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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 NTRS2008

Stability of Formulations Contained in the Pharmaceutical Payload Aboard Space Missions

Efficacious pharmaceuticals with adequate shelf life are essential for successful space medical operations in support of space exploration missions. Physical and environmental factors unique to space missions such as vibration, G forces and ionizing radiation may adversely affect stability of pharmaceuticals intended for standard care of astronauts aboard space missions. Stable pharmaceuticals, therefore, are of paramount importance for assuring health and wellness of astronauts in space. Preliminary examination of stability of formulations from Shuttle and International Space Station (ISS) medical kits revealed that some of these medications showed physical and chemical degradation after flight raising concern of reduced therapeutic effectiveness with these medications in space. A research payload experiment was conducted with a select set of formulations stowed aboard a shuttle flight and on ISS. The payload consisted of four identical pharmaceutical kits containing 31 medications in different dosage forms that were transported to the International Space Station (ISS) aboard the Space Shuttle, STS 121. One of the four kits was stored on the shuttle and the other three were stored on the ISS for return to Earth at six months intervals on a pre-designated Shuttle flight for each kit; the shuttle kit was returned to Earth on the same flight. Standard stability indicating physical and chemical parameters were measured for all pharmaceuticals returned from the shuttle and from the first ISS increment payload along with ground-based matching controls. Results were compared between shuttle, ISS and ground controls. Evaluation of data from the three paradigms indicates that some of the formulations exhibited significant degradation in space compared to respective ground controls; a few formulations were unstable both on the ground and in space. An increase in the number of pharmaceuticals from ISS failing USP standards was noticed compared to those from the shuttle flight. A comprehensive evaluation of results is in progress.

Putcha, Lakshmi↗

NASA NTRS2009

Stability of Dosage Forms in the Pharmaceutical Payload Aboard Space Missions

Efficacious pharmaceuticals with adequate shelf lives are essential for successful space medical operations. Stability of pharmaceuticals, therefore, is of paramount importance for assuring the health and wellness of astronauts on future space exploration missions. Unique physical and environmental factors of space missions may contribute to the instability of pharmaceuticals, e.g., radiation, humidity and temperature variations. Degradation of pharmaceutical formulations can result in inadequate efficacy and/or untoward toxic effects, which could compromise astronaut safety and health. Methods: Four identical pharmaceutical payload kits containing 31 medications in different dosage forms (liquid, tablet, capsule, ointment and suppository) were transported to the International Space Station aboard the Space Shuttle (STS-121). One of the 4 kits was stored on the Shuttle and the other 3 were stored on the International Space Station (ISS) for return to Earth at 6-month interval aboard a pre-designated Shuttle flight for each kit. The kit stored on the Shuttle was returned to Earth aboard STS-121 and 2 kits from ISS were returned on STS 117 and STS-122. Results: Analysis of standard physical and chemical parameters of degradation was completed for pharmaceuticals returned by STS-121 after14 days, STS - 117 after11 months and STS 122 after 19 months storage aboard ISS. Analysis of all flight samples along with ground-based matching controls was completed and results were compiled. Conclusion: Evaluation of results from the shuttle (1) and ISS increments (2) indicate that the number of formulations degraded in space increased with duration of storage in space and was higher in space compared to their ground-based counterparts. Rate of degradation for some of the formulations tested was faster in space than on Earth. Additionally, some of the formulations included in the medical kits were unstable, more so in space than on the ground. These results indicate that the space flight environment may adversely affect the shelf life of pharmaceuticals aboard space missions.

Du, Brian J.↗

NASA NTRS2018

Development of a Ground Test and Analysis Protocol for NASA's NextSTEP Phase 2 Habitation Concepts

The NASA Next Space Technologies for Exploration Partnerships (NextSTEP) program is a public-private partnership model that seeks commercial development of deep space exploration capabilities to support human spaceflight missions around and beyond cislunar space. NASA first issued the Phase 1 NextSTEP Broad Agency Announcement to U.S. industries in 2014, which called for innovative cislunar habitation concepts that leveraged commercialization plans for low-Earth orbit. These habitats will be part of the Deep Space Gateway (DSG), the cislunar space station planned by NASA for construction in the 2020s. In 2016, Phase 2 of the NextSTEP program selected five commercial partners to develop ground prototypes. A team of NASA research engineers and subject matter experts (SMEs) have been tasked with developing the ground-test protocol that will serve as the primary means by which these Phase 2 prototypes will be evaluated. Since 2008, this core test team has successfully conducted multiple spaceflight analog mission evaluations utilizing a consistent set of operational tools, methods, and metrics to enable the iterative development, testing, analysis, and validation of evolving exploration architectures, operations concepts, and vehicle designs. The purpose of implementing a similar evaluation process for the Phase 2 Habitation Concepts is to consistently evaluate different commercial partner ground prototypes to provide data-driven, actionable recommendations for Phase 3. This paper describes the process by which the ground test protocol was developed and the objectives, methods, and metrics by which the NextSTEP Phase 2 Habitation Concepts will be rigorously and systematically evaluated. The protocol has been developed using both a top-down and bottom-up approach. Top-down development began with the Human Exploration and Operations Mission Directorate (HEOMD) exploration objectives and ISS Exploration Capability Study Team (IECST) candidate flight objectives. Strategic questions and associated rationales, derived from these candidate architectural objectives, provide the framework by which the ground-test protocol will address the DSG stack elements and configurations, systems and subsystems, and habitation, science, and EVA functions. From these strategic questions, high-level functional requirements for the DSG were drafted and associated ground-test objectives and analysis protocols were established. Bottom-up development incorporated objectives from NASA SMEs in autonomy, avionics and software, communication, environmental control and life support systems, exercise, extravehicular activity, exploration medical operations, guidance navigation and control, human factors and behavioral performance, human factors and habitability, logistics, Mission Control Center operations, power, radiation, robotics, safety and mission assurance, science, simulation, structures, thermal, trash management, and vehicle health. Top-down and bottom-up objectives were integrated to form overall functional requirements - ground-test objectives and analysis mapping. From this mapping, ground-test objectives were organized into those that will be evaluated through inspection, demonstration, analysis, subsystem standalone testing, and human-in-the-loop (HITL) testing. For the HITL tests, mission-like timelines, procedures, and flight rules have been developed to directly meet ground test objectives and evaluate specific functional requirements. Data collected from these assessments will be analyzed to determine the acceptability of habitation element configurations and the combinations of capabilities that will result in the best habitation platform to be recommended by the test team for Phase 3.

Gernhardt, Michael L.↗

NASA NTRS2019

International Space Station Multilateral Medical Policy Board Transitions in Space Medicine: 25 Years in Photos

This collection of photographic highlights covers the past 25 years of international collaboration in human space flight. Beginning in 1993, the international community came together to develop the medical systems for an international space station. Initially, this collaboration was bilateral in support of the Shuttle / Mir Space Station (Phase 1). However, the framework that was established to serve as the medical authority structure provided a foundation for the multilateral boards and panel, which were codified in the memoranda of understanding. The Multilateral Medical Policy Board, the Multilateral Space Medicine Board, and the Multilateral Medical Operations Panel were developed in a collegial and mutually beneficial environment by the men and women of the space agencies of Canada, Europe, Japan, Russia, and the United States. This collection of photographs from official and personal collections captures the spirit and collegiality to which we have grown accustomed. They are also presented to commemorate the integrity, professionalism, tenacity, and dedication to human space exploration consistently demonstrated by individuals involved in this amazing effort.

photographs↗

NASA NTRSDate not supplied

Objective Structured Clinical Evaluation (OSCE) of an Artificial Intelligence (AI) Clinical Decision Support System (CDSS) Tool

BACKGROUND Objective Structured Clinical Evaluations (OSCEs) have long been established as a robust methodology for summative assessment of clinical skills and decision-making during medical education. The recent integration of Artificial Intelligence (AI) into clinical decision-making processes has prompted the need for novel evaluation frameworks to assess the efficacy and reliability of AI clinical decision support system (CDSS) tools. This abstract outlines the process of quantitatively evaluating a novel CDSS (“Doc in a Box” Google 2024) trained on curated medical spaceflight data in the psychomotor domain as it interfaces with a human volunteer acting as the crew medical officer (CMO). PURPOSE The AI CDSS under review was developed as part of the Lunar Command and Control Interoperability (LuCCI) project, which is intended to address a gap in how Lunar Surface Systems (LSS) would interoperate across multiple programs, commercial partners, and international partners. The project objective is to define, prototype, integrate, and evaluate an interoperable lunar command, control, data, and software reference architecture to enable autonomy and informatics capability through common standards across LSS. A multi-modal AI-based CDSS compatible with Federated LSS will assist clinicians in diagnosing and managing complex medical conditions by providing evidence-based recommendations through predictive analytics. Given the critical role of decision-support as NASA continues to evolve its Earth-independent medical operations (EIMO), it is imperative to ensure that such AI tools perform reliably and align with clinical standards during progressive lunar and Martian exploration class missions. METHODS The OSCE framework, traditionally used for evaluating human clinicians, was adapted to assess the AI tool's decision-making capabilities in simulated clinical scenarios. In this adapted OSCE, the AI CDSS was tested across a series of structured clinical scenarios designed to mimic real-life spaceflight patient cases. These scenarios included a range of conditions and complexities, allowing for comprehensive assessment of the tool's performance. Key evaluation metrics included accuracy of diagnosis, timeliness of decision-making, and appropriate recommendations for therapies. The OSCE was scored by human physician evaluators who assessed the AI's recommendations in comparison with expert clinicians' medical decision making to ensure alignment with best practices and the standard of care. RESULTS Preliminary results indicate that the AI CDSS demonstrated high accuracy in diagnostic recommendations and decision support across various scenarios. However, certain limitations were noted, such as occasional discrepancies in handling complex or nuanced cases that required a more contextual understanding. Additionally, the tool scored higher on the diagnostic portion of the rubric, with lower scores in the therapeutic recommendations. These findings highlight the importance of continuous refinement and validation of AI tools through rigorous evaluation frameworks like the OSCE. The adaptation of OSCEs for AI tools presents several advantages, including a structured and reproducible approach to evaluation, the ability to test AI systems in diverse clinical scenarios, and the opportunity to benchmark AI performance against established clinical standards to permit charting of future progress as aerospace medicine evolves as a discipline. Remaining challenges include ensuring that these evaluations capture the full spectrum of clinical decision-making scenarios that will be confronted by CMOs during missions and adequately reflecting real-world variability of the austere spaceflight environment. CONCLUSION Employing OSCEs to evaluate AI clinical decision support tools offers a promising approach to validating their clinical utility and efficacy. This methodology not only provides insights into the tool's performance but also fosters ongoing improvement and alignment with standard of care practices. Future research should focus on refining these evaluation processes and addressing limitations to enhance the integration of AI tools in clinical spaceflight settings. REFERENCES Scott S, Hearns V, Barker MA. Testing Clinical Skills: A Look at the OSCE and USMLE Clinical Skills Exams. S D Med. 2019 Oct;72(10):451-453. Majumder MAA, Kumar A, Krishnamurthy K, Ojeh N, Adams OP, Sa B. An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives. Adv Med Educ Pract. 2019 Jun 5;10:387-397. Karam VY, Park YS, Tekian A, Youssef N. Evaluating the validity evidence of an OSCE: results from a new medical school. BMC Med Educ. 2018 Dec 20;18(1):313.

Ariana M Nelson↗

NASA NTRS2022

Enabling Innovative Research on the International Space Station to Solve the Challenges of A Human Mission to Mars: Results of the ISS4Mars International Workshops 2020–2021

During the ISS4Mars workshops in 2020–2021, personnel from the International Space Station (ISS) partner agencies convened to reflect on scenarios for how the ISS could be used and its operations possibly modified to simulate aspects of a human mission to Mars. Scientific leaders, operations experts, crewmembers, managers, and flight surgeons discussed the five hazards of human spaceflight—gravity transitions, radiation, isolation and confinement, distance from Earth, and hostile closed environments—and considered how an ISS-based analog of Mars transit could benefit assessments and mitigations of these hazards. A focused writing team then discussed the advantages and disadvantages of each approach identified by the workshop participants before developing a set of eight use cases to consider the feasibility of implementing on the ISS. The writing team also identified the prerequisites needed, including ground analog studies simulating a mission to Mars required to verify measurements and procedures, before testing could begin on the ISS. Five of the use cases were considered feasible to assess in simulations using an ISS-based analog of Mars transit if some ground rules and assumptions were met. These five use cases were Earth-independent medical operations, Earth-independent integrated operations, life support and food for a one year duration, lower-body negative pressure as a countermeasure against the effects of exposure to microgravity, and fitness levels after landing. In addition, three more extensive interventions—extended Mars surface operations, a small-volume transit analog, and artificial gravity—were deemed unfeasible for testing on the ISS. Experience gained from the five use cases executed on the ISS may help answer some of the questions in the deferred scenarios, or it may be possible to complete them on another platform (e.g. commercial space station, lunar habitat). Simulating conditions during a Mars mission on the ISS will afford higher fidelity for assessing multiple integrated hazards of human spaceflight, however, ground analogs of Mars missions can be used to ensure effective measures and experimental design before testing begins on the ISS. The strategic concepts refined as part of these workshops were brought to a multilateral forum, Mulitlateral Human Research Planel for Exploration (MHRPE), where ISS partner agencies are now discussing implementation plans to provide new opportunities to use the ISS to prepare for deep space exploration over the coming decade. In this publication we present a summary of the international strategic plans for future research that will enable operations, software, and countermeasures to be developed that will reduce the risk to humans during future crewed missions to Mars.

Human space exploration↗

NASA NTRS2002

Performance of advanced trauma life support procedures in microgravity

BACKGROUND: Medical operations on the International Space Station will emphasize the stabilization and transport of critically injured personnel and so will need to be capable of advanced trauma life support (ATLS). METHODS: We evaluated the ATLS invasive procedures in the microgravity environment of parabolic flight using a porcine animal model. Included in the procedures evaluated were artificial ventilation, intravenous infusion, laceration closure, tracheostomy, Foley catheter drainage, chest tube insertion, peritoneal lavage, and the use of telemedicine methods for procedural direction. RESULTS: Artificial ventilation was performed and appeared to be unaltered from the 1-G environment. Intravenous infusion, laceration closure, percutaneous dilational tracheostomy, and Foley catheter drainage were achieved without difficulty. Chest tube insertion and drainage were performed with no more difficulty than in the 1-G environment due to the ability to restrain patient, operator and supplies. A Heimlich valve and Sorenson drainage system were both used to provide for chest tube drainage collection with minimal equipment, without the risk of atmospheric contamination, and with the capability to auto-transfuse blood drained from a hemothorax. The use of telemedicine in chest tube insertion was demonstrated to be useful and feasible. Peritoneal lavage using a percutaneous technique, although requiring less training to perform, was found to be dangerous in weightlessness due to the additional pressure of the bowel on the anterior abdominal wall creating a high risk of bowel perforation. CONCLUSIONS: The performance of ATLS procedures in microgravity appears to be feasible with the exception of diagnostic peritoneal lavage. Minor modifications to equipment and techniques are required in microgravity to effect surgical drainage in the presence of altered fluid dynamics, to prevent atmospheric contamination, and to provide for the restraint requirements. A parabolic simulation system was developed for equipment and procedure verification, physiological research, and possible crew medical officer training in the future.

Parabolic Flight↗

DOE OSTI2025

Influence of background sources and topographic resolution in the Weather Research and Forecasting Model on xenon plume characteristics at monitoring stations

For many atmospheric monitoring applications, networks of measurement sites—such as the radionuclide stations of the International Monitoring System—can be sparse. With measurement locations potentially hundreds to thousands of kilometers from a release it is important to quantify the effects of physical processes on transport and dispersion of plumes between source and measurement locations. This study addresses the effects of background sources and topography resolution near the release location of radionuclides. We use the Weather Research and Forecasting (WRF) model with inline chemistry to investigate (1) how an additional, time-varying source of 133 Xe, such as an operational medical isotope production facility, contributes to activity concentration measurements at monitoring sites, and (2) how complex topography influences on atmospheric conditions near emission sources impact plume concentrations at varying distances from the source. Two 133 Xe emission sources, including (1) a high flux rate of short duration representing an explosive event, and (2) a variable and continuous background source, are simulated. The continuous background source contributes significantly to total 133 Xe concentrations at several monitoring stations. Further, a WRF simulation at 9 km horizontal resolution is compared with a nested grid simulation, where the innermost domain has a resolution of 1 km. Increased topographic resolution leads to an improved representation of plume responses to local winds, with topographic influences greatest at locations closest to the sources. Differences between the two domain resolutions decrease at greater distances from the sources, as plumes have time to spread and mix and are influenced by synoptic scale circulation patterns that are represented similarly in both simulations.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2026

Augmented Reality Technologies for Radiation Safety Training: A Systematic Review of Sensor Integration and Visualization Approaches

This paper presents a comprehensive systematic review examining the application of augmented reality (AR) and sensor technologies for visualizing ionizing radiation in virtual training environments. The review methodology involved systematic identification and analysis of the relevant literature based on predetermined criteria including publication type, year of publication, application domain, and technological approach. The literature search encompassed publications from 2011 to 2021 across four major academic databases: Web of Science, Google Scholar, IEEE Xplore, and Scopus. Through rigorous screening following PRISMA 2020 guidelines, 23 research articles met the inclusion criteria for detailed analysis. From 404 initial database records, 360 were excluded during title/abstract screening (primarily for lacking AR components, radiation focus, or training applications) and 4 during full-text assessment (all for lacking sensor integration). The findings reveal that AR-based ionizing radiation visualization has been successfully implemented across diverse domains, including nuclear facility operations, medical procedures, CERN research activities, and educational and monitoring applications. The analysis identified multiple dimensions of impact, encompassing distinct benefits, emerging opportunities, and implementation challenges associated with AR deployment for ionizing radiation training. Each of these dimensions is comprehensively examined and documented within this review. Additionally, this study identifies critical research gaps that currently limit the full potential of AR technology in supporting ionizing radiation training programs. These gaps are systematically analyzed and discussed to establish clear directions for future research endeavors in this emerging field.

61 - RADIATION PROTECTION AND DOSIMETRY↗

NASA NTRS1975

The medical story

The paper discusses the medical program of the Skylab missions. The major medical systems discussed include the food system, the waste-management system, the personal-hygiene system, and the inflight medical support system. The life-sciences experiments conducted on Skylab are reviewed. These dealt with the cardiovascular system, mineral balance and bioassay of fluids, sleep, blood, metabolic activity, vestibular function, and time and motion studies. The medical operations were accomplished with only minor problems.

Johnston, R. S.↗

NASA NTRS1983

Biomedical results of the Space Shuttle orbital flight test program

On July 4, 1982, the Space Shuttle Columbia landed at Edwards Air Force Base, CA, thus successfully completing the fourth and last in a series of Orbital Flight Tests (OFT) of the Space Transportation System (STS). The primary goal of medical operations support for the OFT was to assure the health and well-being of flight personnel during all phases of the mission. To this end, crew health status was evaluated preflight, inflight, and postflight. Biomedical flight test requirements were completed in the following areas: physiological adaptation to microgravity, cabin acoustical noise, cabin atmospheric evaluation, radiation dosimetry, crew exercise equipment evaluation, and a cardiovascular deconditioning countermeasure assessment.

Pool, S. L.↗

NASA NTRS1992

Advanced Cardiac Life Support (ACLS) utilizing Man-Tended Capability (MTC) hardware onboard Space Station Freedom

Because of the time and distance involved in returning a patient from space to a definitive medical care facility, the capability for Advanced Cardiac Life Support (ACLS) exists onboard Space Station Freedom. Methods: In order to evaluate the effectiveness of terrestrial ACLS protocols in microgravity, a medical team conducted simulations during parabolic flights onboard the KC-135 aircraft. The hardware planned for use during the MTC phase of the space station was utilized to increase the fidelity of the scenario and to evaluate the prototype equipment. Based on initial KC-135 testing of CPR and ACLS, changes were made to the ventricular fibrillation algorithm in order to accommodate the space environment. Other constraints to delivery of ACLS onboard the space station include crew size, minimum training, crew deconditioning, and limited supplies and equipment. Results: The delivery of ACLS in microgravity is hindered by the environment, but should be adequate. Factors specific to microgravity were identified for inclusion in the protocol including immediate restraint of the patient and early intubation to insure airway. External cardiac compressions of adequate force and frequency were administered using various methods. The more significant limiting factors appear to be crew training, crew size, and limited supplies. Conclusions: Although ACLS is possible in the microgravity environment, future evaluations are necessary to further refine the protocols. Proper patient and medical officer restraint is crucial prior to advanced procedures. Also emphasis should be placed on early intubation for airway management and drug administration. Preliminary results and further testing will be utilized in the design of medical hardware, determination of crew training, and medical operations for space station and beyond.

Smith, M.↗

NASA NTRS1992

Countermeasure development to space adaptation

At the Johnson Space Center we are actively involved, with the collaboration of other NASA Centers and the scientific community at large, in the search for ways to counter the negative affects of spaceflight beginning with the improvement in our understanding of the adaptation. Heretofore this search will be broadly referred to as countermeasures development and includes not only the preservation of physiological well-being but also pyschological well-being. The psychological integrity of crews will, undoubtedly, become progressively more important as lengths, remoteness, and risks of missions increase. The character and priorities of our contermeasure development is very much dependent upon the character of the mission and requires a very close liaison between Medical Operations and the investigators. Because of the demands which countermeasure implementation imposes upon crew schedules and because of the potential weight, power, and budget impacts of the hardware and its development, a countermeasure can only become operational when it is either adequately validated or the human risk of not applying the existing technology exceeds the other negative impacts not directly related to crew health and safety.

Larochelle, F. T.↗

NASA NTRS2000

Clinical Space Medicine Panel

The practice of space medicine is diverse. It includes routine preventive medical care of astronauts and pilots, the development of inflight medical capability and training of flight crews as well as the preflight, inflight, and postflight medical assessment and monitoring. The Johnson Space Center Medical Operations Branch is a leader in the practice of space medicine. The papers presented in this panel will demonstrate some of the unique aspects of space medicine.

Baisden, Denise L.↗

NASA NTRS1976

Trace Gas Monitoring

Space technology is contributing to air pollution control primarily through improved detectors and analysis methods. Miniaturized mass spectrometer is under development to monitor vinyl chloride and other hydrocarbon contaminants in an airborne laboratory. Miniaturized mass spectrometer can be used to protect personnel in naval and medical operations as well as aboard aircraft.

Source record↗

NASA NTRS2003

Evaluation of Critical Care Monitor Technology During the US Navy Strong Angel Exercise

The NASA critical path road map identifies "trauma and acute medical problems" as a clinical capability risk category (http://criticalDath.isc.nasa.gov). Specific risks include major trauma, organ laceration or contusion, hemoperitoneum, pulmonary failure, pneumo- and hemothorax, burn, open bone fracture, blunt head trauma, and penetrating injury. Mitigation of these risks includes the capability for critical care monitoring. Currently, the International Space Station (ISS) Crew Health Care System (CHeCS) does not provide such a capability. The Clinical Space Medicine Strategic Planning Forum (4/8/97), sponsored by NASA Medical Operations, identified the development of trauma care capabilities as one of the top priorities for space medicine. The Clinical Care Capability Development Project (CCCDP) subsequently undertook the task to address this need.

Johannesen, John↗

NASA NTRS2006

Advances in Pharmacotherapeutics of Space Motion Sickness

Space Motion Sickness (SMS) is common occurrence in the U.S. manned space flight program and nearly 2/3 of Shuttle crewmembers experience SMS. Several drugs have been prescribed for therapeutic management of SMS. Typically, orally-administered SMS medications (scopolamine, promethazine) have poor bioavailability and often have detrimental neurocognitive side effects at recommended doses. Intramuscularly administered promethazine (PMZ) is perceived to have optimal efficacy with minimal side effects in space. However, intramuscular injections are painful and the sedating neurocognitive side effects of promethazine, significant in controlled ground testing, may be masked in orbit because injections are usually given prior to crew sleep. Currently, EVAs cannot be performed by symptomatic crew or prior to flight day three due to the lack of a consistently efficacious drug, concern about neurocognitive side effects, and because an in-suit vomiting episode is potentially fatal. NASA has long sought a fast acting, consistently effective anti-motion sickness medication which has only minor neurocognitive side effects. Development of intranasal formulations of scopolamine and promethazine, the two commonly used SMS drugs at NASA for both space and reduced gravity environment medical operations, appears to be a logical alternative to current treatment modalities for SMS. The advantages are expected to be fast absorption, reliable and high bioavailability, and probably reduced neurocognitive side effects owing to dose reduction. Results from clinical trials with intranasal scopolamine gel formulation and pre-clinical testing of a prototype microcapsule intranasal gel dosage form of PMZ (INPMZ) will be discussed. These formulations are expected to offer a dependable and effective noninvasive treatment option for SMS.

Putcha, Lakshmi↗