Emergency and Wilderness Medicine Training for Physician Astronauts on Exploration Class Missions

Abstract

The National Aeronautics and Space Administration (NASA) has been challenged to develop capabilities designed to meet the unique challenges required to explore the solar system and is working toward a goal of landing humans on near-Earth asteroids, the Moon, and eventually Mars. 1 The current plan for NASA is to support the extension of the International Space Station (ISS) through 2020. The ISS will serve as a platform for space life sciences research as well as preparation for future exploration class missions by further increasing our understanding of space physiology. 2,3 The primary objectives in sending humans back to the lunar surface or to Mars are to explore, perform research, and gain knowledge. The safeguarding of human health and performance, using appropriate medical care, is essential to meet these mission objectives. History has shown that during the exploration of frontiers on Earth, human physiologic maladaptation, illness, and injury have accounted for more failures of expeditions than any single technical or environmental factor. 4 Carrying out this bold vision creates many new challenges, including a level of medical autonomy unprecedented for human spaceflight. Because a prompt evacuation back to Earth is not feasible in exploration missions, the capability of delivering medical care on site will be the key to success. 5 However, it will be impossible to provide medical care for all imaginable problems. The crew will, therefore, need improvisational skills and acceptance of a certain amount of risk. This paper focuses on the medical and communication challenges of exploration type missions and explicates the value of combined emergency medicine (EM) and wilderness medicine (WM) training for astronaut physicians. Communication Challenges and Self-Sufficiency The time to reach definitive medical care from the ISS may be as brief as 24 hours, but from a lunar base, it would be at best several days. Assuming there are no major developments in propulsion technology, even a Mars "fly-by" with direct return to Earth may represent a 9-month round trip. The entire trip may last as long as 1000 days. Radio communication will require up to 20

Airway management in microgravity: A systematic review

“…Evacuation and real‐time tele‐medical support will not be an option for deep space exploration class missions so the crew will have to manage acute medical events autonomously. The current ISS crew medical officer (CMO) training of 40 hours will not be sufficient; therefore, training requirements and prevention of skill erosion during long duration missions are being developed . In particular, High‐fidelity Environment Analog Training (HEAT) has shown positive effects on skill learning and maintenance .…”

“…The current ISS crew medical officer (CMO) training of 40 hours will not be sufficient; therefore, training requirements and prevention of skill erosion during long duration missions are being developed . In particular, High‐fidelity Environment Analog Training (HEAT) has shown positive effects on skill learning and maintenance . ISS testing of these concepts would be desirable, but challenging to achieve in light of transportation costs to low Earth orbit.…”

Anaesthesia in austere environments: literature review and considerations for future space exploration missions

“…The likelihood of events requiring anaesthesia during SEM can be estimated to some extent from large case series from ground-analogue populations, military and civilian populations, and data gathered throughout the 140 person-years of cumulated spaceflight experience. 8 – 10 , 13 For example, the risk of acute appendicitis has been estimated as 1–2 per 100,000 person-days, which would be equivalent to 1–2 cases every 45 years for a 6-person space crew. 8 The cumulated risk of severe event requiring surgery may add up to one or more during a 900-day Mars mission.…”

“…Among the expected severe medical conditions, surgical problems are of central concern, and will require anaesthesia, 4 , 8 – 13 which currently represents a gap in space medicine knowledge. 12 , 14 , 15 No human has ever required an anaesthetic procedure in space or shortly after returning to Earth.…”

Medizinische Versorgung bei Langzeitmissionen in der Raumfahrt

“…Da bereits auf der ISS ein Ultraschallgerät verlastet ist und ein solches ebenso auf zukünftigen Missionen zur Diagnostik vorhanden sein wird, kann es direkt in Doppelverwendung für die Regionalanästhesie verwendet werden [29]. Probleme ergeben sich zum Einen durch die begrenzte Mitführung von Verbrauchsgütern, zum Anderen durch die beschränkte Haltbarkeit mit teilweise relevanten Wirkungsverlusten der Medikamente [30].…”