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At least 73 records · Page 4

High Altitude Long Endurance (HALE) Unmanned Aircraft System (UAS): Pilot Knowledge, Skills and Abilities

This report summarizes the initial work accomplished by the ACCESS 5 Human System Integration (HSI) team to identify Unmanned Aircraft System (UAS) Pilot Knowledge, Skill and Ability (KSA), Training and Medical requirements. To derive this information the following tasks were accomplished: a) Mission and Function analyses were performed; b) Applicable FARs and FAA Advisory Circulars (ACs) were reviewed; c) Meetings were conducted with NASA and FAA Human Factors personnel; d) Surveys were completed by ACCESS 5 HSI Working group UA Pilots; e) Coordination meetings were conducted with the ACCESS 5 Policy IPT. The results of these efforts were used to develop a summary of the current qualifications. for an individual to function as a Pilot In Command (PIC) for UAs currently flown by UNITE companies, to develop preliminary Pilot KSAs for each phase of flight, and to delineate preliminary Pilot Training and Medical requirements. These results are to be provided to the Policy IPT to support their development of recommendations for UA Pilot Rating Criteria, training and medical qualifications. It is expected that the initially an instrument rated pilot will be required to serve as the PIC. However, as operational experience is gained, and automation is applied to accomplish various system functions, it is expected that pilot rating criteria could be lessened.

Source record↗

Medical care of spacecrews, (Medical care, equipment, and prophylaxis)

Treatment and prevention of the physiologic problems of spacecrews are discussed. Preflight procedures, inflight monitoring and medication, and postflight examination are described. Specific factors covered include: medical screening and astronaut selection; health stabilization and exposure prevention; preflight medical examinations and training; biomedical data; medical kits; diagnosis and treatment; and implications of postflight findings.

Berry, C. A.↗

Telemedicine in Space Flight - Summary of a NASA Workshop

The Exploration Medical Capability Element of the Human Research Program at NASA Johnson Space Center hosted the Telemedicine Workshop in January 2011 to discuss the medical operational concept for a crewed mission to a near-Earth asteroid (NEA) and to identify areas for future work and collaboration. With the increased likelihood of a medical incident on a long duration exploration mission to a near-Earth asteroid, as well as the fact that there will likely be limited medical capabilities and resources available to diagnose and treat medical conditions, it is anticipated that a more structured use of telemedicine will become highly desirable. The workshop was convened to solicit expert opinion on current telemedicine practices and on medical care in remote environments. Workshop Objectives: The workshop brought together leaders in telemedicine and remote medicine from The University of Texas Medical Branch, Henry Ford Hospital, Ontario Telemedicine Network, U.S. Army Institute of Surgical Research, University of Miami, American Telemedicine Association, Doctors Without Borders, and the Pan American Health Organization. The primary objectives of the workshop were to document the medical operations concept for a crewed mission to a NEA, to determine gaps between current capabilities and the capabilities outlined in the operations concept, to identify research required to close these gaps, and to discuss potential collaborations with external-to-NASA organizations with similar challenges. Summary of Discussions and Conclusions: The discussions held during the workshop and the conclusions reached by the workshop participants were grouped into seven categories: Crew Medical Officers, Patient Area in Spacecraft, Training, Electronic Medical Records, Intelligent Care Systems, Consultation Protocols, Prophylactic Surgical Procedures, and Data Prioritization. The key points discussed under each category will be presented.

Barsten, K. N.↗

Assessing Crew Medical Officer Preparedness for International Space Station Missions

INTRODUCTION Astronaut crew medical officers (CMO) undergo additional, specialized training to provide medical support onboard the International Space Station (ISS). CMO training focuses on utilizing resources on-station and optimizing communication with ground-based expertise to manage both common minor conditions as well as emergency/trauma situations. As NASA moves towards future Artemis and exploration class missions, we sought CMO perspectives on past, present, and future CMO training and medical resourcing to help inform mission planners regarding medical risk mitigation considerations. We present an interview-based qualitative assessment of CMO preparedness for the International Space Station with the aim to help iterate future training flows for Low Earth Orbit, Artemis, and exploration-class missions. METHODS A semi-structured interview tool was developed to assess CMO experience and their recommendations for future mission training considerations. Participants were recruited from former or current US astronauts who were designated as CMO and subsequently flew to the International Space Station. 10 former CMOs took part in the study. Interview transcripts were deidentified and evaluated for qualitative thematic analysis by two independent coders with NVivo Software suite (Lumivero, Denver, CO), and emergent themes were compiled. RESULTS Former CMO crew expressed appropriate preparedness for current ISS medical capabilities and requirements. They identified the role of the CMO as serving as a healthcare extender to ground-based flight surgeons for ISS and other LEO missions. Individuals with prior medical experience were preferred though not felt to be necessary for LEO missions. For exploration class missions with limitations in ground communication, a physician-as-CMO and more rigorous training curricula for both the CMO and astronaut crew were desired. DISCUSSION Former NASA astronaut crew were interviewed to retrospectively assess their preparedness as ISS crew medical officers and hypothesize future medical knowledge, skill, and ability needs. Along with medical operations subject matter expert opinion and advanced probabilistic risk assessment modeling, past CMO experience can help inform future CMO training considerations and responsibilities for future Artemis and exploration class missions.

M A Labarbera↗

Atrial Fibrillation During an Exploration Class Mission

Background: A long-duration exploration class mission is fraught with numerous medical contingency plans. Herein, we explore the challenges of symptomatic atrial fibrillation (AF) occurring during an exploration class mission. The actions and resources required to ameliorate the situation, including the availability of appropriate pharmaceuticals, monitoring devices, treatment modalities, and communication protocols will be investigated. Challenges of Atrial Fibrillation during an Exploration Mission: Numerous etiologies are responsible for the initiation of AF. On Earth, we have the time and medical resources to evaluate and determine the causative situation for most cases of AF and initiate therapy accordingly. During a long-duration exploration class mission resources will be severely restricted. How is one to determine if new onset AF is due to recent myocardial infarction, pulmonary embolism, fluid overload, thyrotoxicosis, cardiac structural abnormalities, or CO poisoning? Which pharmaceutical therapy should be initiated and what potential side effects can be expected? Should anti-coagulation therapy be initiated? How would one monitor the therapeutic treatment of AF in microgravity? What training would medical officers require, and which communication strategies should be developed to enable the best, safest therapeutic options for treatment of AF during a long-duration exploration class mission? Summary: These questions will be investigated with expert opinion on disease elucidation, efficient pharmacology, therapeutic monitoring, telecommunication strategies, and mission cost parameters with emphasis on atrial fibrillation being just one illustration of the tremendous challenges that face a long-duration exploration mission. The limited crew training time, medical hardware, and drugs manifested to deal with such an event predicate that aggressive primary and secondary prevention strategies be developed to protect a multibillion-dollar asset like the International Space Station or a mission to the Moon or Mars. Learning Objectives: The audience will become familiar with the risks and challenges inherent to developing a therapeutic strategy for the treatment of atrial fibrillation during a long-term exploration class mission.

Lipset, Mark A.↗

ISS Medical Checklist Procedures Validation and Training

The Health Maintenance System (HMS) hardware will be used to support a medical contingency for the International Space Station (ISS). During two test flights, the procedures for performing Advanced Cardiac Life Support (ACLS) were evaluated to determine the required level of detail, assess the logic of the steps and division of tasks among crew members.

Tom Marshburn↗

Autonomous Medical Care for Exploration Class Space Missions

The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.

Hamilton, Douglas↗

Musculoskeletal Changes, Injuries and Rehabilitation Associated with Spaceflight

The in-flight musculoskeletal database provides the foundation for directing operationally-relevant research in space medicine. This effort will enable medical operations to develop medical kits, training programs, and preventive medicine strategies for future CxP missions: a) Quantify medications and medical supplies for next-generation spacecraft. b) Objective data for engineers to determine weight requirements. Flight surgeons can make specific recommendations to astronauts based on injury data, such as emphasizing hand protection while in-flight. EVA and spacecraft engineers can examine evidence-based data on injuries and design countermeasures to help prevent them.

Scheuring, Richard A.↗

Legacy of Operational Space Medicine During the Space Shuttle Program

The Johnson Space Center s Medical Science Division branches were involved in preparing astronauts for space flight during the 30 year period of the Space Shuttle Program. These branches included the Flight Medicine Clinic, Medical Operations and the Behavioral Health Program. The components of each facet of these support services were: the Flight Medicine Clinic s medical selection process and medical care; the Medical Operations equipment, training, procedures and emergency medical services; and the Behavioral Health and Performance operations. Each presenter will discuss the evolution of its operations, implementations, lessons learned and recommendations for future vehicles and short duration space missions.

Stepaniakm, P.↗

Developing a Simulation-Based Training Program for Non-Traditional Caregivers

Simulation-based training enables learning in controlled environments which nevertheless mimic real-world scenarios. It has proven effective in the training of medical personnel and affords rapid assimilation and integration of necessary skills. Non-traditional caregivers often operate in austere environments, where resource and personnel limitations preclude more standard provision of care by highly trained and fully equipped health care teams. In these settings, training time for the caregivers may be limited, with long gaps between time of the training and use of the skills, a limited grasp of the underlying physiology, and unfamiliarity with "medical English" which can render it difficult to communicate concepts to more advanced practitioners when such interaction can take place, as for example, when telemedicine can be used to project medical skills further forward . Methods: Simulation-based training can assist in the familiarization of caregivers to the environment, ensure adequate execution of skills at the appropriate time(s), and allow practice of telemedicine communication patterns between the mentor and caregiver. Results: Scenario-based training can and has been used for initial and sustainment training modules, including self-taught modules for use in the field. Strict identification of the critical concepts is vital, as is development and practice of technically simple procedures wherever possible. Medical devices can off-load tasks from caregivers, as well as to minimize the necessary level of caregiver knowledge, while integrated simulations among all members of the mission team can improve communication and efficiency. Discuss ion: Nontraditional caregivers face unique challenges when learning to provide medical care. Scenario-based curricula allow lesson plans to be tailored to each group's individual needs, as well as being suited for the participation of numerous groups, including the caregiver, evacuation/transport staff, decision-makers, and hospital-based physician.

Bacal, Kira↗

Simulation System for Training in Laparoscopic Surgery

A computer-based simulation system creates a visual and haptic virtual environment for training a medical practitioner in laparoscopic surgery. Heretofore, it has been common practice to perform training in partial laparoscopic surgical procedures by use of a laparoscopic training box that encloses a pair of laparoscopic tools, objects to be manipulated by the tools, and an endoscopic video camera. However, the surgical procedures simulated by use of a training box are usually poor imitations of the actual ones. The present computer-based system improves training by presenting a more realistic simulated environment to the trainee. The system includes a computer monitor that displays a real-time image of the affected interior region of the patient, showing laparoscopic instruments interacting with organs and tissues, as would be viewed by use of an endoscopic video camera and displayed to a surgeon during a laparoscopic operation. The system also includes laparoscopic tools that the trainee manipulates while observing the image on the computer monitor (see figure). The instrumentation on the tools consists of (1) position and orientation sensors that provide input data for the simulation and (2) actuators that provide force feedback to simulate the contact forces between the tools and tissues. The simulation software includes components that model the geometries of surgical tools, components that model the geometries and physical behaviors of soft tissues, and components that detect collisions between them. Using the measured positions and orientations of the tools, the software detects whether they are in contact with tissues. In the event of contact, the deformations of the tissues and contact forces are computed by use of the geometric and physical models. The image on the computer screen shows tissues deformed accordingly, while the actuators apply the corresponding forces to the distal ends of the tools. For the purpose of demonstration, the system has been set up to simulate the insertion of a flexible catheter in a bile duct. [As thus configured, the system can also be used to simulate other endoscopic procedures (e.g., bronchoscopy and colonoscopy) that include the insertion of flexible tubes into flexible ducts.] A hybrid approach has been followed in developing the software for real-time simulation of the visual and haptic interactions (1) between forceps and the catheter, (2) between the forceps and the duct, and (3) between the catheter and the duct. The deformations of the duct are simulated by finite-element and modalanalysis procedures, using only the most significant vibration modes of the duct for computing deformations and interaction forces. The catheter is modeled as a set of virtual particles uniformly distributed along the center line of the catheter and connected to each other via linear and torsional springs and damping elements. The interactions between the forceps and the duct as well as the catheter are simulated by use of a ray-based haptic-interaction- simulating technique in which the forceps are modeled as connected line segments.

Basdogan, Cagatay↗

Performance Support Tools for Space Medical Operations

Early Constellation space missions are expected to have medical capabilities similar to those currently on board the Space Shuttle and International Space Station (ISS). Flight surgeons on the ground in Mission Control will direct the Crew Medical Officer (CMO) during medical situations. If the crew is unable to communicate with the ground, the CMO will carry out medical procedures without the aid of a flight surgeon. In these situations, use of performance support tools can reduce errors and time to perform emergency medical tasks. The research presented here is part of the Human Factors in Training Directed Research Project of the Space Human Factors Engineering Project under the Space Human Factors and Habitability Element of the Human Research Program. This is a joint project consisting of human factors teams from the Johnson Space Center (JSC) and the Ames Research Center (ARC). Work on medical training has been conducted in collaboration with the Medical Training Group at JSC and with Wyle that provides medical training to crew members, biomedical engineers (BMEs), and flight surgeons under the Bioastronautics contract. Human factors personnel at Johnson Space Center have investigated medical performance support tools for CMOs and flight surgeons.

Byrne, Vicky↗

Hardware

The full complement of EDOMP investigations called for a broad spectrum of flight hardware ranging from commercial items, modified for spaceflight, to custom designed hardware made to meet the unique requirements of testing in the space environment. In addition, baseline data collection before and after spaceflight required numerous items of ground-based hardware. Two basic categories of ground-based hardware were used in EDOMP testing before and after flight: (1) hardware used for medical baseline testing and analysis, and (2) flight-like hardware used both for astronaut training and medical testing. To ensure post-landing data collection, hardware was required at both the Kennedy Space Center (KSC) and the Dryden Flight Research Center (DFRC) landing sites. Items that were very large or sensitive to the rigors of shipping were housed permanently at the landing site test facilities. Therefore, multiple sets of hardware were required to adequately support the prime and backup landing sites plus the Johnson Space Center (JSC) laboratories. Development of flight hardware was a major element of the EDOMP. The challenges included obtaining or developing equipment that met the following criteria: (1) compact (small size and light weight), (2) battery-operated or requiring minimal spacecraft power, (3) sturdy enough to survive the rigors of spaceflight, (4) quiet enough to pass acoustics limitations, (5) shielded and filtered adequately to assure electromagnetic compatibility with spacecraft systems, (6) user-friendly in a microgravity environment, and (7) accurate and efficient operation to meet medical investigative requirements.

Source record↗

A Pilot Project for Quantifying the Effect of Medical Provider Knowledge, Skills, and Abilities on Outcomes for Spaceflight Using a Probabilistic Risk Assessment Tool

In order to enable the future of long-duration deep space exploration we must confront the uncertainty in medical risk. Limitations of communication, resupply, and evacuation in deep space will require a high degree of crew autonomy and accurate risk assessment will be critical to ensure adequate crew training and medical system design. To address this, NASA’s Human Research Program Exploration Medical Capability Element has developed the Informing Mission Planning via Analysis of Complex Tradespaces Tool (IMPACT). IMPACT is a suite of tools that can provide evidence-based, data-driven trade space assessments between available medical resources in the mass- and volume-constrained environment of a deep space exploration vehicle. In the current model, medical conditions either can or cannot be treated based on the availability of medical system resources and equipment. However, medical outcomes often depend just as much on the knowledge, skills, and abilities (KSA) of the provider operating the system. This paper presents a method for modeling and quantifying the effect of medical officer KSA on medically relevant mission risk outcomes during spaceflight.

capabilities↗

Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to support crew medical needs in the context of a Mars mission. MONSTR is a novel approach to performing a quantitative risk analysis that will assess the relative value of individual resources needed for the diagnosis and treatment of various medical conditions. It will provide the operational and research communities at NASA with information to support informed decisions regarding areas of research investment, future crew training, and medical supplies manifested as part of the exploration medical system.

Shah, R. V.↗

Making Games Not Work: Paradoxes Embedded in Game-Based Training and Concepts for Overcoming Them

An interest in game-based training solutions is natural. All one has to do is watch someone fully engaged in a modern game to see the potential of harnessing that attention for training. However, the reality of game-based training has not fully satisfied these expectations. This paper explains two paradoxes that must be overcome for games to support training. These paradoxes are a result of the realities of the basic human condition clashing with the requirements of learning theory. 80th paradoxes arise from the concept of "engagement" that is central to games. The first comes from a more robust definition of engagement, which is the condition of Flow or Optimal Experience. Flow is the state game developers want to see in users. One aspect of Flow is loss of sense of self as the individual becomes immersed in the experience. The paradox arises because this loss of self directly contradicts the learning requirement of self-reflection. The second paradox comes from theories of play, which state in part that play requires a level of individual freedom. The contradiction arises when game-based play must be harnessed to an organizational training program or regimen. The paper will discuss these paradoxes in the context of an effort to design a game-based training modality to train combat medics and will close with a review of compensating strategies identified by the designers. The paper will provide information important to anyone interested in conceptualizing and designing game-based training.

Jones, Phillip N.↗