Results for “Integrated Medical Model” — Page 5

NASA NTRS2016

Clinical Outcome Metrics for Optimization of Robust Training

Introduction: The emphasis of this research is on the Human Research Program (HRP) Exploration Medical Capability's (ExMC) "Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-Flight Medical Capabilities." Specifically, this project aims to contribute to the closure of gap ExMC 2.02: We do not know how the inclusion of a physician crew medical officer quantitatively impacts clinical outcomes during exploration missions. The experiments are specifically designed to address clinical outcome differences between physician and non-physician cohorts in both near-term and longer-term (mission impacting) outcomes. Methods: Medical simulations will systematically compare success of individual diagnostic and therapeutic procedure simulations performed by physician and non-physician crew medical officer (CMO) analogs using clearly defined short-term (individual procedure) outcome metrics. In the subsequent step of the project, the procedure simulation outcomes will be used as input to a modified version of the NASA Integrated Medical Model (IMM) to analyze the effect of the outcome (degree of success) of individual procedures (including successful, imperfectly performed, and failed procedures) on overall long-term clinical outcomes and the consequent mission impacts. The procedures to be simulated are endotracheal intubation, fundoscopic examination, kidney/urinary ultrasound, ultrasound-guided intravenous catheter insertion, and a differential diagnosis exercise. Multiple assessment techniques will be used, centered on medical procedure simulation studies occurring at 3, 6, and 12 months after initial training (as depicted in the following flow diagram of the experiment design). Discussion: Analysis of procedure outcomes in the physician and non-physician groups and their subsets (tested at different elapsed times post training) will allow the team to 1) define differences between physician and non-physician CMOs in terms of both procedure performance (pre-IMM analysis) and overall mitigation of the mission medical impact (IMM analysis); 2) refine the procedure outcome and clinical outcome metrics themselves; 3) refine or develop innovative medical training products and solutions to maximize CMO performance; and 4) validate the methods and products of this experiment for operational use in the planning, execution, and quality assurance of the CMO training process The team has finalized training protocols and developed a software training/testing tool in collaboration with Butler Graphics (Detroit, MI). In addition to the "hands on" medical procedure modules, the software includes a differential diagnosis exercise (limited clinical decision support tool) to evaluate the diagnostic skills of participants. Human subject testing will occur over the next year.

Ebert, D.↗

NASA NTRS2015

ExMC Work Prioritization Process

Last year, NASA's Human Research Program (HRP) introduced the concept of a "Path to Risk Reduction" (PRR), which will provide a roadmap that shows how the work being done within each HRP element can be mapped to reducing or closing exploration risks. Efforts are currently underway within the Exploration Medical Capability (ExMC) Element to develop a structured, repeatable process for prioritizing work utilizing decision analysis techniques and risk estimation tools. The goal of this effort is to ensure that the work done within the element maximizes risk reduction for future exploration missions in a quantifiable way and better aligns with the intent and content of the Path to Risk Reduction. The Integrated Medical Model (IMM) will be used to identify those conditions that are major contributors of medical risk for a given design reference mission. For each of these conditions, potential prevention, screening, diagnosis, and treatment methods will be identified. ExMC will then aim to prioritize its potential investments in these mitigation methods based upon their potential for risk reduction and other factors such as vehicle performance impacts, near term schedule needs, duplication with external efforts, and cost. This presentation will describe the process developed to perform this prioritization and inform investment discussions in future element planning efforts. It will also provide an overview of the required input information, types of process participants, figures of merit, and the expected outputs of the process.

Simon, Matthew↗

NASA NTRS2017

Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system. Beyond the traditional limitations in mass, power, and volume, consideration must be given to other factors such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. As NASA develops the medical system for an exploration mission, it must have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources (MONSTR) was developed over the past year for this reason, and is now a system for managing data pertaining to medical resources and their relative importance when addressing medical conditions. METHODS: The MONSTR web application with a Microsoft SQL database backend was developed and made accessible to Tableau v9.3 for analysis and visualization. The database was initially populated with a list of medical conditions of concern for an exploration mission taken from the Integrated Medical Model (IMM), a probabilistic model designed to quantify in-flight medical risk. A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program compiled a list diagnostic and treatment medical resources required to address best- and worst-case scenarios of each medical condition using a terrestrial standard of care and entered this data into the system. This list included both tangible resources (e.g. medical equipment, medications) and intangible resources (e.g. clinical skills required to perform a procedure). The physician team then assigned criticality values to each instance of a resource, representing the importance of that resource to diagnosing or treating its associated condition(s). Medical condition probabilities of occurrence during a Mars mission were pulled from the IMM and imported into the MONSTR database for use within a resource criticality-weighting algorithm. DISCUSSION: The MONSTR tool is a novel approach to assess the relative value of individual resources needed for the diagnosis and treatment of medical conditions. Future work will add resources for prevention and long term care of these conditions. Once data collection is complete, MONSTR 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 any exploration medical system.

Rubin, D.↗

NASA NTRS2017

A Quantitative Risk-Benefit Analysis of Prophylactic Surgery Prior to Extended-Duration Spaceflight

INTRODUCTION: Among otherwise healthy astronauts undertaking deep space missions, the risks for acute appendicitis (AA) and cholecystitis (AC) are not zero. If these conditions were to occur during spaceflight they may require surgery for definitive care. The proposed study quantifies and compares the risks of developing de novo AA and AC in-flight to the surgical risks of prophylactic laparoscopic appendectomy (LA) and cholecystectomy (LC) using NASA's Integrated Medical Model (IMM). METHODS: The IMM is a Monte Carlo simulation that forecasts medical events during spaceflight missions and estimates the impact of these medical events on crew health. In this study, four Design Reference Missions (DRMs) were created to assess the probability of an astronaut developing in-flight small-bowel obstruction (SBO) following prophylactic 1) LA, 2) LC, 3) LA and LC, or 4) neither surgery (SR# S-20160407-351). Model inputs were drawn from a large, population-based 2011 Swedish study that examined the incidence and risks of post-operative SBO over a 5-year follow-up period. The study group included 1,152 patients who underwent LA, and 16,371 who underwent LC. RESULTS: Preliminary results indicate that prophylactic LA may yield higher mission risks than the control DRM. Complete analyses are pending and will be subsequently available. DISCUSSION: The risk versus benefits of prophylactic surgery in astronauts to decrease the probability of acute surgical events during spaceflight has only been qualitatively examined in prior studies. Within the assumptions and limitations of the IMM, this work provides the first quantitative guidance that has previously been lacking to this important question for future deep space exploration missions.

Carroll, Danielle↗

NASA NTRS2017

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.↗

NASA NTRS2019

The Effect of Heroic Medical Care on Mission Medical Outcomes

Study Objective: A catastrophic medical event depletes medical resources. What happens to the rest of the mission’s medical outcomes after such an event? Use Probabilistic Risk Assessment (PRA) to see if we can find out. What is the Integrated Medical Model? PRA model using Monte Carlo methodology; Used to assess mission risk due to in-flight medical events; User defined Design Reference Missions (DRM) (crew, duration, EVA (Extra-Vehicular Activity), etc.); Considers outcomes for 100 medical conditions that have or may occur in-flight; 100,000 trials conducted per DRM.

Reyes, David P.↗

NASA NTRSDate not supplied

Developing A New Medical Condition List for Exploration Spaceflight

For the last decade, the National Aeronautics and Space Administration (NASA) has utilized a probabilistic risk analysis tool called the Integrated Medical Model (IMM), which contains 100 medical conditions, to conduct medical trade-space analyses and risk assessments for International Space Station (ISS) operations. Planning for future missions to the Moon and Mars will require updated tools and evidence that consider the unique features of exploration missions. To address this need, the Exploration Medical Capability (ExMC) Element of the NASA Human Research Program is developing an advanced trade-space analysis tool suite, IMPACT. As a part of this effort, ExMC has produced the IMPACT version 1 Condition List (ICL 1.0) which expands the scope and definition of medical conditions.

Amy Jean Kreykes↗

NASA NTRS2021

Comparison of Health and Performance Risk for Accelerated Mars Mission Scenarios

This document details the results for a quantitative estimate of the difference in human health and performance risk that crews would face for two hypothetical variations on Mars mission scenarios: an Accelerated Mars Mission (AMM) and a Standard Mars Mission(SMM).NASA goals for Mars mission concepts, duration, and tasks have varied over the years. While neither of the cases considered here are likely to accurately represent the initial mission to Mars, the exercise of evaluating significant differences in mission duration from an astronaut health perspective can provide bounding insight to the level of risk that is likely to be encountered in an eventual Mars mission. Medical Probabilistic Risk Assessment using the Integrated Medical Model (IMM)(1–3)and the NASA Space Radiation Cancer Risk Model (NSCR)(4,5) are used here to help mission planners gain the best insight currently available into the expected magnitude of impacts to astronaut health when undertaking a Mars mission. These impacts occur both in-mission as well as in the long-term health of the astronauts post-mission. These evaluations are currently the best available modeling estimates to characterize and bound the health risks in a proposed mission domain where humans have no experience.

Erik Antonsen↗

NASA NTRSDate not supplied

Brace For Impact – It’s Coming, Do You Know What to Do With It?

Long-duration human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for providing in-mission medical care. Compared with the International Space Station, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to define and quantitatively estimate human system risk attributable to medical conditions. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a probabilistic risk assessment (PRA) and medical trade space analysis tool being developed by NASA to advance medical system design for exploration missions. IMPACT has made a number of enhancements on the Integrated Medical Model, the PRA tool currently used by NASA. These updates include a novel medical evidence base baselined to a long duration, deep space exploration environment; an expanded medical condition list; and a trade space analysis capability (e.g. comparing risk profiles and mass/volume constraints for medical capabilities and resources). IMPACT core functionality includes quantification of a medical capability set and assisting with identification of specific medical resources/hardware for exploration missions. In addition, IMPACT provides sophisticated trade space capabilities to estimate how human system risk varies with changes to the mission architecture or medical capability set. This presentation will provide a brief overview of the IMPACT tool, discuss representative use cases, and show example results.

Benjamin Easter↗

NASA NTRSDate not supplied

Derivation of the Most Influential Medical Conditions for An Extended Duration Artemis Mission

BACKGROUND: The risk of loss of mission due to medical conditions may be influenced by loss of crew life (LOCL), need for evacuation (RTDC; return to definitive care), and crew task time lost. Predicting what medical conditions are most likely to lead to crew morbidity and mortality may influence medical system design, clinical capability prioritization, and research strategies. NASA’s Informing Mission Planning via Analysis of Complex Tradespaces tool (IMPACT) applies Probabilistic Risk Assessment (PRA) methodology to assess these risks. OVERVIEW: A team of subject matter experts (SME) from a variety of medical disciplines developed a consensus-based process to determine 120 of the most clinically relevant medical conditions for long-duration exploration missions (LDEMs) . This IMPACT Condition List (ICL) expanded upon previous work done for Integrated Medical Model (IMM). For each condition a best-case and worst-case definition were derived. These definitions were used to identify probability of occurrence, proportion of cases that are best case vs. worst case, clinical phase duration, and risk of outcomes (task time loss [TTL], RTDC, and LOCL) for both treated and untreated states. These data were sources from existing spaceflight databases (e.g. Longitudinal Survey of Astronaut Health), relevant models (e.g. the ISS fire model), and/or terrestrial literature. Each condition was then tied to diagnostic and therapeutic resources and capabilities. IMPACT was then run for the LDLOLS DRM (see Abstract #2 for this panel). DISCUSSION: This abstract will present the process for generating the IMPACT condition list, the relevant data for each clinical condition, and present results for the ten most influential conditions impacting LOCL, RTDC, and TTL for a representative extended duration Artemis mission.

A Nelson↗

NASA NTRSDate not supplied

Future Improvements to Impact for Long Duration Exploration Spaceflight

BACKGROUND: While NASA currently uses the Integrated Medical Model (IMM) to model spaceflight medical risk for Low Earth Orbit missions, IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) was created to improve the fidelity of medical risk analysis for exploration missions involving the Lunar surface and beyond. OVERVIEW: While completion work continues on the initial version of the IMPACT tool, work has already begun to investigate ways to further enhance the fidelity of the model and its utility to stakeholders. DISCUSSION: Future additions leveraging the more robust and flexible IMPACT architecture include analyzing mission segments to account for segment-specific environments (ie. Lunar surface or microgravity), clinically tracible outcomes based on partial treatment of conditions, the ability to model mission outcomes based on provider Knowledge, Skills, and Abilities (KSAs), and the ability to affect the incidence of conditions based on the occurrence of related conditions (e.g. UTI progressing to sepsis). IMPACT also enables the addition of new conditions to its database as required to meet future risk assessment needs. Ultimately, the desire is to broaden IMPACT from a tool that models/trades medical risk to one that does so for all crew health and performance relevant systems (e.g., food, exercise, etc.).

E Stratton↗

NASA NTRSDate not supplied

IMPACT-ing Exploration Spaceflight Risk Prediction and Medical System Design

Human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in-mission medical care. Compared with the ISS, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to: a) quantitatively estimate human system risk attributable to medical conditions, a process known as Probabilistic Risk Analysis, and b) use these estimates to inform medical system design. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a PRA and medical trade space analysis tool developed by NASA to advance exploration mission medical system design. IMPACT improves upon and will soon replace NASA’s existing tool, the Integrated Medical Model, with: a novel evidence base baselined to exploration environments; an expanded list of 120 medical conditions; a significant increase in the number of medical resources that can be utilized and in the flexibility of their use; and the modelling of time lost performing mission-specific tasks due to medical conditions. IMPACT provides evidence-based, mission-specific PRA estimates of in-flight medical risk and an initial list of clinical capabilities and medical resources/hardware to be considered. In addition, sophisticated trade space capabilities estimate how human system risk varies with changes to the mission architecture or medical capability set (e.g., if the system mass constraint decreases by 10% or ultrasound is removed). This panel will provide an overview of IMPACT, its intended use cases, and future development plans. The panel will be the first public presentation of IMPACT results, including medical risk estimates for extended duration Artemis missions, the medical conditions most influencing medical risk metrics, and the clinical capabilities that have the largest effect on medical risk.

Ben Easter↗

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

Preliminary Medical Risk Estimates and Clinical Capability Needs for Artemis IV

BACKGROUND Human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in- mission medical care. Compared with the ISS, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to: a) quantitatively estimate human system risk attributable to medical conditions, a process known as Probabilistic Risk Analysis, and b) use these estimates to inform medical system design. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a PRA and medical trade space analysis tool developed by NASA to advance exploration mission medical system design. IMPACT v1.0 improves upon and will soon replace NASA’s existing tool, the Integrated Medical Model, with: a novel evidence base baselined to exploration environments; an expanded list of 119 medical conditions; a significant increase in the number of medical resources that can be utilized and in the flexibility of their use; and the modelling of time lost performing mission-specific tasks due to medical conditions. METHODOLOGY: This abstract will present IMPACT estimates of medical system risk and clinical capability needs for the Artemis IV mission. Artemis IV is currently scheduled for 2026 and will visit the Gateway space station in lunar orbit prior to the second lunar landing of the Artemis program. The baseline Artemis IV mission that was modeled was 28 days in duration with phases including Orion outbound, 4 days on the Gateway space station in lunar orbit, 2 crew on the surface of the Moon for approximately one week, an additional 5 days on Gateway, and then return to Earth. This baseline was compared to two alternative 34-day design reference missions (DRMs) that shifted the lunar sortie earlier or later in the mission profile. Assumptions included 2 female and 2 male crew and a notional medical system mass of 25 kg. Medical system risk estimates include loss of crew life (LOCL), consideration of medical evacuation (known as return to definitive care – RTDC), and an estimate of crew time lost due to medical conditions (Task Time Lost – TTL). The presentation will also describe the medical conditions that are the greatest drivers of risk as well as the clinical capabilities and resources that have the largest effect on risk. RESULTS: All three DRMs had very low probability of LOCL from medical conditions, primarily due to short duration. RTDC was also similar across the DRMs. In contrast, TTL was higher in the early lunar sortie DRM due to earlier occurrence of EVA-related medical conditions. Taken as a whole, there was no clinically significant difference in medical risk across the three missions. Results for clinical capabilities and an example medical equipment list will be discussed but were similar across DRMs.

D Hilmers↗

NASA NTRSDate not supplied

Medical Risk Estimates and Clinical Capability Needs for A Long Duration Artemis Mission

BACKGROUND Human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in-mission medical care. Compared with the ISS, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to: a) quantitatively estimate human system risk attributable to medical conditions, a process known as Probabilistic Risk Analysis, and b) use these estimates to inform medical system design. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a PRA and medical trade space analysis tool developed by NASA to advance exploration mission medical system design. IMPACT v1.0 improves upon and will soon replace NASA’s existing tool, the Integrated Medical Model, with: a novel evidence base baselined to exploration environments; an expanded list of 119 medical conditions; a significant increase in the number of medical resources that can be utilized and in the flexibility of their use; and the modelling of time lost performing mission-specific tasks due to medical conditions. DISCUSSION: This abstract will present IMPACT estimates of medical system risk and clinical capability needs for an extended duration Artemis mission of approximately 9 months, with phases including outbound transit, 3 months on the Lunar Gateway space station, 3 months on the Lunar surface with EVAs, 3 months on Gateway (simulating the return phase of a Mars mission), and transit back to Earth. Medical system risk estimates include loss of crew life (LOCL), consideration of medical evacuation (known as return to definitive care – RTDC), and an estimate of crew time lost due to medical conditions (Task Time Lost – TTL). The presentation will also describe the medical conditions that are the greatest drivers of risk as well as the clinical capabilities and resources that have the largest effect on risk.

W Thompson↗

NASA NTRS2022

Medical Risk Estimates and Clinical Capability Needs for a Late Artemis Mission

BACKGROUND Human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in-mission medical care. Compared with the ISS, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to: a) quantitatively estimate human system risk attributable to medical conditions, a process known as Probabilistic Risk Analysis, and b) use these estimates to inform medical system design. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a PRA and medical trade space analysis tool developed by NASA to advance exploration mission medical system design. IMPACT v1.0 improves upon and will soon replace NASA’s existing tool, the Integrated Medical Model, with: a novel evidence base baselined to exploration environments; an expanded list of 119 medical conditions; a significant increase in the number of medical resources that can be utilized and in the flexibility of their use; and the modelling of time lost performing mission-specific tasks due to medical conditions. DISCUSSION: This abstract will present IMPACT estimates of medical system risk and clinical capability needs for an extended duration Artemis mission of approximately 9 months, with phases including outbound transit, 3 months on the Lunar Gateway space station, 3 months on the Lunar surface with EVAs, 3 months on Gateway (simulating the return phase of a Mars mission), and transit back to Earth. Medical system risk estimates include loss of crew life (LOCL), consideration of medical evacuation (known as return to definitive care –RTDC), and an estimate of crew time list due to medical conditions (Task Time Lost –TTL). The presentation will also describe the medical conditions that are the greatest drivers of risk as well as the clinical capabilities and resources that have the largest effect on risk.

A Anderson↗

NASA NTRS2024

Preliminary Medical Risk Estimates and Clinical Capability Needs for Late Artemis Missions

BACKGROUND Human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in- mission medical care. Compared with the ISS, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to: a) quantitatively estimate human system risk attributable to medical conditions, a process known as Probabilistic Risk Analysis, and b) use these estimates to inform medical system design. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a PRA and medical trade space analysis tool developed by NASA to advance exploration mission medical system design. IMPACT v1.0 improves upon and will soon replace NASA’s existing tool, the Integrated Medical Model, with: a novel evidence base baselined to exploration environments; an expanded list of 119 medical conditions; a significant increase in the number of medical resources that can be utilized and in the flexibility of their use; and the modelling of time lost performing mission-specific tasks due to medical conditions. METHODOLOGY: This abstract will present IMPACT estimates of medical system risk and clinical capability needs for the Artemis IV mission. Artemis IV is currently scheduled for 2026 and will visit the Gateway space station in lunar orbit prior to the second lunar landing of the Artemis program. The baseline Artemis IV mission that was modeled was 28 days in duration with phases including Orion outbound, 4 days on the Gateway space station in lunar orbit, 2 crew on the surface of the Moon for approximately one week, an additional 5 days on Gateway, and then return to Earth. This baseline was compared to two alternative 34-day design reference missions (DRMs) that shifted the lunar sortie earlier or later in the mission profile. Assumptions included 2 female and 2 male crew and a notional medical system mass of 25 kg. Medical system risk estimates include loss of crew life (LOCL), consideration of medical evacuation (known as return to definitive care – RTDC), and an estimate of crew time lost due to medical conditions (Task Time Lost – TTL). The presentation will also describe the medical conditions that are the greatest drivers of risk as well as the clinical capabilities and resources that have the largest effect on risk. RESULTS: All three DRMs had very low probability of LOCL from medical conditions, primarily due to short duration. RTDC was also similar across the DRMs. In contrast, TTL was higher in the early lunar sortie DRM due to earlier occurrence of EVA-related medical conditions. Taken as a whole, there was no clinically significant difference in medical risk across the three missions. Results for clinical capabilities and an example medical equipment list will be discussed but were similar across DRMs.

D. Hilmers↗

NASA NTRS2018

Exploration Medical System Trade Study Tools Overview

ExMC is creating an ecosystem of tools to enable well-informed medical system trade studies. The suite of tools address important system implementation aspects of the space medical capabilities trade space and are being built using knowledge from the medical community regarding the unique aspects of space flight. Two integrating models, a systems engineering model and a medical risk analysis model, tie the tools together to produce an integrated assessment of the medical system and its ability to achieve medical system target requirements. This presentation will provide an overview of the various tools that are a part of the tool ecosystem. Initially, the presentation's focus will address the tools that supply the foundational information to the ecosystem. Specifically, the talk will describe how information that describes how medicine will be practiced is captured and categorized for efficient utilization in the tool suite. For example, the talk will include capturing what conditions will be planned for in-mission treatment, planned medical activities (e.g., periodic physical exam), required medical capabilities (e.g., provide imaging), and options to implement the capabilities (e.g., an ultrasound device). Database storage and configuration management will also be discussed. The presentation will include an overview of how these information tools will be tied to parameters in a Systems Modeling Language (SysML) model, allowing traceability to system behavioral, structural, and requirements content. The discussion will also describe an HRP-led enhanced risk assessment model developed to provide quantitative insight into each capability's contribution to mission success. Key outputs from these various tools, to be shared with the space medical and exploration mission development communities, will be assessments of medical system implementation option satisfaction of requirements and per-capability contributions toward achieving requirements.

Mindock, J.↗