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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 NTRS2017

Medical Data Architecture Project Capabilities and Design

Mission constraints will challenge the delivery of medical care on a long-term, deep space exploration mission. This type of mission will be restricted in the availability of medical knowledge, skills, procedures and resources to prevent, diagnose, and treat in-flight medical events. Challenges to providing medical care are anticipated, including resource and resupply constraints, delayed communications and no ability for medical evacuation. The Medical Data Architecture (MDA) project will enable medical care capability in this constrained environment. The first version of the system, called "Test Bed 1," includes capabilities for automated data collection, data storage and data retrieval to provide information to the Crew Medical Officer (CMO). Test Bed 1 seeks to establish a data architecture foundation and develop a scalable data management system through modular design and standardized interfaces. In addition, it will demonstrate to stakeholders the potential for an improved, automated, flow of data to and from the medical system over the current methods employed on the International Space Station (ISS). It integrates a set of external devices, software and processes, and a Subjective, Objective, Assessment, and Plan (SOAP) note commonly used by clinicians. Medical data like electrocardiogram plots, heart rate, skin temperature, respiration rate, medications taken, and more are collected from devices and stored in the Electronic Medical Records (EMR) system, and reported to crew and clinician. Devices integrated include the Astroskin biosensor vest and IMED CARDIAX electrocardiogram (ECG) device with INEED MD ECG Glove, and the NASA-developed Medical Dose Tracker application. The system is designed to be operated as a standalone system, and can be deployed in a variety of environments, from a laptop to a data center. The system is primarily composed of open-source software tools, and is designed to be modular, so new capabilities can be added. The software components and integration methods will be discussed.

Data architecture↗

NASA NTRS2017

Medical Data Architecture Capabilities and Design

Mission constraints will challenge the delivery of medical care on a long-term, deep space explorationmission. This type of mission will be restricted in the availability of medical knowledge, skills, procedures and resourcesto prevent, diagnose, and treat in-flight medical events. Challenges to providing medical care are anticipated, includingresource and resupply constraints, delayed communications and no ability for medical evacuation. The Medical DataArchitecture (MDA) project will enable medical care capability in this constrained environment.The first version of thesystem, called Test Bed 1, includes capabilities for automated data collection, data storage and data retrieval to provideinformation to the Crew Medical Officer (CMO). Test Bed 1 seeks to establish a data architecture foundation and developa scalable data management system through modular design and standardized interfaces. In addition, it will demonstrateto stakeholders the potential for an improved, automated, flow of data to and from the medical system over the currentmethods employed on the International Space Station (ISS). It integrates a set of external devices, software andprocesses, and a Subjective, Objective, Assessment, and Plan (SOAP) note commonly used by clinicians. Medical datalike electrocardiogram plots, heart rate, skin temperature, respiration rate, medications taken, and more are collectedfrom devices and stored in the Electronic Medical Records (EMR) system, and reported to crew and clinician. Devicesintegrated include the Astroskin biosensor vest and IMED CARDIAX electrocardiogram (ECG) device with INEED MDECG Glove, and the NASA-developed Medical Dose Tracker application.The system is designed to be operated as astandalone system, and can be deployed in a variety of environments, from a laptop to a data center. The system isprimarily composed of open-source software tools, and is designed to be modular, so new capabilities can be added. Thesoftware components and integration methods will be discussed.

Exploration medical system↗

NASA NTRS2014

Identification of Medical Training Methods for Exploration Missions

As the National Aeronautics and Space Administration (NASA) and its international partner agencies anticipate eventual exploration missions of longer duration, there is a need to plan for the medical capabilities necessary to maximize crew health and provide the best likelihood of mission success. Current spaceflights consist of 5- to 6-month excursions to the International Space Station (ISS) in low-Earth orbit (LEO), and a 12-month ISS mission is currently in planning stages. However, missions to a near-Earth asteroid (NEA), a return to the moon, or even a mission to Mars will demand unprecedented medical capabilities, particularly relating to the training of the crew medical officers (CMOs). In its attempts to address the questions about medical preparation for spaceflight beyond LEO, the Exploration Medical Capability (ExMC) element within NASA's Human Research Program (HRP) defines a series of gaps. These gaps are shortcomings in knowledge, training, or technology that require resolution before an exploration mission can be undertaken. The ExMC element maintains current information about measures to close these gaps while developing plans for further investigation and research. Data pertaining to the gaps and their present status are available to the general public on the NASA Human Research Wiki and the NASA Human Research Roadmap Web sites (34, 36). One such gap, Gap 3.01, identifies a lack of knowledge about the optimal training methods for in-flight medical conditions identified on the Exploration Medical Condition List (EMCL), taking into account the crew medical officer s (CMOs) clinical background (33). This broad statement encompasses several related issues with the current methods of training CMOs and the medical ground support staff, specifically flight surgeons and biomedical engineers (BMEs) located in mission control, in addition to questions pertaining to the ways in which training will need to be adapted for the medical contingencies unique to exploration missions. To determine the optimal methods of medical training for an exploration medical crew and their ground support team, the historical context of medical operations, the current CMO training methods, and potential alternative training methods were identified.

Long duration space flight↗

NASA NTRS2016

Conceptual Drivers for an Exploration Medical System

Interplanetary spaceflight, such as NASA's proposed three-year mission to Mars, provides unique and novel challenges when compared with human spaceflight to date. Extended distance and multi-year missions introduce new elements of operational complexity and additional risk. These elements include: inability to resupply medications and consumables, inability to evacuate injured or ill crew, uncharted psychosocial conditions, and communication delays that create a requirement for some level of autonomous medical capability. Because of these unique challenges, the approaches used in prior programs have limited application to a Mars mission. On a Mars mission, resource limitations will significantly constrain available medical capabilities, and require a paradigm shift in the approach to medical system design and risk mitigation for crew health. To respond to this need for a new paradigm, the Exploration Medical Capability (ExMC) Element is assessing each Mars mission phase-transit, surface stay, rendezvous, extravehicular activity, and return-to identify and prioritize medical needs for the journey beyond low Earth orbit (LEO). ExMC is addressing both planned medical operations, and unplanned contingency medical operations that meld clinical needs and research needs into a single system. This assessment is being used to derive a gap analysis and studies to support meaningful medical capabilities trades. These trades, in turn, allow the exploration medical system design to proceed from both a mission centric and ethics-based approach, and to manage the risks associated with the medical limitations inherent in an exploration class mission. This paper outlines the conceptual drivers used to derive medical system and vehicle needs from an integrated vision of how medical care will be provided within this paradigm. Keywords: (Max 6 keywords: exploration, medicine, spaceflight, Mars, research, NASA)

Antonsen, Erik↗

NASA NTRS2016

Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions: ExMC Pharmacy Research Plan

The Exploration Medical Capabilities (ExMC) Element of NASA's Human Research Program is charged with identifying medical capabilities that can address the challenges of prevention, diagnosis, and treatment of disease and injuries that could occur during exploration missions beyond Earth's orbit. Faced with the obstacle of access to in-flight medical care, and limitations of vehicle space, time, and communications; it is necessary to prioritize what medical consumables are manifested for the flight, and which medical conditions are addressed. Studies of astronaut health establish the incidence of common and high risk medical conditions that require medical intervention during long-duration exploration missions. In 2000, the Institute of Medicine (IOM) convened a committee of experts, Committee on Creating a Vision for Space Medicine during Travel beyond Earth Orbit, to examine the issues surrounding astronaut health and safety for long duration space missions. Two themes run throughout the committee's final report: (1) that not enough is known about the risks to human health during long-duration missions beyond Earth's orbit or about what can effectively mitigate those risks to enable humans to travel and work safely in the environment of deep space and (2) that everything reasonable should be done to gain the necessary information before humans are sent on missions of space exploration (IOM, 2001). Although several spaceflight focused pharmaceutical research studies have been conducted, few have provided sufficient data regarding medication usage or potency changes during spaceflight. The Du pharmaceutical stability study assessed medications flown on space shuttles to and from the International Space Station (ISS) from 2006 until 2008; of which some medications were still viable beyond their expiration dates (Du et al, 2011). However, as with many spaceflight studies, the small 'n' associated with this study limits the ability to draw strong conclusions from it. Dr. Wotring and others have recently published articles containing information regarding medication usage, indications, and efficacy gleaned from spaceflight records (Wotring et al, 2015, 2016; Barger et al, 2014; Basner and Dinges, 2014). Although some conclusions can be drawn from these studies, the inability to fully quantify medication usage, indications, side effects, and effectiveness, limits insight as to which medications should be prioritized for further research.

Antonsen, Erik↗

NASA NTRS2019

Recommendation for a Medical System Concept of Operations for Gateway Missions

NASA’s exploration missions to cis-lunar space will establish a permanent gateway to future transport missions to Mars. These missions mandate a significant paradigm change for mission planning, spacecraft design, human systems integration, and in-flight medical care due to constraints on mass, volume, power, resupply, and medical evacuation capability. These constraints require medical system development to be tightly integrated with mission and habitat design to provide a sufficient medical infrastructure and enable mission success. This concept of operations provides a vision of medical care needs that will be used to guide the development of a medical system for the cis-lunar Gateway Habitat. This medical system will serve as the precursor to what is implemented in future exploration missions to Mars. This concept of operations documents an overview of the stakeholder needs and system goals of a medical system and provides examples of the types of activities for which the system will be used during the mission. This concept of operations informs the ExMC systems engineering effort to define the Gateway Habitat Medical System by documenting the medical activities and capabilities relevant to Gateway missions, as identified by the ExMC clinician community. In addition, this concept of operations will inform the subsequent systems engineering process of developing technical requirements, system architectures, interfaces, and verification and validation approaches for the medical system. This document supports the closure of ExMC Gap Med01: We do not have a concept of operations for medical care during exploration missions, corresponding to the ExMC-managed human system risk: Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions.

Rubin, David↗

NASA NTRS2022

Turning Limitations into Opportunities in the Development of the Orion Medical System: Incorporation of mHealth Devices

INTRODUCTION: Selection of medical devices for the Orion medical system is a complex task which is dependent on the current state of terrestrial technology. In this work we review the interplay between NASA requirements, constraints, and opportunities for synergy during the development of the Orion medical system. METHODS: The “plan to treat” list of conditions, and subsequently the medical resource list for the Orion Artemis II lunar flyby mission was completed using semi-quantitative methods. During this process, some medical resources were excluded to comply with mass and volume limits, while other resources applicable to multiple medical requirements were prioritized for inclusion. Choices were also examined considering NASA level of care standards for the Artemis design reference missions. As a means to optimize capabilities in spite of mass and volume constraints, ideas for integration of multiple devices into a single platform were explored, including a ‘hackathon’ challenge which was conducted to generate and evaluate concepts for combining medical devices into a single app-based mobile device (ultrasound, ECG, etc.). RESULTS: The Orion team identified 128 medical conditions that we “plan to treat”, with 139 unique medical resources to address these conditions, including 5 digital diagnostic devices (ECG, otoscope, stethoscope, pulse oximeter, and blood pressure monitor). During selection of these digital devices the team noted that miniaturized medical devices often use mobile device platforms (mHealth), some displaying and transmitting data exclusively via mobile device. Of the 5 initially selected devices, all are capable of mobile connection, one which cannot function without a mobile device (ECG). Furthermore, only one of these devices connects natively to a Windows platform, which is currently the only operating system available on Orion. DISCUSSION: Significant savings in mass and volume as well as training and usability improvements can be achieved by leveraging mHealth technologies. However, the platform presents significant challenges for deployment within the Artemis Program including lack of internet connectivity, incompatible operating systems, and radiation concerns. Each of these drawbacks are surmountable with investment in the supporting vehicle architecture, which may become necessary to support the technology trends seen in commercially available medical devices today. Objective: Learn about the opportunities and challenges of leveraging mHealth devices in the development of medical capabilities for austere environments. Learn about the constraints of the NASA spaceflight environment with regards to digital medical device integration.

Douglas Ebert↗

NASA NTRS2023

Identifying and Closing Medical Capability Gaps for Human Spaceflight Missions Beyond Low Earth Orbit

BACKGROUND: Features of human space missions beyond low Earth orbit such as increasing distance from Earth, lack of real-time communication, and limited or no evacuation or resupply capability are expected to drive an increase in medical risk and require crews to operate in an increasingly autonomous fashion. A diverse set of stakeholders at NASA are seeking to fund the development of concepts of operations, medical requirements, and medical capabilities for such missions. However, a systematic approach to identification of current medical capability gaps and a strategic framework to gap closure is needed. OVERVIEW: The Exploration Medical Integrated Product Team (XMIPT) has developed a list of nine high-level medical capability gaps and associated activities required for gap closure. The list was derived based on inputs from subject matter experts at NASA including flight surgeons, other clinical providers, as well as operational and research communities regarding medical capabilities required to support human missions to the Moon and the Mars surface. Responses were reviewed and distilled to identify common themes across capabilities. To ensure alignment with established human system risks, the gap list was further refined based on inputs from NASA’s Human System Risk Board. Relevant medical gap closure activities outside of those funded by the XMIPT were identified through solicitation of inputs from Elements of NASA’s Human Research Program (particularly Exploration Medical Capability), the broader medical operations community, and other stakeholders. This medical capability gap list is reviewed and updated regularly as new information becomes available or new stakeholders are identified. DISCUSSION: The medical capability gap list has matured to include a large group of NASA stakeholders and development activities. This has enabled articulation of priorities to funding entities and programmatic stakeholders, while serving as an accessible resource summarizing gap closure activities, relevant programmatic infusion points, and opportunities for collaboration between stakeholders. This presentation will provide an overview of the nine NASA medical capability gaps and their associated gap closure activities.

Moriah Thompson↗

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 NTRS2024

Earth Independent Medical Operations (EIMO) Datascope: Challenges and Potential Solutions

Data flows and storage/retrieval capacity are severely constrained during missions in space and challenges will become even greater during exploration class missions. There is a need for an artificial intelligence (AI)-based clinical decision support system (CDSS) to monitor and analyze data to provide real-time consultative support for crew medical officer (CMO) decision-making. EIMO is defined as the 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. While a hallmark of this paradigm shift from low-earth orbit is that on-board care will increasingly become the responsibility of the astronauts for primary management and decision making, terrestrial assets will continue to be paramount in pre-mission screening and planning, as well as prevention, health maintenance and long-term care contingencies. New capabilities and systems that enable progressively more robust and resilient systems and crews will be necessary to reduce risk and increase probability of deep space exploration mission success. An aspiration for EIMO is to develop AI-enhanced solutions for analysis of crew health & performance data and to facilitate clinical decision support for autonomous medical operations. A “system of systems” approach is envisioned whereby EIMO will deploy AI-supported natural language processing and machine learning (ML) techniques to utilize embedded reference databases and real-time data streams [input vectors] from multiple data sources. Constituent input vectors may include environmental controls, countermeasures data, behavioral data, physiologic wearables, point-of-care laboratory tests, personalized medical records, inventory trade space risk assessments, COTS medical databases, and ground support inputs. An ideal AI capability would possess trained fusion algorithms to cross reference input vectors with medical ‘knowledge’ [cultivated database] to stratify relevant data streams for predictive and actionable capabilities. In addition, EIMO will feature mobility, in that it can be accessed and can push/pull data within and between multiple vehicles/habitats. Large amounts and variable sources of data can be leveraged to diagnose, inform treatment strategies, and potentially predict medical events and performance decrements. Inclusion of advanced training tools using extended reality will enable increasingly autonomous medical care to aid a CMO when ground support is unavailable or time-delayed beyond required action window, e.g., emergent medical situations. EIMO CDSS would require very large datasets to train pre-flight and significant amounts of data are needed to support ML via in-flight CDSS operations. An additional challenge will be to find sufficient data to train a model relevant to astronaut demographics. The rapid, accelerating evolution of this field creates a propitious solution space to leverage multi-modal AI through public-private partnership(s). The status of multi-modal AI systems today would preclude their use for long duration missions as they remain unreliable and are subject to “digital hallucinations” and other errors that could pose operational risk. A federated labs structure is being considered to test and optimize data flow from the multiple input vectors leading to field testing in suitable ground/flight analogs. Critical to the success of an EIMO CDSS will be integration and interoperability and success will be defined by a system that can serve as an in-flight medical consult for the CMO providing critical support during medical contingencies. Benefits to terrestrial medicine may be significant as an outflow of the EIMO medical system, particularly for remote areas and communities lacking significant infrastructure, personnel and resources.

Medical Operations↗

NASA NTRS2014

Exploration Medical System Demonstration

BACKGROUND: Exploration class missions will present significant new challenges and hazards to the health of the astronauts. Regardless of the intended destination, beyond low Earth orbit a greater degree of crew autonomy will be required to diagnose medical conditions, develop treatment plans, and implement procedures due to limited communications with ground-based personnel. SCOPE: The Exploration Medical System Demonstration (EMSD) project will act as a test bed on the International Space Station (ISS) to demonstrate to crew and ground personnel that an end-to-end medical system can assist clinician and non-clinician crew members in optimizing medical care delivery and data management during an exploration mission. Challenges facing exploration mission medical care include limited resources, inability to evacuate to Earth during many mission phases, and potential rendering of medical care by non-clinicians. This system demonstrates the integration of medical devices and informatics tools for managing evidence and decision making and can be designed to assist crewmembers in nominal, non-emergent situations and in emergent situations when they may be suffering from performance decrements due to environmental, physiological or other factors. PROJECT OBJECTIVES: The objectives of the EMSD project are to: a. Reduce or eliminate the time required of an on-orbit crew and ground personnel to access, transfer, and manipulate medical data. b. Demonstrate that the on-orbit crew has the ability to access medical data/information via an intuitive and crew-friendly solution to aid in the treatment of a medical condition. c. Develop a common data management framework that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all activities pertaining to crew health and life sciences. d. Ensure crew access to medical data during periods of restricted ground communication. e. Develop a common data management framework that allows for scalability, extensibility, and interoperability of data sources and data users. f. Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management. g. Provide a better standard of healthcare for crew members through reductions in the time required by crew and ground personnel to provide medical treatment and the number of crew errors experienced during treatment.

Rubin, D. A.↗

NASA NTRS2014

Optimizing Medical Kits for Spaceflight

The Integrated Medical Model (IMM) is a probabilistic model that estimates medical event occurrences and mission outcomes for different mission profiles. IMM simulation outcomes describing the impact of medical events on the mission may be used to optimize the allocation of resources in medical kits. Efficient allocation of medical resources, subject to certain mass and volume constraints, is crucial to ensuring the best outcomes of in-flight medical events. We implement a new approach to this medical kit optimization problem. METHODS We frame medical kit optimization as a modified knapsack problem and implement an algorithm utilizing a dynamic programming technique. Using this algorithm, optimized medical kits were generated for 3 different mission scenarios with the goal of minimizing the probability of evacuation and maximizing the Crew Health Index (CHI) for each mission subject to mass and volume constraints. Simulation outcomes using these kits were also compared to outcomes using kits optimized..RESULTS The optimized medical kits generated by the algorithm described here resulted in predicted mission outcomes more closely approached the unlimited-resource scenario for Crew Health Index (CHI) than the implementation in under all optimization priorities. Furthermore, the approach described here improves upon in reducing evacuation when the optimization priority is minimizing the probability of evacuation. CONCLUSIONS This algorithm provides an efficient, effective means to objectively allocate medical resources for spaceflight missions using the Integrated Medical Model.

Optimization↗

NASA NTRS2017

Medical Systems Engineering to Support Mars Mission Crew Autonomy

Human spaceflight missions to Mars face exceptionally challenging resource limitations that far exceed those faced before. Increasing transit times, decreasing opportunity for resupply, communications challenges, and extended time to evacuate a crew to definitive medical care dictate a level of crew autonomy in medical care that is beyond the current medical model. To approach this challenge, a medical systems engineering approach is proposed that relies on a clearly articulated Concept of Operations and risk analysis tools that are in development at NASA. This paper proposes an operational clinical model with key terminology and concepts translated to a controls theory paradigm to frame a common language between clinical and engineering teams. This common language will be used for design and validation of an exploration medical system that is fully integrated into a Mars transit vehicle. This approach merges medical simulation, human factors evaluation techniques, and human-in-the-loop testing in ground based analogs to tie medical hardware and software subsystem performance and overall medical system functionality to metrics of operational medical autonomy. Merging increases in operational clinical autonomy with a more restricted vehicle system resource scenario in interplanetary spaceflight will require an unprecedented level of medical and engineering integration. Full integration of medical capabilities into a Mars vehicle system may require a new approach to integrating medical system design and operations into the vehicle Program structure. Prior to the standing-up of a Mars Mission Program, proof of concept is proposed through the Human Research Program.

Antonsen, Erik↗

NASA NTRSDate not supplied

Developing a Medical System Foundation for Level of Care IV: Short-Duration Lunar Orbit

The Human Research Program (HRP) Exploration Medical Capability (ExMC) element has developed a Medical System Foundation for Level of Care IV, as defined by NASA’s space flight human-system standards, for short-duration lunar orbit missions by employing a systems engineering approach using model-based systems engineering tools. This Foundation includes a concept of operations, medical system architecture, associated functional and non-functional requirements and rationales, and medical conditions, capabilities, and resources. Collectively, these serve as a starting point (“Foundation”) for a medical system that meets the Level of Care IV requirement. The Foundation also includes traces to the current versions of NASA standards documents and lower (e.g., sub-system) and higher (e.g., vehicle system) level requirements. Stakeholders can use the Foundation to analyze the traces between medical capabilities, medical conditions, medical resources, and requirements; identify medical system interfaces with other vehicle systems/subsystems; and as a basis for performing trades on risks vs. medical system mass and volume allocation. To facilitate communication of the Foundation to stakeholders who do not have access to the modeling tools used, an HTML representation of the Foundation was created. This discussion will focus on the processes through which the Medical System Foundation was developed, how the Foundation builds a bridge between the medical and engineering domains and facilitates communication between these communities, and how these processes can be applied more broadly to a crew health and performance system and other system domains.

S. Lumpkins↗

NASA NTRSDate not supplied

The Potential of Medical Drones: An Analysis of Current and Future Use Cases

Modern Application of Medical-Based Drone Delivery Drones have been used advantageously by militaries for nearly a century, but their uses in civilian life are still mostly cutting-edge, if not theoretical. After a decade of bold proclamations, Amazon’s “PrimeAir” drone delivery system is still in the stage of “preparing” for deliveries, while the public awaits for start ups like SkyDrop (formerly Flirtey) to follow through on impressive promises. Despite the well-publicized disappointment so far in commercial drone delivery, medical drone delivery has already proven itself practical and cheap in several countries, and it promises to expand in the coming years. Drones are uniquely suited to make valuable and urgent deliveries to remote areas, quickly transporting medical supplies where road transportation is prohibitively slow or not available at all. Drones have been used notably to deliver AEDs for out-of-hospital cardiac arrest, frequently beating first-responders to the scene; to deliver blood when there is none on hand at hospitals; to deliver vaccines to an island nation with little transportation infrastructure; and to respond flexibly to medical emergencies in a war zone. Economics make the delivery of food and other cheap goods by drone unattractive in the near-term, but the value and time-sensitivity of medical deliveries mean that drones are already saving lives in healthcare. “We believe the value of new technology is most valuable where it is clearly needed...that’s why we wanted to focus on drones delivering medicine and not delivering pizzas, ”said one executive of a drone system manufacturer. The immediate prospects for the expansion of medical drone use are many; however, they do not exist without their own drawbacks and challenges. Most obvious is the limited range of current commercially-available drones, most of which are isolated to a perimeter of roughly 18 miles. Technological know-how presents another barrier to integration of medical drones on a larger scale. Reports from the United Nations frequently cite a“skill deficit”—a prohibitively low number of qualified drone operators in low-and moderate-income countries (LMICs). Another perhaps more discreet speed bump in global drone development and usage are the various regulations on drone usage. Drone technology has developed so quickly that many states, out of an excess of caution, have nearly snuffed out the fledgling industry with regulation. There also exist significant concerns over the security of private citizens, the efficacy of medical deliveries, and the costs of drone operation. It is these last three barriers which this study will seek to overcome. Put simply, the prospect for human development in LMICs from drone-based medical delivery is far too great to disregard. As of 2020, 3.4 billion people live in rural communities, containing fewer than 5,000 people/km^2. Often lacking infrastructure, these communities are largely isolated from their more populated, urban counterparts. In drones lies the potential to reshape the geographic and developmental distinctions that divide the global population. This development must, therefore, begin first and foremost with advancement in regional well-being and life expectancy. Life expectancy makes up a key facet of human development. The United Nations relies on it as a key indicator of a state’s health. Lars Kunze of the Dortmund University Department of Economic sex plains this as a matter of physical capital accumulation. The longer people live, the more they save as opposed to spend. The more they save, the more which eventually gets invested in themselves and the community as a whole. In providing medical products via drone, it is the intention of this study to enable communities with the means and incentives for long-run savings and investment for future economic development. Through a close analysis of Vanuatu, Rwanda, Tanzania, and Ukraine—four states where drones are currently used to deliver medical supplies—this study develops a framework that LMICs in general and Mexico and particular can adopt and to use medical drones in difficult-to-reach communities for the sake of long-run human developmental initiatives.

Ryan Teoh↗

NASA NTRSDate not supplied

Earth Independent Medical Operations (EIMO) Datascope: Challenges and Potential Solutions

J Lemery↗