ST - Surgical Technology
ST101 Surgical Technology Theory I
Credits 4Fall
Registration Requirement: Acceptance into the Surgical Technology program; health and safety requirements, including immunizations, must be met.
Students are introduced to the field of surgical technology. The course is designed to provide an orientation to healthcare facility organization and to the physical environment, with focus on surgical areas. Practice concepts and issues, including professional management, self-management and standards of conduct are introduced and explored. Ethical and legal issues relevant to the surgical technologist are identified and discussed. Additional content includes communication in the surgical environment, patient care concepts, patient confidentiality and privacy under HIPAA, infection control, principles of asepsis, environmental safety and introduction to surgical routines in the preoperative phase in preparation for surgical procedures.
View Course Outcomes:
- Assess current trends and employment opportunities for the Surgical Technologist
- Demonstrate critical thinking skills in application of aseptic techniques and principles in selected scenarios and case studies
- Demonstrate proper surgical attire
- Describe a typical hospital organization and structure
- Describe the role of the Surgical Technologist
- Discuss medical, legal and ethical issues relevant to the role of the surgical technologist
- Identify and demonstrate principles of communication in the surgical setting
- Identify and discuss the specific needs of the special populations
- Identify basic furniture, equipment and supplies in the surgical suite and describe their function
- Identify environmental hazards in the surgical environment and describe appropriate measures to reduce hazards
- Identify hospital departments that directly support or relate to surgical services
- Identify members of the surgical team and their roles
- Identify principles and practices in the surgical setting that can reduce the incidence of surgical site infection
- Identify the principles of aseptic technique and provide examples for the application of each as observed during a surgical setting
- Interpret the legal responsibilities of the surgical technologist and other surgical team members for selected scenarios and case studies
- Tour a surgical suite and identify the design type, traffic patterns and direct support areas
- Utilize Maslow’s Hierarchy and human development models to identify basic physical and psychosocial needs of the surgical patient in case studies provided
- Utilize OR design principles to identify advantages and disadvantages of actual surgical departments observed
ST102 Surgical Technology Theory II
Credits 4Winter
Registration Requirement: ST101 with a grade of "C" or better. Concurrent enrollment in ST103 and ST111; health and safety requirements must be met.
The focus of this course is on surgical instrumentation: manufacture, classification, identification, care and handling, processing, storage and distribution. Content includes sterilization and disinfection standards and techniques, sterilization monitoring, instrument cleaning, decontamination and inspection, sterile packaging standards and techniques, storage and distribution. Additional content includes central sterile processing and distribution department organization and routines, and environmental disinfection and sanitation standards and practices in the surgical setting.
View Course Outcomes:
- Apply principles of sterile storage to systems used for handling and storage of sterile supplies
- Assess distribution systems used by sterile processing departments
- Compare and contrast disinfecting agents
- Compare and contrast methods of sterilization
- Compare and contrast shelf life and event related sterility
- Compare and contrast the materials used for creating microbial barriers
- Define terms related to the terminal disinfection/ sterilization process
- Describe current standards for storing, handling and distributing sterile supplies
- Describe principles of wound exposure
- Describe proper care and handling of surgical instruments
- Describe standards and practices for decontamination of the OR environment
- Explain the relationship between instrument type and usage
- Identify criteria used to select wound exposure devices
- Identify process monitoring devices and methods
- Identify the classifications, names, parts, materials, finishes and uses of basic surgical instrumentation
- Identify variables related to the sterilization process and the materials to be processed
- List the methods for sealing microbial barriers/ packaging materials
- List the process for preparing items for sterilization
- Prepare for the national certification examination for the Sterile Processing and Distribution Technician
- Review and critique an article from a professional journal relevant to ST102 content
ST103 Surgical Technology Theory III
Credits 4Winter
Registration Requirement: ST101 with a grade of "C" or better. Concurrent enrollment in ST102 and ST111; health and safety requirements must be met.
The focus of this course is on perioperative case management during the preoperative and intraoperative phases. Content includes preparation of the patient including patient positioning, transfer and surgical site prep; preparation of the sterile field; principles and techniques of hemostasis; specimen care; principles of wound healing, including selection and handling of suture, drains and dressings; prevention of retained surgical items and All - Hazards preparation.
View Course Outcomes:
- Analyze and assess the factors that influence the closure of each wound layer
- Analyze the mechanisms of wound healing, the inflammatory process and the healing process
- Analyze the principles, methods and techniques of hemostasis
- Analyze the use, components and aides utilized to achieve various surgical positions
- Compare and contrast different chemical agents used for skin preparation
- Compare and contrast different types of skin preparations
- Compare and contrast suture materials and needles and analyze their significance
- Compare and contrast the most commonly used types of surgical dressings
- Compare and contrast the types and characteristics of various catheters and drainage devices
- Describe the physical preparation and care that the surgical patient may receive prior to the surgical procedure
- Describe the procedure for completing the pre-operative patient checklist
- Describe the standard procedures, and techniques for prevention of retained surgical items
- Describe the steps and rationale for surgical skin preparation
- Describe various types of draping material used in surgical procedures
- Discuss All-Hazard preparation and planning, including detection and communication, incident management and support systems, safety and security, clinical/public health assessment and intervention, contingency, continuity and recovery
- Discuss perioperative case management concepts related to the responsibilities of the surgical technologist in the scrub role and in the circulator assist role
- Discuss procedures for obtaining, handling, verification, transfer and storage of surgical specimens
- Discuss public health law and ethics as related to All-Hazards preparation and strategies
- Discuss review of the patient chart in preparation for surgery, including laboratory reports
- Discuss the aseptic principles of draping the patient, equipment and furniture for surgical procedures
- Discuss the factors related to the family members and transportation of the surgical patient
- Discuss the purpose of surgical dressings and proper application techniques
- Discuss the purposes and legal responsibilities for counts
- Evaluate the classification of surgical wounds and analyze factors that influence healing
- Identify methods of patient transportation and transfer
- Identify the perioperative phases and describe responsibilities of the surgical technologist in the scrub role and in the circulator assist role during each phase
ST104 Surgical Technology IV
Credits 4Spring
Registration Requirement: ST102 and ST103 with a grade "C" or better. Concurrent enrollment in ST112; health and safety requirements must be met.
This course introduces students to technology and equipment in the surgical setting, including principles and applications for endoscopic, lasers, electrosurgery, ultrasonic, robotics and image guided surgery. Other specialty and accessory equipment is introduced and discussed. Selected general and gynecologic procedures are introduced. Additional content includes pharmacology and anesthesia for the surgical technologist, post-anesthesia care, emergency patient procedures and death and dying.
View Course Outcomes:
- Analyze the principles of anesthesia administration as well as be able to explain the necessity of each component of anesthesia preparation of the surgical patient
- Apply general terminology to medication use
- Apply the principles of robotics to patient safety
- Assess the function, assembly, use and care of equipment in the surgical environment
- Calculate medication conversions and dosages
- Compare and contrast methods, agents and techniques of anesthesia administration and preparation
- Compare and contrast responses to the process of death and various coping strategies and mechanisms
- Correctly identify instruments, supplies and equipment used in procedures presented
- Correlate anesthesia monitoring devices with patient homeostasis
- Demonstrate critical thinking skills in planning for surgical procedures presented
- Demonstrate electrical knowledge as it relates to patient safety
- Describe proper care and handling of medications and solutions used in surgery
- Describe the application of surgical equipment
- Describe the creation and usage of various surgical incisions
- Describe the emergency procedures carried out in the OR setting
- Describe the immediate postoperative care of the surgical patient
- Describe the principles of electricity and electrical flow
- Describe the roles and responsibilities of the surgical team in emergency procedures
- Describe the surgical application of robotics
- Discuss expected outcomes and potential complications for surgical procedures presented
- Discuss relevant surgical anatomy and pathophysiology for surgical procedures presented
- Evaluate attitudes, beliefs and classifications regarding death and dying
- Explain anesthesia complications and interventions
- Identify medications used in surgery, including classification, indication and preparation and delivery
- Identify the basic components of equipment used in robotic surgery
- Trace the steps that are implemented when a patient death occurs in the operating room
ST111 Surgical Technology Lab I
Credits 2Winter
Registration Requirement: ST101 with a grade of "C" or better. Concurrent enrollment in ST102 and ST103; health and safety requirements must be met.
This laboratory course is designed to correlate with ST102 and ST103. Students have the opportunity to practice and demonstrate cognitive, psychomotor and affective competencies relevant to the role of the surgical technologist in the surgical practice setting. Emphasis is placed on the principles of aseptic and sterile technique and their application for safe patient care practices. Professional behaviors are expected and evaluated.
Additional Course Fee: $198.00
View Course Outcomes:
- Demonstrate application of aseptic technique principles
- Demonstrate competency in psychomotor skills listed for preoperative, intraoperative and postoperative surgical routines
- Demonstrate critical thinking skills in the application of aseptic technique and maintenance of the sterile field in varying situations and scenarios
- Demonstrate identification, care, assembly, packaging, processing and storage of surgical instrumentation and supplies
- Demonstrate planning and organization for surgical procedures using resources including the surgery schedule, surgeon preference list, and instrument lists
- Demonstrate preparation of the operating room for basic surgical procedures
- Demonstrate the ability to manage the Mayo stand, back table and field during mock surgical procedures
- Demonstrate the ability to prioritize tasks and anticipate basic surgical sequences during mock surgical procedures
ST112 Surgical Technology Lab II
Credits 2Spring
Registration Requirement: ST102, ST103 and ST111, each with a grade of "C" or better. Concurrent enrollment in ST104; health and safety requirements must be met.
This laboratory course is designed to correlate with ST104. Students have the opportunity to practice and demonstrate cognitive, psychomotor and affective competencies relevant to the role of the surgical technologist in the surgical practice setting. Emphasis is placed on the principles of aseptic and sterile technique and their application on safe patient care practices. Professional behaviors are expected and evaluated.
Additional Course Fee: $198.00
View Course Outcomes:
- Demonstrate competency in psychomotor skills listed for preoperative, intraoperative and postoperative routines
- Demonstrate consistent application of correct aseptic technique
- Demonstrate consistent application of principles of safety in the surgical setting, with emphasis on patient safety
- Demonstrate critical thinking skills in planning, selecting, and organizing equipment, supplies and instruments for selected surgical procedures
- Demonstrate critical thinking skills in the application of aseptic technique and maintenance of the sterile field
- Demonstrate effective case management skills
- Demonstrate patient preparation and positioning for selected general and gynecologic procedures
- Demonstrate preparation of the operating room for selected general and gynecologic surgical procedures
- Demonstrate professional behaviors required for the role of the surgical technologist
- Demonstrate the ability to prioritize tasks in scenarios provided
- Demonstrate the ability to provide and receive constructive criticism during self evaluation and peer review of performance in lab simulations
- Demonstrate the application of principles of patient safety, economy of motion, organization and planning, and aseptic technique in the scrub and circulating role
ST155 Surgical Technology Lab for Clinical Readiness
Credits 0Summer
Registration Requirement: ST111 and ST112
Each student will attend a six-hour lab session in preparation for surgical tech clinical practicum in 4th term. The lab will include practice of skill sets and mock surgery procedures. Students will be expected to review skill rubrics from ST111 and ST112 before coming to lab. Students will prepare a list of any specific skills or objectives they need to work on. Lab requirements including proper scrub attire and professional behaviors will apply (see ST111 and ST112).
Additional Course Fee: $198.00
View Course Outcomes:
- Aseptic technique will be emphasized. Students will practice application of aseptic technique in varying situations. Students will be evaluated on their ability to apply aseptic technique consistently and to identify breaks in technique and resolve or correct breaks without prompting.
- Critical elements required in ST112 apply. Students must demonstrate the following critical elements to proceed to clinical practicum:• Demonstrate consistent application of correct aseptic technique• Demonstrate surgical conscience• Demonstrate safe work practices and safe patient care practices• Demonstrate prior learning (from previous ST coursework and labs)• Demonstrate critical thinking• Pass the instrument/supply identification test with 95% by the second attempt
- Lab instructors work with students to identify any weak skills-based on a review of the student’s ST112 final lab evaluation and student’s objectives
- Mock surgeries-students will participate in mock surgeries in the scrub role. Mock surgeries will include procedures presented and practiced in ST104 and ST112. Students will practice surgical routines, sequences and skills. Weak skills will be identified and principles and techniques reviewed. The students will be able to practice to improve skills identified as needing improvement
- Skill stations will be set up to address specific skills identified in step 1
ST204 Surgical Technology - General and Pediatric Surgery
Credits 4Fall
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST221. Health and safety requirements must be met.
This course provides orientation to general surgery procedures for the adult and pediatric patient, with related surgical anatomy, physiology, pathophysiology and specialty instrumentation, equipment and technologies. Special considerations for care of the pediatric patient undergoing surgical procedures are discussed. Special populations and relevant ethical and legal issues are discussed. Roles and responsibilities of the surgical technologist are emphasized.
View Course Outcomes:
- Correlate the relevant pathophysiology to the surgical procedure
- Correlate the relevant surgical anatomy and physiology to the surgical procedures
- Describe any special considerations for patient preparation and surgical positioning for the surgical procedures
- Discuss care of patients in special populations in the surgical environment
- Discuss expected outcomes and potential complications for procedures presented
- Discuss specific factors that are unique to the surgical procedure
- Discuss the postoperative care of the patient according to the procedure
- Explain the correct order of steps taken during the surgical procedure. Discuss the postoperative care of the patient according to the procedure
- Explain the diagnostic interventions that are utilized for obtaining a diagnosis
- List the supplies, equipment and instrumentation needed for the procedure
- List the wound classification and correlate to wound management
ST205 Surgical Technology - Obstetric, Gynecologic and Genitourinary Surgery
Credits 4Fall
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST221; health and safety requirements must be met.
This course provides orientation to gynecologic, obstetric and genitourinary surgery for the adult and pediatric patient, with related surgical anatomy, physiology, pathophysiology and specialty instrumentation, equipment and technologies. Special populations and relevant ethical and legal issues are discussed. Roles and responsibilities of the surgical technologist are emphasized.
View Course Outcomes:
- Correlate the relevant pathophysiology to the surgical procedure
- Correlate the relevant surgical anatomy and physiology to the surgical procedures
- Describe any special considerations for patient preparation and surgical positioning for the surgical procedures
- Discuss care of patients in special populations in the surgical environment
- Discuss expected outcomes and potential complications for procedures presented
- Discuss specific factors that are unique to the surgical procedure
- Discuss the postoperative care of the patient according to the procedure
- Explain the correct order of steps taken during the surgical procedure. Discuss the postoperative care of the patient according to the procedure
- Explain the diagnostic interventions that are utilized for obtaining a diagnosis
- List the supplies, equipment and instrumentation needed for the procedure
- List the wound classification and correlate to wound management
ST206 Surgical Technology - Orthopedic Surgery
Credits 4Winter
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST222; health and safety requirements must be met.
This course provides orientation to orthopedic surgery for the adult and pediatric patient, with related surgical anatomy, physiology, pathophysiology and specialty instrumentation, equipment and technologies. Special populations and relevant ethical and legal issues are discussed. Roles and responsibilities of the surgical technologist are emphasized.
View Course Outcomes:
- Correlate the relevant pathophysiology to the surgical procedure
- Correlate the relevant surgical anatomy and physiology to the surgical procedures
- Describe any special considerations for patient preparation and surgical positioning for the surgical procedures
- Discuss care of patients in special populations in the surgical environment
- Discuss expected outcomes and potential complications for procedures presented
- Discuss specific factors that are unique to the surgical procedure
- Discuss the postoperative care of the patient according to the procedure
- Explain the correct order of steps taken during the surgical procedure. Discuss the postoperative care of the patient according to the procedure
- Explain the diagnostic interventions that are utilized for obtaining a diagnosis
- List the supplies, equipment and instrumentation needed for the procedure
- List the wound classification and correlate to wound management
ST207 Surgical Technology - Otorhino- laryngologic, Oromaxillofacial, Plastic and Burn Surgery
Credits 4Winter
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L.Concurrent enrollment in ST222 and health and safety requirements must be met.
This course provides orientation to otorhinolaryngologic, oromaxillofacial, plastic and burn surgery for the adult and pediatric patient, with related surgical anatomy, physiology, pathophysiology and specialty instrumentation, equipment and technologies. Special populations and relevant ethical and legal issues are discussed. Roles and responsibilities of the surgical technologist are emphasized.
View Course Outcomes:
- Correlate the relevant pathophysiology to the surgical procedure
- Correlate the relevant surgical anatomy and physiology to the surgical procedures
- Describe any special considerations for patient preparation and surgical positioning for the surgical procedures
- Discuss care of patients in special populations in the surgical environment
- Discuss expected outcomes and potential complications for procedures presented
- Discuss specific factors that are unique to the surgical procedure
- Discuss the postoperative care of the patient according to the procedure
- Explain the correct order of steps taken during the surgical procedure. Discuss the postoperative care of the patient according to the procedure
- Explain the diagnostic interventions that are utilized for obtaining a diagnosis
- List the supplies, equipment and instrumentation needed for the procedure
- List the wound classification and correlate to wound management
ST208 Surgical Technology - Ophthalmologic and Neurosurgery
Credits 4Spring
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST223; health and safety requirements must be met.
This course provides orientation to ophthalmic and neurosurgery for the adult and pediatric patient, with related surgical anatomy, physiology, pathophysiology and specialty instrumentation, equipment and technologies. Special populations and relevant ethical and legal issues are discussed. Roles and responsibilities of the surgical technologist are emphasized.
View Course Outcomes:
- Correlate the relevant pathophysiology to the surgical procedure
- Correlate the relevant surgical anatomy and physiology to the surgical procedures
- Describe any special considerations for patient preparation and surgical positioning for the surgical procedures
- Discuss care of patients in special populations in the surgical environment
- Discuss expected outcomes and potential complications for procedures presented
- Discuss specific factors that are unique to the surgical procedure
- Discuss the postoperative care of the patient according to the procedure
- Explain the correct order of steps taken during the surgical procedure. Discuss the postoperative care of the patient according to the procedure
- Explain the diagnostic interventions that are utilized for obtaining a diagnosis
- List the supplies, equipment and instrumentation needed for the procedure
- List the wound classification and correlate to wound management
ST209 Surgical Technology - Thoracic, Cardiovascular and Vascular Surgery
Credits 4Spring
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST223; health and safety requirements must be met.
This course provides orientation to thoracic, cardiovascular and vascular surgery for the adult and pediatric patient, with related surgical anatomy, physiology, pathophysiology and specialty instrumentation, equipment and technologies. Special populations and relevant ethical and legal issues are discussed. Roles and responsibilities of the surgical technologist are emphasized.
View Course Outcomes:
- Correlate the relevant pathophysiology to the surgical procedure
- Correlate the relevant surgical anatomy and physiology to the surgical procedures
- Describe any special considerations for patient preparation and surgical positioning for the surgical procedures
- Discuss care of patients in special populations in the surgical environment
- Discuss expected outcomes and potential complications for procedures presented
- Discuss specific factors that are unique to the surgical procedure
- Discuss the postoperative care of the patient according to the procedure
- Explain the correct order of steps taken during the surgical procedure. Discuss the postoperative care of the patient according to the procedure
- Explain the diagnostic interventions that are utilized for obtaining a diagnosis
- List the supplies, equipment and instrumentation needed for the procedure
- List the wound classification and correlate to wound management
ST221 Surgical Tech Clinical Practicum
Credits 6Fall
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program core curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST204, ST205 and health and safety requirements must be met.
This course is designed to provide clinical experience concurrent with theory. Students will research assigned procedures and participate as a member of the surgical team during the perioperative care of adult and pediatric patients undergoing general, gynecologic and genitourinary surgical procedures. Emphasis is placed on safe patient care practices including principles of aseptic and sterile techniques and their application. Professional behaviors are expected and evaluated.
Additional Course Fee: $350.00
View Course Outcomes:
- Consistently demonstrate correct application of principles of aseptic and sterile techniques
- Consistently demonstrate safe practices for the surgical setting
- Demonstrate grasp of concepts and application of techniques relevant to ST111, ST112, ST204, and ST205
- Demonstrate professional behaviors for the surgical setting, including accountability and attendance
- Demonstrate professional behaviors for the surgical technologist, including accountability and attendance
- Demonstrate progression in first and second scrub role for surgical procedures of increased complexity in surgical procedures assigned
- Discuss the role of the Surgical Technologist during anesthesia induction and emergence
- Function in the circulator assist role as assigned
- Maintain accurate documentation of surgical cases in accordance with program accreditation standards
- Observe the preoperative, intraoperative and immediate postoperative care of the surgical patient by the anesthesia care providers
- Participate as a team member after becoming familiar with operating room routines
ST222 Surgical Tech Clinical Practicum
Credits 6Winter
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST206 and ST207; health and safety requirements must be met.
This course is designed to provide clinical experience concurrent with theory. Students will research assigned procedures and participate as a member of the surgical team during the perioperative care of adult and pediatric patients undergoing orthopedic, otorhinolaryngologic, oromaxillofacial, plastic and burn surgical procedures. Emphasis is placed on safe patient care practices including principles of aseptic and sterile techniques and their application. Professional behaviors are expected and evaluated. Additional content includes preparation for employment as a surgical technologist.
Additional Course Fee: $350.00
View Course Outcomes:
- Consistently demonstrate correct application of principles of aseptic and sterile techniques
- Consistently demonstrate safe practices for the surgical setting
- Demonstrate grasp of concepts and application of techniques relevant to ST111, ST112, ST206 and ST207
- Demonstrate professional behaviors for the surgical setting, including accountability and attendance
- Demonstrate professional behaviors for the surgical technologist, including accountability and attendance
- Demonstrate progression in first and second scrub role for surgical procedures of increased complexity in surgical procedures assigned
- Develop a plan of action to secure employment in the health care field
- Function in the circulator assist role as assigned
- Maintain accurate documentation of surgical cases in accordance with program accreditation standards
- Participate as a team member after becoming familiar with operating room routines
ST223 Surgical Tech Clinical Practicum
Credits 6Spring
Registration Requirement: A grade of "C" or better in all previous Surgical Technology program curriculum and BI231, BI232, BI233, AH110, CIS120 and CIS120L. Concurrent enrollment in ST208 and ST209; health and safety requirements must be met.
This course is designed to provide clinical experience concurrent with theory. Students research assigned procedures and participate as a member of the surgical team during the perioperative care of adult and pediatric patients undergoing thoracic, cardiovascular, vascular, ophthalmic and neurologic surgical procedures. Emphasis is placed on safe patient care practices including principles of aseptic and sterile techniques and their application. Professional behaviors are expected and evaluated. Students explore tools for making a successful transition from student to employee.
Additional Course Fee: $350.00
View Course Outcomes:
- Consistently demonstrate correct application of principles of aseptic and sterile techniques
- Consistently demonstrate safe practices for the surgical setting
- Demonstrate grasp of concepts and application of techniques relevant to ST111, ST112, ST208 and ST209
- Demonstrate professional behaviors for the surgical setting, including accountability and attendance
- Demonstrate professional behaviors for the surgical technologist, including accountability and attendance
- Demonstrate progression in first and second scrub role for surgical procedures of increased complexity in surgical procedures assigned
- Function in the circulator assist role as assigned
- Function independently as a surgical technologist in the first scrub role for entry level procedures
- Identify tools for successful transition from student to employee
- Maintain accurate documentation of surgical cases in accordance with program accreditation standards
- Participate as a team member after becoming familiar with operating room routines
Course fees are subject to change. Additional section fees (web, hybrid, etc.) may apply.