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NASA NTRSDate not supplied

Medical Database Accomplishments and Lessons Learned - 2021

The Medical Database (MD) is a virtual repository consisting of two software components: the Medical Item Database (MedID) and the Evidence Library (EL). MedID consists of engineering data and associated information for specific medical resource items (e.g., pharmaceutical, medical devices, and supporting components), while the EL is a tool which provides all of the medical evidence necessary. The Medical Database will serve as the single “source of truth” for the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite for both medical evidence and medical resource engineering data. It will be used in conjunction with the IMPACT tool suite to inform research prioritizations and perform systematic trade study evaluations using probabilistic risk assessment and simulated human spaceflight missions to aid stakeholders in making informed decisions during Pre-Phase-A planning of human spaceflight missions. The IMPACT project is conducted under the Exploration Medical Capability (ExMC) element of the Human Research Program (HRP), within NASA’s Human Exploration and Operations Mission Directorate. Over the past year, the MedID software has been successfully merged with the Evidence Library into one cohesive Medical Database with two independent user interface experiences for modifying either clinical evidence or resource engineering data. As MD has evolved substantially over the past year, a number of challenges have been encountered and overcome along the way. A number of ‘lessons learned’ and practical/logistical realizations have emerged which will be detailed in the forthcoming Medical Database presentation.

Exploration Medical Capability↗

NASA NTRS1993

Medical evaluations on the KC-135 1991 flight report summary

The medical investigations completed on the KC-135 during FY 1991 in support of the development of the Health Maintenance Facility and Medical Operations are presented. The experiments consisted of medical and engineering evaluations of medical hardware and procedures and were conducted by medical and engineering personnel. The hardware evaluated included prototypes of a crew medical restraint system and advanced life support pack, a shuttle orbiter medical system, an airway medical accessory kit, a supplementary extended duration orbiter medical kit, and a surgical overhead canopy. The evaluations will be used to design flight hardware and identify hardware-specific training requirements. The following procedures were evaluated: transport of an ill or injured crewmember at man-tended capability, surgical technique in microgravity, transfer of liquids in microgravity, advanced cardiac life support using man-tended capability Health Maintenance Facility hardware, medical transport using a model of the assured crew return vehicle, and evaluation of delivery mechanisms for aerosolized medications in microgravity. The results of these evaluation flights allow for a better understanding of the types of procedures that can be performed in a microgravity environment.

Lloyd, Charles W.↗

NASA NTRS2005

Autonomous Medical Care for Exploration

The goal of Autonomous Medical Care (AMC) is to ensure a healthy, well-performing crew which is a primary need for exploration. The end result of this effort will be the requirements and design for medical systems for the CEV, lunar operations, and Martian operations as well as a ground-based crew health optimization plan. Without such systems, we increase the risk of medical events occurring during a mission and we risk being unable to deal with contingencies of illness and injury, potentially threatening mission success. AMC has two major components: 1) pre-flight crew health optimization and 2) in-flight medical care. The goal of pre-flight crew health optimization is to reduce the risk of illness occurring during a mission by primary prevention and prophylactic measures. In-flight autonomous medical care is the capability to provide medical care during a mission with little or no real-time support from Earth. Crew medical officers or other crew members provide routine medical care as well as medical care to ill or injured crew members using resources available in their location. Ground support becomes telemedical consultation on-board systems/people collect relevant data for ground support to review. The AMC system provides capabilities to incorporate new procedures and training and advice as required. The on-board resources in an autonomous system should be as intelligent and integrated as is feasible, but autonomous does not mean that no human will be involved. The medical field is changing rapidly, and so a challenge is to determine which items to pursue now, which to leverage other efforts (e.g. military), and which to wait for commercial forces to mature. Given that what is used for the CEV or the Moon will likely be updated before going to Mars, a critical piece of the system design will be an architecture that provides for easy incorporation of new technologies into the system. Another challenge is to determine the level of care to provide for each mission type. The level of care refers to the amount and type of care one will render based on perceived need and ability. This is in contrast to the standard of care which is the benchmark by which that care is provided. There are certainly some devices and procedures that have unique microgravity or partial gravity requirements such that terrestrial methods will not work. For example, performing CPR on Mars cannot be done in exactly the same way as on Earth because the reduced gravity causes too large a reduction in the forces available for effective compression of the chest. Likewise, fluid behavior in microgravity may require a specialized water filtration and mixing system for the creation of intravenous fluids. This paper will outline the drivers for the design of the medical care systems, prioritization and planning techniques, key system components, and long term goals.

Johnson-Throop, Kathy A.↗

NASA NTRS2010

Exploration Medical Capability (ExMC) Projects

During missions to the Moon or Mars, the crew will need medical capabilities to diagnose and treat disease as well as for maintaining their health. The Exploration Medical Capability Element develops medical technologies, medical informatics, and clinical capabilities for different levels of care during space missions. The work done by team members in this Element is leading edge technology, procedure, and pharmacological development. They develop data systems that protect patient's private medical information, aid in the diagnosis of medical conditions, and act as a repository of relevant NASA life sciences experimental studies. To minimize the medical risks to crew health the physicians and scientists in this Element develop models to quantify the probability of medical events occurring during a mission. They define procedures to treat an ill or injured crew member who does not have access to an emergency room and who must be cared for in a microgravity environment where both liquids and solids behave differently than on Earth. To support the development of these medical capabilities, the Element manages the development of medical technologies that prevent, monitor, diagnose, and treat an ill or injured crewmember. The Exploration Medical Capability Element collaborates with the National Space Biomedical Research Institute (NSBRI), the Department of Defense, other Government-funded agencies, academic institutions, and industry.

Wu, Jimmy↗

NASA NTRS2017

Using A Model-Based Systems Engineering Approach For Exploration Medical System Development

NASA's Human Research Program's Exploration Medical Capabilities (ExMC) element is defining the medical system needs for exploration class missions. ExMC's Systems Engineering (SE) team will play a critical role in successful design and implementation of the medical system into exploration vehicles. The team's mission is to "Define, develop, validate, and manage the technical system design needed to implement exploration medical capabilities for Mars and test the design in a progression of proving grounds." Development of the medical system is being conducted in parallel with exploration mission architecture and vehicle design development. Successful implementation of the medical system in this environment will require a robust systems engineering approach to enable technical communication across communities to create a common mental model of the emergent engineering and medical systems. Model-Based Systems Engineering (MBSE) improves shared understanding of system needs and constraints between stakeholders and offers a common language for analysis. The ExMC SE team is using MBSE techniques to define operational needs, decompose requirements and architecture, and identify medical capabilities needed to support human exploration. Systems Modeling Language (SysML) is the specific language the SE team is utilizing, within an MBSE approach, to model the medical system functional needs, requirements, and architecture. Modeling methods are being developed through the practice of MBSE within the team, and tools are being selected to support meta-data exchange as integration points to other system models are identified. Use of MBSE is supporting the development of relationships across disciplines and NASA Centers to build trust and enable teamwork, enhance visibility of team goals, foster a culture of unbiased learning and serving, and be responsive to customer needs. The MBSE approach to medical system design offers a paradigm shift toward greater integration between vehicle and the medical system and directly supports the transition of Earth-reliant ISS operations to the Earth-independent operations envisioned for Mars. Here, we describe the methods and approach to building this integrated model.

Hanson, A.↗

NASA NTRS2019

Medical Decision Making in the Physician Hierarchy: A Pilot Pedagogical Evaluation

Context: Recently, The American College of Graduate Medical Education (ACGME) has included the medical decision making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. Objective: In this study we hope to examine differences in medical decision making ability of different physicians across their various stages of post-graduate hierarchy. Method: Physcians spanning a wide spectrum of scientific disciplines were recruited for three catagories: administrative physicians(AP) representing physcians with the most experience but mostly practice administratively; resident physicians completing their postgraduate medical training (RP) and seasoned attending physicians with mastery level experience (MP). Participants completed four medical simulations focused on abdominal pain: cholecystitis (CH) and renal colic(RC) and chest pain; Cardiac ischemia (STEMI) and pneumothorax (PX). Simulation were ordered randomly so that there was no systematic bias due to learning or to fatigue. The Medical judgment metric (MJM) was used to evaluate medical decision-making. Results: There were no significant differences between the AP, RP, and MP groups in the gender, race, ethnicity, education, and baseline heart rate. There was a significant (p=0.002) interaction effect for simulation time and RP group, 6.2 minutes (+/-1.58); MP group, 8.7 minutes (+/-2.46); and AP group, 10.3 minutes (+/-2.78). The RC MJM scores were significantly (P=0.10) worse in the AP group 12.3 (+/-2.66) then the RP 14.7(+/-1.15) and MP17.7 (+/-1.15) groups. In every simulation, the AP group MJM scores were worse on average (no significantly) compared to the MP and RP groups. The AP group was significantly (P=0.040) less likely to stabilize the subject in the RC simulation than MP and RP groups. Conclusion: There remains significant variability in the medical education and skill retention influences medical decision making throughout a physician's career.

Rosasco, John↗

NASA NTRSDate not supplied

Spaceflight Medical Evacuation Risk Assessment Principles - A Qualitative Investigation

BACKGROUND Future human space exploration beyond Low Earth Orbit (LEO) will require innovative solutions in many areas, primarily those that provide direct medical support to crew on long-duration missions and optimize their health and performance. The associated challenges therein will be numerous, including but not necessarily limited to extended one-way or "asynchronous" communication delays, minimal to non-existent resupply, and a prolonged transit time to "definitive care" ranging from 3-days to 9-months. At the same time, long-duration exploration spacecraft and crew will face restrictions on mass, power, volume, and data far more significant than that seen in current LEO settings. Given these limitations, medical risk assessment is of primary importance, especially evaluating the implications of a medical evacuation of an ill or injured crewmember. Such evacuations are complicated, potentially dangerous, and well may be impossible in certain phases of the mission. Regardless, such issues must be weighed against the risks of the injured crew remaining aboard a spacecraft with limited medical resources. OBJECTIVE This qualitative study drew from the experiences of subject matter experts (SMEs) in spaceflight and appropriate analog environments (i.e., military, disaster, and extreme environment fields) to identify unique principles common amongst medical evacuation considerations helpful in informing future risk assessment tools. Appropriate analog environments included austere operational settings where multiple factors (weather, logistics/limited resupply, denied/extreme environments, and patient condition) resulted in a limited ability to provide definitive local medical care. The fundamental principles in question revolved around scenarios where evacuation became a complicating yet necessary consideration and where life-threatening medical concerns had to be weighed against critical mission objective(s). The primary authors collected semi-structured data gathered through in-depth interviews with 16 subject matter experts (SMEs). Interview questions investigated how these SMEs consider and weigh the attendant risks present in medical evacuation scenarios. Among the critical questions posed were those that sought to understand how the SME balanced the challenges and requirements of medical evacuation (or keeping an injured patient "on-site" aka: "prolonged field care") against the evacuation operation's risks on impacting overarching mission success. The team analyzed interview transcripts for common themes and principles using the qualitative methods of thematic analysis based on consensus, co-occurrence, and comparison. As a result, nine primary risk consideration themes and nine contributing factor themes emerged, all of which will ideally inform future medical evacuation decision-making tools and operational decision-making for exploration class missions. Specific aims for this study included: 1. Identification of common principles used to assess risks and benefits of medical evacuations in extreme environments 2. Identification of common points of friction or complication and challenges in extreme environment evacuations

A T Almand↗

NASA NTRSDate not supplied

Medical System Foundation Overview for Long-Duration Lunar Orbit and Surface Operations Missions

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 long-duration lunar orbit and surface operation missions by employing a systems engineering approach using model-based systems engineering tools. This Foundation model includes a concept of operations; functional decomposition; clinical content (medical conditions, capabilities, and resources); associated functional, interface and non-functional technical requirements; and traces to the current versions of NASA standards documents and parent-level (Program- and Vehicle habitat system level) requirements. Collectively, these components constitute a foundation that serves as a starting point for a medical system that meets the Level of Care IV requirement. The Foundation was developed by a multidisciplinary team consisting of systems engineers, scientists, and clinicians across NASA, and information is presented in an easily accessible format that is understandable across disciplines. Stakeholders can use the Foundation to analyze the traces between medical capabilities, medical conditions, medical resources, and requirements and to identify medical system interfaces with other vehicle systems/subsystems. It can also be used as a basis for performing trades on risks vs. medical system mass and volume allocation. 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. The presentation also discusses Foundation modifications based on the recently updated versions of the NASA 3001 Standards.

S. Lumpkins↗

NASA NTRSDate not supplied

Harnessing Artificial Intelligence for Medical Diagnosis and Treatment During Space Exploration Missions

BACKGROUND The medical capabilities necessary for long-duration exploration missions (LDEMs) will differ tremendously from those currently available to crew medical officers (CMOs) on the International Space Station (ISS). Ground support will be more challenging due to distance-related communication delays and data transmission, and resource utilization must be optimized given limited ability for resupply. Clinical decision support systems (CDSSs) can help mitigate these limitations. The recent launch of generative artificial intelligence (AI) tools based upon large language models (LLM) support the creation of a smart assistant for onboard triage, diagnosis, and guided treatment of medical conditions during these missions. The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool can help predict which clinical problems and outcomes are likely to occur for a design reference mission (DRM) and assist Medical Operations and systems engineering teams in creating a medical system that may optimally mitigate the predicted risks. The purpose of this study was to identify AI tools currently available or in development for the assistive diagnosis and care of medical conditions predicted for an extended duration Lunar mission. METHODS The 119 medical conditions currently built into the IMPACT suite were categorized into systems, and these diagnoses were used as keywords for our literature search. Using PubMed and Google Scholar, we performed a literature survey of AI tools applicable to these conditions. Article inclusion criteria included publication between the years 2017-2023, as the sentinel paper discussing the “selective attention” driving ChatGPT and other generative transformer models was published in June 2017. Where applicable, we reviewed only the top 1000 research articles (based on relevance) for each of the keywords/phrases. AI tools whose training sets were exclusive to a pediatric patient population were excluded. We also excluded any medical diagnostic tools (such as CT, MRI, mass spectrometry) or procedures (such as endoscopy, surgery) that are unlikely to be available during LDEMs due to mass and volume constraints, CMO knowledge, skills, and abilities, and/or inherent procedural risks. RESULTS Our survey highlighted several AI-driven tools for the triage, diagnosis, and management of those medical conditions highlighted by IMPACT. Selected publications for each medical condition were then screened for inclusion within ten systems-based categories including: general diagnostic tools (25), tools to diagnose and manage respiratory (40), dermatologic (34), neurologic (28), auditory and vestibular (30), ophthalmic (34), musculoskeletal (104), infection-associated (92), and gynecologic (19) conditions, as well as tools that could be deployed in the setting of trauma and emergency (34). CONCLUSIONS Numerous AI-driven tools were highlighted within this literature survey, ranging from chatbot assistants that triage knee pain to vision transformer models for diagnosis of ophthalmic conditions using ocular surface images captured with a mobile phone. Remaining challenges include optimizing connectivity and integration of existing and developing systems into the vehicles or habitats. Notably, findings from this survey could help guide the initial design of an all-encompassing, onboard medical AI assistant for use during future LDEMs.

R A Lacinski↗

NASA NTRSDate not supplied

Earth Independent Medical Operations (EIMO)

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

Benjamin Easter↗

NASA NTRS2016

In-Flight Personalized Medication Management

Current medication selection for treatment of astronauts during spaceflight missions is primarily dictated by the task of efficiently treating the widest possible range of physiological conditions and illnesses with a limited set of medications. Dosage and recommendations on the combination of drugs are based on the assumption of genetically equal drug sensitivity and unchanged metabolism. To our knowledge, there was no pre-flight drug sensitivity testing on a genetic level for any of the previous manned NASA space missions. Although many of the common, binary drug-drug interactions are, most likely, already considered in the ISS Medical kit composition, multi-drug and multi-drug-gene factors are not incorporated in the medication selection or prescription. Furthermore, due to the physiological changes occurring in microgravity environments, astronauts might be susceptible to potential increased drug toxicity as a result of decreased clearance of numerous drugs. In particular, perturbation of CYP450 enzymes which contribute to the hepatic metabolism of the majority of drugs may have significant effects on therapeutic efficacy and increase treatment-related toxicity5. The genes encoding the CYP450 enzymes are highly variable in humans. Inheritable variations of CYP450 hepatic metabolizer enzymes and transport proteins play a crucial role in the inter-individual variability of drug efficiency and risks of adverse drug reactions5. Additionally, there are some reports that document changes in the levels of production of drug-metabolizing enzymes in microgravity. These data can be extrapolated to provide reasonable assumptions of decreased levels of expression for most CYP450 enzymes in human body during prolonged space travel. If the prescribed medication regiment is not fully effective or causes undesirable side effects, the ability of the astronauts to function and maintain peak performance levels during space flight could be seriously compromised. Therefore, technologies capable of predicting and managing medication side effects, interactions, and toxicity of drugs during spaceflight are needed. We propose to develop and customize for NASAs applications available on the market Personalized Prescribing System (PPS) that would provide a comprehensive, non-invasive solution for safer, targeted medication management for every crew member resulting in safer and more effective treatment and, consequently, better performance. PPS will function as both decision support and record-keeping tool for flight surgeons and astronauts in applying the recommended medications for situations arising in flight. The information on individual drug sensitivity will translate into personalized risk assessment for adverse drug reactions and treatment failures for each drug from the medication kit as well as predefined outcome of any combination of them. Dosage recommendations will also be made individually. The mobile app will facilitate ease of use by crew and medical professionals during training and flight missions.

Personalized Medication↗

NASA NTRSDate not supplied

Earth-Independent Medical Operations (EIMO) Concept of Operations

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

Earth Independent Medical Operations↗

NASA NTRS2024

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

Earth Independent Medical Operations↗

NASA NTRSDate not supplied

Pilot Study of Medications Exposed to Vacuum

Background Few studies have been conducted regarding the effects of vacuum on medications and their packaging. While relevant on the International Space Station, understanding these effects becomes even more critical as future NASA missions venture farther away from Earth. Vehicles supporting the Artemis missions will have dedicated, vehicle-specific medical kits as well as crew medical accessory kits. Although most of the kits will be stored in a pressurized, climate-controlled volume, there are specific scenarios in which they may become exposed to vacuum. These include the vehicle being brought to vacuum to enable clearance of atmospheric contaminants, and on Human Landing System (HLS), in the airlock (in which kits may be stored) during extravehicular activities. Overview The Exploration Medical Integrated Product Team (XMIPT) in collaboration with the Department of Defense is conducting a pilot study to assess the effects of vacuum on the medications and their packaging to be used in exploration missions. Phase A of this study will focus on manufacturer’s package integrity and Phase B on identifying chemical changes through active pharmaceutical ingredient (API) testing of the medications at 0, 4.5 and 9 months post exposure. Two exposure durations, 1 hour and 8 hours were selected to represent the expected time at vacuum for an Orion contaminated atmosphere vent/repress and the time at vacuum for a lunar surface EVA. The medications for this study were identified based on those currently being considered for future Artemis missions and represent the types of pharmaceuticals and formulations that are likely to comprise an exploration formulary. Discussion The results from this pilot study will aid in decision making related to the development of medical kits, medication packaging and stowage for long duration lunar and Mars missions, and inform the direction of future medication in vacuum studies.

Vacuum↗

NASA NTRS1992

Medicine on Mars: Remote medical care and the space exploration initiative

Mars exploration missions as described in the Synthesis Group report will involve extended exposures of crew members to remote, hazardous environments for up to 100 days. Maintenance of crew health and performance will be critical to ensure mission success. Because of the great distances between the Earth and Mars, round trip telecommunication will take from seven to forty minutes and immediate return to Earth will not be feasible: an autonomous medical care system that integrates preventive, occupational, and environmental aspects of health care and provides diagnostic and treatment capabilities will be necessary. Providing medical care for Mars explorers will pose some unique technical and engineering challenges. Medical care equipment will need to be designed to be modular and portable to ensure that it is interchangeable between vehicle and planetary surface elements. Miniaturization will be necessary to reduce mass and volume. Computerized systems that automatically acquire and manage medical information and provide medical references (literature), decision support, and automated medical record keeping will be a crucial part of a Martian medical care system. Medical care will also rely on remote consultation with Earth-based specialists. This presentation will provide an overview of the health and medical concerns associated with Mars exploration missions and will describe some specific concepts for Mars medical care systems.

Simmons, S. C.↗

NASA NTRS2007

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

The goal of this work is to review the principles, design, and function of the ISS multilateral medical authority and the medical support system of the ISS Program. Multilateral boards and panels provide operational framework, direct, and supervise the ISS joint medical operational activities. The Integrated Medical Group (IMG) provides front-line medical support of the crews. Results of ongoing activities are reviewed weekly by physician managers. A broader status review is conducted monthly to project the state of crew health and medical support for the following month. All boards, panels, and groups function effectively and without interruptions. Consensus prevails as the primary nature of decisions made by all ISS medical groups, including the ISS medical certification board. The sustained efforts of all partners have resulted in favorable medical outcomes of the initial fourteen long-duration expeditions. The medical support system appears to be mature and ready for further expansion of the roles of all Partners, and for the anticipated increase in the size of ISS crews.

Duncan, J. M.↗

NASA NTRS2007

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↗

NASA NTRS2009

Performance Support Tools for Space Medical Operations

The early Constellation space missions are expected to have medical capabilities very similar to those currently on the Space Shuttle and International Space Station (ISS). For Crew Exploration Vehicle (CEV) missions to ISS, medical equipment will be located on ISS, and carried into CEV in the event of an emergency. Flight Surgeons (FS) on the ground in Mission Control will be expected to direct the Crew Medical Officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks. Human factors personnel at Johnson Space Center have recently investigated medical performance support tools for CMOs on-orbit, and FSs on the ground. This area of research involved the feasibility of Just-in-time (JIT) training techniques and concepts for real-time medical procedures. In Phase 1, preliminary feasibility data was gathered for two types of prototype display technologies: a hand-held PDA, and a Head Mounted Display (HMD). The PDA and HMD were compared while performing a simulated medical procedure using ISS flight-like medical equipment. Based on the outcome of Phase 1, including data on user preferences, further testing was completed using the PDA only. Phase 2 explored a wrist-mounted PDA, and compared it to a paper cue card. For each phase, time to complete procedures, errors, and user satisfaction were captured. Information needed by the FS during ISS mission support, especially for an emergency situation (e.g. fire onboard ISS), may be located in many different places around the FS s console. A performance support tool prototype is being developed to address this issue by bringing all of the relevant information together in one place. The tool is designed to include procedures and other information needed by a FS during an emergency, as well as procedures and information to be used after the emergency is resolved. Several walkthroughs of the prototype with FSs have been completed within a mockup of an ISS FS console. Feedback on the current tool design as well as recommendations for existing ISS FS displays were captured.

Byrne, Vicky E.↗