Justification of the power supply system for life support of rescue units and the injured population during field deployment

Introduction. Increasing of number, scale and duration of the consequences of emergency situations associated with the violation of the conditions of normal living of people requires the creation of temporary field accommodation points for the affected population and rescue units. At the same time, electric power supply in field temporary accommodation facilities plays a crucial role in the complex of tasks and measures aimed at providing life to the injured population and rescue units. At the same time, there are no mobile autonomous sources of electric energy for providing life support to people in the field in the organizational and staff structure of rescue units, and the existing sources of electric energy in the complexes of equipment used in areas of emergency situations cannot be used for these purposes. Therefore, it is necessary to develop a scientific and methodological approach to determine necessary and sufficient number of sources of electric energy for the power supply of the life support of the injured population and rescue units when they are placed in field temporary accommodation points. The purpose of the study. Electric power supply of field temporary accommodation points for the injured population and rescue units, ensuring the required reliability of electric power supply, maximizing its efficiency in the conditions of possible resource constraints and minimizing the influence of the uncertainty factor in the planning of electricity consumption. Research methods. The main provisions of the calculation of electrical loads, system theory, set theory, probability theory and the apparatus of mathematical statistics. The results of the study. A methodology has been developed that allows to justify the power of electric energy sources for the power supply of field temporary accommodation points for the injured population and rescue units, rational options for the power supply system, the nomenclature and number of electric energy sources for the life support of people in the field; to calculate the electric network; to evaluate the operation of the power supply system, based on the probability of failure-free operation of the source of electric energy; to justify the composition of engineering means to ensure the creation of the power supply system. Conclusion. The scientific and methodological approach for determining the composition of electric energy sources for the power supply of life support for the injured population and rescue units when they are placed in field temporary accommodation points is justified, which also allows to resolve the contradiction between the need to organize the power supply of life support for people in temporary accommodation points and the lack of a reasonable structure of electric energy sources for these purposes. Keywords: temporary accommodation point, injured population, rescue formation, consumers, electric power supply, organization

505 Burn Sepsis: Does the Initial Vitamin C Level Matter?

Introduction After the first 24 hours, the principle cause of death in burn patients is multiple organ dysfunction/failure syndrome. It is preceded by infection in 83% of burn patients, with reported septic mortality up to 65%. In a recent journal article involving septic medical ICU patients, Marik et al. reports that all initial Vitamin C levels were below the normal range (0.4–2.0 mg/dL) prior to any intervention. Independent of each other, both early recognition and treatment of infection and vitamin C have been shown to be beneficial in sepsis. We monitored Vitamin C levels as part of our “Burn Code Sepsis” algorithm to obtain a baseline understanding of Vitamin C levels in infected adult burn patients. Methods Adult (≥18 yo) admissions between 7/1/2018 – 6/30/2019 were identified from our Burn Registry and all sepsis screens were evaluated in the EMR. Patients were screened clinically at least BID and were considered a “positive” screen if MAP < 65 mmHg (SBP< 90 mmHg) or if 2 of the 3 occurred: Temp >102.2F; HR >120; RR >28 (or RR >10% of ventilator set rate if set rate is >24 bpm). A positive screen prompted lab work to include CBC, BMP, procalcitonin (PCT), lactic acid (LA) and Vitamin C (VC), per protocol. If PCT >3.0 ng/ml or LA >2.0 mmol/L, or both thrombocytopenia and hyperglycemia were present, a “Burn Code Sepsis” was initiated and included cultures, a CXR, and empiric antibiotics. If the cultures were positive or the CXR demonstrated an infectious process, a patient was considered “septic”. All burn injured patients with greater than or equal to 20% TBSA burns receive Vitamin C supplementation as part of our standard of care. Results There were 286 admissions during the 12-month period, with 38 positive initial sepsis screens (mean TBSA = 35%) that have an associated VC level. Of these positive screens, 26 (65%) were infected and 12 (35%) were not infected. ROC Curve analysis of VC levels and its ability to diagnose septic patients yields an AUC = 0.60 (p = 0.37). The mean VC level of infected patients at the time of initial screening was 1.9 +/- 1.4 mg/dL, and the mean VC level of non-infected patients at initial screening was 1.5 +/- 1.0 mg/dL. Conclusions Our results contrast with the previously published article on Vitamin C levels in a septic, non-burn injured population. Only 1 of 26 infected patients possessed a Vitamin C level below the normal range (0.4–2.0 mg/dL). Infected patients possessed higher Vitamin C levels than the non-infected patients, though not statistically significant (p = 0.35). AUC analysis indicates Vitamin C level is a poor prognostic test for sepsis. Applicability of Research to Practice Further research on Vitamin C levels and Its role in sepsis in the burn injured population is warranted.