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This document establishes requirements for the United States (U.S.) Human Space Flight Program relating to the Flight Crew Health Stabilization Program (HSP) for launches from the U.S. The HSP constitutes the U.S. implementation of internationally approved health stabilization guidelines for the prevention of infectious disease specified in SSP 50480-ANX1.
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.
This viewgraph presentation reviews the development of an Integrated Medical Model (IMM) decision support tool for in-flight crew health care safety. Clinical methods, resources, and case scenarios are also addressed.
The mission of NASA's Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks by identifying and then filling gaps in understanding the risks and in the ability to disposition the risks. The primary bases for identifying gaps have been past experience and requirements definition. This approach has been very effective in identifying some important, relevant gaps, but may be inadequate for identifying gaps outside the past experience base. We are exploring the use of a gap taxonomy as a comprehensive, underlying conceptual framework that allows a more systematic identification of gaps. The taxonomy is based on these stages in medical care: prediction, prevention, detection/diagnosis, treatment, monitoring, rehabilitation, and lifetime surveillance. This gap taxonomy approach identifies new gaps in HRP health risks. Many of the new gaps suggest risk reduction approaches that are more cost effective than present approaches. A major benefit of the gap taxonomy approach is to identify new, economical approaches that reduce the likelihood and/or consequence of a risk.
This slide presentation reviews the Integrated Medical Model (IMM) database, which is an organized evidence base for assessing in-flight crew health risk. The database is a relational database accessible to many people. The database quantifies the model inputs by a ranking based on the highest value of the data as Level of Evidence (LOE) and the quality of evidence (QOE) score that provides an assessment of the evidence base for each medical condition. The IMM evidence base has already been able to provide invaluable information for designers, and for other uses.
The Space Radiation Analysis Group (SRAG) at Johnson Space Center (JSC) is tasked with monitoring changes to space weather and mitigating any resultant impacts to crew health and safety. As human spaceflight goals extend from Low-Earth Orbit (LEO) missions like the International Space Station (ISS) to the moon, Mars and beyond, SRAG will need to update their current approach for crew monitoring of and protection from radiation exposure due to energetic Solar Particle Events (ESPEs). Challenges faced in planning exo-LEO missions include the lack of protection from the Earth’s geomagnetic field employed by the ISS in addition to limited communication capability between the crew and the ground. In the event of an ESPE, the current ISS trajectory ensures that the vehicle is only traveling through fields of higher radiation exposure for a brief period of time; the Earth’s geomagnetic field prevents the penetration of the high-energy particles of concern throughout the majority of the orbit. Exo-LEO missions, on the other hand, require that the vehicle travel through free space, exposing vehicle and crew to the full impact of the ESPE. NASA has combined multiple approaches to resolve this radiation exposure issue. New vehicles are designed to take advantage of advances in particle transport modeling capabilities and shielding technology, allowing redistribution of mass throughout the vehicle to areas of thinner shielding when the energetic particle flux has increased to levels of concern. Although vehicle shielding is an important aspect of radiation exposure protection, there is a continued requirement to monitor and predict the space weather environment. To this end, SRAG maintains a console position in Mission Control with 24/7 mission support capability. In the event of increased solar activity, SRAG collaborates with the Flight Control Team (FCT) to determine if crew action (i.e., shelter) is required. During any increase in solar activity, the FCT needs three pieces of information to effectively decide the crew response in light of other required mission tasks: if an event (ESPE) will occur, how ‘intense’ an observed event will be, and how long will an observed event will last. An ideal alert system limits false alarms, therefore causing the crew to take action unnecessarily, without ignoring events that pose a hazard to the crew. SRAG’s current operational concept for ISS missions focuses on short-term forecasts, best described as ‘now-casting’. Console operators are in daily communication with the Space Weather Prediction Center (SWPC) for situational awareness purposes. When conditions exist that may lead to increased solar activity, operators receive notifications from SWPC. In the case of a well-connected ESPE, the console operator may only have on the order of minutes to several hours to notify the FCT of the event and provide a recommendation for crew action. As NASA shifts to exo-LEO missions, the increased time in free space as well as the reduced ability to communicate with the crew will force a transition in crew protection strategy that emphasizes improvments to both the accuracy and the lead time in forecasting capabilities.
The purpose of this catalog is to provide a detailed description of each piece of hardware in the Crew Health Care System (CHeCS), including subpacks associated with the hardware, and to briefly describe the interfaces between the hardware and the ISS. The primary user of this document is the Space Medicine/Medical Operations ISS Biomedical Flight Controllers (ISS BMEs).
This paper will provide an overview of the International Space Station (ISS) Environmental Control and Life Support (ECLS) design of the Crew Health Care System (CHeCS) Rack 1 and it will document some of the lessons that have been learned to date for the ECLS equipment in this rack.
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All three manned Skylab missions were supported by a cadre of medical personnel who were responsible not only for the management and conduct of the medical experiments but also for the operational planning and crew health. The day-to-day medical care of the crewmen and their families was left to a team of flight surgeons who were responsible for the health care during all phases of the mission, as well as the development and use of the inflight medical support system. The preventive medicine aspects of the preflight and postflight health stabilization program are discussed. The clinical problems encountered are identified and the significance of these medical entities are reviewed. The inflight physiological changes of a clinical nature are discussed in light of the significance of these changes as result of the space environment.
Human missions to Mars will fundamentally transform how the planet is explored, enabling new scientific discoveries through more sophisticated sample acquisition and processing than can currently be implemented in robotic exploration. The presence of humans also poses new challenges, including ensuring astronaut safety and health and monitoring contamination. Because the capability to transfer materials to Earth will be extremely limited, there is a strong need for in situ diagnostic capabilities. Nucleotide sequencing is a particularly powerful tool because it can be used to: (1) mitigate microbial risks to crew by allowing identification of microbes in water, in air, and on surfaces; (2) identify optimal treatment strategies for infections that arise in crew members; and (3) track how crew members, microbes, and mission-relevant organisms (e.g., farmed plants) respond to conditions on Mars through transcriptomic and genomic changes. Sequencing would also offer benefits for science investigations occurring on the surface of Mars by permitting identification of Earth-derived contamination in samples. If Mars contains indigenous life, and that life is based on nucleic acids or other closely related molecules, sequencing would serve as a critical tool for the characterization of those molecules. Therefore, spaceflight-compatible nucleic acid sequencing would be an important capability for both crew health and astrobiology exploration. Advances in sequencing technology on Earth have been driven largely by needs for higher throughput and read accuracy. Although some reduction in size has been achieved, nearly all commercially available sequencers are not compatible with spaceflight due to size, power, and operational requirements. Exceptions are nanopore-based sequencers that measure changes in current caused by DNA passing through pores; these devices are inherently much smaller and require significantly less power than sequencers using other detection methods. Consequently, nanopore-based sequencers could be made flight-ready with only minimal modifications.
Dr. Davis' presentation includes a brief overview of space flight and the lessons learned for health care in microgravity. He will describe the development of policy for health care for international crews. He will conclude his remarks with a discussion of an integrated health care system.
This document supplements the white paper titled CBS Integrated Research Plan: Problem Statement. The Problem Statement describes why it is important to implement a fully integrated research plan to derive risk estimates for the combined, potentially synergistic, effects of the three major spaceflight hazards (space radiation; isolated, confined, and extreme environments; altered gravity). These risk estimates will help establish acceptable maximum decrement or change in a physiological or behavioral parameter during or after spaceflight, and the acceptable limit of exposure to the combined spaceflight hazards. This Implementation Strategy describes how the research plan will accomplish the CBS Integrated Research Plan goals. The Implementation Strategy includes approaches to evaluate relationships among biological responses underlying three risks that are managed by three of NASA’s Human Research Project (HRP) organizational “elements”. This CBS (Acute effects of radiation on CNS, BMed, Sensorimotor) Integrated Research Plan also identifies strategies to monitor and mitigate decrements to operationally relevant performance. Currently, the strategy that was initiated in 2018, includes an eight-year research plan and a four-year validation plan that extend to the year 2030. Once the monitoring tools and countermeasures are developed, they will be validated and refined during four years of early exploration missions. The planned tasks and their associated research products and deliverables have been mapped to the individual research emphases to clearly demonstrate how each research area helps ensure crew health and safety during exploration missions.
Future crewed exploration missions to Mars could last up to three years and will expose astronauts to unprecedented environmental challenges. Challenges to the nervous system during these missions will include factors of: space radiation that can damage sensitive neurons in the central nervous system (CNS); isolation and confinement can affect cognition and behavior; and altered gravity that will change the astronauts’ perception of their environment and their spatial orientation, and will affect their coordination, balance, and locomotion. In the past, effects of spaceflight stressors have been characterized individually. However, long-term, simultaneous exposure to multiple stressors will produce a range of interrelated behavioral and biological effects that have the potential to adversely affect operationally relevant crew performance. These complex environmental challenges might interact synergistically and increase the overall risk to the health and performance of the astronaut. Therefore, NASA’s Human Research Program (HRP) has directed an integrated approach to characterize and mitigate the risk to the CNS from simultaneous exposure to these multiple spaceflight factors. The proposed research strategy focuses on systematically evaluating the relationships among three existing research risks associated with spaceflight: Risk of Acute (In-flight) and Late Central Nervous System Effects from Radiation (CNS), Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders (BMed), and Risk of Impaired Control of Spacecraft/Associated Systems and Decreased Mobility Due to Vestibular/Sensorimotor Alterations Associated with Spaceflight (SM). NASA’s HRP approach is intended to identify the magnitude and types of interactions as they affect behavior, especially as it relates to operationally relevant performance (e.g., performance that depends on reaction time, procedural memory, etc.). In order to appropriately characterize this risk of multiple spaceflight environmental stressors, there is a recognition of the need to leverage research approaches using appropriate animal models and behavioral constructs. Very little has been documented on the combined effects of altered gravity, space radiation, and other psychological and cognitive stressors on the CNS. Preliminary evidence from rodents suggest that a combination of a minimum of exposures to even two of three stressors of: simulated space radiation, simulated microgravity, and simulated isolation and confinement, have produced different and more pronounced biological and performance effects than exposure to these same stressors individually. Structural and functional changes to the CNS of rodents exposed to transdisciplinary combined stressors indicate that important processes related to information processing are likely altered including impairment of exploratory and risk taking behaviors, as well as executive function including learning, memory, and cognitive flexibility — all of which may be linked to changes in related operational relevant performance. The fully integrated research plan outlines approaches to evaluate how combined, potentially synergistic, impacts of simultaneous exposures to spaceflight hazards will affect an astronaut’s CNS and their operationally relevant performance during future exploration missions, including missions to the Moon and Mars. The ultimate goals are to derive risk estimates for the combined, potentially synergistic, effects of the three major spaceflight hazards that will establish acceptable maximum decrement or change in a physiological or behavioral parameters during or after spaceflight, the acceptable limit of exposure to a spaceflight factor, and to evaluate strategies to mitigate any associated decrements in operationally relevant performance.
During future human exploration missions, spaceflight crews will encounter adverse health outcomes and decrements in performance during the missions and for long term health. The Psychophysiological Research Lab is currently conducting a technology demonstration of a prototype wearable biosensor system (Astroskin) on astronaut surrogates during 30 day missions within NASAs Human Exploration Research Analog (HERA). HERA, located at Johnson Spaceflight Center, represents a flight analog for simulation of isolation, confinement and remote conditions of mission exploration scenarios. Astroskin, an autonomous medical monitoring system, consists of an intelligent garment for the upper body and a headband fitted with sensors, and associated software and hardware that can measure, transmit and store vital signs (ECG, respiration, blood pressure, etc.), sleep quality and activity level of the wearer. One of the main goals of the technology demonstration is to evaluate the performance of the Astroskin system (i.e., data quality), crew usability and comfort. To validate the Astroskin as a viable option for use during future spaceflight missions, crew data from HERA are sent to Ames researchers for processing and analyses. Crew surveys on usability and comfort will also be evaluated. This work supports the Exploration Medical Capabilities element within NASAs Human Research Program.
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Management and analysis of crew and environmental microbiological data from SMEAT and Skylab are discussed. Samples were collected from ten different body sites on each SMEAT and Skylab crew-member on approximately 50 occasions and since several different organisms could be isolated from each sample, several thousand lab reports were generated. These lab reports were coded and entered in a computer file and from the file various tabular summaries were constructed.
While the primary goal of the Apollo Program was to land men on the moon and return them safely to Earth, there were other very important medical objectives. The earlier Mercury and Gemini programs bad raised some concerns about the health and safety of future crews. For example, the high metabolic energy expenditure of extravehicular activity during the Gemini missions was unexpected. Before Apollo astronauts could safely explore the lunar surface, reliable predictors of energy cost and real-time monitoring techniques had to be developed. Physiological changes were noted in individual crewmen, some more consistently than others. The most important of these changes was in cardiopulmonary status demonstrated by decreased exercise capacity, loss of red blood cell mass, and cardiovascular deconditioning demonstrated by a decrease in the effectiveness of antigravity cardiovascular responses during postflight stress testing.