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NASA NTRSDate not supplied

Clinical Decision Support For Exploration Space Flight: Software Augmentation To Enhance Progressively Earth-Independent Medical Operations

This panel identifies the challenges of supporting medical events in deep space using integrated systems software to augment existing capabilities during increasingly Earth-independent missions where an asynchronous communication environment becomes routine. An interdisciplinary team of software designers, physicians, human factors engineers, and computational modelers applied their respective expertise to develop a roadmap for supporting the crew making medical decisions in more autonomous fashion with time-delayed ground support. The first presentation describes predictive modeling implemented to assist medical system design and address risk reduction using robust clinical decision support software. The second presentation details how operational and environmental challenges guide assumptions and, in turn, by what means requirements for medical decision-making in deep space are derived. The third presentation describes and defines the skills and capabilities an exploration spaceflight medical officer will need to perform effectively during extended-duration spaceflight missions. The fourth presentation covers the potential models and function of the software element for supporting clinical decisions. The final presentation covers how these elements may work together with ground support to provide comprehensive care despite deep space travel's extreme challenges and limitations.

Dana Levin↗

NASA NTRSDate not supplied

Root Cause Analysis of the Data Refinement Process – Medical Conditions Capability Resource Tables

The medical system for spaceflight thus far has been designed to support missions in low earth orbit (LEO). Crew capabilities are limited and heavily dependent on the team of medical support staff at Mission Control Center (MCC) to guide diagnosis and management. However, missions to the Moon and Mars will suffer from several constraints that will make this ground support focused approach to care ineffective. In order to update and modify medical system design, NASA has relied on Probabilistic Risk Assessment (PRA) modeling to mitigate medical risk through trade space analysis. Specifically, capability resource tables (CRT’s) were developed to create a dataset of resources required to manage a list of accepted medical conditions significant in exploration spaceflight. With 120 conditions, this dataset contained hundreds of capabilities and thousands of resources with tens of thousands of cells of data. Initially these tables were built in excel for high throughput during development, but ultimately had to be transferred, managed, and modified into the Evidence Library database for modeling purposes. The process of collating and reviewing the Evidence Library revealed numerous errors in the dataset that had to be corrected through iterative changes. Several error types emerged during this process and can be broken into specific classifications defined as “input”, “transcription”, “structural”, “branching”, and “information”. In reviewing these error types through the root cause analysis (RCA) approach, we were able to identify the contributors to these errors which included single data review points, changing product end goals, limited software selection, time constraints and several others. By reviewing and evaluating the underlying causes we can provide possible system improvements that can be implemented for current and future data management in PRA model inputs.

A. Anderson↗

NASA NTRSDate not supplied

Lessons Learned from Medical System Foundation Development for Long-Duration Lunar Orbit and Lunar Surface Missions

The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has been tasked with the development of Medical System Foundations for Level of Care IV for both short-duration lunar orbital missions and, subsequently, long-duration lunar orbital and surface operations missions. These Medical System Foundations serve as a framework to aid in early medical system design and mission planning. The content of both Foundation models is similar, consisting of a concept of operations, functional decomposition, clinical content (medical conditions, capabilities, and resources), technical requirements (interface, non-functional, and functional), and traces between these components and to the NASA standards documents and parent-level (Program- and Vehicle habitat system-level) requirements. Additionally, the development of both Foundations employed systems engineering principles and a model-based systems engineering (MBSE) approach. Throughout the development of these Foundations, ExMC has strived to improve the efficiency and robustness of its processes and to be more responsive to change (i.e., in design reference mission parameters and assumptions) and to stakeholders’ feedback. The most significant improvements made between the short- and long-duration Foundation models during this transformation process are the following: • Replacement of the traditional document-based ConOps with a model-based ConOps according to MBSE principles, which facilitated more efficient understanding of the material and the consolidation of all relevant information into a centralized location. • Utilization of an agile approach with tasks organized into sprints. This approach enabled solicitation of more frequent usability feedback from stakeholders, incorporation of more human factors reviews into the sprints, and more efficient tasking of team members. This presentation will discuss the journey of developing both Foundation models, as well as the lessons learned and resulting improvements made between the Short- and Long-Duration models.

M Kaetzer↗

NASA NTRSDate not supplied

Selection of Next Priority IMPACT Medical Conditions Based on Available Terrestrial and Spaceflight Data

BACKGROUND: As the era of exploration class missions begins, identification of medical conditions that may occur and require management becomes essential for the modeling of medical risk. To this end, NASA has developed IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces), a suite of tools to assist in assessment of medical risk analysis. It has incorporated an initial list of the 120 conditions of highest concern, labeled the IMPACT condition list 1.0 (ICL 1.0). This abstract describes a method for prioritizing the 92 conditions included on the Proposed Future Conditions List (PFCL) for inclusion in future iterations of the ICL. OVERVIEW: To construct the Prioritized Proposed Future Conditions List (P-PFCL), each condition on the PFCL was scored as “low,” “medium,” or “high” on each of four variables: incidence, likelihood of significant task impairment, diagnostic and treatment complexity, and treatment futility. Qualitative assessment using clinical judgement was utilized to score complexity, futility, and likelihood of impairment. Incidence was assessed quantitatively using spaceflight data and/or analog populations where available then assigned a score using established cutoffs. Logarithmic numerical values were assigned to each category label. A Prioritization Score was generated for each condition by taking the product of incidence and likelihood of task impairment (risk) divided by the product of complexity and futility (difficulty of care), with higher values corresponding to higher priority for future inclusion in the ICL. DISCUSSION: The described methods allow for the generation of a ranked P-PFCL to act as a decision support tool for selection of the next generation of modeled medical conditions. Some of the conditions ranked highly on the P-PFCL include EVA-related upper and lower extremity sprain/strain, iron deficiency, delirium, and hypertension, among others. While this effort does not attempt to quantify the absolute risk associated with each condition, it does attempt to semi-quantitatively estimate the risk of each condition relative to the other possible conditions. This tool in concert with subject matter expert opinion could optimize the future use of limited resources thereby producing a more accurate medical risk model, which will be essential to the upcoming exploration class missions.

Michael Pohlen↗

NASA NTRS2023

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

Background: 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. Methods: In the survey, 20 experienced NASA flight surgeons responded to 57 standardized questions covering 17 categories, 22 questions of which were covered in this analysis including 4 categories: Cardiovascular, Catastrophic Situations, Pulmonary, and Respiratory/O2 Support. These results were categorized into recommendations and observations. The recommendations were used to objectively quantify the responses to look for consensus, differences and uncertainty among responses. The observations remain important but were not included in this review. Analysis: Regarding questions related to changes in medical conditions treated for long-duration missions, percentage of “No Change” responses varied from 20% to 75%. In the “Change” treatment plan responses, a variety of recommendations were made, which were further made into graphics for better illustration. Additionally, recommendations on capability questions in multiple systems were visualized altogether in one product. Discussion: This work demonstrates the importance of collaboration and thorough analysis amongst experienced NASA flight surgeons for helping establish medical systems and contributing to the likelihood of mission success during Artemis long-duration missions. Through this review, we were able to identify some positive attributes as well as areas for improvement, which will facilitate further discussions.

Andrew Bushong↗

NASA NTRS2023

Enabling Human Space Exploration Missions Through Progressively Earth Independent Medical Operations (EIMO)

Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and crews to reduce risk and increase mission success. Terrestrial assets will continue to provide pre-mission screening, planning, health maintenance, and prevention, while onboard medical care will increasingly be the purview of the crew. Conclusions: This paper defines and describes the key components of EIMO.

ExMC↗

NASA NTRS2023

Earth Independent Medical Operations (EIMO) Training Technical Interchange Meeting, 26th October 2023: Background and Summary of Discussion

On 26th October 2023, ExMC convened a panel of Subject Matter Experts (SMEs) from NASA, broadly representing Headquarters, the Human Research Program, Medical Operations, the Human Health and Performance Directorate at JSC, the Health and Medical Technical Authority, the Flight Operations Directorate, and representation from other Centers including: Ames Research Center (ARC), and Glenn Research Center (GRC). Representatives from the Canadian Space Agency also participated in this TIM. In addition, SMEs from industry included representation from the following entities: Axiom Space, Space Exploration Technologies Corporation, Level Ex, Shiny Box Interactive. Additional SMEs from academia included: University of Houston, Touro University, Weill Cornell Medical College and the Translational Research Institute for Space Health at Baylor College of Medicine. This group of stakeholders discussed the training issues related to facilitating EIMO. Sub-topics for this discussion included the following: - Pre-launch medical curriculum development - Ground-based training on medical hardware - Dental health - Behavioral health - Telemedicine - Just-in-time training - Simulation-based training (extended reality)

CMO Training↗

NASA NTRS2024

Uncrewed Aerial Systems for Emergency Medical First Response: A Market Research Report

This report presents the findings from market research conducted for NASA’s Aerial Aid Convergent Aeronautics Solutions (CAS) exploration project, which aims to assess the current state of the market and technological readiness for Uncrewed Aerial Systems (UAS) for medical emergency first response. The research reveals a robust and rapidly growing market for UAS, with a notable emerging sector for Drones as First Responders (DFR). Despite this growth, DFR applications are currently limited by regulatory, technical, and other challenges, which restrict their use primarily to manned remote video surveillance, and therefore are primarily employed by police units. To our knowledge, there is no evidence of UAS being utilized by medical first responders for scene assessment. Limited evidence exists for closely related applications; however, these are mostly confined to pilot programs for the delivery of medical supplies or equipment. Although there has been discussion around fully autonomous DFR applications for medical purposes such as UAS ambulances or patient transport drones, these applications are generally not yet operational in practice. The technology for full autonomy, especially in guidance and control, has seen significant advancements, and recent Federal Aviation Administration (FAA)regulations are likely to accelerate adoption. Computer vision algorithms for fully autonomous medical emergency response scene surveillance are primed for advancement and deployment. A notable gap likely exists between advancements in computer vision research and what is being integrated in the commercial DFR sector. This gap is primarily due to challenges such as quality assurance for autonomous systems, the availability of application-specific training datasets for computer vision algorithms, regulatory constraints, and public perception and privacy concerns.

Joshua M Fody↗

NASA NTRSDate not supplied

Assessing the Influence of Decompression Sickness on Medical Risk for Artemis

As NASA begins to shift its focus from LEO missions to the Moon and beyond, our understanding of the risk associated with human spaceflight is challenged by mission profiles and objectives far different from preceding missions. For Artemis, one of these aspects is surface Extra Vehicular Activity (EVA) tempo, in which the crew will perform 3 to 4 surface EVA’s in quick succession. The crew health and performance risk associated with EVA Decompression Sickness (DCS) and its associated countermeasures, is an important consideration for Artemis missions given this new and unprecedented EVA frequency. Successfully completing Artemis mission objectives relies heavily on the crew being able to perform and complete these EVAs. This analysis quantifies how medical risk changes when accounting for the expected increase in DCS risk due to the increase in EVA frequency. If there is an occurrence of DCS during a mission, appropriate downtime needs to be accounted for. Treatment for DCS requires crewmember to stop the current EVA and return to the habitat. This impacts the current EVA the crew is performing, could potentially delay the next EVA, and increases the chance of the crewmember being unable to perform future EVAs. Capturing the downtime and impact of that downtime based on the number of DCS occurrences allows us to better understand how the risk associated with DCS affects the overall medical risk and completion of missions that have more frequent EVA tempo. There are preventative strategies and mitigation countermeasures to decrease the chance of DCS occurring such as different prebreathe protocols, variable suit pressure, and vehicle pressure settings. Modeling the medical risk with and without different DCS countermeasures enables quantitative comparisons of risk reduction associated with each DCS countermeasure. We present results on how these countermeasures affect medical risks and quantify changes in the medical kit contents with respect to the countermeasures implemented within Artemis-class missions.

Clara Gasiewski↗

NASA NTRS2019

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

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

photographs↗

NASA NTRS2016

Integrated Medical Model (IMM) Optimization Version 4.0 Functional Improvements

The IMMs ability to assess mission outcome risk levels relative to available resources provides a unique capability to provide guidance on optimal operational medical kit and vehicle resources. Post-processing optimization allows IMM to optimize essential resources to improve a specific model outcome such as maximization of the Crew Health Index (CHI), or minimization of the probability of evacuation (EVAC) or the loss of crew life (LOCL). Mass and or volume constrain the optimized resource set. The IMMs probabilistic simulation uses input data on one hundred medical conditions to simulate medical events that may occur in spaceflight, the resources required to treat those events, and the resulting impact to the mission based on specific crew and mission characteristics. Because IMM version 4.0 provides for partial treatment for medical events, IMM Optimization 4.0 scores resources at the individual resource unit increment level as opposed to the full condition-specific treatment set level, as done in version 3.0. This allows the inclusion of as many resources as possible in the event that an entire set of resources called out for treatment cannot satisfy the constraints. IMM Optimization version 4.0 adds capabilities that increase efficiency by creating multiple resource sets based on differing constraints and priorities, CHI, EVAC, or LOCL. It also provides sets of resources that improve mission-related IMM v4.0 outputs with improved performance compared to the prior optimization. The new optimization represents much improved fidelity that will improve the utility of the IMM 4.0 for decision support.

risk assessment↗

NASA NTRSDate not supplied

Medical countermeasures for extraterrestrial environments: Current status and future prospects with focus on acute injuries

In all space exploratory activities involving humans there are associated risks to health and well-being. Exposure to ionizing radiation represents one of the more serious health concerns. Although medical issues can arise shortly following the rare acute exposures, the more likely radiation-associated injuries will manifest in a delayed fashion following sub-acute exposures or protracted exposures to relatively low radiation doses. The radiological conditions that present these health risks during extraterrestrial space travel are presented in this article, along with current physical and medical countermeasures for such exposure contingencies. The aim of this article is to discuss radiation medical countermeasures that may be considered for future space exploration and travel. Biomedical advances have occurred toward the control and minimization of acute, sub-acute, and fractionated radiation exposure injuries, whether they stem from intentional application of radio-therapeutic procedures or unintentional, accidental terrestrial-based exposures. Those advances, based largely on novel bioengineering, genetic, and combinatorial pharmaceutical strategies, are briefly reviewed here, along with the promising prospects of additional, new and improved medical countering systems/agents that will be forthcoming with additional research and development efforts.

Acute/chronic radiation injuries↗

NASA NTRSDate not supplied

Architectural Framework for Conceptualizing Exploration Class Medical Operations

Currently, discrete projects within NASA’s Human Research Program (HRP) take aim at providing future exploration missions with the capabilities necessary to operate within a progressively Earth-independent operative environment. Realizing an entire ecosystem that can accomplish these goals requires a clear visualization on how each project contributes to the overall objectives of Human Health and Performance (HH&P) in that context. The Exploration Medical Capability (ExMC) Element has developed an architectural framework for exploration class medical operations by utilizing a systems engineering approach using model-based systems engineering (MBSE). This model, a System of Systems Architecture (SoSA), captures a means of integrating various independent but related efforts into a comprehensive view associated with HRP’s goal of providing progressively Earth-Independent Medical Operations (EIMO). This level of visibility is realized by identifying interfaces between development efforts and existing programs that contribute to the overall mission of EIMO even if those extend past the traditional boundary of HRP. Potential interfaces that are considered important when constructing an architecture include program/project Needs, Goals, and Objectives (NGOs), capabilities, envisioned use cases/scenarios, and system/subsystem structure. This presentation will focus on the processes that were used to generate the SoSA along with a means to realize its utility amongst other MBSE products from ExMC. Evaluation of the best architecture moving forward can then be achieved that promotes cohesion between various functional areas of HH&P. Additionally, the SoSA is developed with a long-term vision for the dynamic integration of novel technological developments that may be implemented in the future. The SoSA is intended to enable Stakeholders the ability to view the broader interconnections that exist and begin to create avenues of communication between various efforts. The benefits of a SoSA provide an essential step towards addressing the unique challenges of attaining the goals of broader exploration class medical missions of the future.

Systems engineering↗

NASA NTRS2024

Architectural Framework for Conceptualizing Exploration Class Medical Operations

Systems engineering↗

NASA NTRS1973

Medical operations: Crew surgeon's report

To assure the safety and well being of the Skylab environment simulation crewmembers it was necessary to develop a medical safety plan with emergency procedures. All medical and nonmedical test and operations personnel, except those specifically exempted, were required to meet the medical standards and proficiency levels as established. Implemented programs included health care of the test crew and their families, occupational medical services for chamber operating personnel, clinical laboratory support and hypobaric and other emergency support.

Ross, C. E.↗

NASA NTRS1975

The medical story

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

Johnston, R. S.↗

NASA NTRS1983

OSHA medical and workplace surveillance requirements and NIOSH recommendations (for employees exposed to toxic substances and other work hazards)

Both OSHA medical and work place surveillance requirements and NIOSH recommendations were prepared as a desk reference to help occupational health professionals to perform their duties. The medical surveillance information focuses on frequency of physical examinations, specific problems that may arise as a result of exposure (e.g., decreased immunocompetence, weight loss, ets.), conditions that intensify the harmful effects of exposure (e.g., medication an exposed employee may be taking, cigarette smoking, etc.), the areas that should be scrutinized in medical and work histories and during the physical exam, and specific clinical tests that should be conducted. Recordkeeping requirements are also specified. The workplace surveillance information consists of monitoring requirements, personal protective equipment requirements, and recordkeeping requirements. Such details as the sampling devices that should be used, the type of respirators that should be worn, and the frequency of inspections are included. This document does not specify the training, labeling and posting, and safe work practice requirements and recommendations due to space considerations.

Cooper, L. P.↗

NASA NTRS1989

Interactive displays in medical art

Medical illustration is a field of visual communication with a long history. Traditional medical illustrations are static, 2-D, printed images; highly realistic depictions of the gross morphology of anatomical structures. Today medicine requires the visualization of structures and processes that have never before been seen. Complex 3-D spatial relationships require interpretation from 2-D diagnostic imagery. Pictures that move in real time have become clinical and research tools for physicians. Medical illustrators are involved with the development of interactive visual displays for three different, but not discrete, functions: as educational materials, as clinical and research tools, and as data bases of standard imagery used to produce visuals. The production of interactive displays in the medical arts is examined.

Mcconathy, Deirdre Alla↗