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NASA NTRS2010

Performance Support Tools for Space Medical Operations

Early Constellation space missions are expected to have medical capabilities similar to those currently on board the Space Shuttle and International Space Station (ISS). Flight surgeons on the ground in Mission Control will direct the Crew Medical Officer (CMO) during medical situations. If the crew is unable to communicate with the ground, the CMO will carry out medical procedures without the aid of a flight surgeon. In these situations, use of performance support tools can reduce errors and time to perform emergency medical tasks. The research presented here is part of the Human Factors in Training Directed Research Project of the Space Human Factors Engineering Project under the Space Human Factors and Habitability Element of the Human Research Program. This is a joint project consisting of human factors teams from the Johnson Space Center (JSC) and the Ames Research Center (ARC). Work on medical training has been conducted in collaboration with the Medical Training Group at JSC and with Wyle that provides medical training to crew members, biomedical engineers (BMEs), and flight surgeons under the Bioastronautics contract. Human factors personnel at Johnson Space Center have investigated medical performance support tools for CMOs and flight surgeons.

Byrne, Vicky↗

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 NTRS2023

Flight Surgeon Survey Results Review: Long-Duration Artemis Medical System ConOps

The Artemis Mission Functional Medical Concept of Operation (ConOp) is an operational document that describes the functional medical capabilities and concept of operations for early Artemis missions of around 30 days duration. It is currently under revision for longer missions (180+ days), aiming to build a foundational diagnostic and treatment capabilities list considering mission parameters, crew selection and training, and mass/volume constraints. An interview of NASA operational flight surgeons was completed to start the revision of the medical ConOp.

Andrew Bushong↗

NASA NTRSDate not supplied

Supporting Crew Medical Decisions on Deep Space Missions: A Real-Time Performance Monitoring

Crewed missions into deep space will require astronauts to respond autonomously to safety- and time-critical anomalies. These and other potential issues will require the continuous monitoring and recognition of potentially subtle, but complex, anomalous data patterns. NASA continues to investigate real-time metrics for Extravehicular Operations1 and for providing feedback to improve performance2. Since it is unknown how long-term exposure to deep space will affect crew health, continuous monitoring of clinical and subclinical status is warranted. NASA is characterizing crew medical decision-support needs and identifying the recommended requirements of a Clinical Decision Support System (CDSS) within the Exploration Medical Capability Element (ExMC) of the Human Research Program3. Early detection, and continuous monitoring, of performance may provide an effective prognostic capability for assessing crew health state, and the identified requirements could be provided for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. There is evidence to suggest that automatic, unobtrusive collection of keystroke features, such as alphanumeric key latencies, backspaces or typing rhythm, could be a valuable performance screening tool. Keystroke features show significant differences between control subjects and patients with overt clinical illness, such as multiple sclerosis4 and Parkinson’s disease5, as well as behavioral health and performance issues, such as mild cognitive impairment6 and depression7. This work is exploring a capability for the assessment of early task performance decline in crew as they perform daily activities. Timestamped keyboard entries are continuously collected and stored. Nominal keystroke interactions are compared to those obtained after exposure to spaceflight stressors, e.g., fatigue, to determine the methods sensitivity. This work will pave the way toward an objective detection tool that may be deployed in a spaceflight setting.

clinical↗

NASA NTRS1988

Space medicine

This paper attempts to underscore the importance of continued studies on the effects of space on human physiology. With particular reference to the Space Station, it is pointed out that there are two aspects which are challenging to life scientists: first is the development of a research capability for the life sciences which will be used to conduct investigations necessary to extend the time humans can remain in space; second is the challenge to develop a medical capability to provide prevention, diagnosis, and therapy. A discussion of physiological changes that have been observed in spacecrews follows along the lines of the two aspects mentioned.

Pool, Sam L.↗

NASA NTRSDate not supplied

Preliminary Design of an 'Autonomous Medical Response Agent' Interface Prototype for Long Duration Spaceflight

Major challenges for astronauts in future long-duration exploration missions (LDEMs) will be that crewmembers are not expected to be medical professionals, may be under high workload and stress, are facing physiological challenges caused by spaceflight, and will have limited, delayed voice communications with medical support from Earth. An autonomous medical response agent (AMRA) is envisioned to help astronauts address medical complaints, develop a differential diagnosis, and guide self-treatment until a healthy state is restored. AMRA develops a process of personalized diagnosis and treatment through a Bayesian predictive control system that recommends therapeutic control actions including diagnostic tests and treatments to crewmembers (Menon, 2020). The Human Computer Interaction (HCI) lab from NASA Ames Research Center’s Human Systems Integration Division (Code TH) has collaborated with Nahlia Inc in human-centered design augmentation research for AMRA. The project, titled Design of ‘Autonomous Medical Response Agent Interface Prototype for Long Duration Spaceflight, has been funded by the Translational Research Institute for Space Health (TRISH) and introduces an interactive user-interface prototype that guides astronauts through self-diagnosis, treatment, and rehabilitation while communicating with remote specialists in ground support (most notably a patient’s flight surgeon). Our project develops the interaction design for the crewmember using AMRA through user research, iterative design, and usability testing to evaluate the user interface and workflow designed. The interface design deliverable for this project, titled AMRA Aggregate Information Display (AMRA AID) is an integrated information display system for comprehensive autonomous medical guidance, diagnosis, and treatment of in-flight medical conditions experienced by crewmembers. AMRA AID demonstrates how we might ensure crew autonomy, increase the crew’s medical capabilities, and decrease cognitive burden within a front-end user interface. AMRA AID refrains from relying on input from ground or mission control for self-treatment of medical issues—though ground awareness and communication with ground is maintained as a means of ensuring trust between mission control and crew. AMRA AID demonstrates how the crew’s on-board medical system might integrate with information from vehicle monitoring and crew schedule, without assuming causal relationships. AMRA AID’s comprehensive view enables efficient information access for both crew and ground support, reducing cognitive burden in the event of an unplanned or emergency medical incident and enabling informed analytical decisions to be made based on both crew and vehicle health. Human-centered design augmentation advanced within the prototype included: enhanced workflow and treatment guidance for two medical scenarios for a non-specialist user base with various levels of medical training, interaction design which considered speech (conversational user interface) elements and on-screen interactions to be developed in future iterations of the project, communication design and functional requirements relevant to self-care versus caring for another astronaut, as well as user testing of the prototype with an international space medical community. This project arrives at critical findings regarding usability needs, communication requirements, and integrated information requirements for a future technology interface functioning to increase confidence between ground support and LDEM crewmembers.

TRISH↗

NASA NTRSDate not supplied

rHealth One Demonstration Aboard ISS: A Microfluidic Bioanalyzer Based on Sheath/Hydrodynamic Focusing Flow Cytometry

The Exploration Medical Capability (ExMC) element aims to provide astronauts with the means for their own health monitoring, diagnosis, and treatment during exploration missions. As space flight ventures further from earth, the need for autonomous medical care increases under greater constraints on size, mass, and resources. One pillar for diagnosis that crew would be separated from is laboratory analysis. Even now on ISS, blood samples must be collected and returned to earth for testing. In response, ExMC is assessing how assays for hematology, bone health, radiation exposure etc. could be addressed through commercial-off-the-shelf (COTS) and Small Business Innovation Research (SBIR) funded bioanalyzers that are miniaturizing lab technology. Since missions will reach distances where there are no timely replacements, validation on the International Space Station (ISS) is a necessary part of that assessment. In partnership with NASA Johnson Space Center (JSC) Immunology Lab and the Research Operations and Integration (ROI) element, ExMC conducted a technology demonstration on ISS of the rHEALTH ONE, a flow cytometry based bioanalyzer, to assess future devices based on this design. In flow cytometry, there are predominantly three ways to focus the cells (or particles) into a single file stream: hydrodynamic focusing, microcapillary, and acoustic focusing. The rHEALTH ONE utilizes the commercial standard, sheath-based hydrodynamic focusing. rHEALTH itself represents both a company and a suite of medical tools NASA has funded through SBIR grants towards the development of a promising diagnosis instrument for exploration missions. rHEALTH ONE is the interim version of the technology, functional as a benchtop analyzer and test bed for the next generation of rHEALTH in development. Several modifications were made to the rHEALTH ONE analyzer for operation in microgravity. For function, fluid management was key. A sheath-based analyzer uses sheath fluid to flow the sample, cleaning fluid to prevent biological contamination, and a reservoir to collect the liquid waste. The rHEALTH ONE analyzer uses bottles dependent on gravity to separate the air and liquid pathways and keep the liquids contained. It uses only 1 psig of air pressure to directly push the liquid through the device, requiring little-to-no resistance at inlet and outlet. A microtubing assembly with self-sealing luer connectors was designed – featuring 0.014 mm thick durable medical balloons to hold water inside the supply bottles – to create safe containment and easy access for the crew while maintaining the analyzer’s function. For safety, copper tape was added to the interior of the plastic housing to reduce electromagnetic interference, fluid and electrical connections were secured against vibration and leaks, and gaps were further sealed to ensure containment of the optical block and lasers. Water as the sheath and cleaning fluid and TOX 0 samples were used to reduce the biohazard risk to the crew. In May 2022, European Space Agency astronaut Samantha Cristoforetti demonstrated the rHEALTH ONE aboard ISS for its sample loading, flow cytometry, and data collection capability in microgravity. The JSC Immunology Lab provided flow cytometry expertise, designed the sample test protocol, and manufactured and benchmarked the flight samples on a ‘gold-standard’ flow cytometer. The analyzer was primed with water, purged of air, and four calibration solutions of polystyrene microparticles were tested to characterize its performance. Tightly controlled procedures and excellent execution prevented air bubble interference during air/water separation, fluid transfer, sample mixing and loading. Data showed a slight increase in signal noise on 3 of 5 channels and an anomaly of fluorophores migrating in one sample (confirmed by JSC post-flight). Flight results correctly detected the change in sample, matched the analyzer’s ground performance, and were consistent with the gold-standard’s ground results. Although areas were noted for improvement, these outcomes signified complete mission success.

R. S. Miller↗

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 NTRS2008

The Integrated Medical Model: Statistical Forecasting of Risks to Crew Health and Mission Success

The Integrated Medical Model (IMM) helps capture and use organizational knowledge across the space medicine, training, operations, engineering, and research domains. The IMM uses this domain knowledge in the context of a mission and crew profile to forecast crew health and mission success risks. The IMM is most helpful in comparing the risk of two or more mission profiles, not as a tool for predicting absolute risk. The process of building the IMM adheres to Probability Risk Assessment (PRA) techniques described in NASA Procedural Requirement (NPR) 8705.5, and uses current evidence-based information to establish a defensible position for making decisions that help ensure crew health and mission success. The IMM quantitatively describes the following input parameters: 1) medical conditions and likelihood, 2) mission duration, 3) vehicle environment, 4) crew attributes (e.g. age, sex), 5) crew activities (e.g. EVA's, Lunar excursions), 6) diagnosis and treatment protocols (e.g. medical equipment, consumables pharmaceuticals), and 7) Crew Medical Officer (CMO) training effectiveness. It is worth reiterating that the IMM uses the data sets above as inputs. Many other risk management efforts stop at determining only likelihood. The IMM is unique in that it models not only likelihood, but risk mitigations, as well as subsequent clinical outcomes based on those mitigations. Once the mathematical relationships among the above parameters are established, the IMM uses a Monte Carlo simulation technique (a random sampling of the inputs as described by their statistical distribution) to determine the probable outcomes. Because the IMM is a stochastic model (i.e. the input parameters are represented by various statistical distributions depending on the data type), when the mission is simulated 10-50,000 times with a given set of medical capabilities (risk mitigations), a prediction of the most probable outcomes can be generated. For each mission, the IMM tracks which conditions occurred and decrements the pharmaceuticals and supplies required to diagnose and treat these medical conditions. If supplies are depleted, then the medical condition goes untreated, and crew and mission risk increase. The IMM currently models approximately 30 medical conditions. By the end of FY2008, the IMM will be modeling over 100 medical conditions, approximately 60 of which have been recorded to have occurred during short and long space missions.

Fitts, M. A.↗

NASA NTRS2002

Percutaneous aspiration of fluid for management of peritonitis in space

BACKGROUND: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. METHODS: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. RESULTS: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. CONCLUSIONS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

Non-NASA Center↗

NASA NTRSDate not supplied

Envisioning the Future Role of an Exploration Clinical Decision Support System

The Exploration Medical Capability Element of the NASA Human Research Program seeks to fuse new and existing technologies with practical mission goals into feasible and fiscally realizable human missions to the Moon and Mars. Expected communication delays with Earth-based medical experts will require unprecedented crew self-reliance to rapidly identify and treat anticipated and unforeseen medical conditions using constrained onboard resources with limited crew clinical skill. During this session, the current status of this project will be presented. We will discuss how current modes of decision support (e.g., alerts of critical values, reminders of overdue preventive health tasks, guided clinical workflows, advice for drug prescribing, critiques of existing health care orders, and suggestions for various active care issues) can be tailored to exploration crew needs.

human-system integration↗

NASA NTRSDate not supplied

IMPACT - Information for the Development of Human Health and Performance Systems

IMPACT is a suite of computational and systems engineering tools. Currently being developed for NASA Exploration Medical Capabilities (ExMC) and could be extended to other Human Research Program (HRP) elements. The purpose is to provide a data-driven means to inform human health and performance risk mitigation during exploration missions considering resource constraints in the medical system. IMPACT enables systematic trade studies to evaluate options. IMPACT uses Probabilistic Risk Assessment (PRA) as a systematic methodology to evaluate risks. IMPACT is currently under development to inform decision-makers the risks involved with trade-options that have likelihoods and consequences backed by scientific research in a medical evidence library. IMPACT supports multi-segment analysis to determine probabilities and risks in different mission segments. There are currently 122 medical conditions and 900 resources in the IMPACT Medical Database. IMPACT modeling is using mission segments and multiple vehicles for the NASA Artemis campaign and could support future complex missions in deep space.

IMPACT PRA↗

NASA NTRS2013

Design Constraints Regarding The Use Of Fluids In Emergency Medical Systems For Space Flight

The Exploration Medical Capability Project of the Human Research Program is tasked with identifying, investigating and addressing gaps existing gaps in either knowledge or technology that need to be addressed in order to enable safer exploration missions. There are several gaps that involve treatment for emergency medical situations. Some of these treatments involve the handling of liquids in the spacecraft environment which involve gas-liquid mixtures handling, dissolution chemistry and thermal issues. Some of the recent technology efforts include the Intravenous fluid generation (IVGEN) experiment, the In-Suit Injection System (ISIS) experiment, and medical suction. Constraints include limited volume, shelf life, handling biohazards, availability of power, crew time and medical training.

McQuillen, John↗

NASA NTRS2011

IVGEN

The Exploration Medical Capabilities Element of NASA's Human Research Program chartered the IV fluid GENeration (IVGEN) project at the NASA Glenn Research Center to develop a system that could produce IV fluid in a microgravity environment meeting USP standards. NASA's flight surgeons have identified medical conditions likely to arise during exploration missions of various length and distance from the earth. Adequately treating some of those conditions will require the ability to utilize Intravenous (IV) therapy to either serve as a method for delivering pharmaceuticals that can only be administered via that route, or to hydrate patients that are unable to hydrate themselves. Given that need, NASA currently maintains a reserve of IV fluid on ISS sufficient to treat an astronaut until they can be returned to earth, which is generally within 24 hours. Because such a rapid return will not be an designed to produce United States Pharmacopeia ( USP) grade IV fluid in a reduced gravity p option for missions extending beyond low earth orbit, NASA must either fly as many as 100 liters of IV fluid, with a total mass of 100 Kg, or provide systems that can use vehicle resources to produce such fluid if it is needed. The IVGEN hardware, a compact water purification and mixing system, was environment using available resources.

DeVon, Griffin↗

NASA NTRS2011

NASA Human Research Wiki - An Online Collaboration Tool

In preparation for exploration-class missions, the Exploration Medical Capability (ExMC) element of NASA's Human Research Program (HRP) has compiled a large evidence base, which previously was available only to persons within the NASA community. The evidence base is comprised of several types of data, for example: information on more than 80 medical conditions which could occur during space flight, derived from several sources (including data on incidence and potential outcomes of these medical conditions, as captured in the Integrated Medical Model's Clinical Finding Forms). In addition, approximately 35 gap reports are included in the evidence base, identifying current understanding of the medical challenges for exploration, as well as any gaps in knowledge and/or technology that would need to be addressed in order to provide adequate medical support for these novel missions. In an effort to make the ExMC information available to the general public and increase collaboration with subject matter experts within and outside of NASA, ExMC has developed an online collaboration tool, very similar to a wiki, titled the NASA Human Research Wiki. The platform chosen for this data sharing, and the potential collaboration it could generate, is a MediaWiki-based application that would house the evidence, allow "read only" access to all visitors to the website, and editorial access to credentialed subject matter experts who have been approved by the Wiki's editorial board. Although traditional wikis allow users to edit information in real time, the NASA Human Research Wiki includes a peer review process to ensure quality and validity of information. The wiki is also intended to be a pathfinder project for other HRP elements that may want to use this type of web-based tool. The wiki website will be released with a subset of the data described and will continue to be populated throughout the year.

Barr, Y. R.↗

NASA NTRSDate not supplied

Developing A New Medical Condition List for Exploration Spaceflight

For the last decade, the National Aeronautics and Space Administration (NASA) has utilized a probabilistic risk analysis tool called the Integrated Medical Model (IMM), which contains 100 medical conditions, to conduct medical trade-space analyses and risk assessments for International Space Station (ISS) operations. Planning for future missions to the Moon and Mars will require updated tools and evidence that consider the unique features of exploration missions. To address this need, the Exploration Medical Capability (ExMC) Element of the NASA Human Research Program is developing an advanced trade-space analysis tool suite, IMPACT. As a part of this effort, ExMC has produced the IMPACT version 1 Condition List (ICL 1.0) which expands the scope and definition of medical conditions.

Amy Jean Kreykes↗

NASA NTRS2018

The Pathway to a Safe and Effective Spaceflight Medication Formulary: Expert Review Panel Recommendations

Exploration spaceflight poses several challenges to the provision of a comprehensive medication formulary. This formulary must accommodate the size and space limitations of the spacecraft, while addressing individual medication needs and preferences of the crew, consequences of a degrading inventory over time, the inability to resupply used or expired medications, and the need to forecast the best possible medication candidates to treat conditions that may occur. The Exploration Medical Capability (ExMC) Element's Pharmacy Project Team has developed a research plan (RP) that is focused on evidence-based models and theories as well as new diagnostic tools, treatments, or preventive measures aimed to ensure an available, safe, and effective pharmacy sufficient to manage potential medical threats during exploration spaceflight. Here, we will discuss the ways in which the ExMC Pharmacy Project Team pursued expert evaluation and guidance, and incorporated acquired insight into an achievable research pathway, reflected in the revised RP.

Daniels, V. R.↗

NASA NTRS2023

Progressively Enabling Earth Independent Medical Operations (EIMO)

This panel presents the findings from a series of Technical Interchange Meetings (TIMs) hosted by the Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program. The topics for the TIMs were derived from a 2-day conference of senior leaders and subject matters experts that collectively outlined a multi-faceted strategy designed to optimize crew health and performance through an increasingly autonomous medical approach. The first abstract in this panel outlines the scope of issues related to data collection, usage, transmission and computing capacity to facilitate EIMO. The second presentation provides an overview of the challenges in developing curricula and advanced training tools to baseline knowledge, skills and abilities (KSA), verify clinical competency and assure retention during prolonged durations inherent in exploration-class missions. An overview of the complicated medical supply and resource chain necessary to facilitate EIMO is provided in the third presentation of this panel. The final presentation in this EIMO panel surveys the breadth and depth of demands on cognitive load expected to be experienced by crew on an exploration mission and proposes strategies to mitigate the prospect of cognitive overload through methods to shift task load from the crew to multi-modal artificial intelligence based medical support systems. Taken together, these presentations summarize the challenges to be expected and potential solution spaces to be explored and developed to progressively enable increasing autonomous medical operations to support crewed missions beyond low earth orbit. Through EIMO focused pre-mission planning, integrated data architecture design, innovative training development and AI-assisted task load management, the gradual transition of medical care and decision making from terrestrial to space-based assets enabling support of astronaut health and performance and reducing overall mission risk is achievable.

Jay Lemery↗