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NASA NTRS2018

Defining Medical Capabilities for Exploration Missions

Exploration-class missions to the moon, Mars and beyond will require a significant change in medical capability from today's low earth orbit centric paradigm. Significant increases in autonomy will be required due to differences in duration, distance and orbital mechanics. Aerospace medicine and systems engineering teams are working together within ExMC to meet these challenges. Identifying exploration medical system needs requires accounting for planned and unplanned medical care as defined in the concept of operations. In 2017, the ExMC Clinicians group identified medical capabilities to feed into the Systems Engineering process, including: determining what and how to address planned and preventive medical care; defining an Accepted Medical Condition List (AMCL) of conditions that may occur and a subset of those that can be treated effectively within the exploration environment; and listing the medical capabilities needed to treat those conditions in the AMCL. This presentation will discuss the team's approach to addressing these issues, as well as how the outputs of the clinical process impact the systems engineering effort.

Hailey, M.↗

NASA NTRS2020

Enabling Space Exploration Medical System Development Using a Tool Ecosystem

The NASA Human Research Program’s (HRP) Exploration Medical Capability (ExMC) Element is utilizing a Model Based Systems Engineering (MBSE) approach to enhance the development of systems engineering products that will be used to advance medical system designs for exploration missions beyond Low Earth Orbit. In support of future missions, the team is capturing content such as system behaviors, functional decompositions, architecture, system requirements and interfaces, and recommendations for clinical capabilities and resources in Systems Modeling Language (SysML) models. As these products mature, SysML models provide a way for ExMC to capture relationships among the various products, which includes supporting more integrated and multi-faceted views of future medical systems. In addition to using SysML models, HRP and ExMC are developing supplementary tools to support two key functions: 1) prioritizing current and future research activities for exploration missions in an objective manner; and 2) enabling risk-informed and evidence-based trade space analysis for future space vehicles, missions, and systems. This paper will discuss the long-term HRP and ExMC vision for the larger ecosystem of tools, which include dynamic Probabilistic Risk Assessment (PRA) capabilities, additional SysML models, a database of system component options, and data visualizations. It also includes a review of an initial Pilot Project focused on enabling medical system trade studies utilizing data that is coordinated across tools for consistent outputs (e.g., mission risk metrics that are associated with medical system mass values and medical conditions addressed). This first Pilot Project demonstrated successful operating procedures and integration across tools. Finally, the paper will also cover a second Pilot Project that utilizes tool enhancements such as medical system optimization capabilities, post-processing, and visualization of generated data for subject matter expert review, and increased integration amongst the tools themselves.

Amador, Jennifer R.↗

NASA NTRS2020

Enabling Space Exploration Medical System Development Using a Tool Ecosystem

The NASA Human Research Program's (HRP) Exploration Medical Capability (ExMC) Element is utilizing a Model Based Systems Engineering (MBSE) approach to enhance the development of systems engineering products that will be used to advance medical system designs for exploration missions beyond Low Earth Orbit. In support of future missions, the team is capturing content such as system behaviors, functional decompositions, architecture, system requirements and interfaces, and recommendations for clinical capabilities and resources in Systems Modeling Language (SysML) models. As these products mature, SysML models provide a way for ExMC to capture relationships among the various products, which includes supporting more integrated and multi-faceted views of future medical systems. In addition to using SysML models, HRP and ExMC are developing supplementary tools to support two key functions: 1) prioritizing current and future research activities for exploration missions in an objective manner; and 2) enabling risk-informed and evidence-based trade space analysis for future space vehicles, missions, and systems. This paper will discuss the long-term HRP and ExMC vision for the larger ecosystem of tools, which include dynamic Probabilistic Risk Assessment (PRA) capabilities, additional SysML models, a database of system component options, and data visualizations. It also includes a review of an initial Pilot Project focused on enabling medical system trade studies utilizing data that is coordinated across tools for consistent outputs (e.g., mission risk metrics that are associated with medical system mass values and medical conditions addressed). This first Pilot Project demonstrated successful operating procedures and integration across tools. Finally, the paper will also cover a second Pilot Project that utilizes tool enhancements such as medical system optimization capabilities, post-processing, and visualization of generated data for subject matter expert review, and increased integration amongst the tools themselves.

Amador, Jennifer R.↗

NASA NTRSDate not supplied

Analysis of the Value Added When Deploying a Model-Based Approach for the Validation and Verification of the Medical Database Software

The Medical Database (MD) is a virtual repository consisting of two software components: Medical Item Database (MedID) and the Evidence Library (EL). MedID consists of engineering data and associated information for specific medical resource items (e.g., pharmaceutical, medical devices, and supporting components), while the EL is a tool which provides all of the medical evidence necessary. The MD will 1) serve as the single “source of truth” for the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite for both medical evidence and medical resource engineering data and 2) will be used in conjunction with the IMPACT tool suite to inform research prioritizations and perform systematic trade study evaluations to aid stakeholders in making informed decisions regarding simulated human spaceflight missions. The MD project used a Model-Based Systems Engineering (MBSE) approach to support all life cycles of the software development, while in parallel the human factors engineering team used modeling to support Human Centered Design (HCD) strategies in an effort to improve software usability. HCD is a frequently used approach in design frameworks that develops resolutions to complexities and challenges by involving the human perspective in all steps of the problem-solving process. By integrating the model-based approaches used for systems engineering and human factors activities, the project is able to leverage the model-based artifacts originally created for HCD activities for system level and human factors validation. In this presentation, our team highlights the value added when leveraging these model-based artifacts to support the on-going verification and validation activities.

C. Laing↗

NASA NTRS2023

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. In order to accomplish this mission, the Element takes a progressively Earth-independent approach to three main areas: - Answering key clinical and science research questions that will help to address the challenges of providing medical care in the extreme environment of space - Applying systems engineering processes to medical system design with the goal of developing robust requirements that can be fully integrated into future space exploration vehicle designs - 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, the current and future research risks and gaps, and provide an overview of the Element’s progress in 2022. In particular, it will address the ongoing effort for the IMPACT trade space analysis tool suite, the closeout work on a clinical decision support prototype, potential requirements for a long-duration lunar orbit and lunar surface medical system, and an International Space Station technology demonstration of a point-of-care laboratory analysis capability.

Kris Lehnhardt↗

NASA NTRSDate not supplied

Principles for Termination of Medical Care in Austere Analog Environments for Development of Spaceflight Protocols

INTRODUCTION: When compared to operations in low earth orbit, exploration class missions will have substantially limited resources and ground medical support while the risk of a significant medical event is projected to be higher. Termination of care (TOC) may need to be considered in certain instances. We aim to utilize data from earth-based analogs to identify common principles that can help develop future guidelines to this complex medical and ethical challenge. METHODS: A comprehensive literature review was conducted in medline, nasa.gov, Defense Technical Information Center(DTIC) and google scholar. Key search terms including “withdrawal of care, termination of care, termination of CPR, military medicine, wilderness medicine, futility, potentially inappropriate” and others were used to identify analog studies of relevance. These were qualitatively evaluated for recurring principles or themes that were reviewed and structured. RESULTS: Mission planning termination of care principles: definitions of clear medical goals, separate protocols for each relevant condition, protocols developed using best available evidence, crew involvement in development, protocols rehearsal pre-launch, and inclusion of palliative capabilities. In-mission termination of care principles: 1. Crew Medical Officer directed stabilization of the patient; 2. Consultation with mission control with standardized information exchange; 3. Multidisciplinary medical and ethical conference among the mission directors, flight surgeons and relevant specialist experts; 4. Multidisciplinary risk review examining both medical and mission risks for relevant options; 5. Provision of a transparent explanation of the process and decision to crew; 6. Allowing crew feedback and inquiry to review board; 7. Support of the crew in the enacted decision. DISCUSSION: By utilizing the best available evidence in conjunction with expert opinion we have identified common principles from earth-based analogs that could be used to help design future TOC protocols.

Samuel Stephenson↗

NASA NTRSDate not supplied

Task Load Management in Earth Independent Medical Operations

BACKGROUND: Medical care in spaceflight carries a high task load and can easily overwhelm a small crew. Present day operations in low Earth orbit (LEO) offload most medical tasks to ground teams in mission control. This team includes dozens of flight surgeons, specialists, and engineers and supports the on-orbit crew in monitoring environmental systems, tracking medications, guiding procedures, providing expert advice, and many other tasks. However, the physical limitations of the speed of light and technical limitations of bandwidth, channel capacity, and signal processing mean that missions beyond LEO cannot rely on this level of telemedical support. The further we travel from Earth the more these tasks will fall on the shoulders of the crew and the greater the risk of task saturation to the wellbeing of the crew and the success of the mission. Exploration class space crews will need progressively more robust systems for managing task load as they progress further out in space. OVERVIEW: Medical task management systems will need to assist with two broad categories of tasks; cognitively intensive tasks and procedure execution tasks. In both cases the goal is for the systems to operate in the background with minimal human-in-the-loop intervention. To accomplish this such systems will need to be designed with careful consideration for human factors and human systems integration to maximize efficiency, minimize alarm fatigue, and avoid inadvertently increasing task loads. Finally, the key domains of space medicine tasking can be used to map present day and near future technologies to the areas where they are best suited to support and identify gaps which can be targeted for research and development. DISCUSSION: Task load is a major challenge for Earth Independent Medical Operations to overcome. It will require careful coordination between experts in a variety of fields paying attention to human factors and human systems integration as well as technical and medical expertise. If done well medical task management systems can handle many of the tasks currently run by humans in mission control and enable human crews to maintain terrestrial standards of care in the extraterrestrial environment.

Dana Levin↗

NASA NTRS2000

A strategic vision for telemedicine and medical informatics in space flight

This Workshop was designed to assist in the ongoing development and application of telemedicine and medical informatics to support extended space flight. Participants included specialists in telemedicine and medical/health informatics (terrestrial and space) medicine from NASA, federal agencies, academic centers, and research and development institutions located in the United States and several other countries. The participants in the working groups developed vision statements, requirements, approaches, and recommendations pertaining to developing and implementing a strategy pertaining to telemedicine and medical informatics. Although some of the conclusions and recommendations reflect ongoing work at NASA, others provided new insight and direction that may require a reprioritization of current NASA efforts in telemedicine and medical informatics. This, however, was the goal of the Workshop. NASA is seeking other perspectives and views from leading practitioners in the fields of telemedicine and medical informatics to invigorate an essential and high-priority component of the International Space Station and future extended exploration missions. Subsequent workshops will further define and refine the general findings and recommendations achieved here. NASA's ultimate aim is to build a sound telemedicine and medical informatics operational system to provide the best medical care available for astronauts going to Mars and beyond.

Aerospace Medicine/organization & administration↗

NASA NTRS2017

The Integrated Medical Model: Outcomes from Independent Review

In 2016, the Integrated Medical Model (IMM) v4.0 underwent an extensive external review in preparation for transition to an operational status. In order to insure impartiality of the review process, the Exploration Medical Capabilities Element of NASA's Human Research Program convened the review through the Systems Review Office at NASA Goddard Space Flight Center (GSFC). The review board convened by GSFC consisted of persons from both NASA and academia with expertise in the fields of statistics, epidemiology, modeling, software development, aerospace medicine, and project management (see Figure 1). The board reviewed software and code standards, as well as evidence pedigree associated with both the input and outcomes information. The board also assesses the models verification, validation, sensitivity to parameters and ability to answer operational questions. This talk will discuss the processes for designing the review, how the review progressed and the findings from the board, as well as summarize the IMM project responses to those findings. Overall, the board found that the IMM is scientifically sound, represents a necessary, comprehensive approach to identifying medical and environmental risks facing astronauts in long duration missions and is an excellent tool for communication between engineers and physicians. The board also found IMM and its customer(s) should convene an additional review of the IMM data sources and to develop a sustainable approach to augment, peer review, and maintain the information utilized in the IMM. The board found this is critically important because medical knowledge continues to evolve. Delivery of IMM v4.0 to the Crew Health and Safety (CHS) Program will occur in the 2017. Once delivered for operational decision support, IMM v4.0 will provide CHS with additional quantitative capability in to assess astronaut medical risks and required medical capabilities to help drive down overall mission risks.

medical equipment↗

NASA NTRS2024

NASA Spaceflight Medical Selection, Recertification and Mission Evaluation Standards

This NASA Technical Standard provides medical requirements and clinical procedures designed to ensure crew health and safety and occupational longevity of NASA career astronauts. This NASA Technical Standard used for selection and annual recertification of astronauts reflects the medical requirements to successfully complete specific mission tasks and the multifaceted training and performance required of a NASA astronaut. These include, but are not limited to, flying in high performance aircraft, exposure to hypobaric and hyperbaric conditions, exposure to unique environments (e.g., microgravity), and conducting specialized operations (e.g., extra-vehicular activities, robotic arm operations). NASA policy for establishing standards to protect the health and safety of crew and for providing health and medical programs for astronauts during all phases of space flight is authorized by NPD 1000.3 - The NASA Organization, and by NPD 8900.5B - NASA Health and Medical Policy for Human Space Exploration. This document includes medical evaluations for private astronauts and NASA Suborbital Research Specialist (NSRS). Private astronauts are defined as a crew member who is not a NASA career (U.S. government) astronaut or international partner astronaut. NASA Suborbital Research Specialist is an individual who is employed by NASA or funded by NASA to conduct research, technology testing, training, or other activities onboard a sub-orbital vehicle. This excludes those individuals who are the commercially employed crew of the suborbital vehicle. This NASA Technical Standard also provides mission specific medical evaluations which include both clinical and occupational requirements that may be tailored for future missions.

Standards↗

NASA NTRS1973

Skylab medical experiments program

With the completion of the historic Apollo Program, the significant medical findings will be reviewed and the medical results summarized. The medical objectives of Skylab will be presented. The medical experiments which will be conducted and their relationship to the Apollo medical findings and Skylab objectives will be discussed. The interrelationship of the Skylab medical experiments will be described and the anticipated information to be obtained will be postulated.

Hessberg, R. R.↗

NASA NTRS1981

Space Shuttle Program: STS-1 Medical Report

The necessity for developing medical standards addressing individual classes of Shuttle crew positions is discussed. For the U.S. manned program the conclusion of the Apollo era heralded the end of water recovery operations and the introduction of land-based medical operations. This procedural change marked a significant departure from the accepted postflight medical recovery and evaluation techniques. All phases of the missions required careful re-evaluation, identification of potential impact on preexisting medical operational techniques, and development of new methodologies which were carefully evaluated and tested under simulated conditions. Significant coordination was required between the different teams involved in medical operations. Additional dimensions were added to the concepts of medical operations, by the introduction of different toxic substances utilized by the Space Transportation Systems especially during ground operations.

Source record↗

NASA NTRS1981

STS-1 medical report

The report includes a review of the health of the crew before, during and immediately after the first Shuttle orbital flight (April 12-14, 1981). Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical kit carried inflight; 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; cabin acoustical noise. Also included is information on: environmental effects of Shuttle launch and landing, medical information management; and management, planning and implementation of the medical program.

Pool, S. L.↗

NASA NTRS1989

Medical care delivery in space

Consideration is given to the delivery of medical care in space. The history of aviation medicine is reviewed. Medical support for the early space programs is discussed, including the Mercury, Gemini, Apollo, and Skylab programs. The process of training crew members for basic medical procedures for the Space Shuttle program is briefly described and medical problems during the Shuttle program are noted. Plans for inflight medical care on the Space Station are examined, including the equipment planned for the Health Maintenance Facility, the use of exercise to help prevent medical problems.

Stewart, Don F.↗

NASA NTRS1992

Therapeutic effectiveness of medications taken during spaceflight

The therapeutic effectiveness of medications during spaceflight is considered in light of extensive anecdotal and experimental evidence. Attention is given to a range of medications for space motion sickness, sleeplessness, and physical discomfort. About 70 individual cases are reviewed in which crewmembers used such medications as: (1) scopolamine hydrobromide, dextroamphetamine sulfate, and promethazine hydrochloride for motion sickness; (2) metoclopramide hydrochloride and naloxone hydrochloride for bowel motility; and (3) aspirin and acetaminophen for headache and back pain. The effectiveness of orally ingested medications for space motion sickness is shown to be very low, while promethazine hydrochloride is effective when administered intramuscularly. The medications for pain are shown to be generally effective, and the use of sleep-inducing medications is limited by potentially detrimental performance effects.

Pool, Sam L.↗

NASA NTRS1991

Medical care delivery in the US space program

The stated goal of this meeting is to examine the use of telemedicine in disaster management, public health, and remote health care. NASA has a vested interest in providing health care to crews in remote environments. NASA has unique requirements for telemedicine support, in that our flight crews conduct their job in the most remote of all work environments. Compounding the degree of remoteness are other environmental concerns, including confinement, lack of atmosphere, spaceflight physiological deconditioning, and radiation exposure, to name a few. In-flight medical care is a key component in the overall support for missions, which also includes extensive medical screening during selection, preventive medical programs for astronauts, and in-flight medical monitoring and consultation. This latter element constitutes the telemedicine aspect of crew health care. The level of in-flight resources dedicated to medical care is determined by the perceived risk of a given mission, which in turn is related to mission duration, planned crew activities, and length of time required for return to definitive medical care facilities.

Stewart, Donald F.↗

NASA NTRS1994

Emergency medical services

When NASA was established in 1958, it was known that space flight would require efforts beyond those of NASA to ensure the health and safety of our astronauts. On 10 Aug. 1958, a Secretary of Defense memorandum was signed that assigned the first Department of Defense (DOD) Manager to provide support to NASA for Project Mercury. This established a chain of command through the Joint Chiefs of Staff to the Secretary of Defense. The current charter is dated 19 Mar. 1986 and assigns the DOD Manager responsibilities to the Commander and Chief, US Space Command. The DOD Managers charter has many support areas and among them are recovery of astronauts and medical support. Today these efforts support the Space Shuttle and Space Station Programs. Briefly, the program works with each organization tasking the other through a requirements document. Level of care, communications, and recovery requirements are established; NASA and the DOD provide the capability to meet them. NASA is also responsible for the specialized training and equipment needed to meet these requirements. A Shuttle launch a KSC requires an Emergency Medical Services (EMS) coordinator on console to facilitate communications, ensure proper coverage, and coordinate with area hospitals. A contingent of NASA medical personnel are assembled to provide triage and medical support capabilities. The DOD provides medical evacuation (MEDEVAC) helicopters with surgeons and pararescue specialists (PJ's) or emergency medical technicians (EMT's). Each helicopter is equipped with at least one doctor and one PJ/EMT per astronaut crew member. Transoceanic abort landing (TAL) sites and end of mission (EOM) sites have similar structures, with TAL sites utilizing fixed wingg aircraft for MEDEVAC. The DOD also supports contingency planning for the support and return of crew members from the Space Station Freedom. Much of this support has been directed at the recovery of crew members following the landing of an Assured Crew Return Vehicle.

Billica, Roger↗

NASA NTRS2000

Medical Training Issues and Skill Mix for Exploration Missions

The approach for treating in-flight medical events during exploration-class missions must reflect the need for an autonomous crew, and cannot be compared to current space flight therapeutic protocols. An exploration mission exposes the crew to periods of galactic cosmic radiation, isolation, confinement, and microgravity deconditioning far exceeding the low-Earth orbital missions performed to date. In addition, exploration crews will not be able to return to Earth at the onset of a medical event and will need to control the situation in-flight. Medical consultations with Earth-based physicians will be delayed as much as 40 minutes, dictating the need for a highly-trained medical team on board. This presentation will address the mix of crew medical skills and the training required for crew health care providers for missions beyond low-Earth orbit. Both low- and high-risk options for medical skill mix and preflight training will be compared.

Janney, R. P.↗