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At least 19 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS1995

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

Emergency Medicine/education/organization & admini↗
NASA NTRS1994

Human factors and safety in emergency medicine

A model based on an input process and outcome conceptualisation is suggested to address safety-relevant factors in emergency medicine. As shown in other dynamic and demanding environments, human factors play a decisive role in attaining high quality service. Attitudes held by health-care providers, organisational shells and work-cultural parameters determine communication, conflict resolution and workload distribution within and between teams. These factors should be taken into account to improve outcomes such as operational integrity, job satisfaction and morale.

Non-NASA Center↗
NASA NTRS1980

Emergency medicine and the airline passenger

Problems related to immediate medical care in case of in-flight emergencies are discussed with reference to such critical types of medical emergencies as obstructed airway, cardiac dysfunction, trauma, hemorrhage, hypoxia, and pain. It is shown that training flight attendants to deal with in-flight medical emergencies and to use first-aid support equipment and essential and useful drugs may later help with stabilization of a victim and allow continuing the flight to the scheduled destination without the need for a diverted landing. Among the steps suggested in order to upgrade inflight welfare and safety of passengers are the development of an advisory circular by the FAA covering standardized training for flight attendants, regulatory action requiring upgrading of the present rudimentary first-aid kit, and the enactment of Good Samaritan legislation by the U.S. Government.

Mohler, S. R.↗
NASA NTRS1991

International disaster research

No existing telecommunications system can be expected to provide strategy and tactics appropriate to the complex, many faceted problem of disaster. Despite the exciting capabilities of space, communications, remote sensing, and the miracles of modern medicine, complete turnkey transfers to the disaster problem do not make the fit, and cannot be expected to do so. In 1980, a Presidential team assigned the mission of exploring disaster response within the U.S. Federal Government encountered an unanticipated obstacle: disaster was essentially undefined. In the absence of a scientifically based paradigm of disaster, there can be no measure of cost effectiveness, optimum design of manpower structure, or precise application of any technology. These problems spawned a 10-year, multidisciplinary study designed to define the origins, anatomy, and necessary management techniques for catastrophes. The design of the study necessarily reflects interests and expertise in disaster medicine, emergency medicine, telecommunications, computer communications, and forencsic sciences. This study is described.

Silverstein, Martin Elliot↗
NASA NTRS2012

Ventilator Technologies Sustain Critically Injured Patients

Consider this scenario: A soldier has been critically wounded in a sudden firefight in a remote region of Afghanistan. The soldier s comrades attend to him and radio for help, but the soldier needs immediate medical expertise and treatment that is currently miles away. The connection between medical support for soldiers on the battlefield and astronauts in space may not be immediately obvious. But when it comes to providing adequate critical care, NASA and the military have very similar operational challenges, says Shannon Melton of NASA contractor Wyle Integrated Science and Engineering. Melton works within Johnson Space Center s Space Medicine Division, which supports astronaut crew health before, during, and after flight. In space, we have a limited number of care providers, and those providers are not always clinicians with extensive medical training. We have limited room to provide care, limited consumables, and our environment is not like that of a hospital, she says. The Space Medicine Division s Advanced Projects Group works on combining the expertise of both clinicians and engineers to develop new capabilities that address the challenges of medical support in space, including providing care to distant patients. This field, called telemedicine, blends advanced communications practices and technologies with innovative medical devices and techniques to allow caregivers with limited or no medical experience to support a patient s needs. NASA, just by its nature, has been doing remote medicine since the beginning of the Space Program, says Melton, an engineer in the Advanced Projects Group. Since part of NASA s mandate is to transfer the results of its technological innovation for the benefit of the public, the Agency has worked with doctors and private industry to find ways to apply the benefits of space medicine on Earth. In one such case, a NASA partnership has resulted in new technologies that may improve the quality of emergency medicine for wounded soldiers on the battlefield and regular civilians.

Source record↗
NASA NTRS2014

Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique Into a Clinical Monitoring Tool for Space Flight

Emergency medicine physicians recently adopted the use of ultrasonography to quickly measure optic nerve sheath diameter (ONSD) as concomitant with increased intracranial pressure. NASA Space and Clinical Operations Division has been using ground and on-orbit ultrasound capabilities since 2009 to consider this anatomical measure as a proxy for intracranial pressure in the microgravity environment. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut-off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before missions. Crew Surgeon clinical decision-making is complicated by the fact that many astronauts have history of previous spaceflights. Data will be presented characterizing the distribution of baseline ONSD in the astronaut corps, longitudinal trends in-flight, and the predictive power of this measure related to increased intracranial pressure outcomes.

Mason, Sara S.↗
NASA NTRS2007

Clinical Core Competency Training for NASA Flight Surgeons

Introduction: The cohort of NASA flight surgeons (FS) is a very accomplished group with varied clinical backgrounds; however, the NASA Flight Surgeon Office has identified that the extremely demanding schedule of this cohort prevents many of these physicians from practicing clinical medicine on a regular basis. In an effort to improve clinical competency, the NASA FS Office has dedicated one day a week for the FS to receive clinical training. Each week, an FS is assigned to one of five clinical settings, one being medical patient simulation. The Medical Operations Support Team (MOST) was tasked to develop curricula using medical patient simulation that would meet the clinical and operational needs of the NASA FS Office. Methods: The MOST met with the Lead FS and Training Lead FS to identify those core competencies most important to the FS cohort. The MOST presented core competency standards from the American Colleges of Emergency Medicine and Internal Medicine as a basis for developing the training. Results: The MOST identified those clinical areas that could be best demonstrated and taught using medical patient simulation, in particular, using high fidelity human patient simulators. Curricula are currently being developed and additional classes will be implemented to instruct the FS cohort. The curricula will incorporate several environments for instruction, including lab-based and simulated microgravity-based environments. Discussion: The response from the NASA FS cohort to the initial introductory class has been positive. As a result of this effort, the MOST has identified three types of training to meet the clinical needs of the FS Office; clinical core competency training, individual clinical refresher training, and just-in-time training (specific for post-ISS Expedition landings). The MOST is continuing to work with the FS Office to augment the clinical training for the FS cohort, including the integration of Web-based learning.

Polk, J. D.↗
NASA NTRS2003

Development of a Multi-Channel, High Frequency QRS Electrocardiograph

With the advent of the ISS era and the potential requirement for increased cardiovascular monitoring of crewmembers during extended EVAs, NASA flight surgeons would stand to benefit from an evolving technology that allows for a more rapid diagnosis of myocardial ischemia compared to standard electrocardiography. Similarly, during the astronaut selection process, NASA flight surgeons and other physicians would also stand to benefit from a completely noninvasive technology that, either at rest or during maximal exercise tests, is more sensitive than standard ECG in identifying the presence of ischemia. Perhaps most importantly, practicing cardiologists and emergency medicine physicians could greatly benefit from such a device as it could augment (or even replace) standard electrocardiography in settings where the rapid diagnosis of myocardial ischemia (or the lack thereof) is required for proper clinical decision-making. A multi-channel, high-frequency QRS electrocardiograph is currently under development in the Life Sciences Research Laboratories at JSC. Specifically the project consisted of writing software code, some of which contained specially-designed digital filters, which will be incorporated into an existing commercial software program that is already designed to collect, plot and analyze conventional 12-lead ECG signals on a desktop, portable or palm PC. The software will derive the high-frequency QRS signals, which will be analyzed (in numerous ways) and plotted alongside of the conventional ECG signals, giving the PC-viewing clinician advanced diagnostic information that has never been available previously in all 12 ECG leads simultaneously. After the hardware and software for the advanced digital ECG monitor have been fully integrated, plans are to use the monitor to begin clinical studies both on healthy subjects and on patients with known coronary artery disease in both the outpatient and hospital settings. The ultimate goal is to get the technology out into the clinical world, where it has the potential to save lives.

DePalma, Jude L.↗
NASA NTRS2004

Intelligent Medical Systems for Aerospace Emergency Medical Services

The purpose of this project is to develop a portable, hands free device for emergency medical decision support to be used in remote or confined settings by non-physician providers. Phase I of the project will entail the development of a voice-activated device that will utilize an intelligent algorithm to provide guidance in establishing an airway in an emergency situation. The interactive, hands free software will process requests for assistance based on verbal prompts and algorithmic decision-making. The device will allow the CMO to attend to the patient while receiving verbal instruction. The software will also feature graphic representations where it is felt helpful in aiding in procedures. We will also develop a training program to orient users to the algorithmic approach, the use of the hardware and specific procedural considerations. We will validate the efficacy of this mode of technology application by testing in the Johns Hopkins Department of Emergency Medicine. Phase I of the project will focus on the validation of the proposed algorithm, testing and validation of the decision making tool and modifications of medical equipment. In Phase 11, we will produce the first generation software for hands-free, interactive medical decision making for use in acute care environments.

Epler, John↗
NASA NTRS2002

Goal-Directed Ultrasound for the Diagnosis of Long-Bone Fractures by Crew Medical Officer Analogs

Current construction activities on-board the International space Station (ISS) may increase fracture incidence in space, and ultrasound (US) is the only tm-board diagnostic imaging capability. The clinical utility of US in identifying long-bone fractures is un1aowe, particularly using non-radiologist operators. We sought to determine the accuracy of US in identifying fractures of the humerus and femur, as performed by emergency medicine physicians and surgeons with minimal experience in ultrasound image acquisition and interpretation, after a standardized taming session.

Marshburn, Thomas H.↗
NASA NTRSDate not supplied

Ongoing Work: A Prototype Dataset for Low-flying Autonomous Medical UAS Operations

This paper presents ongoing work to create a dataset for low-flying autonomous medical UAS operations, focused on human stance recognition. This is an exploration of the viability of airborne classification for the Drone as a First Responder (DFR) concept in which a UAS arrives at the scene of an incident before emergency response personnel can get there and provides some level of situational awareness for the personnel arriving to the scene. Future incarnations could also see the UAS administer some level of care to injured parties at the scene. The data set, focused on detecting human stance, being developed here is the result of 30 test flights at NASA Langley Research Center in early 2024. In addition to flights where the participant (an anthropomorphic testing device or human) is alone in the viewing area holding a particular stance, two emergency scenes have been fabricated and collected through video - ``bike crash'' and ``difficult camping''. These test flights include four human participants. The contribution of this work upon completion will be a publicly available data set for the development of classification engines focused on human stance, and in the future, even triage.

Uncrewed Aerial Systems↗
NASA NTRS2003

Biomaterials and Magnetic fields for Cancer Therapy

The field of biomaterials has emerged as an important topic in the purview of NASA s new vision of research activities in the Microgravity Research Division. Although this area has an extensive track record in the medical field as borne out by the routine use of polymeric sutures, implant devices, and prosthetics, novel applications such as tissue engineering, artificial heart valves and controlled drug delivery are beginning to be developed. Besides the medical field, biomaterials and bio-inspired technologies are finding use in a host of emerging interdisciplinary fields such as self-healing and self-assembling structures, biosensors, fuel systems etc. The field of magnetic fluid technology has several potential applications in medicine. One of the emerging fields is the area of controlled drug delivery, which has seen its evolution from the basic oral delivery system to pulmonary to transdermal to direct inoculations. In cancer treatment by chemotherapy for example, targeted and controlled drug delivery has received vast scrutiny and substantial research and development effort, due to the high potency of the drugs involved and the resulting requirement to keep the exposure of the drugs to surrounding healthy tissue to a minimum. The use of magnetic particles in conjunction with a static magnetic field allows smart targeting and retention of the particles at a desired site within the body with the material transport provided by blood perfusion. Once so located, the therapeutical aspect (radiation, chemotherapy, hyperthermia, etc.) of the treatment, now highly localized, can be implemented.

Ramachandran, Narayanan↗
NASA NTRS2000

Application of an Electronic Medical Record in Space Medicine

Electronic Medical Records (EMR) have been emerging over the past decade. Today, they are replacing the paper chart in clinics throughout the nation. Approximately three years ago, the NASA-JSC Flight Medicine Clinic initiated an assessment of the EMRs available on the market. This assessment included comparing these products with the particular scope of practice at JSC. In 1998, the Logician EMR from Medicalogic was selected for the JSC Flight Medicine Clinic. This presentation reviews the process of selection and implementation of the EMR into the unique practice of aerospace medicine at JSC.

McGinnis, Patrick J.↗
NASA NTRS2000

Physiological effects of light on the human circadian pacemaker

The physiology of the human circadian pacemaker and its influence and on the daily organization of sleep, endocrine and behavioral processes is an emerging interest in science and medicine. Understanding the development, organization and fundamental properties underlying the circadian timing system may provide insight for the application of circadian principles to the practice of clinical medicine, both diagnostically (interpretation of certain clinical tests are dependent on time of day) and therapeutically (certain pharmacological responses vary with the time of day). The light-dark cycle is the most powerful external influence acting upon the human circadian pacemaker. It has been shown that timed exposure to light can both synchronize and reset the phase of the circadian pacemaker in a predictable manner. The emergence of detectable circadian rhythmicity in the neonatal period is under investigation (as described elsewhere in this issue). Therefore, the pattern of light exposure provided in the neonatal intensive care setting has implications. One recent study identified differences in both amount of sleep time and weight gain in infants maintained in a neonatal intensive care environment that controlled the light-dark cycle. Unfortunately, neither circadian phase nor the time of day has been considered in most clinical investigations. Further studies with knowledge of principles characterizing the human circadian timing system, which governs a wide array of physiological processes, are required to integrate these findings with the practice of clinical medicine.

Review, Tutorial↗
NASA NTRS2015

Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique into a Clinical Monitoring Tool for Spaceflight

Ultrasonography is increasingly used to quickly measure optic nerve sheath diameter (ONSD) when increased intracranial pressure (ICP) is suspected. NASA Space and Clinical Operations Division has been using ground and on‐orbit ultrasound since 2009 as a proxy for ICP in non‐acute monitoring for space medicine purposes. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut‐off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before launch. Crew Surgeon clinical decision‐making is complicated by the fact that many astronauts have history of previous spaceflights. Our data characterize the distribution of baseline ONSD in the astronaut corps, its longitudinal trends in long‐duration spaceflight, and the predictive power of this measure related to increased ICP outcomes.

Mason, Sara↗
NASA NTRS2006

Providing Housing, Food and Medical Support for 25,000 Katrina Evacuees with 12 Hours Notice: The Harris County Medical Support of the Superdome Evacuees

Hurricane Katrina was responsible for trapping 25,000 people in the New Orleans Superdome and isolating many others throughout Louisiana and Mississippi. The transport of these evacuees to the Reliant Park (Houston, Texas) used 500 buses each containing about 55 people. Processing the arriving evacuees included addressing their health status and medical needs as follows: an initial triage at disembarkation, a secondary triage in the Reliant Astrodome and Center, and definitive clinical care in the Reliant Arena "Katrina" Clinic. Baylor College of Medicine (BCM) physicians boarded buses and identified the sickest for emergency transport to Harris County Hospital District (HCHD) hospitals. BCM departments represented included pediatrics, family and community medicine, internal medicine, radiology, obstetrics and gynecology, orthopedics, surgery, and psychiatry. Astrodome and Center triage was managed by BCM physicians and staffed by HCHD Nurses and volunteers from Texas and beyond. The Reliant Astrodome, Center and Arena reached peak headcounts of 15,000,4500, and 2500, respectively Most evacuees visiting the triage sites in the Astrodome and Center were treated using "over-the-counter" medications with the remaining being transported to the "Katrina" clinic. The clinic was equipped with a lab, pharmacy, digital X-ray, and ultrasound machines in addition to electronic patient records created using 80 computer terminals. The Katrina clinic saw more than 15,000 patients during 15 days of operations (2,000 on the first full day), administered 10,000 tetanus shots, and filled thousands of prescriptions. At the peak of operations, the clinic saw 150 patients/hour with 25 physicians scheduled for each 12-hour shift. Approximately 900 people were transported to hospital emergency rooms. Within 3 weeks of arriving at the Reliant Park facilities, more than 90% of the families found permanent housing, enrolled children in schools, and found work. Using data obtained from manual and electronic medical records, this presentation will document the major milestones and lessons learned from this extraordinary project to help the Katrina evacuees.

Hamilton, Douglas↗