ER because the last time we were there, barely 2 months ago, she was dying. and then when he got admitted, the room was nearly identical and on the same floor she was on. it was hard for me, and i imagine much harder for him since he couldnt leave.

[@kellyyyyy1993]

all the hateful comments are vile, she’s doing a job she loves and wants to do, i’d love to see you lot try do it 🤷‍♀️ got nothing nice to say don’t say anything

[@parafraceren]

It’s not about what SHE wants, its about the safety of the patients. Based on this you cannot conclude anything, but if your own trauma response interferes with your duties as a first responder, the job is not for you, regardless of what you want and love to do.

[@amymcdonald845]

@@parafracerenher “ own trauma response” didn’t affect her job in the slightest, did u even watch the video or did u just read the title and comment this. She treated the baby perfectly, as she would with any other patient, got the baby to hospital, and when they were gone, she talked abt her own similar experience. There is absolutely nothing wrong with that. If a paramedic seen someone’s mum die and they too had lost their mum, would u shame them for relating to it and being upset???? God forbid someone have human emotions nowadays.

[@parafraceren]

@@amymcdonald845 I see my general point was too abstract for you?

[@PrinceOfLillies]

@@parafracerenbut why bother making that point if that isn’t what happened here?

[@mdrocks7842]

@@parafraceren do you people want medical robots or something?

[@MsTinkerbelle87]

Awwe bless! :(

[@all_is_well_Mara]

Brave ❤👏

[@Heisenberg_99.1]

Im so tired of seeing people fight invisible comments 😂 its embarrassing

[@GrandHighGamer]

They're only invisible because they eventually get removed, or buried due to dislikes. Doesn't mean they weren't there when they replied.

[@ashlynnsomers]

...Can we talk about how the mum was showig the kid baby sensory videos

[@hgmb1705]

Yep! Hey Bear Baby Sensory. The dancing fruit was magical 🍓🍍🥑

[@xEPICxNESS]

I dream of having my own kids one day, but I’m so scared of the big feelings and worry for the rest of my life! How do parents do it? 😳😭

[@littlemissleslie2345]

The strength that God gives them.

[@Tanieeebry]

It’s as simple as ‘we have to’. You bring a baby into the world, you should do whatever you can to protect them and make sure they’re okay.

[@SAYEEEF]

To the people who think this Paramedic is not fit for the job, why don't you lot leave your cushty 9-5 desk job and do what these guys do, you would be flustered after a couple of hours

[@breezeh1127]

I almost lost my 6 year-old to anaphylaxis(She is now 23). I was diagnosed with PTSD the following year. Unfortunately all 3 of my girls have the most allergies (if I listed them all it would cover the page) and all anaphylactic. When my littlest went into anaphylaxis it triggered me so badly. Every day I'm in fight or flight looking out for allergens and keeping everything separate and clean. It isn't a way to live. 😢

[@hgmb1705]

Ruben is my son. Thank you for your understanding ❤️ I’m so sorry you’ve had to live through this too. Anaphylaxis is no joke, my partner, daughter and Ruben all have allergies - with ruben and his dad both being EpiPen carriers. Thankfully Ruben hasn’t had to use his EpiPens since he was 6 months old, hasn’t had any ambulance journeys since this was filmed, and he’s now nearly 4. ❤️

[@breezeh1127]

@hgmb1705 I'm so grateful your little one has not had to used it again. ♥️I pray Ruben has no more incidents and you both have a long healthy life. I wish more was known by the public about allergies so people could be more compassionate 💜

[@maggiemccauslin1084]

@hgmb1705 I'm glad your little boy is okay now

[@pizza_queen8345]

Oh yes because paramedics should be robots and not show any emotions. Would people cop on.

[@maggiemccauslin1084]

Apparently some people in these comments are robots and get upset at humans showing empathy and emotions lol

[@gisellep177]

❤❤❤❤💔💔💔💔💔💔💔💔💔

[@christianbell-r5f]

what episode is this what number

[@hgmb1705]

It was season 12 episode 6

[@joserubenpolomercado4654]

unconscious ?

[@hgmb1705]

He was unconscious when the call took place.

[@josephb8499]

That baby was absolutely stable. Just some allergic reaction.

[@hgmb1705]

He was unconscious when the call was made and has had previous anaphylactic episodes with EpiPens prescribed.

[@maggiemccauslin1084]

@hgmb1705 I'm so sorry you are having to see people hate on the paramedic that helped you and your son... she talked to both you and him so kindly and professional in the video and people are hating on her for showing human emotions... I bet you didn't even know she cried like that till this video... she at least waited till you and him we're out of the ambulance...

[@YawnGod]

Apparently this is a CLICKBAIT title.

[@ЧурбанХачи]

Благодарю Уважаемые власти России я россиянин родился в Воронежской обл , большое вам спасибо за то что не избиваете меня и за то что не угрожаете ! Спасибо вам за то что не ломаете мне мои кости . Спасибо вам за то что заплатили мне зарплату за февраль месяц и разрешаете на них купить мне у вас продукты питания , спасибо вам за то что я перестал голодать !!! также большое вам спасибо за то что разрешаете мне дышать бесплатно. серьёзно нижайший вам поклон за вашу доброту комне .

[@spicybeantofu]

If youve got PTSD, you probably shouldnt be in a job that requires a flat head. I have PTSD. After watching this isnt PTSD. The title is misleading. Having something remind you of something that happened to you isnt PTSD.

[@b1p0lar.b1tch]

Bit insensitive to say, there's many great people who work in the nhs who have PTSD including this woman. At least she was able to provide the woman with some comfort with actual experience of it

[@tylerfoyle8096]

Seriously, she's incredible for doing this job

[@shambug2851]

I’m not completely sure of the exact number but I’m pretty sure it’s like 40-50% of paramedics have PTSD, it was a number released by the paramedic mental health charity, having PTSD doesn’t stop you from doing your job the training is so intense you just go into patient treatment mode and then feel your feelings afterwards. When you have to treat dying people and diagnose deaths, see horrible life changing injuries etc on a constant basis chances are that at some point your going to develop PTSD at some point. Being an emergency worker doesn’t stop you from having feelings even if you have to remain professional when with patients. Paramedics and police officers see more traumatic incidents in one year than basically any other person would ever see in their entire lives, they also have a constant reminder of every incident whenever they drive past “that house” or “that road”

[@bipsi15]

Exactly! This isnt PTSD, but a trauma memory from her own kid

[@joshneumann9130]

Im sorry but you can’t truly say that this lady does not have PTSD, anyone can suffer with PTSD and anyone is allowed to suffer and they don’t need people like you to make comments about it. There is a very large number of staff in the NHS that suffer with some form of mental health conditions due to some of the scenes we see, it can take the smallest of things to then trigger this off again. There is no right to say that an individual who suffers with PTSD should not be in the job because actually they make a far better medical professional as they are real and they give that lived experience, if none of us showed this personal side then we would all be very heartless and we would be suffering silently on our own. It’s great to know as a paramedic how little support some people give us and trust when show an ounce of our personal life or experiences.

[@tamas1235]

This whole show is just pathetic. As a paramedic says this. Disgrace.

[@jamesstevenson9340]

Just wondering how is it pathetic?

[@AccidentallyOnPurpose]

Next time you have an emergency, maybe the EMTs shouldn't show up if you think their job is so pathetic.

[@hgmb1705]

How dare Paramedics be humans with emotions and empathy for people going through their worst days 😂

[@maggiemccauslin1084]

@jamesstevenson9340 Apparently paramedics aren't supposed to show emotions...

[@ZackBasson]

I mean...everyone has ptsd these days...

[@ariadne0w1]

They did before too, it was just "nerves" or "hysteria" or "melancholy" or "shellshock" or any other number of names or entirely unremarked upon and untreated.

[@fabplays6559]

So you don't think almost seeing your child die counts as traumatic enough for PTSD?

[@lenniegodber7805]

A solider in WW1 who saw his mates cut down by machine gun fire after going over the wall had PTSD. This woman got her fee fees hurt and is making a Shakespearean drama over it. Get rid of her. She doesn’t have the mental fortitude to be a paramedic.

[@ralph6142]

Obviously you have no idea what can cause PTSD. And it doesn't sound from your comment that you work in the medical field. If you did you learn quickly that empathy is one of the best qualities you can have. A quality this student paramedic showed dealing with the mother and in explaining her reaction afterwards. But if we're looking for mistakes... "solider", maybe soldier?

[@themoonhurtsdaddy]

Nice flag, flag of the weak these days 😂

[@minimushrooom]

@lenniegodber7805 what on earth do you mean? She did her job perfectly then shared an emotional moment with her colleague afterwards once the patient had been safely handed over. She gathered herself and continued on with her job. Are you suggesting people shouldn't talk about their feelings, or should constantly suppress them? That's a one way ticket to horrible mental health problems. Over the long term it reduces their capacity and can lead to people unable to continue their careers.

[@toninatoli]

Are you a mental health professional? Clearly, not.

[@nursealex3615]

She saw her newborn baby resuscitated and intubated?? It’s highly traumatic. Get a grip.

[@anthonyjones7264]

People need to stop throwing around the word PTSD. PTSD can show in many factors but this isn't really PTSD. Doctors deal with harder issues and probably lose more patients. From someone with a lot of brain issues. This isn't something that you would want. From being around combat vets I can tell you when it occurs the only thought is escaping. All she did was start to cry. I have had buddies get tickets because they ran red lights and stuff because of PTSD issues. They don't use them as excuses. Sometimes the cops give them a break others they don't. When they don't they pay the ticket. Everyone wants to have mental health issues because they think it's all the rage. When in reality it's hell that those of us are part want the nightmare to end. Transgenderism is a perfect example of what I mean. The fact that everyone thinks they have anxiety and just can't deal with the world. The world sucks and it's an awful place. The quicker y'all understand the faster we can get to helping real people with problems. Like the vets that had to serve 20 years and given no leadership to a win.

[@GOOBENsticks]

lol

[@fabplays6559]

Are you.... are you seriously claiming that paramedics don't have PTSD?

[@fabplays6559]

Did you even finish watching the video? She's diagnosed with PTSD. Her child nearly died. Seeing a child in respiratory distress reminded her of that experience. What about this told you that she didn't genuinely have PTSD?

[@aaronburbach2344]

You might want to try actually reading the diagnostic criteria for PTSD before accusing random people of not having it based on a short youtube video. Where in this video do you see her using her PTSD as an excuse? I see someone who coped with the trigger well enough to perform her job and then took a moment to process the emotions once everyone was safe. She literally said that she's in therapy which has presumably improved her symptoms and ability to function. Of course, veterans should receive effective and affordable treatment for their PTSD. This woman is not preventing veterans from receiving treatment. Neither are trans people, though I'm not sure how that's even related.

[@pfftxoxo1502]

Do doctors pull mangled bodies from car crashes? Are doctors the ones doing CPR on a child’s body in their kitchen in front of their screaming parents? to say that paramedics don’t have ptsd is wild.

[@user-zr3tb6bg7o]

Shouldn't be a paramedic if she can't handle it, bunch of cry babies in the UK get real

[@scottmurphy4278]

I take it you wouldn’t want to be treated with empathy and compassion then if you ever needed paramedics?

[@user-zr3tb6bg7o]

Need a paramedic? I am a paramedic

[@scottmurphy4278]

@@user-zr3tb6bg7o So you’re telling me that none of the cases you’ve ever dealt with have ever left you emotional? That the predicament that your patients were in meant absolutely nothing to you?

[@TheChristy56]

Dude don’t bother. A lot of these comments are usually from tweens/kids. Ignore it.

[@user-zr3tb6bg7o]

yeah I agree@@TheChristy56

[@patkelly6349]

Grow up I did this job for 38 years. I can’t stand this nonsense.

[@PrinceOfLillies]

You sound bitter. Did you not, in all your 38 years, have an emotional moment with a coworker who can understand? Especially if you had just been on a call that was similar to an experience you had had in the past? Your response just seems harsh and a bit cold.

[@patkelly6349]

@@PrinceOfLillies yes I am a little bitter. I will agree with that. I probably should have sought help myself but unfortunately a lot of my colleagues were not trustworthy.

[@mahoganysoulll]

⁠​⁠@@patkelly6349 Well go and seek help now then, you’re still alive? You sound resentful that she’s able to express herself. She has nothing to do with your experience. Are you sure you weren’t one of the colleagues you say weren’t trustworthy? Sure does sound like it with that attitude.

[@shackles5850]

@@patkelly6349 Hard to believe you did this job for 38 years when you lack this much empathy. I hope you never said something like that to any patients struggling with mental health problems. Besides, if you watch she video she did a wonderful job. The title is just deceiving, she just took a minute to breathe after what had happened, which is what any good paramedic should do if they feel overwhelmed, instead of jumping straight back into work where they may make mistakes due to stress.

[@patkelly6349]

What a good paramedic should do. Are you kidding me. Go away and grow up