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NASA NTRS2006

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

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

Johnson-Troop↗
NASA NTRS2007

Organization, Management and Function of International Space Station (ISS) Multilateral Medical Operations

Long duration crews have inhabited the ISS since November of 2000. The favorable medical outcomes of its missions can be largely attributed to sustained collective efforts of all ISS Partners medical organizations. In-flight medical monitoring and support, although crucial, is just a component of the ISS system of Joint Medical Operations. The goal of this work is to review the principles, design, and function of the multilateral medical support of the ISS Program. The governing documents, which describe the relationships among all ISS partner medical organizations, were evaluated, followed by analysis of the roles, responsibilities, and decision-making processes of the ISS medical boards, panels, and working groups. The degree of integration of the medical support system was evaluated by reviewing the multiple levels of the status reviews and mission assurance activities carried out throughout the last six years. The Integrated Medical Group, consisting of physicians and other essential personnel in the mission control centers represents the front-line medical support of the ISS. Data from their day-to-day activities are presented weekly at the Space Medicine Operations Team (SMOT), where known or potential concerns are addressed by an international group of physicians. A broader status review is conducted monthly to project the state of crew health and medical support for the following month, and to determine measures to return to nominal state. Finally, a comprehensive readiness review is conducted during preparations for each ISS mission. The Multilateral Medical Policy Board (MMPB) issues medical policy decisions and oversees all health and medical matters. The Multilateral Space Medicine Board (MSMB) certifies crewmembers and visitors for training and space flight to the Station, and physicians to practice space medicine for the ISS. The Multilateral Medical Operations Panel (MMOP) develops medical requirements, defines and supervises implementation of operational countermeasures, environmental monitoring, medical care, and emergency medical services. MMOP assures the medical readiness of the Station for each subsequent mission or critical event. All boards and panels have functioned effectively and without interruptions even in various challenging circumstances. Based on the experience of the authors, consensus has prevailed as the primary nature of decisions made by all ISS medical groups, at all levels. The six first years of piloted operation have demonstrated the ability of the ISS medical authority groups and the medical infrastructure to implement medical policies and requirements, effectively interface with non-medical groups, and maintain the health and productivity of the crew in an integrated, multilaterally coordinated fashion. The medical support system appears to be mature and ready for further expansion of all Partners roles, and for the anticipated increase in the size of ISS crews.

Duncan, James M.↗
NASA NTRS2023

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

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

Brian K. Russell↗
NASA NTRS2015

Electronic Procedures for Medical Operations

Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

Source record↗
NASA NTRSDate not supplied

Earth-Independent Medical Operations (EIMO) Concept of Operations

Compared to the current paradigm for crew health in low-Earth orbit and Lunar missions that rely on constant communication with Mission Control, there is an anticipated shift in medical operations for deep-space exploration missions. This shift stems from mission constraints imposed by the considerable distance from Earth, which include resource limitations due to a lack of resupply, mass, power, volume, and data limitations, challenges imposed by communication latency and the inability to evacuate in case of emergencies. To transition towards a more self-reliant medical approach, a comprehensive strategy is essential to progressively enable crew autonomy and mitigate mission success risks in the challenging environment of space. This transformative shift is collectively referred to as "Earth-Independent Medical Operations" (EIMO), signifying the gradual transfer of medical care and decision-making from terrestrial resources to space-based assets. This transition is aimed at bolstering astronaut health and performance while simultaneously reducing the overall risks associated with space missions. The constraints related to EIMO necessitate an integrated development of medical systems, featuring interoperability with mission planning, vehicle design, spacesuit design, and data architecture. This integration is vital in establishing a robust medical infrastructure that not only supports the well-being of astronauts but also ensures the success of the mission as a whole. The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has developed a model-based Concept of Operations (ConOps) outlining an initial vision for EIMO. Within this ConOps, a comprehensive view is presented, encompassing stakeholder needs, system objectives, and system goals associated with EIMO. Additionally, it provides illustrative examples of the various activities (scenarios) for which the system will be employed during missions. The selection of these activities has been meticulous, aiming to encompass a wide spectrum of medical conditions, including those falling under different risk categories, such as low-likelihood-low-consequence, low-likelihood-high-consequence, and high-likelihood-low-consequence. The selection of these activities (scenarios) effectively encompasses the wide range of medical events situated within an assumed probability-consequence bell curve. In each scenario, at least one of the five main EIMO components identified is captured. Those EIMO components are: Pre-mission Planning, Acute and Emergent Management Decision Making, Prolonged Medical Management Decision Making, Supplies and Resource Management, and Task Load Management. The ConOps was developed by a multidisciplinary team consisting of systems engineers, scientists, and clinicians across NASA and aims to serve as an initial recommendation to gradually and safely enabling crew autonomy for Mars missions and beyond.

Earth Independent Medical Operations↗
NASA NTRS2024

Earth-Independent Medical Operations (EIMO) Concept of Operations (ConOps)

Compared to the current paradigm for crew health in low-Earth orbit and Lunar missions that rely on constant communication with Mission Control, there is an anticipated shift in medical operations for deep-space exploration missions. This shift stems from mission constraints imposed by the considerable distance from Earth, which include resource limitations due to a lack of resupply, mass, power, volume, and data limitations, challenges imposed by communication latency and the inability to evacuate in case of emergencies. To transition towards a more self-reliant medical approach, a comprehensive strategy is essential to progressively enable crew autonomy and mitigate mission success risks in the challenging environment of space. This transformative shift is collectively referred to as "Earth-Independent Medical Operations" (EIMO), signifying the gradual transfer of medical care and decision-making from terrestrial resources to space-based assets. This transition is aimed at bolstering astronaut health and performance while simultaneously reducing the overall risks associated with space missions. The constraints related to EIMO necessitate an integrated development of medical systems, featuring interoperability with mission planning, vehicle design, spacesuit design, and data architecture. This integration is vital in establishing a robust medical infrastructure that not only supports the well-being of astronauts but also ensures the success of the mission as a whole. The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has developed a model-based Concept of Operations (ConOps) outlining an initial vision for EIMO. Within this ConOps, a comprehensive view is presented, encompassing stakeholder needs, system objectives, and system goals associated with EIMO. Additionally, it provides illustrative examples of the various activities (scenarios) for which the system will be employed during missions. The selection of these activities has been meticulous, aiming to encompass a wide spectrum of medical conditions, including those falling under different risk categories, such as low-likelihood-low-consequence, low-likelihood-high-consequence, and high-likelihood-low-consequence. The selection of these activities (scenarios) effectively encompasses the wide range of medical events situated within an assumed probability-consequence bell curve. In each scenario, at least one of the five main EIMO components identified is captured. Those EIMO components are: Pre-mission Planning, Acute and Emergent Management Decision Making, Prolonged Medical Management Decision Making, Supplies and Resource Management, and Task Load Management. The ConOps was developed by a multidisciplinary team consisting of systems engineers, scientists, and clinicians across NASA and aims to serve as an initial recommendation to gradually and safely enabling crew autonomy for Mars missions and beyond.

Earth Independent Medical Operations↗
NASA NTRSDate not supplied

Earth-Independent Medical Operations (EIMO) Concept of Operations

In contrast to the current crew health paradigm for low-Earth orbit and Lunar missions, which depends on real-time communication with Mission Control, deep-space exploration missions will require a significant shift in medical operations. This shift is driven by the constraints of operating at a considerable distance from Earth, such as resource limitations—lack of resupply, restricted mass, power, volume, and data—as well as communication delays and the inability to evacuate back to Earth during emergencies. To move toward a more self-reliant medical model, a strategy is needed to gradually increase space-based crew autonomy and reduce risks to mission success in the challenging environment of deep space. This transformative change, known as "Earth-Independent Medical Operations" (EIMO), explores the gradual transfer of medical care and decision-making from Earth-based support to space-based systems. The goal of this transition is to enhance astronaut health and performance while minimizing mission risks. EIMO requires the development of a medical system that integrates seamlessly with mission planning, vehicle and spacesuit design, and data architecture. This integration is crucial for building a robust medical infrastructure that not only safeguards astronaut well-being but also ensures overall mission success. The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has revised the EIMO model-based Concept of Operations (ConOps) which outlines an initial vision for EIMO. The ConOps, which is built on the stakeholders’ need, system goals, and objectives (NGOs), presents an array of in-mission scenarios that span a wide range of medical conditions demonstrating the system’s capabilities from basic to complex events. Developed by a multidisciplinary team of systems engineers, scientists, and clinicians within ExMC, the ConOps revision includes two new scenarios(Barotrauma and Self-Medical Management and Behavioral Health and Chronic Medical Care), and implementation of findings from EIMO technical interchange meetings that focused on data and training. The envisioned EIMO Medical System (MS) operates as a system of systems, gathering data from various sources such as reference databases, real-time wearable sensors, point-of-care diagnostics, and environmental controls. The MS also incorporates advanced training tools to support autonomous medical care, assisting the Crew Medical Officer (CMO) during medical events where Ground Support is either unavailable or communication-delayed beyond practicality. Furthermore, MS functions and capabilities were decomposed from the scenarios to establish foundational requirements for EIMO and traced to the NASA Spaceflight Human-System Standard(NASA-STD-3001, Volumes 1 and 2). These traces were performed to gain insights on the alignment of EIMO requirements with the NASA standard. This work serves as an initial recommendation to increase crew autonomy gradually and safely for Mars missions and future deep-space exploration.

medical system↗
NASA NTRSDate not supplied

A Multi-Faceted Approach to Demonstrating Multi-Functional Integrated Medical Devices to Advance Earth-Independent Medical Operations

INTRODUCTION TO MIM DEVICES Multi-functional Integrated Medical (MIM) devices conveniently incorporate multiple medical system capabilities within one device. The NASA Exploration Medical Integrated Product Team (XM-IPT) sponsored a market survey and trade study which identified the Tempus ProTM and the LifeBot 10® as the MIM devices that best met the evaluation criteria of the trade study. The Tempus ProTM (Remote Diagnostic Technologies, Ltd., Philips Corp., Farnborough, UK) and LifeBot 10® (LifeBot Health, Chicago, IL) both provide vital sign measurements such as blood pressure, electrocardiograms, heart rate, end tidal CO2, respiration rate, pulse oximetry and temperature along with ultrasound imaging. A video laryngoscopy capability is unique to the Tempus ProTM, while the LifeBot 10® supports connectivity with a digital stethoscope, otoscope, eye exam camera, and dermatoscope. Both devices include procedural guidance capabilities and have various data transmission and report generation features. TECHNOLOGY DEMONSTRATIONS NASA’s exploration-class missions will have severe resource constraints, long return trip durations, significant communication delays, and limited resupply opportunities. The medical systems of these missions will need to fit within an Earth-Independent Medical Operations (EIMO) construct. Key features of an EIMO medical system include: 1) technologies that support the prevention, diagnosis, and treatment of spaceflight medical events; 2) components that meet mass, volume, power and crew time/training constraints; 3) consideration of the medical skill level of the astronaut caregiver; 4) collection, storage and analysis of medical data within a central data architecture; and 5) incorporation of appropriate guidance and support tools that allow crew autonomy. Evaluations are underway to determine if it will be beneficial to include MIM devices within exploration medical systems by conducting a series of planned technical demonstrations. Exploration Atmosphere Chamber studies are being performed to determine MIM functionality in a high oxygen concentration atmosphere. A side-by-side comparison of the Tempus ProTM and LifeBot 10® will be performed during ground-based demonstrations. Use of the MIM devices within an EIMO medical scenario simulation will be practiced during ground-based demonstrations in preparation for International Space Station (ISS) demonstrations of the MIM device. These various demonstrations are designed to gather evidence for or against the inclusion of MIM devices within an EIMO medical system. EXPECTED DEMONSTRATION OUTCOMES Information will be gained about the feasibility, benefits, and challenges of using a multifunctional, all-in-one, medical device for medical diagnosis. Information will also be collected about performance differences as available ground support decreases. Gaining this understanding will allow for further development of exploration medical system capabilities, which take the EIMO construct into consideration.

B. E. Lewandowski↗
NASA NTRSDate not supplied

Earth Independent Medical Operations (EIMO)

Inherent in interplanetary space travel are unprecedented challenges that could threaten mission success and negatively impact crew health and performance. Return to definitive care is essentially untenable and resources will be constrained with practically no re-supply capability. Access to ground-based medical expertise will be significantly delayed under nominal conditions with exacerbation during conjunction or prolonged dust storms. Taken together, these challenges necessitate the development of a progressively autonomous medical operational support system to assist the crew medical officer (CMO). While support from ground based medical experts will remain indispensable for pre-mission planning, the approach to management of acute/emergent medical contingencies will require a 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. To progressively enable EIMO, a series of meetings were convened with subject matter experts from within NASA, academia and industry to facilitate mapping of the path to support autonomous medical operations. Topics explored in these meetings included the scope of data (storage capacity, usage, transmission rate and bandwidth, computing capacity), CMO training, supply and resource management and task load balance. Recommendations from these meetings will inform the EIMO Concept of Operations and definition of the associated requirements culminating in updates to the NASA 3001 standards. The EIMO project team will work with stakeholders to conceptualize a clinical decision support system (CDSS) to assist the CMO in response to medical contingencies when terrestrial support is delayed or otherwise unavailable. The CDSS will be a system of systems that will utilize data from numerous input vectors. Successful deployment of the CDSS will facilitate medical decision making while decreasing the cognitive load leading to an improvement in task load balancing. Additional benefits of the envisioned CDSS include assistance with inventory management, locating resources, storage/retrieval of medical records, highlighting trends in recorded data, in addition to providing a consult for diagnosis and treatment. More advanced features might include passive monitoring to identify early warning signs of behavioral or medical anomalies to possibly pre-empt onset of conditions that would compromise crew health and performance.

Benjamin Easter↗
NASA NTRS1999

Medical Operation KC-135 Familiarization Flight

As new personnel join the Medical Operations Branch, it is critical that they understand the effects of microgravity on medical procedures, hardware, and supplies. The familiarization flight provided new personnel with a better understanding of the effects of microgravity on (1) medical procedures, (2) patient and rescuer restraint, (3) medical fluids, and (4) medical training for space flight. The flight process also provided experience in flight proposal preparation, flight test plan preparation and execution, and final report preparation. In addition, first time flyers gained insight on their performance level in microgravity for future flights.

Dawson, Chris↗
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 NTRS2004

Star City, Russia Medical Operations

Since the beginning of the NASA/Mir missions, NASA has had astronauts in training at the Gagarin Cosmonaut Training Center (GCTC), also known as Star City, with crewmembers currently there to train for the International Space Station missions. Agreements have been reached with all International Partners that allow the crewmember's parent agency to provide a flight surgeon to oversee crewmember health and safety during training away from home. NASA Medical Operations through the Bioastronautics Contract employs flight surgeons to provide medical support for U.S. crewmembers and their support staff. This poster presentation reviews the aspects of NASA medical operations at Star City.

Chandler, Michael R.↗
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

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 NTRSDate not supplied

An Automated Medical Inventory System (AMIS) to Enable Earth-Independent Medical Operations

BACKGROUND: Inventory of medical consumables and durables (medications, treatment aids, diagnostic equipment, etc.) aboard the International Space Station is a manual process whereby crewmembers reach out to their flight surgeon to relay when items are used. Performing a full medical system inventory is time intensive. However, as exploration progresses to long duration missions with little to no resupply or evacuation capabilities, maintaining an accurate account of inventory and location for medical systems across the mission will become increasingly critical. A new system must be developed for future exploration missions to meet the need for a crew-facing, real time method of managing medical inventory. OVERVIEW: NASA’s Exploration Medical Integrated Product Team (XMIPT) is funding the AMIS project to mature the technology readiness level and to conduct a flight demonstration of a medical inventory capability. AMIS will leverage lessons learned from a Medical Consumables Tracking project previously demonstrated aboard the ISS in 2016 and 2017. Key components of AMIS include a database, supporting hardware and software, and interfaces to power, communications, or other vehicle or medical systems. Some medical inventory capability may be provided by the vehicle inventory management system which relies upon RFID-based technology and can track larger items such as medical kits or medical hardware. AMIS will augment these capabilities to enable tracking of individual medical kit contents. Efforts are underway to characterize the optimal solution trade space by comparing system specifications (e.g. mass and volume, etc.) across maintenance and operational use cases (e.g. crew time saved, total inventory automated, etc). DISCUSSION: The contents of a Mars Medical System have not been fully defined which poses challenges to defining an inventory system and requires assumptions regarding medical kit contents and medical system design. Other important considerations include minimizing crew time required, avoiding access restrictions to medical inventory in the event of an emergency, and ensuring that data is accessible to other medical system elements to enable crew autonomy in provision of medical care.

Automated Medical Inventory System↗
NASA NTRSDate not supplied

Summary of Technical Interchange Meetings (TIMs) Designed to Enable Earth Independent Medical Operations (EIMO)

The Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program hosted a series of TIMs in 2023-2024 designed to stimulate discussion around specific topics with the goal of enabling EIMO. In context of the thematic constituent elements of EIMO, namely pre-mission planning, acute/emergent/prolonged medical decision making, supply/resource management and task load management, subject matter experts from industry, academia and government (NASA and other Agencies) provided valuable and actionable guidance and recommendations. Earth-based medical experts will remain indispensable for pre-mission planning, however, management of acute/emergent medical contingencies will require a gradual transition of medical care and decision making from terrestrial to space-based assets to enable support of astronaut health and performance and reduce overall mission risk. Key to achieving these enhancements is providing an integrated data system platform capable of utilizing multiple data streams in concert with a variety of on-board databases and passive monitoring of video and wearable sensors to enable a multi-modal, agentic AI-based clinical decision support system (CDSS) to support crew medical officer (CMO) medical decision-making. The EIMO series of TIMs (I-V) have proven to be instructive and portend a significant paradigm shift will be necessary to maintain crew health and performance on exploration class missions. Importantly, since the expected paradigm shift will be significantly different from the methods of operation that have been employed for the majority of missions from the inception of human spaceflight to date, any proposed methods must be deployed in the setting of ongoing operations early and be “tested, reviewed and practiced” while reliable back-up is available to facilitate an Enterprise-wide level of comfort and acceptance. Serious constraints on data transmission coupled with a large and expanding universe of on-board medical informatics data streams will necessitate implementation of a CDSS to supplant the current reliance on support provided by ground-based SMEs. Establishment of trust in the system by CMO/crew and the ground-based medical support team will be essential. Co-development of a CDSS with industry partners will assure that state of the art tools can be employed, and industry efficiencies can be leveraged. Training regimens, materials and tools must evolve to be responsive (just-in-time training) and facilitate autonomous execution of procedures. Proficiency metrics should be established and be based on validated competencies or milestones as opposed to a prescribed number of training hours. Training should be prioritized for broad, translatable skills that have universal application across a variety of medical conditions. Repetition was deemed to be the key to achieving proficiency and emphasis should lie in procedural training which is known to extinguish more rapidly than diagnostic skills. Advanced tools, e.g., extended reality, can provide more realistic and effective training. Use of advanced probabilistic risk assessment tools will be essential to optimize the medical system capability while carefully balancing risk relative to mass/power/volume limitations. Importance of factoring use-life of medical supplies and maintaining awareness of redundancy and opportunity to re-purpose under off nominal situations was emphasized. Consideration of adopting optimized performance standards vs. “good-enough” performance thresholds is warranted. The use of legacy systems as opposed to creating new systems may be preferable. Managing task load and associated cognitive load will be essential to maintain operational safety and behavioral health. ExMC aspires to create a shared EIMO paradigm and strategic vision for advancing medical system design through novel technologies, training, protocols, and support capabilities, built upon the spirit of successful strategies and innovations over the past six decades of space medicine operations.

Jay Lemery↗
NASA NTRSDate not supplied

NASA Commercial Crew Program and Medical Operational Challenges

This abstract is submitted as part of the USSPACECOM Command Surgeon’s panel demonstrating the medical capabilities and challenges involved in human space flight support operations. BACKGROUND: NASA embarked on the Commercial Crew Program to launch astronauts into low-earth orbit from US soil and dock with the International Space Station (ISS). The eventual industry providers selected were SpaceX (SpX) and Boeing. These commercial transportation systems are vital to ensure crew availability on ISS for research and discovery. OVERVIEW: NASA/SpaceX Demo-2 (DM2) mission launched from the Kennedy Space Center in 2020 as the historic first crewed test-flight of the Crew Dragon spacecraft with two NASA Astronauts onboard. DM2 represented the first flight in 9-years from US soil since STS-135 in 2011. The 63-day mission ended with splashdown in the Gulf of Mexico, the first US water recovery in 45-years since Apollo-Soyuz. Validation of system hardware and operations allowed four-person crews to launch on subsequently missions (Crew-1, Crew-2, Crew-3, Crew-4, Crew-5 to date), which included International Partner crewmembers. DISCUSSION: A multitude of operational, training, medical, and technical issues needed to be addressed between NASA Medical Operations, the commercial provider SpaceX, and the Department of Defense. These included Flight rule development, occupant protection, pressurized suit testing, communication plans during mission phases, and emergency simulations for supporting Flight Surgeons and Biomedical Engineers. In providing crew experience with expected launch and entry G-force profile, Centrifuge training was established. Preventive health measures via the Health Stabilization Program were especially vital during the global COVID-19 pandemic. Unique aspects arise for SpX Dragon parachute splashdown and shipboard recovery operations in the Atlantic Ocean and Gulf of Mexico. The new Commercial Crew Program is indeed a wonderfully challenging and exciting era for human spaceflight.

Joseph Dervay↗