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NASA NTRS2009

Human Research Program Requirements Document (Revision C)

The purpose of this document is to define, document, and allocate the Human Research Program (HRP) requirements to the HRP Program Elements. It establishes the flow-down of requirements from Exploration Systems Mission Directorate (ESMD) and Office of the Chief Health and Medical Officer (OCHMO) to the various Program Elements of the HRP to ensure that human research and technology countermeasure investments are made to insure the delivery of countermeasures and technologies that satisfy ESMD's and OCHMO's exploration mission requirements. Requirements driving the HRP work and deliverables are derived from the exploration architecture, as well as Agency standards regarding the maintenance of human health and performance. Agency human health and performance standards will define acceptable risk for each type and duration of exploration mission. It is critical to have the best available scientific and clinical evidence in setting and validating these standards. In addition, it is imperative that the best available evidence on preventing and mitigating human health and performance risks is incorporated into exploration mission and vehicle designs. These elements form the basis of the HRP research and technology development requirements and highlight the importance of HRP investments in enabling NASA's exploration missions. This PRD defines the requirements of the HRP which is comprised of the following major Program Elements: Behavioral Health and Performance (BHP), Exploration Medical Capability (ExMC), Human Health Countermeasures (HHC), ISS Medical Project (ISSMP), Space Human Factors and Habitability (SHFH), and Space Radiation (SR).

Vargas, Paul R.↗

NASA NTRS2003

An Independent Human Factors Analysis and Evaluation of the Emergency Medical Protocol Checklist for the International Space Station

Emergency medical capabilities aboard the ISS include a Crew Medical Officer (CMO) (not necessarily a physician), and back-up, resuscitation equipment, and a medical checklist. It is essential that CMOs have reliable, usable and informative medical protocols that can be carried out independently in flight. The study evaluates the existing ISS Medical Checklist layout against a checklist updated to reflect a human factors approach to structure and organization. Method: The ISS Medical checklist was divided into non-emergency and emergency sections, and re-organized based on alphabetical and a body systems approach. A desk-top evaluation examined the ability of subjects to navigate to specific medical problems identified as representative of likely non-emergency events. A second evaluation aims to focus on the emergency section of the Medical Checklist, based on the preliminary findings of the first. The final evaluation will use Astronaut CMOs as subjects comparing the original checklist against the updated layout in the task of caring for a "downed crewmember" using a Human Patient Simulator [Medical Education Technologies, Inc.]. Results: Initial results have demonstrated a clear improvement of the re-organized sections to determine the solution to the medical problems. There was no distinct advantage for either alternative, although subjects stated having a preference for the body systems approach. In the second evaluation, subjects will be asked to identify emergency medical conditions, with measures including correct diagnosis, time to completion and solution strategy. The third evaluation will compare the original and fully updated checklists in clinical situations. Conclusions: Initial findings indicate that the ISS Medical Checklist will benefit from a reorganization. The present structure of the checklist has evolved over recent years without systematic testing of crewmember ability to diagnose medical problems. The improvements are expected to enable ISS Crewmembers to more speedily and accurately respond to medical situations on the ISS.

Marshburn, Thomas↗

NASA NTRS2012

Exploration Laboratory Analysis - ARC

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk, Risk of Inability to Adequately Treat an Ill or Injured Crew Member, and ExMC Gap 4.05: Lack of minimally invasive in-flight laboratory capabilities with limited consumables required for diagnosing identified Exploration Medical Conditions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability in future exploration missions. Mission architecture poses constraints on equipment and procedures that will be available to treat evidence-based medical conditions according to the Space Medicine Exploration Medical Conditions List (SMEMCL). The SMEMCL provided diagnosis and treatment for the evidence-based medical conditions and hence, a basis for developing ELA functional requirements.

Krihak, Michael K.↗

NASA NTRS2013

Exploration Laboratory Analysis FY13

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk, which is stated as the Risk of Inability to Adequately Treat an Ill or Injured Crew Member, and ExMC Gap 4.05: Lack of minimally invasive in-flight laboratory capabilities with limited consumables required for diagnosing identified Exploration Medical Conditions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability in future exploration missions. Mission architecture poses constraints on equipment and procedures that will be available to treat evidence-based medical conditions according to the Space Medicine Exploration Medical Conditions List (SMEMCL), and to perform human research studies on the International Space Station (ISS) that are supported by the Human Health and Countermeasures (HHC) element. Since there are significant similarities in the research and medical operational requirements, ELA hardware development has emerged as a joint effort between ExMC and HHC. In 2012, four significant accomplishments were achieved towards the development of exploration laboratory analysis for medical diagnostics. These achievements included (i) the development of high priority analytes for research and medical operations, (ii) the development of Level 1 functional requirements and concept of operations documentation, (iii) the selection and head-to-head competition of in-flight laboratory analysis instrumentation, and (iv) the phase one completion of the Small Business Innovation Research (SBIR) projects under the topic Smart Phone Driven Blood-Based Diagnostics. To utilize resources efficiently, the associated documentation and advanced technologies were integrated into a single ELA plan that encompasses ExMC and HHC development efforts. The requirements and high priority analytes was used in the selection of the four in-flight laboratory analysis performers. Based upon the competition results, a down select process will be performed in the upcoming year. Looking ahead, this unified effort has positioned each element for an in-flight lab analysis demonstration of select diagnostics measurements in the 2015 timeframe.

Krihak, Michael↗

NASA NTRSDate not supplied

HemoCue ISS Tech Demo - Results and Lessons Learned

During long duration space missions, astronauts experience immune system dysregulation [1], and white blood cell (WBC) count can give vital information about the body’s immune response. The ability to measure WBC count is currently an unmet need on the International Space Station (ISS) and for future exploration missions. To address this need, the Human Research Program’s (HRP) Exploration Medical Capability (ExMC) Element, along with the Research Operations and Integration (ROI) Element and the NASA Johnson Space Center Immunology Lab, flew HemoCue®, a commercial-off-the-shelf analyzer with the ability to measure whole blood WBC count with 5-part differential to ISS in December 2020.

Exploration Medical Capability↗

NASA NTRS2012

ExMC Technology Watch

The Technology Watch (Tech Watch) project is a NASA endeavor conducted under the Human Research Program's (HRP) Exploration Medical Capability (ExMC) element, and focusing on ExMC technology gaps. The project involves several NASA centers, including the Johnson Space Center (JSC), Glenn Research Center (GRC), Ames Research Center (ARC), and the Langley Research Center (LaRC). The objective of Tech Watch is to identify emerging, high-impact technologies that augment current NASA HRP technology development efforts. Identifying such technologies accelerates the development of medical care and research capabilities for the mitigation of potential health issues encountered during human space exploration missions. The aim of this process is to leverage technologies developed by academia, industry and other government agencies and to identify the effective utilization of NASA resources to maximize the HRP return on investment. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion and further NASA's goal to provide a safe and healthy environment for human exploration. In 2011, the major focus areas for Tech Watch included information dissemination, education outreach and public accessibility to technology gaps and gap reports. The dissemination of information was accomplished through site visits to research laboratories and/or companies, and participation at select conferences where Tech Watch objectives and technology gaps were presented. Presentation of such material provided researchers with insights on NASA ExMC needs for space exploration and an opportunity to discuss potential areas of common interest. The second focus area, education outreach, was accomplished via two mechanisms. First, several senior student projects, each related to an ExMC technology gap, were sponsored by the various NASA centers. These projects presented ExMC related technology problems firsthand to collegiate laboratories. Second, a RASC-AL (Revolutionary Aerospace Systems Concepts - Academic Linkage) topic for FY12 was developed for medical systems and astronaut health under the Human-Focused Mars Mission Systems and Technologies theme. Announcement of the competition was made to the public in August 2011. Finally, critical Tech Watch information was prepared for public release in the form of gap reports. Complementing the ExMC technology gaps in the public domain, gap reports were generated, reviewed and revised through a series of technical, medical and subject matter expert reviews before approval for public release. An important vehicle for the public release of such documents was development of the ExMC wiki website, which will continue to be populated with gap reports and relevant documents throughout the upcoming year.

Exploration medical capability↗

NASA NTRS2014

ExMC Technology Watch

The Technology Watch (Tech Watch) project is directed by the NASA Human Research Program's (HRP) Exploration Medical Capability (ExMC) element, and primarily focuses on ExMC technology gaps. The project coordinates the efforts of multiple NASA centers, including the Johnson Space Center (JSC), Glenn Research Center (GRC), Ames Research Center (ARC), and the Langley Research Center (LaRC). The objective of Tech Watch is to identify emerging, high-impact technologies that augment current NASA HRP technology development efforts. Identifying such technologies accelerates the development of medical care and research capabilities for the mitigation of potential health issues encountered during human space exploration missions. The aim of this process is to leverage technologies developed by academia, industry and other government agencies and to identify the effective utilization of NASA resources to maximize the HRP return on investment. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion, and advance NASA's goal to provide a safe and healthy environment for human exploration. In fiscal year 2013, the Tech Watch project maintained student project activity aimed at specific ExMC gaps, completed the gap report review cycle for all gaps through a maturated gap report review process, and revised the ExMC Tech Watch Sharepoint site for enhanced data content and organization. Through site visits, internships and promotions via aerospace journals, several student projects were initiated and completed this past year. Upon project completion, the students presented their results via telecom or WebEx to the ExMC Element as a whole. The upcoming year will continue to forge strategic alliances and student projects in the interest of technology and knowledge gap closure. Through the population of Sharepoint with technologies assessed by the gap owners, the database expansion will develop a more comprehensive technology set for each gap. By placing such data in Sharepoint, the gap report updates in fiscal year 2014 are anticipated to be streamlined since the evaluated technologies will be readily available to the gap owners in a sortable archive, and may be simply exported into the final gap report presentation

Exploration Medical Capability↗

NASA NTRS2014

ExMC Technology Watch

The Technology Watch (Tech Watch) project is directed by the NASA Human Research Programs (HRP) Exploration Medical Capability (ExMC) element, and primarily focuses on ExMC technology gaps. The project coordinates the efforts of multiple NASA centers, including the Johnson Space Center (JSC), Glenn Research Center (GRC), Ames Research Center (ARC), and the Langley Research Center (LaRC). The objective of Tech Watch is to identify emerging, high-impact technologies that augment current NASA HRP technology development efforts. Identifying such technologies accelerates the development of medical care and research capabilities for the mitigation of potential health issues encountered during human space exploration missions. The aim of this process is to leverage technologies developed by academia, industry and other government agencies and to identify the effective utilization of NASA resources to maximize the HRP return on investment. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion, and advance NASAs goal to provide a safe and healthy environment for human exploration. In fiscal year 2013, the Tech Watch project maintained student project activity aimed at specific ExMC gaps, completed the gap report review cycle for all gaps through a maturated gap report review process, and revised the ExMC Tech Watch Sharepoint site for enhanced data content and organization. Through site visits, internships and promotions via aerospace journals, several student projects were initiated and completed this past year. Upon project completion, the students presented their results via telecom or WebEx to the ExMC Element as a whole. The upcoming year will continue to forge strategic alliances and student projects in the interest of technology and knowledge gap closure. Through the population of Sharepoint with technologies assessed by the gap owners, the database expansion will develop a more comprehensive technology set for each gap. By placing such data in Sharepoint, the gap report updates in fiscal year 2014 are anticipated to be streamlined since the evaluated technologies will be readily available to the gap owners in a sortable archive, and may be simply exported into the final gap report presentation.

Technology gaps↗

NASA NTRSDate not supplied

Medical System Requirements Development for Lunar Operations

The major health hazards of spaceflight include higher levels of damaging radiation, altered gravity, extended periods of isolation and confinement, a closed and potentially hostile living environment, and the stress associated with being a long distance from Earth. As we increase the duration of lunar stays with foreseeable communication latencies and disruptions, there will be a progressive need for crew to maintain their own health and independently respond to critical medical events. The Exploration Medical Capability element of the NASA Human Research Program is developing a set of Medical System requirements for lunar transit and surface operations. These requirements specify the capabilities, processes and procedures of a habitat Medical System needed for a range of conditions known to occur during spaceflight. Requirement text is written so as not to constrain innovative design solutions necessary for a resilient system. The requirement set includes attributes and functions the Medical System imposes on eight additional habitat systems. A key property of the Medical System is the provision of medical knowledge that will be stored, updated, analyzed, and secured within a Habitat Data System. A Task Performance Support System will aid in medical data acquisition and interpretation, crew training, medical condition prevention, diagnosis and treatment, provide interactive procedures, and track medical inventory. A Wellness System will focus on the provision of countermeasures to prevent, mitigate or treat adverse physical and behavioral health effects while the Medical System recommends adjustments to these countermeasures to maintain crew health. An Environmental Monitoring System will share out-of-bounds readings of air and water quality, acoustics, and radiation exposure levels with the Medical System to help identify issues before they affect crew health and performance. A Communications System will provide secured and private consultations between crew and the ground medical team and their loved ones on Earth. The Medical System also imposes requirements on a Research & Testbed System, fostering advanced medical science such as human research. A Waste Management System provides biohazard waste containment and waste disposal options (recycle and reuse). An Extravehicular Activity System supports crew health during lunar surface activities. And finally, a Maintenance Support System ensures that medical equipment is performing as expected. These requirements are being specifically developed for lunar surface operations but could help to identify Medical System requirements for any space habitat (e.g., I-Hab, commercial endeavors, etc.).

technology↗

NASA NTRS2025

Assessing the Added Value of Miniature X-Ray in the Setting of Portable Ultrasound in Spaceflight

INTRODUCTION: Point-of-care ultrasound (POCUS) has become the standard of care for imaging diagnosis and management in low-Earth Orbit (LEO) spaceflight and it has long been hypothesized that POCUS will also be the standard of care for exploration spaceflight. However, like the trajectory for which ultrasound became more portable and user-friendly, the mass, volume, and power requirements of radiography devices for both diagnostic and therapeutic applications have also been dramatically reduced. This study seeks to determine the clinical utility and added value of miniature x-ray (XR) for the diagnosis and management of each of the 119 conditions within NASA Exploration Medical Capability’s IMPACT Condition List (ICL) given that the medical system is presumed to already be carrying a handheld portable POCUS device. METHODS: For each condition, a team of reviewers performed a rapid systematic literature review seeking sensitivity and specificity data for both handheld portable ultrasound and miniature XR. When there was a paucity of data, subject matter expertise and clinical experience was added to semi-quantitatively score the added value of miniature XR, given an US was already available for both diagnosis and management. Diagnostic utility of a modality for a condition was evaluated in the setting of both the best- and worst-case scenario definitions included and defined by the ICL. Evidence tracing and quality of evidence scores were also recorded. RESULTS/DISCUSSION: Conditions for which it was determined that miniature XR added diagnostic or therapeutic value are provided in this presentation. Previously presented work by our team has demonstrated that XR provides diagnostic and management capabilities that are hypothesized to complement or surpass ultrasound for over one-third of medical conditions that may arise during exploration spaceflight (i.e., diagnosis of injuries to the axial skeleton, teeth, and lungs as well as management of orthopedic reductions, endotracheal tube placement, and drain placement confirmation). In the setting of known inclusion of a handheld portable POCUS device, there remains significant added value of portable miniature XR. Whether or not this added clinical benefit is worth the mass, volume, and power requirements of the radiography system remains yet unknown and is the focus of future work. LEARNING OBJECTIVES: 1) Understand the value of ultrasound and radiography in the diagnosis and management of medical comorbidities that may arise in exploration spaceflight; 2) Understand the medical conditions of highest concern on exploration class missions for which miniature x-ray may provide added value to portable ultrasound.

J G Steller↗

NASA NTRSDate not supplied

Assessing the Added Value of Miniature X-Ray in the Setting of US in Spaceflight

INTRODUCTION: Point-of-care ultrasound (POCUS) has become the standard of care for imaging diagnosis and management in lowEarth Orbit (LEO) spaceflight and it has long been hypothesized that POCUS will also be the standard of care for exploration spaceflight. However, like the trajectory for which ultrasound became more portable and user-friendly, the mass, volume, and power requirements of radiography devices for both diagnostic and therapeutic applications have also been dramatically reduced. This study seeks to determine the clinical utility and added value of miniature x-ray (XR) for the diagnosis and management of each of the 119 conditions within NASA Exploration Medical Capability’s IMPACT Condition List (ICL) given that the medical system is presumed to already be carrying a handheld portable POCUS device. METHODS: For each condition, a team of reviewers performed a rapid systematic literature review seeking sensitivity and specificity data for both handheld portable ultrasound and miniature XR. When there was a paucity of data, subject matter expertise and clinical experience was added to semi-quantitatively score the added value of miniature XR, given an US was already available for both diagnosis and management. Diagnostic utility of a modality for a condition was evaluated in the setting of both the best- and worst-case scenario definitions included and defined by the ICL. Evidence tracing and quality of evidence scores were also recorded. RESULTS/DISCUSSION: Conditions for which it was determined that miniature XR added diagnostic or therapeutic value are provided in this presentation. Previously presented work by our team has demonstrated that XR provides diagnostic and management capabilities that are hypothesized to complement or surpass ultrasound for over one-third of medical conditions that may arise during exploration spaceflight (i.e., diagnosis of injuries to the axial skeleton, teeth, and lungs as well as management of orthopedic reductions, endotracheal tube placement, and drain placement confirmation). In the setting of known inclusion of a handheld portable POCUS device, there remains significant added value of portable miniature XR. Whether or not this added clinical benefit is worth the mass, volume, and power requirements of the radiography system remains yet unknown and is the focus of future work. LEARNING OBJECTIVES: 1) Understand the value of ultrasound and radiography in the diagnosis and management of medical comorbidities that may arise in exploration spaceflight; 2) Understand the medical conditions of highest concern on exploration class missions for which miniature x-ray may provide added value to portable ultrasound.

Jon Steller↗

NASA NTRS2025

Human Spaceflight Applications of Novel Miniature X-Ray Technologies

INTRODUCTION: Radiography (XR) has long been a cornerstone of terrestrial medical imaging, though it has not yet been used in the spaceflight environment. Medical systems for human spaceflight missions are constrained by mass, volume, and power, and until recently, XR systems have been considered too large and power-consuming for spaceflight diagnostic and therapeutic applications. However, the rise of commercial spaceflight and NASA’s refocused efforts on returning crews to the Moon for long-duration missions have introduced a higher degree of medical risk to human spaceflight and require a re-evaluation when optimizing medical system design. Over the last decade, XR devices have miniaturized while maintaining good diagnostic and therapeutic sensitivity and specificity, making new in-flight medical and non-medical XR applications a possibility. Initial research identified several medical conditions where miniature XR would be beneficial for the diagnosis and/or management of medical conditions arising in space, though a more in-depth analysis is required to identify whether XR may add value to the management of such conditions. With this presentation, we aim to introduce the potential utility of miniature XR, review prior work highlighting where XR may be beneficial, and evaluate how miniature XR may reduce medical risk in human spaceflight missions. METHODS: IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a risk assessment tool developed by NASA to advance exploration mission medical system design by quantitatively estimating mission medical risk. IMPACT v1.0 includes a novel evidence library baselined to exploration environments, an expanded list of 119 medical conditions, medical capabilities and resources critical for management of these medical conditions, and the ability for rapid and iterative analysis in the setting of modifiable design reference missions (DRMs). Our first analysis identified which of the 119 medical conditions XR had diagnostic or therapeutic utility for. Subject matter experts (SMEs) recorded which XR views would be performed under ideal terrestrial circumstances for diagnosis/management of each condition, as well as which views are pragmatic for spaceflight limitations. A second analysis utilized IMPACT to identify significant conditions that contribute greatest to medical risk during a notional long-duration Lunar orbit and Lunar surface DRM. Medical system risk estimates include loss of crew life (LOCL), need for return to definitive care (RTDC; medical evacuation), and an estimate of crew task time affected (TTA). Using a standardized semi-quantitative scoring methodology, a deeper evaluation of each of the most significant medical conditions was performed. Data from both of these separate analyses were used to hypothesize what ideal and pragmatic XR studies may impact clinical management of the most significant conditions predicted to lead to medical risk. RESULTS: Approximately 1/3 of the IMPACT conditions were identified as being more effectively or comprehensively assessed or treated with the addition of miniature XR technology. The resulting conditions benefitting diagnostically and therapeutically from XR are revealed, as well as the ideal and pragmatic XR views and medical procedures benefitting from XR. The conditions of clinical significance and those most contributing to risk are also displayed. Among the conditions that contribute greatest to LOCL, four conditions for which XR may improve the diagnosis and management of include: decompression sickness, traumatic shock, dental abscess, and respiratory failure. Among conditions that contributed to RTDC, the evaluation and management of wrist fracture is likely improved by XR. For conditions leading to crew TTA, evaluation and management of EVA shoulder injuries, upper and lower extremity strains, back strains, and EVA hand injuries are likely improved by XR. DISCUSSION: Miniature XR in spaceflight has the potential to improve the evaluation and management of a substantial portion of conditions that most contribute to medical risk. This presentation is an introduction to the possibilities miniature XR provides for future human spaceflight missions and subsequent presenters will expand on potential applications in more detail. LEARNING OBJECTIVES: 1) Understand the previous limitations of using radiography in the management of spaceflight medical conditions; 2) Evaluate the findings from the IMPACT tool analysis, which allows quantification of the benefit miniature XR could provide for managing high-risk medical conditions in long-duration lunar orbit and surface missions, focusing on improvements in crew health outcomes; 3) Analyze case studies where miniature XR technology could reduce the medical risks associated with spaceflight missions, specifically in diagnosing and managing conditions such as decompression sickness, traumatic shock, and EVA-related injuries.

A Anderson↗

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 NTRSDate not supplied

What Has ExMC Systems Engineering Been Up To Since Last IWS?

Long duration Lunar and Martian missions will change the way NASA currently practices medicine. The missions will require more autonomous capability compared to current low Earth orbit operations. For the medical system, lack of consumable resupply, evacuation opportunities, and real-time ground support are key drivers toward greater autonomy. Recognition of the limited mission and vehicle resources available to carry out exploration missions motivates the Exploration Medical Capability (ExMC) Element’s approach to enabling the necessary autonomy. This element promotes human health and performance in space by advancing medical systems design and risk-informed decision-making for long-duration deep-space exploration missions (LDEMs). ExMC is using system engineering processes and Model-Based System Engineering (MBSE) tools to identify the user needs and requirements of LDEM medical systems. The MBSE approach to medical system design offers a paradigm shift toward greater integration between the vehicle and the medical system, and directly supports the transition of Earth-reliant International Space Station operations to the Earth-independent operations envisioned for LDEMs. This talk will provide a high-level overview of what the ExMC SE team has accomplished since the last IWS, an introduction to upcoming SE talks, and the ongoing systems engineering work.

K. McGuire↗

NASA NTRSDate not supplied

Impact Outputs for A Representative Extended Duration Artemis Mission

BACKGROUND: As NASA and private industry begin preparation for long-duration spaceflight, quantifying the impact that potential human health and performance capabilities have on crew health outcomes is imperative for medical risk mitigation. NASA’s Informing Mission Planning via Analysis of Complex Tradespaces tool (IMPACT) applies Probabilistic Risk Assessment (PRA) methodology to estimate these outcomes. OVERVIEW: As NASA prepares to return to the Moon, medical system planning has already begun for extended Artemis missions, which will see humans spending months at a time in cis-lunar space and on the surface of the Moon. The Long Duration Lunar Orbital and Lunar Surface (LDLOLS) design reference mission (DRM) lasts 9 months, including 3 months on the lunar surface, and involves 2 male and 2 female crewmembers. LDLOLS assumes no extravehicular activities (EVAs) in orbit, but, while on the lunar surface, involves 2-4 EVAs/month in a pressurized rover and 2-4 EVAs/month in an unpressurized rover or on foot. This DRM assumes a physician level Crew Medical Officer with commensurate knowledge, skills, and abilities. The IMPACT tool was utilized to estimate in-flight medical risk for this mission. More specifically, 100,000 simulations of this DRM were modeled, and overall estimates for loss of crew life (LOCL), need for evacuation (RTDC; return to definitive care), and crew task time lost (TTL; a measure of disability) were calculated. A recommended medical capability set, with appropriate mass and volume constraints, was also generated. DISCUSSION: This abstract reviews the IMPACT-derived risk for these mission outcomes with and without treatment, a macroscopic look at the total mass and volume necessary for full diagnostic and treatment capability, and how these change with input mission parameters.

J G Steller↗

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 NTRS1983

Health care delivery system for long duration manned space operations

Specific requirements for medical support of a long-duration manned facility in a low earth orbit derive from inflight medical experience, projected medical scenarios, mission related spacecraft and environmental hazards, health maintenance, and preventive medicine. A sequential buildup of medical capabilities tailored to increasing mission complexity is proposed. The space station health maintenance facility must provide preventive, diagnostic, and therapeutic medical support as immediate rescue capability may not exist.

Logan, J. S.↗

NASA NTRS2023

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

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

capabilities↗