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NASA NTRS2020

Cross-Cutting Computational Modeling Project: Exploration Medical Station Analysis

Astronauts will be away from Earth-based medical care for long periods during future exploration missions. Thus, it will be necessary for the astronauts to perform various medical tasks to monitor and maintain their health in the microgravity environment of space. Performance of these tasks will be constrained due to the limited volume available to perform the task, the absence of gravity and the limited resources and capabilities available in the medical work area. It is therefore necessary to evaluate exploration medical workstation designs for how well the designs will support crew performance of medical tasks. This evaluation featured two trained medical caregivers (99th percentile male, 26th percentile female) performing emergent care procedures (alone and in tandem) on a medical manikin. The procedures came from the The procedures came from the International Space Station Medical Checklist, and they are designed for spaceflight. The objectives of the evaluation included determining the operational volume required to perform the tasks, examining the effect of constraining the operational volume with partitions, determining candidate locations for foot restraints and equipment placements and determining the effect of single vs. dual caregiver on the operational volume.A marker-based motion capture system collected the motion data, which enabled computation of operational volumes and foot placement maps using custom Python code. Additional data collected included heart rate, time to perform the procedures, and feedback from the caregivers in the form of the NASA Task Load Index (TLX), the US Government System Usability Survey, and an open-ended questionnaire.

Christopher A Gallo↗
NASA NTRSDate not supplied

Developing a Medical System Concept of Operations for Level of Care IV: Long-Duration Lunar Orbital and Surface Operations

A goal of the Human Research Program (HRP) Exploration Medical Capability (ExMC) Element Systems Engineering (SE) team is to define the technical system needed to support crew medical system capabilities for future exploration missions, including a mission with lunar orbital and long duration surface operations. The medical system concept of operations (ConOps) is the starting point of creating a foundation for a medical system that meets Level of Care IV requirements, as defined by NASA’s space flight human-system standards. This ConOps illustrates how NASA can provide a Level of Care IV medical system for crews within the various cis-lunar orbit and lunar surface habitat environments. The use case scenarios included in this ConOps illustrate required medical system capabilities for Level of Care IV and enable the ExMC SE team to develop integrated medical system requirements and identify capabilities required to meet those requirements. This discussion will focus on how this concept of operations was constructed – by utilizing the lessons learned from ExMC’s existing Short-Duration Lunar Orbit Medical System Concept of Operations, by employing Model-Based Systems Engineering, and by collaborating with stakeholders in order to ensure the necessary assumptions were made.

M. Kaetzer↗
NASA NTRSDate not supplied

MEDPRAT Treatment Clusters: Improving Representation of Mission Medical Risk

INTRODUCTION The Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) implements a computational model that aims to quantify spaceflight medical risk by utilizing probabilistic techniques to simulate critical event incidence and outcomes over thousands of simulated mission trials. The goal of MEDPRAT is to characterize mission medical risk and provide insight into medical resource utilization. In order to analyze the medical resource space, treatment must be mapped from each simulated condition, and resources consumed as a result of this treatment must be tracked throughout the course of the mission. A new MEDPRAT feature, ‘treatment clusters’, provide a more sophisticated method of defining the structure and interaction between resources, more closely mimicking the way treatment is carried out clinically. METHODS Treatment clusters expand on the two existing treatment groupings (combination and alternate) adding a new grouping: bundled treatment. Treatment clusters may be combined to any depth, giving users the ability to specify complex treatment trees whose behavior is governed by several user-specified parameters. This approach emphasizes reusability, as treatment clusters, once defined, can be used to create more complex treatment trees or applied to many conditions. By configuring parameters for contribution, efficacy, necessity, primacy, and equivalence, resource relationships and dependencies can be more accurately represented, thereby allowing users to build capabilities with desired treatment properties, for example an intravenous capability for conditions such as anaphylaxis, acute radiation syndrome, etc. MEDPRAT v1.0 remains backward compatible with existing treatment structures, giving users the ability to define new treatment clusters as evidence becomes available, without having to recode their existing treatment databases. In addition to facilitating the representation of more complex treatment options, by pairing treatment clusters with the internal optimization routine, the MEDPRAT set selector, medical resources can be identified as organized in bundles, where appropriate, so that optimized resource sets include groups of highly-dependent resources only when all resources of the group are together. For example, it would be wasteful to include ultrasound gel but not an ultrasound machine, since the gel provides no benefit as a treatment without the ultrasound machine. With treatment clusters, the user may require that both resources are available to provide any benefit as treatment, so that if one resource is optimized out of the set, the other resource will be optimized out as well. RESULTS AND CONCLUSIONS We will report on MEDPRAT treatment clusters used in a bundling study under the IMPACT project of the ExMC element. We will discuss an example of a complex treatment tree. Through the implementation of this feature MEDPRAT enables treatment to be defined and applied in a way that is more representative of the real world, providing more accurate insight into mission medical risk and the medical resource space.

Lawrence Leinweber↗
NASA NTRSDate not supplied

Exploration Medical Capability Science and Research Overview and Update

The mission of the Exploration Medical Capability (ExMC) Element is to advance medical system design and risk-informed decision making for exploration beyond Low Earth Orbit to promote human health and performance in space. To accomplish this mission, ExMC focuses on several key areas: • Investigating specific risks that are relevant for human exploration spaceflight, including in-flight medical conditions, degraded or toxic medications, and renal stones • Developing medical probabilistic risk analysis tools that are integrated with systems engineering processes to inform the medical system trade space and support the development of robust requirements • Demonstrating and defining requirements for a prototype clinical decision support system • Developing and demonstrating novel medical technologies that will improve future medical capabilities in space This presentation will focus on selected scientific and technical conceptual drivers for the Element and its current and future research risks and gaps while providing an overview of the Element’s progress in 2021 and areas of focus for 2022.

Benjamin Easter↗
NASA NTRS2023

The Value of a Spaceflight Clinical Decision Support System for Earth-Independent Medical Operations

As NASA prepares for crewed lunar missions over the next several years, plans are also underway to journey farther into deep space. Deep space exploration will require a paradigm shift in astronaut medical support toward progressively earth-independent medical operations (EIMO). The Exploration Medical Capability (ExMC) element of NASA’s Human Research Program (HRP) is investigating the feasibility and value of advanced capabilities to promote and enhance EIMO. Currently, astronauts rely on real-time communication with ground-based medical providers. However, as the distance from Earth increases, so do communication delays and disruptions. Moreover, resupply and evacuation will become increasingly complex, if not impossible, on deep space missions. In contrast to today’s missions in low earth orbit (LEO), where most medical expertise and decision-making are ground-based, an exploration crew will need to autonomously detect, diagnose, treat, and prevent medical events. Due to the sheer amount of pre-mission training required to execute a human spaceflight mission, there is often little time to devote exclusively to medical training. One potential solution is to augment the long duration exploration crew’s knowledge, skills, and abilities with a clinical decision support system (CDSS). An analysis of preliminary data indicates the potential benefits of a CDSS to mission outcomes when augmenting cognitive and procedural performance of an autonomous crew performing medical operations, and we provide an illustrative scenario of how such a CDSS might function.

Brian K. Russell↗
NASA NTRSDate not supplied

A Strategy for Advancing Earth Independent Medical Operations

Exploration medical operations to the Moon and Mars present unprecedented challenges for providing in-mission medical care. The greater distance from Earth is the primary hazard that drives the need for a medical operations paradigm shift from low earth orbit mission. Increasingly complex long duration and long distance missions will have resource constraints (ex: mass, power, volume, data), a paucity of resupply or evacuation opportunities, and disruptions in real-time communications. In order to advance a more autonomous medical approach, a multi-faceted strategy will need to optimize all aspects of human health and performance in space. This strategy will include: increasing onboard medical autonomy through the development of novel crew health and performance systems; decision support capabilities to augment astronauts’ abilities in preventing, diagnosing, and treating medical conditions; creating new procedures and training tools for skill maintenance and just-in-time training; and enabling rapid crew access to data from all on-board systems, leading to better-informed, real-time, autonomous decisions. Collectively, this approach can be referred to as “Earth Independent Medical Operations” (EIMO). The Exploration Medical Capability Element of NASA’s Human Research Program has undertaken a longitudinal planning process to consensus around EIMO. Technical interchange meetings will occur with key constituents in late 2022 and again in early 2023 to define EIMO in practical terms and identify key elements of an EIMO system, with greater conceptual articulation and dissemination planned for the second half of 2023. We will share insights into the strategy for internal and external consensus building around EIMO, with a particular focus on the approach to partner stakeholders within NASA as well as commercial agencies.

Jay Lemery↗
NASA NTRSDate not supplied

Coordinated NASA Development of Medical Capabilities and Technologies for Deep Space Exploration

Building upon the success of the last two decades of human spaceflight medical operations onboard the International Space Station (ISS), NASA now must start to evolve to a deep space medical operations paradigm. This new paradigm will include myriad challenges including communication delays and blackouts, infrequent or unavailable resupply, potentially significant vehicle resource constraints, and delayed or non-existent evacuation options. To overcome these challenges, two separate but highly coordinated NASA groups are working together to develop and test solutions to these problems: the Exploration Medical Capability (ExMC) Element of the NASA Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) of the Environmental Control and Life Support System – Crew Health and Performance Systems Capability Leadership Team. Although the work of these two groups is very complementary, ExMC generally focuses more on research and early technology development work while the XMIPT works on maturing and integrating new medical capabilities for exploration. During this panel, these two groups together will present details on how medical capability gaps are defined and addressed, a new work plan in development to increase medical autonomy in spaceflight, a technology maturation effort to generate intravenous fluids from potable water onboard a spacecraft, multiple new technology demonstrations of in-situ laboratory analysis capabilities, and new onboard tools to advance medical care for deep space missions.

Kris Lehnhardt↗
NASA NTRS2023

Automated Medical Inventory System (AMIS) TechPort Entry

The current medical inventory paradigm on the International Space Station (ISS) requires crew to report use of medications and supplies to be manually decremented by ground teams. This method is not only tedious and time consuming for both the crew and ground teams but also results in inaccuracies in location and availability of medical supplies over time. Fortunately, the ISS is frequently resupplied by cargo launches and crew expeditions, and an accurate inventory count is less critical. However, for exploration missions, resupply will be greatly limited or unavailable entirely, and increasing communication latency will impair crew-ground communications. On longer missions, with large medical systems and time constrained crew, NASA needs a method of accurately managing medical inventory without reliance on ground teams and with as little crew time and effort as possible. The Exploration Medical Integrated Product Team (XMIPT) project called Medical Exploration Development and Implementation Scoping (MEDIScope) prepared a concept of operations and preliminary requirements for an Automated Medical Inventory System (AMIS) and completed a market survey and trade study of potential inventory management technologies in partnership with the market research firm, yet2. The products from the MEDIScope effort, including the market survey results, preliminary functional requirements and a concept of operations, have been handed off to a development team at Glenn Research Center (GRC) and ZIN Technologies for technology maturation. In the development phase, the AMIS team will finalize system requirements, down select technologies, integrate with a future exploration Crew Health and Performance Integrated Data Architecture, and conduct design reviews. The project will culminate in an ISS technical flight demonstration in FY27.

MEDIScope↗
NASA NTRSDate not supplied

Novel Approach to Simulating Diagnostic Capabilities in Medical Resource Risk Assessment

Diagnostics represent a key subset of medical resources considered for helping mitigate and control spaceflight medical risk. Historically, when modeling the medical risk domain for spaceflight, diagnostic resources have been handled like any other medical resource used for treatment. That is to say, the resource being unavailable will result in the related condition having suboptimal treatment outcomes. However in the real world, should a diagnostic resource be unavailable, a more analogous effect would be that the condition might be misdiagnosed, and thus inappropriate treatment applied. This talk presents an alternative means of representing diagnostic resources within the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) that can simulate the effect both in risk, resource consumption, and competition for resources of a missing or depleted diagnostic. The scenario where a differential diagnosis may not be possible for abdominal conditions that use an ultrasound machine as a diagnostic tool is considered. Two approaches for modeling the effect of not having a diagnostic capability on the medical system are demonstrated. In the “simple” approach, it is assumed that any abdominal condition requiring the ultrasound machine for diagnosis is mis-diagnosed and treated as an appendicitis. This is represented by replacing the treatment for the affected conditions with the treatment for appendicitis, thereby changing the optimized medical set available for treatment for the remainder of the mission. In the “complex” approach, MEDPRAT treatment clusters are utilized to capture and represent overlapping treatment between the misdiagnosed condition and appendicitis. This elicits both the effect that inappropriate treatment is applied, resulting in wasted resource consumption, and that treatment which was truly needed for the misdiagnosed condition was not applied, which reduces the treatment effectiveness. In this talk, results comparing the simple and complex diagnostic capability approach to a baseline where the diagnostic is treated as a traditional resource is presented. Either approach provides an option for a more analogous representation of diagnostic resources and provides insight into how the modeled spaceflight medical resources and outcomes change when that diagnostic is unavailable.

C. M. Gasiewski↗
NASA NTRSDate not supplied

Exploration Atmosphere Demonstration of A Multi-Functional Integrated Medical Device (Tempus Pro)

INTRODUCTION The Exploration Medical Capability (ExMC) element within the Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) within the Mars Campaign Office seek to advance medical system design and risk-informed decision-making for exploration missions. This includes assessment of candidate devices and their compatibility within a variety of increasingly Earth-independent medical scenarios. The Tempus Pro (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) is a commercial-off-the-shelf (COTS), multi-functional integrated medical device capable of vital signs monitoring, with built-in procedure support (iAssist), patient record and telemedicine communication features, and medical imaging (e.g., camera, laryngoscope, ultrasound) that meets multiple exploration medical capability needs. One of several hypobaric atmospheres being considered for exploration vehicles is 8.2 psi with 34% oxygen. To assess the useability of the Tempus Pro in such environments by individuals without formal medical training, the unit was tested in May and June of 2023 at the Johnson Space Center 20-Foot Exploration Atmosphere Chamber in conjunction with the Exploration Atmospheres-2 (EA-2) study. TECHNOLOGY DEMONSTRATION Eight subjects in the EA-2 study were assigned roles as the caregiver or patient – or both in the case of a self-exam – and caregivers were asked to place sensors for 3-Lead ECG, non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and temperature using Tempus Pro’s iAssist. Depending on the procedure, additional tasks included an oropharyngeal exam of the throat with the laryngoscope and capturing ultrasound images of a cardiac subxiphoid view or of the user’s choice from a pre-specified list. Scenarios ranged from remote-guided to fully autonomous operations and surveyed the effectiveness of support, amount of support desired, and importance of support by type (e.g., written crew procedures, iAssist and device guidance, remote console guidance, etc.). Feedback from the subjects and the support personnel was also gathered to inform future designs for training and support and to determine what operations are plausible given different levels of each. An unweighted NASA task load index (TLX) was used to profile the demands of using the device, however the sample size does not support statistics. The research was exploratory in nature and qualitative information was the main goal. Calibration checks on the Tempus Pro were conducted before and after chamber testing to ensure the device was in useable condition. RESULTS All subjects performed their tasks successfully and found the Tempus Pro easy to use with the support provided. The calibration checks outside the chamber showed that the Tempus Pro remained unchanged and measurements inside the chamber were within normal values. Caregivers taking the NASA TLX reported mean scores ≤ 41/100 showing the tasks to be undemanding and less demanding with repeated use (~20/100). Novice users were able to easily connect sensors and take vital signs with the guidance from Tempus Pro’s iAssist feature. For more complex tasks, such as the oropharyngeal exam and ultrasound image acquisition, guidance beyond iAssist was needed, primarily from a supporting physician. Feedback on the importance of support types varied by person and scenario but greater than 50% of the support used by each was non-native to the device. Overall opinions were positive, but the ultrasound users expressed a lack of confidence in their results and 3 out of 4 desired more time, training, or support. Subjects found the sensors to be comfortable and comparable to prior experiences with such devices, except for the blood pressure cuff, which squeezed too tightly for uncomfortably long periods. Many observations provoked discussion, especially regarding ultrasound, that will aide decisions about future demonstrations.

R. S. Miller↗
NASA NTRS1982

STS-3 medical report

The medical operations report for STS-3, which includes a review of the health of the crew before, during, and immediately after the third Shuttle orbital flight is presented. Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical 'kit' carried in flight, tests and countermeasures for space motion sickness, cardiovascular profile, biochemistry and endocrinology results, hematology and immunology analyses, medical microbiology, food and nutrition, potable water, shuttle toxicology, radiological health, and cabin acoustic noise. Environmental effects of shuttle launch and landing medical information management, and management, planning, and implementation of the medical program are also dicussed.

Pool, S. L.↗
NASA NTRS1991

Shuttle abort landing site emergency medical services

NASA and DOD studies of medical-planning and logistical problems are reviewed as applicable to providing emergency medical care at remote transoceanic abort landing (TAL) sites. Two options are analyzed including a modified surgical response team and a combination physician/medical technician team. The two concepts are examined in terms of cost-effectiveness, specific types of medical support such as blood procurement, and search-and-rescue requirements. It is found that the physician/technician team is more economically efficient, and the description of the concept permits the development of an effective TAL-site astronaut medical-support system. A balance is struck between the competing problems of cost and medical capability by planning for on-scene medical stabilization and air evacuation to DOD tertiary medical centers.

Mckenas, David K.↗
NASA NTRS1991

Linking medical records to an expert system

This presentation will be done using the IMR-Entry (Intelligent Medical Record Entry) system. IMR-Entry is a software program developed as a front-end to our diagnostic consultant software MEDAS (Medical Emergency Decision Assistance System). MEDAS (the Medical Emergency Diagnostic Assistance System) is a diagnostic consultant system using a multimembership Bayesian design for its inference engine and relational database technology for its knowledge base maintenance. Research on MEDAS began at the University of Southern California and the Institute of Critical Care in the mid 1970's with support from NASA and NSF. The MEDAS project moved to Chicago in 1982; its current progress is due to collaboration between Illinois Institute of Technology, The Chicago Medical School, Lake Forest College and NASA at KSC. Since the purpose of an expert system is to derive a hypothesis, its communication vocabulary is limited to features used by its knowledge base. The development of a comprehensive problem based medical record entry system which could handshake with an expert system while creating an electronic medical record at the same time was studied. IMR-E is a computer based patient record that serves as a front end to the expert system MEDAS. IMR-E is a graphically oriented comprehensive medical record. The programs major components are demonstrated.

Naeymi-Rad, Frank↗
NASA NTRS1992

A prototype Crew Medical Restraint System (CMRS) for Space Station Freedom

The Crew Medical Restrain System (CMRS) is a prototype system designed and developed for use as a universally deployable medical restraint/workstation on Space Station Freedom (SSF), the Shuttle Transportation System (STS), and the Assured Crew Rescue Vehicle (ACRV) for support of an ill or injured crewmember requiring stabilization and transportation to Earth. The CMRS will support all medical capabilities of the Health Maintenance Facility (HMF) by providing a restraint/interface system for all equipment (advance life support packs, defibrillator, ventilator, portable oxygen supply, IV pump, transport monitor, transport aspirator, and intervenous fluids delivery system) and personnel (patient and crew medical officers). It must be functional within the STS, ACRV, and all SSF habitable volumes. The CMRS will allow for medical capabilities within CPR, ACLS and ATLS standards of care. This must all be accomplished for a worst case transport time scenario of 24 hours from SSF to a definitive medical care facility on Earth. A presentation of the above design prototype with its subsequent one year SSF/HMF and STS/ACRV high fidelity mock-up ground based simulation testing will be given. Also, parabolic flight and underwater Weightless Test Facility evaluations will be demonstrated for various medical contingencies. The final design configuration to date will be discussed with future space program impact considerations.

Johnston, S. L.↗
NASA NTRS1986

Apparatus for detecting at least one predetermined condition and providing an informational signal in response thereto in a medication infusion system

A medication infusion system provides redundant safety and includes condition detecting and informational alarm signal generating apparatus for indicating if (1) a fluid leak occurs in different portions of the system; (2) a programmable input from a patient or physician would result in exceeding a safe dosage limit; (3) the reservoir containing medication has been filled; (4) the intended medication pumping does not correlate with the pumping actually effected; (5) battery voltage is low; (6) the medication reserve is low; and (7) the system has been switched off. The apparatus may provide subcutaneous electrical, thermal, or audible stimulation to the patient and also provides a signal which a physician may monitor. The stimulation may be coded to separately identify each above-listed deviation in nominal system performance. In addition, the number of medication requests are correlated with actual medication dispensing to assure proper operation. An identification scheme is provided which matches the patient with his or her corresponding medication.

Fischell, Robert E.↗
NASA NTRS2006

Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools.

Johnson-Troop↗
NASA NTRS2010

Exploration Medical Capability

Exploration Medical Capability (ExMC) is an element of NASA's Human Research Program (HRP). ExMC's goal is to address the risk of the Inability to Adequately Recognize or Treat an Ill or Injured Crewmember. This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions. This poster is being presented to inform the audience of the gaps and tasks being investigated by ExMC and to encourage discussions of shared interests and possible future collaborations.

Watkins, Sharmila↗
NASA NTRS2015

Integrated Medical Model (IMM) 4.0 Enhanced Functionalities

The Integrated Medical Model is a probabilistic simulation model that uses input data on 100 medical conditions to simulate expected medical events, the resources required to treat, and the resulting impact to the mission for specific crew and mission characteristics. The newest development version of IMM, IMM v4.0, adds capabilities that remove some of the conservative assumptions that underlie the current operational version, IMM v3. While IMM v3 provides the framework to simulate whether a medical event occurred, IMMv4 also simulates when the event occurred during a mission timeline. This allows for more accurate estimation of mission time lost and resource utilization. In addition to the mission timeline, IMMv4.0 features two enhancements that address IMM v3 assumptions regarding medical event treatment. Medical events in IMMv3 are assigned the untreated outcome if any resource required to treat the event was unavailable. IMMv4 allows for partially treated outcomes that are proportional to the amount of required resources available, thus removing the dichotomous treatment assumption. An additional capability IMMv4 is to use an alternative medical resource when the primary resource assigned to the condition is depleted, more accurately reflecting the real-world system. The additional capabilities defining IMM v4.0the mission timeline, partial treatment, and alternate drug result in more realistic predicted mission outcomes. The primary model outcomes of IMM v4.0 for the ISS6 mission, including mission time lost, probability of evacuation, and probability of loss of crew life, are be compared to those produced by the current operational version of IMM to showcase enhanced prediction capabilities.

Spae Adaptation Syndrome↗