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NASA NTRSDate not supplied

Introduction to the IMPACT Probabilistic Risk and Tradespace Analysis Tool for Medical System Design

Background: Probabilistic risk analysis (PRA) is a method for estimating risk in complex engineered systems that, at a basic level, focuses on what can go wrong and the likelihood and consequences of those occurrences. NASA has used PRA as an integral component of medical system risk estimation and design for spaceflight. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a novel tool to meet these goals for exploration missions. Overview: IMPACT performs hundreds of thousands of Monte Carlo simulations of missions to build aggregate pictures of medical risk. These simulations are based on 120 possible medical conditions (the IMPACT Condition List) selected in a consensus-based process because they are of highest likelihood and/or consequence for exploration spaceflight. The conditions are then tied to clinical capabilities which can be used for management (e.g., inserting an IV) and then to over 600 specific resources needed to deliver a capability (e.g., an angiocath or an ultrasound). Different mission profiles can be simulated with user-specified inputs such as mission duration, destination, number of crew and pre-existing medical conditions, and EVA frequency. While the IMPACT evidence base is designed for exploration environments, these user inputs allow the tool to be used across a broad range of missions. IMPACT’s primary outcome metrics include loss of crew life (LOCL, a measure of in-flight mortality due to medical conditions), need for evacuation (RTDC, return to definitive care), and crew disability (TTL, task time lost based on how medical conditions impact the ability to perform over 1000 specific exploration mission crew tasks). In addition to modeling medical risk, IMPACT also accepts user-specified constraints, such as limitations of mass or volume, and will output a recommended clinical capability set and specific medical resources that meet the mission constraints. Discussion: This abstract will provide an introduction to IMPACT and describe the nature of the underlying medical evidence. It will also detail potential use cases for how this tool can be utilized by NASA or commercial spaceflight providers.

Ben Easter↗

NASA NTRS2023

IMPACTing Medical System Design with a Risk Analysis Tool [“IMPACT” sur la Conception du Système Médical avec un Outil d'Analyse des Risques]

Background: Following the success of Artemis I, NASA is preparing for human extended duration missions. Ongoing efforts are focused on mitigating mission-related risks, including those affecting crew health and performance. Communication latency, logistics of resupply and time frame of medical evacuation are barriers to provision of healthcare for these missions, especially with respect to constraints in mass, volume, and crew training. An in-depth assessment of medical risks, capabilities and resources for a specific mission design is necessary to determine an optimal balance that maximizes likelihood of mission success. Overview: IMPACT (Informed Mission Planning via Analysis of Complex Tradespaces) is a dynamic tool designed to estimate medical risk and outcomes for a specific mission design. In its current iteration, a list of medical conditions selected based on likelihood of occurrence and/or consequence was linked to a set of clinical capabilities and resources necessary for diagnosis and management. A probabilistic risk analysis tool was then used to identify and estimate the likelihood and consequence of risks through the following outcome metrics: loss of crew life (inflight mortality due to medical conditions), need for medical evacuation (return to definitive care), and crew disability (task time affected based on how medical conditions influence the ability to perform specific exploration mission crew tasks). Finally, the model’s optimization algorithm provides recommendations for medical capabilities that maximize risk mitigation relative to mass and volume constraints. In the Spring of 2023, IMPACT was utilized to estimate outcome metrics for a design reference mission that would be representative of an extended duration Artemis mission. Notional data generated were then used to determine a recommended set of medical capabilities and resources relative to user-defined mass and volume constraints. A multidisciplinary team has also been updating IMPACT to strengthen the model’s fidelity. Figure 1 shows how updates to outcome metric inputs for the conditions resulted in different capability and resource allocation recommendations. Discussion: This presentation will discuss the IMPACT tool and share the latest data generated for a representative extended duration Artemis mission. Efforts to improve the fidelity of data generated by the model’s algorithm will also be discussed.

K A Shair↗

NASA NTRSDate not supplied

Assessing Crew Medical Officer Preparedness for International Space Station Missions

INTRODUCTION Astronaut crew medical officers (CMO) undergo additional, specialized training to provide medical support onboard the International Space Station (ISS). CMO training focuses on utilizing resources on-station and optimizing communication with ground-based expertise to manage both common minor conditions as well as emergency/trauma situations. As NASA moves towards future Artemis and exploration class missions, we sought CMO perspectives on past, present, and future CMO training and medical resourcing to help inform mission planners regarding medical risk mitigation considerations. We present an interview-based qualitative assessment of CMO preparedness for the International Space Station with the aim to help iterate future training flows for Low Earth Orbit, Artemis, and exploration-class missions. METHODS A semi-structured interview tool was developed to assess CMO experience and their recommendations for future mission training considerations. Participants were recruited from former or current US astronauts who were designated as CMO and subsequently flew to the International Space Station. 10 former CMOs took part in the study. Interview transcripts were deidentified and evaluated for qualitative thematic analysis by two independent coders with NVivo Software suite (Lumivero, Denver, CO), and emergent themes were compiled. RESULTS Former CMO crew expressed appropriate preparedness for current ISS medical capabilities and requirements. They identified the role of the CMO as serving as a healthcare extender to ground-based flight surgeons for ISS and other LEO missions. Individuals with prior medical experience were preferred though not felt to be necessary for LEO missions. For exploration class missions with limitations in ground communication, a physician-as-CMO and more rigorous training curricula for both the CMO and astronaut crew were desired. DISCUSSION Former NASA astronaut crew were interviewed to retrospectively assess their preparedness as ISS crew medical officers and hypothesize future medical knowledge, skill, and ability needs. Along with medical operations subject matter expert opinion and advanced probabilistic risk assessment modeling, past CMO experience can help inform future CMO training considerations and responsibilities for future Artemis and exploration class missions.

M A Labarbera↗

NASA NTRSDate not supplied

IMPACTing Medical System Design with a Risk Analysis Tool

K A Shair↗

NASA NTRS2017

Medical Data Architecture Project Status

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current International Space Station (ISS) medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable an increasingly autonomous crew than the current ISS paradigm. The MDA will develop capabilities that support automated data collection, and the necessary functionality and challenges in executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. To attain this goal, the first year of the MDA project focused on reducing technical risk, developing documentation and instituting iterative development processes that established the basis for the first version of MDA software (or Test Bed 1). Test Bed 1 is based on a nominal operations scenario authored by the ExMC Element Scientist. This narrative was decomposed into a Concept of Operations that formed the basis for Test Bed 1 requirements. These requirements were successfully vetted through the MDA Test Bed 1 System Requirements Review, which permitted the MDA project to begin software code development and component integration. This paper highlights the MDA objectives, development processes, and accomplishments, and identifies the fiscal year 2017 milestones and deliverables in the upcoming year.

Data management↗

NASA NTRS2017

Medical Data Architecture Project Status

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current International Space Station (ISS) medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable an increasingly autonomous crew than the current ISS paradigm. The MDA will develop capabilities that support automated data collection, and the necessary functionality and challenges in executing a self-contained medical system that approaches crew health care delivery without assistance from ground support.To attain this goal, the first year of the MDA project focused on reducing technical risk, developing documentation and instituting iterative development processes that established the basis for the first version of MDA software (or Test Bed 1). Test Bed 1 is based on a nominal operations scenario authored by the ExMC Element Scientist. This narrative was decomposed into a Concept of Operations that formed the basis for Test Bed 1 requirements. These requirements were successfully vetted through the MDA Test Bed 1 System Requirements Review, which permitted the MDA project to begin software code development and component integration. This paper highlights the MDA objectives, development processes, and accomplishments, and identifies the fiscal year 2017 milestones and deliverables in the upcoming year.

Exploration medical system↗

NASA NTRSDate not supplied

Challenges, Considerations, and Opportunities for Exercise and Medical Accommodation Inside a Small Pressurized Rover

Pressurized Rovers (PR) can enable crew to explore away from a lander or surface habitat at distances not possible on foot or even in unpressurized rovers. Sustaining crew for multiple days, they can rove for weeks, independent of other surface elements. Because these are essentially mobile habitats, it is critical that they provide sufficient volume to accommodate the exercise and medical systems to maintain human health in remote, low gravity environments such as the Moon and Mars. This is an area of extensive unknowns as requirements have not yet been developed for exercise or medical systems in pressurized rovers. Yet they must be considered in vehicle sizing studies as they are significant volume drivers, requiring allocation for stowed and deployed hardware inside the rover cabin. Previously flown spacecraft have allocated varying amounts of volume based on the expected crew mission and the state of the art in these systems. NASA-STD-3001 provides high-level requirements for standards of medical care and exercise capabilities. Crew injuries are possible both inside the cabin and on extravehicular activities (EVA), therefore requiring medical capability. Exercise countermeasures are needed to counteract the debilitating effects of lowered gravity. This may include both reconditioning following a lengthy microgravity transit as well as ongoing countermeasures against the effect of low surface gravity. The NASA reference concept for the PR dates back to the Constellation Program and prototypes have been extensively tested in NASA’s Desert Research and Technology Studies (DRATS) program as well as at the NASA Johnson Space Center. The PR cabin is designed to accommodate two crewmembers and is subdivided into a forward cockpit area and a main body for crew habitation. EVAs are accomplished by transitioning through suit ports in the aft bulkhead into spacesuits. While no exercise devices have been developed for the PR, some have been prototyped and demonstrated in DRATS analog missions. A cycle ergometer performed reasonably well in DRATS testing as an aerobic exercise device and recent analysis work has theorized that a combination aerobic and resistive device could be packaged into a form factor similar to the DRATS ergometer. It is therefore suitable for use as an initial volumetric placeholder. No sensorimotor devices have been considered for the PR to aid in adaptation to surface gravity. However, there are commercially available treadmills that at minimum represent examples of the type of exercise system that could potentially be used for such a purpose. A combination of field test data, analysis, and CAD modeling will be used to perform a first pass assessment of whether these exercise devices can be stowed and deployed within the PR. Medical inventories from the International Space Station will be used as a volume placeholder for the PR medical system. A configuration will be discussed for medical deployment, including positioning of caregiver, patient, and medical equipment / supplies.

Pressurized Rover↗

DOE OSTI2020

State and Regional Variation in Prescription- and Payment-Related Promoters of Adherence to Blood Pressure Medication

Introduction: Medication adherence can improve hypertension management. How blood pressure medications are prescribed and purchased can promote or impede adherence. Methods: We used comprehensive dispensing data on prescription blood pressure medication from Symphony Health’s 2017 Integrated Dataverse to assess how prescription- and payment-related factors that promote medication adherence (ie, fixed-dose combinations, generic formulations, mail order, low-cost or no-copay medications) vary across US states and census regions and across the market segments (grouped by patient age, prescriber type, and payer type) responsible for the greatest number of blood pressure medication fills. Results: In 2017, 706.5 million prescriptions for blood pressure medication were filled, accounting for $29.0 billion in total spending (17.0% incurred by patients). As a proportion of all fills, factors that promoted adherence varied by state: fixed-dose combinations (from 5.8% in Maine to 17.9% in Mississippi); generic formulations (from 95.2% in New Jersey to 98.4% in Minnesota); mail order (from 4.7% in Rhode Island to 14.5% in Delaware); and lower or no copayment (from 56.6% in Utah to 72.8% in California). Furthermore, mean days’ supply per fill (from 43.1 in Arkansas to 63.8 in Maine) and patient spending per therapy year (from $38 in Hawaii to $76 in Georgia) varied. Concentration of adherence factors differed by market segment. Patients aged 18 to 64 with a primary care physician prescriber and Medicaid coverage had the lowest concentration of fixed-dose combination fills, mean days’ supply per fill, and patient spending per therapy year. Patients aged 65 years or older with a primary care physician prescriber and commercial insurance had the highest concentration of fixeddose combinations fills and mail order fills. Conclusion: Addressing regional and market segment variation in factors promoting blood pressure medication adherence may increase adherence and improve hypertension management.

60 APPLIED LIFE SCIENCES↗

NASA NTRS1991

Medical evaluations on the KC-135 1990 flight report summary

The medical investigations completed on the KC-135 during FY 1990 in support of the development of the Health Maintenance Facility and Medical Operations are discussed. The experiments are comprised of engineering evaluations of medical hardware and medical procedures. The investigating teams are made up of both medical and engineering personnel responsible for the development of medical hardware and medical operations. The hardware evaluated includes dental equipment, a coagulation analyzer, selected pharmaceutical aerosol devices, a prototype air/fluid separator, a prototype packaging and stowage system for medical supplies, a microliter metering system, and a workstation for minor surgical procedures. The results of these engineering evaluations will be used in the design of fleet hardware as well as to identify hardware specific training requirements.

Lloyd, Charles W.↗

NASA NTRS1998

Computer-Based Medical System

SYMED, Inc., developed a unique electronic medical records and information management system. The S2000 Medical Interactive Care System (MICS) incorporates both a comprehensive and interactive medical care support capability and an extensive array of digital medical reference materials in either text or high resolution graphic form. The system was designed, in cooperation with NASA, to improve the effectiveness and efficiency of physician practices. The S2000 is a MS (Microsoft) Windows based software product which combines electronic forms, medical documents, records management, and features a comprehensive medical information system for medical diagnostic support and treatment. SYMED, Inc. offers access to its medical systems to all companies seeking competitive advantages.

Source record↗

NASA NTRS2003

Some approaches to medical support for Martian expedition

Medical support in a Martian expedition will be within the scope of crew responsibilities and maximally autonomous. Requirements to the system of diagnostics in this mission include considerable use of means and methods of visualization of the main physiological parameters, telemedicine, broad usage of biochemical analyses (including "dry" chemistry), computerized collection, measurement, analysis and storage of medical information. The countermeasure system will be based on objective methods of crew fitness and working ability evaluation, individual selection of training regimens, and intensive use of computer controlled training. Implementation of the above principles implies modernization and refinement of the countermeasures currently used by space crews of long-term missions (LTM), and increases of the assortment of active and passive training devices, among them a short-arm centrifuge. The system of medical care with the functions of prevention, clinical diagnostics and timely treatment will be autonomous, too. The general requirements to medical care during the future mission are the following: availability of conditions and means for autonomous urgent and special medical aid and treatment of the most possible states and diseases, "a hospital", and assignment to the crew of one or two doctors. To ensure independence of medical support and medical care in an expedition to Mars an automated expert system needs to be designed and constructed to control the medical situation as a whole. c2003 Published by Elsevier Science Ltd.

Mars↗

NASA NTRS2005

GO/NO-GO - When is medical hazard mitigation acceptable for launch?

Medical support of spaceflight missions is composed of complex tasks and decisions that dedicated to maintaining the health and performance of the crew and the completion of mission objectives. Spacecraft represent one of the most complex vehicles built by humans, and are built to very rigorous design specifications. In the course of a Flight Readiness Review (FRR) or a mission itself, the flight surgeon must be able to understand the impact of hazards and risks that may not be completely mitigated by design alone. Some hazards are not mitigated because they are never actually identified. When a hazard is identified, it must be reduced or waivered. Hazards that cannot be designed out of the vehicle or mission, are usually mitigated through other means to bring the residual risk to an acceptable level. This is possible in most engineered systems because failure modes are usually predictable and analysis can include taking these systems to failure. Medical support of space missions is complicated by the inability of flight surgeons to provide "exact" hazard and risk numbers to the NASA engineering community. Taking humans to failure is not an option. Furthermore, medical dogma is mostly comprised of "medical prevention" strategies that mitigate risk by examining the behaviour of a cohort of humans similar to astronauts. Unfortunately, this approach does not lend itself well for predicting the effect of a hazard in the unique environment of space. This presentation will discuss how Medical Operations uses an evidence-based approach to decide if hazard mitigation strategies are adequate to reduce mission risk to acceptable levels. Case studies to be discussed will include: 1. Risk of electrocution risk during EVA 2. Risk of cardiac event risk during long and short duration missions 3. Degraded cabin environmental monitoring on the ISS. Learning Objectives 1.) The audience will understand the challenges of mitigating medical risk caused by nominal and off-nominal mission events. 2.) The audience will understand the process by which medical hazards are identified and mitigated before launch. 3.) The audience will understand the roles and responsibilities of all the other flight control positions in participating in the process of reducing hazards and reducing medical risk to an acceptable level.

Hamilton, Douglas R.↗

NASA NTRS2012

Exploration Medical System Demonstration (EMSD) Project

The Exploration Medical System Demonstration (EMSD) is a project under the Exploration Medical Capability (ExMC) element managed by the Human Research Program (HRP). The vision for the EMSD is to utilize ISS as a test bed to show that several medical technologies needed for an exploration mission and medical informatics tools for managing evidence and decision making can be integrated into a single system and used by the on-orbit crew in an efficient and meaningful manner. Objectives: a) Reduce and even possibly eliminate the time required for on-orbit crew and ground personnel (which include Surgeon, Biomedical Engineer (BME) Flight Controller, and Medical Operations Data Specialist) to access and move medical data from one application to another. b) Demonstrate that the on-orbit crew has the ability to access medical data/information using an intuitive and crew-friendly software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management framework and architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities.

Chin, Duane↗

NASA NTRS2013

Overview of an Integrated Medical System for Exploration Missions

The Exploration Medical Capability (ExMC) element of the NASA Human Research Program (HRP) is charged with addressing the risk of unacceptable health and mission outcomes due to limitations of inflight medical capabilities. The Exploration Medical System Demonstration (EMSD) is a project within the ExMC element aimed at reducing this risk by improving the medical capabilities available for exploration missions. The EMSD project will demonstrate, on the ground and on ISS, the integration of several components felt to be essential to the delivery of medical care during long ]duration missions outside of low Earth orbit. The components of the EMSD include the electronic medical record, assisted medical procedure software, medical consumables tracking technology and RFID ] tagged consumables, video conferencing capability, ultrasound device and probes (ground demonstration only), peripheral biosensors, and the software to allow communication among the various components (middleware). This presentation seeks to inform our international partners of the goals and objectives of the EMSD and to foster collaboration opportunities related to this and future projects.

Watkins, Sharmila↗

NASA NTRS2015

Dose Tracker Application for Monitoring Crew Medication Usage, Symptoms, and Adverse Effects During Missions

Medication usage records can be used as a relatively nonintrusive means of monitoring health. This has been attempted previously through crew medical records, but these records are incomplete from the perspective of a research pharmacologist. During the shuttle era, NASA operations did not include routine questioning of crewmembers about their medication use until after missions were complete. The (long!) questionnaire was on paper. Asking crewmembers to recall medication use from weeks before questioning made getting complete and accurate information virtually impossible. This study will document medication usage of crewmembers before and during their missions. It will capture previously unrecorded data regarding medication use during spaceflight, including side effect qualities, frequencies and severities. The research-oriented data will be collected for research purposes, separate from medical records. Dose Tracker employs an iOS application (app) for fast & easy collection of medication usage data from crewmember participants during their missions.

Wotring, Virginia↗

NASA NTRS2016

A Strategic Approach to Medical Care for Exploration Missions

Exploration missions will present significant new challenges to crew health, including effects of variable gravity environments, limited communication with Earth-based personnel for diagnosis and consultation for medical events, limited resupply, and limited ability for crew return. Providing health care capabilities for exploration class missions will require system trades be performed to identify a minimum set of requirements and crosscutting capabilities, which can be used in design of exploration medical systems. Medical data, information, and knowledge collected during current space missions must be catalogued and put in formats that facilitate querying and analysis. These data are used to inform the medical research and development program through analysis of risk trade studies between medical care capabilities and system constraints such as mass, power, volume, and training. Medical capability as a quantifiable variable is proposed as a surrogate risk metric and explored for trade space analysis that can improve communication between the medical and engineering approaches to mission design. The resulting medical system design approach selected will inform NASA mission architecture, vehicle, and subsystem design for the next generation of spacecraft.

Canga, Michael A.↗

NASA NTRS2017

Defining Medical Levels of Care for Exploration Missions

NASA medical care standards establish requirements for providing health and medical programs for crewmembers during all phases of a mission. These requirements are intended to prevent or mitigate negative health consequences of long-duration spaceflight, thereby optimizing crew health and performance over the course of the mission. Current standards are documented in the two volumes of the NASA-STD-3001 Space Flight Human-System Standard document, established by the Office of the Chief Health and Medical Officer. Its purpose is to provide uniform technical standards for the design, selection, and application of medical hardware, software, processes, procedures, practices, and methods for human-rated systems. NASA-STD-3001 Vol. 1 identifies five levels of care for human spaceflight. These levels of care are accompanied by several components that illustrate the type of medical care expected for each. The Exploration Medical Capability (ExMC) of the Human Research Program has expanded the context of these provided levels of care and components. This supplemental information includes definitions for each component of care and example actions that describe the type of capabilities that coincide with the definition. This interpretation is necessary in order to fully and systematically define the capabilities required for each level of care in order to define the medical requirements and plan for infrastructure needed for medical systems of future exploration missions, such as one to Mars.

Hailey, M.↗

NASA NTRS2017

Exploration Medical System Technical Development

The Exploration Medical Capability (ExMC) Element systems engineering goals include defining the technical system needed to implement exploration medical capabilities for Mars. This past year, scenarios captured in the medical system concept of operations laid the foundation for systems engineering technical development work. The systems engineering team analyzed scenario content to identify interactions between the medical system, crewmembers, the exploration vehicle, and the ground system. This enabled the definition of functions the medical system must provide and interfaces to crewmembers and other systems. These analyses additionally lead to the development of a conceptual medical system architecture. The work supports the ExMC community-wide understanding of the functional exploration needs to be met by the medical system, the subsequent development of medical system requirements, and the system verification and validation approach utilizing terrestrial analogs and precursor exploration missions.

McGuire, K.↗