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NASA NTRSDate not supplied

Impact Real World System Validation

Introduction NASA has developed a new evidence-based data-driven probabilistic risk assessment and tradespace analysis tool as a successor to the Integrated Medical Model. This updated decision support tool is known as IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces). IMPACT estimates the frequency and consequences of medical conditions that might arise during exploration missions. A validation analysis of IMPACT was performed with respect to a set of International Space Station (ISS) and Shuttle Transportation System (STS) real world system (RWS) referent data due to the limited referent data available from exploration missions. Methods Observed mission and crew characteristics from STS and ISS missions were used as model inputs within MEDPRAT (Medical Extensible Dynamic Probabilistic Risk Assessment Tool). For each mission, two hundred thousand simulations were generated. For each mission, model outputs included occurrence counts for each condition, total medical events (TME), and the probability of loss of crew life (LOCL). These simulated model outputs were compared to the RWS referent data. Results The predicted number of total medical events exceeded the total RWS medical events for ISS missions and combined ISS and STS missions and fell within the 90% confidence interval for STS missions. For the 32 ISS missions simulated by IMPACT, the number of total medical events was overpredicted for 19 missions and fell within the 90% confidence interval for 13 missions. For the 21 STS missions, the total number of medical events was overpredicted for 3 missions, fell within the 90% confidence interval for 16 missions, and was underpredicted for 2 missions. Combined, 29 missions were in range, 22 were overpredicted, and 2 were underpredicted. The predicted LOCL probability for the 32 ISS missions, the 21 STS missions, and the combined ISS and STS missions was consistent with the zero LOCL events observed in the RWS referent data. The validation analysis included a comparison of the number of medical events predicted by IMPACT and the number of medical events observed in the RWS data on a condition-by-condition basis. For ISS missions, 50 conditions were in range, 52 conditions were statistically underpowered (not enough observed sample to draw any conclusions on precision), 8 conditions were overpredicted, and 9 conditions were underpredicted. Overall, only 14% (17/119) of conditions were out of range for STS missions, 40 conditions were in range, 59 conditions were statistically underpowered, 10 conditions were overpredicted, and 10 conditions were underpredicted. Overall, only 17% (20/119) of conditions were out of range. For combined ISS and STS missions, 11 conditions were overpredicted, and 11 conditions were underpredicted. Overall, only 18% (22/119) of conditions were out of range. For combined ISS and STS missions, 49 conditions were in range, 46 conditions were statistically underpowered, 18 conditions were overpredicted, and 8 conditions were underpredicted. Overall, 21% (26/121) of conditions were out of range. Conclusion The results of this validation analysis should not be interpreted as a pass/fail test of the validity of IMPACT. Instead, this validation analysis should be used to assess some of the IMPACT outcomes in terms of consistencies and inconsistencies with the ISS and STS RWS referent data.

L. Boley↗
NASA NTRSDate not supplied

Impact, A Tool Suite for Crew Health and Performance System Trade Analyses and Decision to Support - Transition to Operations

Mission planners, systems engineers, and clinicians that support crew health and performance face very difficult choices on upcoming exploration missions. Given that there will be a heavily constrained mass and volume allocation for a medical system on these missions, what medical capability should be manifested to minimize both medical risk and mission risk? Given that not all promising research and technology proposals can be funded, how can proposals be prioritized so that those funded research investments produce the maximum benefit in reducing overall medical risk? The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) project seeks to answer these kinds of questions and others to support upcoming exploration missions. IMPACT enables risk-informed and evidence-based trade space analysis for future space vehicles, missions, and systems. This presentation will discuss the long-term HRP and ExMC vision for the larger ecosystem of tools, which include an updated medical database, consisting of an Evidence Library for medical conditions and a medical item database (MedID) for medical resources, dynamic Probabilistic Risk Assessment (PRA) capabilities, System Modeling Language (SysML) models, and contextual data visualizations of output data. IMPACT is the result of a multi-center collaborative effort. The trade space analyses performed by IMPACT can directly inform mission, vehicle, and habitat development by quantifying medical risk, given a design reference mission, crew attributes and a set of medical capabilities. This presentation will update the audience on the development status of the IMPACT tool suite as it comes out of its System Acceptance Review (SAR) and nears Transition to Operations (TTO). It will review IMPACT’s constituent parts, briefly discuss typical outputs, and outline the plans for transitioning to operations, currently scheduled for later in FY24. Recent development successes on the IMPACT project include the integration of the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) v2.0 to accommodate segmented missions with multiple carriers and medical systems, full onboarding of the IMPACT Medical Database (IMPACT-MD), clustering medical resources and skills into medical capabilities and mutually-dependent bundles, verification of IMPACT-MD, and the ability to perform trade analyses on different medical sets, different design reference missions (DRM), with different crew complements and extra-vehicular activity (EVA) schedules.

IMPACT↗
NASA NTRSDate not supplied

IMPACT, A Tool Suite for Crew Health and Performance System Trade Analyses and Decision Support- Transition to Operations

Mission planners, systems engineers, and clinicians that support crew health and performance face very difficult choices on upcoming exploration missions. Given that there will be a heavily constrained mass and volume allocation for a medical system on these missions, what medical capability should be manifested to minimize both medical risk and mission risk? Given that not all promising research and technology proposals can be funded, how can proposals be prioritized so that those funded research investments produce the maximum benefit in reducing overall medical risk? The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) project seeks to answer these kinds of questions and others to support upcoming exploration missions. IMPACT enables risk-informed and evidence-based trade space analysis for future space vehicles, missions, and systems. This presentation will discuss the long-term HRP and ExMC vision for the larger ecosystem of tools, which include an updated medical database, consisting of an Evidence Library for medical conditions and a medical item database (MedID) for medical resources, dynamic Probabilistic Risk Assessment (PRA) capabilities, System Modeling Language (SysML) models, and contextual data visualizations of output data. IMPACT is the result of a multi-center collaborative effort. The trade space analyses performed by IMPACT can directly inform mission, vehicle, and habitat development by quantifying medical risk, given a design reference mission, crew attributes and a set of medical capabilities. This presentation will update the audience on the development status of the IMPACT tool suite as it comes out of its System Acceptance Review (SAR) and nears Transition to Operations (TTO). It will review IMPACT’s constituent parts, briefly discuss typical outputs, and outline the plans for transitioning to operations, currently scheduled for later in FY24. Recent development successes on the IMPACT project include the integration of the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) v2.0 to accommodate segmented missions with multiple carriers and medical systems, full onboarding of the IMPACT Medical Database (IMPACT-MD), clustering medical resources and skills into medical capabilities and mutually-dependent bundles, verification of IMPACT-MD, and the ability to perform trade analyses on different medical sets, different design reference missions (DRM), with different crew complements and extra-vehicular activity (EVA) schedules.

IMPACT↗
NASA NTRSDate not supplied

Custom Integration of Multiple Medical Functionalities

INTRODUCTION: Previous spaceflight experience and results from probabilistic risk assessment of spaceflight medical risk have highlighted the need for vital sign measurements, medical scopes, and clinical imaging tools for managing medical conditions during spaceflight. The Human Research Program’s Exploration Medical Capability (ExMC) Element and the Mars Campaign Office’s Exploration Medical Integrated Product Team (XMIPT) have performed ground-based evaluations of two Commercial-off-the-Shelf (COTS) Multi-functional Integrated Medical (MIM) devices, which integrate various medical capabilities together in one device. The key findings from these evaluations are presented in a complementary presentation, leaving this presentation to focus on forward recommendations for customized integration of multiple medical functionalities. KEY COMPONENTS: The key features of a custom integration of multiple medical functionalities includes devices and capabilities that optimally reduce medical risk. The COTS MIM devices incorporated functionality for best supporting Earth-based, emergency, pre-hospital care. Our custom integration will use probabilistic risk assessment tools, such as the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT), to determine the optimal functionality to include based on medical risk minimization. An additional feature of custom integration includes the ability to adapt to different requirements within different vehicles and/or missions. The COTS MIM devices store data in patient specific records, however, the format of the records is not modifiable, and data are not easily transferred from the MIM device to a central data architecture outside of the manufacturer’s established system. Our concept for custom integration will use devices that have an open application programming interface, which can easily connect to independent data architectures and third-party visualization software. The ultrasound capabilities included within the COTS MIM devices did not satisfy many of the Artemis Research and Operations Working Group’s ultrasound functional needs, and therefore, incorporation of higher quality ultrasound capabilities within a customized integration will be beneficial. The COTS MIM devices included minimal procedural guidance and clinical decision support tools. Supplemental tools of this type would need to be supplied along with the COTS MIM devices if they were to be used operationally, so another advantage of customization is the ability to integrate these support tools along with the medical functionality, for a more streamlined user experience. CONCLUSION: Investigation of a customized integration of medical functionality provides a method for further understanding the needs of a long-term exploration spaceflight medical system. The crew members of these exploration missions will need to operate more and more independently from Earth-based ground support. Therefore, having an optimized, streamlined medical system, which contains the functionality and supporting information needed, while remaining within mission and vehicle constraints, will help to maintain crew health and performance, which is necessary for achieving high levels of mission success.

B E Lewandowski↗
NASA NTRSDate not supplied

Proof-of-Concept for a Long-Term Health Metric to Quantify End of Mission Health Status in Astronauts

NASA has long used Probabilistic Risk Assessment (PRA) when high-stakes decisions need to be made about complex systems. For spaceflight medical risk, the Human Research Program’s Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) is a significant step towards robustly quantifying the risk to crew health during exploration missions. However, there remains a significant gap in the ability to comprehensively characterize and assess risk across the disparate functionalities and capabilities which comprise the entire Crew Health and Performance (CHP) system. To fill this gap, the Crew Health and Performance – Probabilistic Risk Assessment (CHP-PRA) project aims to perform risk characterization for the CHP system by assessing performance risk in addition to medical risk. This effort also includes quantifying Long-Term Health (LTH) risk in addition to in-mission risk outcomes within the CHP-PRA results. LTH risk encompasses the timeframe from immediately post-flight, through the rest of an astronaut’s career, through retirement, and until death. A proof-of-concept LTH risk metric is based on medical condition end-state, as defined by the Evidence Library, capturing the spaceflight specific medical impacts persisting into post-flight[1]. Condition outcomes in the Evidence Library progress through three Clinical Phases (CP): the diagnostic phase (CP1), the treatment/convalescent phase (CP2), and the end-state phase (CP3) which represents the detrimental effects of the condition after the crew member has recovered to the maximal extent. Each CP has an associated Task Impairment (TI), defined as the degree of crew incapacity due to experiencing the condition, and is quantified with a 0-1 range. Conditions with an associated CP3 (e.g. Sepsis, Traumatic Hypovolemic Shock, Sudden Cardiac Arrest, etc.) typically have serious consequences that can cause an astronaut to be fully or partially debilitated throughout the remainder of the mission. Consequently, the Cumulative CP3 TI End-of-Mission Health Status Metric is developed by CHP-PRA to quantify the cumulative effects of all conditions which progressed to the CP3 state throughout the entirety of the mission. Hence, this End-of-Mission Health Status Metric attempts to serve as an indicator of an astronaut’s health state at the time of landing. The severity of the lingering effects of in-mission medical events are dependent on mission activities and the level of available in-mission medical care. This allows the associated cumulative TI metric to be used in comparison with the crew’s end of mission health status for different levels of in-mission resources. This presentation provides the strategy for using CP3 as an LTH metric component, as well as a proof-of-concept demonstration of LTH risk characterization using this component.

long term health↗
NASA NTRSDate not supplied

Sensorimotor Application of Proposed Methods to Combine the Effects of Multiple Countermeasures for PRisM

Risk associated with human systems is challenging to quantify but is critical for the mission planning and decision making required to enable future Lunar and Martian missions. To address this gap, the Crew Health and Performance-Probabilistic Risk Assessment (CHP-PRA) project is developing an integrated computational model for CHP mission risk. Much like how MEDPRAT is designed to allow medical resource trades informed by medical risk, CHP-PRA will enable analogous trades in human system risks across multiple CHP functions and capabilities. Human performance is one component of the risk intended to be captured by CHP-PRA through the Performance Risk Model (PRisM). The sensorimotor risk area provides a good frame of reference for investigating the structure of a performance model because most tasks that astronauts are expected to perform require input from the sensory system and/or movement/motor control. Additionally, sensorimotor countermeasures are an area of particular concern for NASA’s Human Research Program because of the increased sensorimotor risk associated with surface operations in Lunar and Martian missions. Thus, a tool that can quickly compare risk reductions of potential countermeasures would be beneficial in guiding research and development of effective countermeasures. In this proof of concept, we present a systematic way to combine multiple performance data sets for humans subjected to different countermeasures such that we can predict the countermeasure(s) that optimize astronaut performance on relevant tasks. PRisM assumes that both the tests that are used to measure countermeasure effectiveness (input data) and the tasks we use to represent astronaut performance, can be broken down and represented as a function/vector of the human systems required to perform that test/task. Through mathematical combination, test data are used to predict performance on astronaut tasks that use similar systems. We propose that when combining countermeasures evaluated using the same test, that only one value should be used to represent their combined effectiveness. We start our analysis with the assumption that two countermeasures together will perform better than each countermeasure individually. Our initial implementation of this framework compares various space motion sickness countermeasures and the most up to date analysis will be demonstrated at the IWS.

Caroline R Austin↗
NASA NTRSDate not supplied

Investigating Risks Due to Artemis EVA Tempo Via Probabilistic Risk Assessment

Spaceflight operations pose unique challenges to crew health, safety, and resource management. As space agencies and private companies continue to push the boundaries of human exploration, it is essential to understand the risks associated with Extravehicular Activities (EVAs) and develop strategies to mitigate them. The tempo at which EVAs are conducted – the total number and frequency of these activities – can have a profound impact on medical risks, resource consumption, and overall mission success. Probabilistic risk assessment (PRA) provides a powerful framework for evaluating complex systems and identifying potential hazards. Our work employs the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) [1] to simulate mission events, occurrence and treatment of medical conditions, and track the utilization of resources. Coupled with the Evidence Library [2], a medical evidence base for exploration-class missions developed by the Exploration Medical Capability within NASA’s Human Research Program, we can estimate these risks with increased fidelity and optimize medical kit contents to meet specific mission requirements. This presentation provides a detailed examination of how EVA tempo influences medical risk estimates for a lunar surface design reference mission. A comprehensive analysis is conducted to assess the additional mass and volume burden imposed on medical kits required to maintain adequate levels of risk mitigation. Furthermore, we estimate the distribution of the number of successful EVAs completed based on the level of task impairment imposed by medical events and flight rules related to specific medical events, such as decompression sickness.

Modeling↗
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↗