Exploration Medical Capability Medical System Requirements Overview and Update
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Bardina, Jorge↗
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Cognitive Task Analysis and Knowledge Elicitation to inform Medical Workstation Requirements for long duration space missions
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Ronald Daiker↗
Investigation of Medical Countermeasure Requirements for Meeting Permissible Radiation Exposure Limits in Space
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Charles Martin Werneth↗
Medical Training Requirements for Exploration Medicine Compared to Current Terrestrial Training Programs
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Nora Klinker↗
Video requirements for remote medical diagnosis
Minimal television system requirements for medical telediagnosis were studied. The experiment was conducted with the aid of a simulated telemedicine system. The first step involved making high quality videotape recordings of actual medical examinations conducted by a skilled nurse under the direction of a physician watching on closed circuit television. These recordings formed the baseline for the study. Next, these videotape recordings were electronically degraded to simulate television systems of less than broadcast quality. Finally, the baseline and degraded video recordings were shown (via a statistically randomized procedure) to a large number of physicians who attempted to reach a correct medical diagnosis and to visually recognize key physical signs for each patient. By careful scoring and analysis of the results of these viewings, the pictorial and diagnostic limitations as a function of technical video characteristics were to be defined.
Davis, J. G.↗
Recommendation for a Medical System Concept of Operations for Gateway Missions
NASA’s exploration missions to cis-lunar space will establish a permanent gateway to future transport missions to Mars. These missions mandate a significant paradigm change for mission planning, spacecraft design, human systems integration, and in-flight medical care due to constraints on mass, volume, power, resupply, and medical evacuation capability. These constraints require medical system development to be tightly integrated with mission and habitat design to provide a sufficient medical infrastructure and enable mission success. This concept of operations provides a vision of medical care needs that will be used to guide the development of a medical system for the cis-lunar Gateway Habitat. This medical system will serve as the precursor to what is implemented in future exploration missions to Mars. This concept of operations documents an overview of the stakeholder needs and system goals of a medical system and provides examples of the types of activities for which the system will be used during the mission. This concept of operations informs the ExMC systems engineering effort to define the Gateway Habitat Medical System by documenting the medical activities and capabilities relevant to Gateway missions, as identified by the ExMC clinician community. In addition, this concept of operations will inform the subsequent systems engineering process of developing technical requirements, system architectures, interfaces, and verification and validation approaches for the medical system. This document supports the closure of ExMC Gap Med01: We do not have a concept of operations for medical care during exploration missions, corresponding to the ExMC-managed human system risk: Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions.
Rubin, David↗
Organization, Management and Function of International Space Station (ISS) Multilateral Medical Operations
Long duration crews have inhabited the ISS since November of 2000. The favorable medical outcomes of its missions can be largely attributed to sustained collective efforts of all ISS Partners medical organizations. In-flight medical monitoring and support, although crucial, is just a component of the ISS system of Joint Medical Operations. The goal of this work is to review the principles, design, and function of the multilateral medical support of the ISS Program. The governing documents, which describe the relationships among all ISS partner medical organizations, were evaluated, followed by analysis of the roles, responsibilities, and decision-making processes of the ISS medical boards, panels, and working groups. The degree of integration of the medical support system was evaluated by reviewing the multiple levels of the status reviews and mission assurance activities carried out throughout the last six years. The Integrated Medical Group, consisting of physicians and other essential personnel in the mission control centers represents the front-line medical support of the ISS. Data from their day-to-day activities are presented weekly at the Space Medicine Operations Team (SMOT), where known or potential concerns are addressed by an international group of physicians. A broader status review is conducted monthly to project the state of crew health and medical support for the following month, and to determine measures to return to nominal state. Finally, a comprehensive readiness review is conducted during preparations for each ISS mission. The Multilateral Medical Policy Board (MMPB) issues medical policy decisions and oversees all health and medical matters. The Multilateral Space Medicine Board (MSMB) certifies crewmembers and visitors for training and space flight to the Station, and physicians to practice space medicine for the ISS. The Multilateral Medical Operations Panel (MMOP) develops medical requirements, defines and supervises implementation of operational countermeasures, environmental monitoring, medical care, and emergency medical services. MMOP assures the medical readiness of the Station for each subsequent mission or critical event. All boards and panels have functioned effectively and without interruptions even in various challenging circumstances. Based on the experience of the authors, consensus has prevailed as the primary nature of decisions made by all ISS medical groups, at all levels. The six first years of piloted operation have demonstrated the ability of the ISS medical authority groups and the medical infrastructure to implement medical policies and requirements, effectively interface with non-medical groups, and maintain the health and productivity of the crew in an integrated, multilaterally coordinated fashion. The medical support system appears to be mature and ready for further expansion of all Partners roles, and for the anticipated increase in the size of ISS crews.
Duncan, James M.↗
Behavioral Health and Performance Operations at the NASA Johnson Space Center: A Comprehensive Program that Addresses Flight and Spaceflight Duty Adaptability
NASA astronauts on active status require medical certification for aircraft flying duties as well as readiness for long duration spaceflight training, launch to the International Space Station (ISS), and mission continuation during spaceflight operations. Behavioral fitness and adaptability is an inherent component of medical certification at NASA and requires a unique approach that spans the professional life-span of all active astronauts. TOPIC: This presentation will address the Behavioral Health and Performance (BHP) operations program at the Johnson Space Center. Components of BHP operations include astronaut selection, as well as annual, elective, preflight, inflight, and postflight BHP assessments. Each aspect of the BHP operations program will be discussed, with a focus on behavioral fitness determination and resultant outcomes. Specifically, astronaut selection generates a rating of suitability for long duration spaceflight as well as psychiatric qualification; annual, preflight and postflight BHP assessments provoke a decision regarding the presence of any aeromedical concerns; and inflight assessment requires a conclusion pertaining to mission impact. The combination of these elements provide for a unique, comprehensive approach to flight and spaceflight adaptability. APPLICATIONS: Attendees will understand the differing facets of NASA's comprehensive BHP operations program that occurs over the course of an astronaut's career and be able to compare and contrast this to the Adaptability Rating for Military Aviation (ARMA) and proposed models presented by others on this panel.
Beven, G. E.↗
Medical System Concept of Operations for Mars Exploration Mission-11: Exploration Medical Capability (ExMC) Element - Human Research Program
NASA’s exploration missions to Mars will have durations of 2-3 years and will take humans farther away from Earth than ever before. This will result in a paradigm shift for mission planning, spacecraft design, human systems integration, and in-flight medical care. Constraints on real-time communication, resupply, and medical evacuation are major architectural drivers. These constraints require medical system development to be tightly integrated with mission and vehicle design to provide crew autonomy and enable mission success. This concept of operations provides a common vision of medical care for developing a medical system for Mars exploration missions. It documents an overview of the stakeholder needs and goals of a medical system and provides examples of the types of activities the system will be used for during the mission. Development of the concept of operations considers mission variables such as distance from Earth, duration of mission, time to definitive medical care, communication protocols between crewmembers and ground support, personnel capabilities and skill sets, medical hardware and software, and medical data management. The information provided in this document informs the ExMC Systems Engineering effort to define the functions to be provided by the medical system. In addition, this concept of operations will inform the subsequent systems engineering process of developing technical requirements, system architectures, interfaces, and verification and validation approaches for the medical system. This document supports the closure of ExMC Gap Med01: We do not have a concept of operations for medical care during exploration missions, corresponding to the ExMC-managed human system risk: Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions. This document is applicable to the ExMC Element Systems Engineering process and may be used for collaboration within the Human Research Program.
Urbina, Michelle↗
Visual Impairment and Intracranial Hypertension: An Emerging Spaceflight Risk
During recent long duration missions to the International Space Station (ISS) crewmembers have reported changes in visual acuity or visual field defects. Exams in the postflight period revealed changes to the visual system and elevated intracranial pressures. As a result, NASA Space Medicine has added a number of tests to be performed in the preflight, inflight and postflight periods for ISS and shuttle missions with the goal of determining the processes at work and any potential mitigation strategies. This discussion will acquaint you with the changes that NASA has made to its medical requirements in order to address the microgravity induced intracranial hypertension and associated visual changes. Key personnel have been assembled to provide you information on this topic. Educational Objectives: Provide an overview of the current Medical Operations requirements and the mitigation steps taken to operationally address the issue.
Taddeo, Terrance A.↗
In-flight demonstration of the Space Station Freedom Health Maintenance Facility fluid therapy system (E300/E05)
The Space Station Freedom (SSF) Health Maintenance Facility (HMF) will provide medical care for crew members for up to 10 days. An integral part of the required medical care consists of providing intravenous infusion of fluids, electrolyte solutions, and nutrients to sustain an ill or injured crew member. In terrestrial health care facilities, intravenous solutions are normally stored in large quantities. However, due to the station's weight and volume constraints, an adequate supply of the required solutions cannot be carried onboard SSF. By formulating medical fluids onboard from concentrates and station water as needed, the Fluid Therapy System (FTS) eliminates weight and volume concerns regarding intravenous fluids. The first full-system demonstration of FTS is continuous microgravity will be conducted in Spacelab-Japan (SL-J). The FTS evaluation consists of two functional objectives and an in-flight demonstration of intravenous administration of fluids. The first is to make and store sterile water and IV solutions onboard the spacecraft. If intravenous fluids are to be produced in SSF, successful sterilization of water and reconstituting of IV solutions must be achieved. The second objective is to repeat the verification of the FTS infusion pump, which had been performed in Spacelab Life Sciences - 1 (SLS-1). during SLS-1, the FTS IV pump was operated in continuous microgravity for the first time. The pump functioned successfully, and valuable knowledge on its performance in continuous microgravity was obtained. Finally, the technique of starting an IF in microgravity will be demonstrated. The IV technique requires modifications in microgravity, such as use of restraints for equipment and crew members involved.
Lloyd, Charles W.↗
Medical System Concept of Operations for Mars Exploration Missions
Future exploration missions will be the first time humanity travels beyond Low Earth Orbit (LEO) since the Apollo program, taking us to cis-lunar space, interplanetary space, and Mars. These long-duration missions will cover vast distances, severely constraining opportunities for emergency evacuation to Earth and cargo resupply opportunities. Communication delays and blackouts between the crew and Mission Control will eliminate reliable, real-time telemedicine consultations. As a result, compared to current LEO operations onboard the International Space Station, exploration mission medical care requires an integrated medical system that provides additional in-situ capabilities and a significant increase in crew autonomy. The Medical System Concept of Operations for Mars Exploration Missions illustrates how a future NASA Mars program could ensure appropriate medical care for the crew of this highly autonomous mission. This Concept of Operations document, when complete, will document all mission phases through a series of mission use case scenarios that illustrate required medical capabilities, enabling the NASA Human Research Program (HRP) Exploration Medical Capability (ExMC) Element to plan, design, and prototype an integrated medical system to support human exploration to Mars.
Urbina, M.↗
Medical System Concept of Operations for Mars Exploration Missions
Future exploration missions will be the first time humanity travels beyond Low Earth Orbit (LEO) since the Apollo program, taking us to cis-lunar space, interplanetary space, and Mars. These long-duration missions will cover vast distances, severely constraining opportunities for emergency evacuation to Earth and cargo resupply opportunities. Communication delays and blackouts between the crew and Mission Control will eliminate reliable, real-time telemedicine consultations. As a result, compared to current LEO operations onboard the International Space Station, exploration mission medical care requires an integrated medical system that provides additional in-situ capabilities and a significant increase in crew autonomy. The Medical System Concept of Operations for Mars Exploration Missions illustrates how a future NASA Mars program could ensure appropriate medical care for the crew of this highly autonomous mission. This Concept of Operations document, when complete, will document all mission phases through a series of mission use case scenarios that illustrate required medical capabilities, enabling the NASA Human Research Program (HRP) Exploration Medical Capability (ExMC) Element to plan, design, and prototype an integrated medical system to support human exploration to Mars.
Urbina, Michelle↗
ISS Crew Transportation and Services Requirements Document
The ISS Crew Transportation and Services Requirements Document (CCT-REQ-1130) contains all technical, safety, and crew health medical requirements that are mandatory for achieving a Crew Transportation System Certification that will allow for International Space Station delivery and return of NASA crew and limited cargo. Previously approved on TN23183.
CCT-REQ-1130↗
ISS Crew Transportation and Services Requirements Document
The ISS Crew Transportation and Services Requirements Document (CCT-REQ-1130) contains all technical, safety, and crew health medical requirements that are mandatory for achieving a Crew Transportation System Certification that will allow for International Space Station delivery and return of NASA crew and limited cargo. Previously approved on TN38792.
Commercial Crew Program↗
US-USSR space biology report
The recommendations of the Joint Working Group on Space Biology and Medicine are reported. The exchange of information for the U.S. included the pre- and postflight medical requirements and flight crew health stabilization program for Apollo 16. The U.S.S.R. presentations detailed the medical findings of the Soyuz/Salyut mission, including the postflight autopsy results. The causes of death of the cosmonauts were the occurrence of hypoxia and gaseous embolism. A significant development resulting from the meeting was the agreement that the Joint Working Group strive toward the development of common pre- and postflight medical examination procedures for flight crews for direct comparison of U.S. and U.S.S.R. data.
Friedman, R.↗
Mass and Volume Optimization of Space Flight Medical Kits
Resource allocation is a critical aspect of space mission planning. All resources, including medical resources, are subject to a number of mission constraints such a maximum mass and volume. However, unlike many resources, there is often limited understanding in how to optimize medical resources for a mission. The Integrated Medical Model (IMM) is a probabilistic model that estimates medical event occurrences and mission outcomes for different mission profiles. IMM simulates outcomes and describes the impact of medical events in terms of lost crew time, medical resource usage, and the potential for medically required evacuation. Previously published work describes an approach that uses the IMM to generate optimized medical kits that maximize benefit to the crew subject to mass and volume constraints. We improve upon the results obtained previously and extend our approach to minimize mass and volume while meeting some benefit threshold. METHODS We frame the medical kit optimization problem as a modified knapsack problem and implement an algorithm utilizing dynamic programming. Using this algorithm, optimized medical kits were generated for 3 mission scenarios with the goal of minimizing the medical kit mass and volume for a specified likelihood of evacuation or Crew Health Index (CHI) threshold. The algorithm was expanded to generate medical kits that maximize likelihood of evacuation or CHI subject to mass and volume constraints. RESULTS AND CONCLUSIONS In maximizing benefit to crew health subject to certain constraints, our algorithm generates medical kits that more closely resemble the unlimited-resource scenario than previous approaches which leverage medical risk information generated by the IMM. Our work here demonstrates that this algorithm provides an efficient and effective means to objectively allocate medical resources for spaceflight missions and provides an effective means of addressing tradeoffs in medical resource allocations and crew mission success parameters.
Monte Carlo Method↗
Improving Quantification of Medical Evacuation Risk for Human Spaceflight in the IMPACT Model
Traditionally, mission planners have used a heuristic and qualitative approach to design medical systems based on prior experience however this approach may result in high variability and implicit bias to design and could put missions and crewmembers at risk. The Informing Mission Planning through Analysis of Complex Tradespaces (IMPACT) tool is a probabilistic risk assessment tool designed by NASA to model medical risk in long duration missions outside of low earth orbit (LEO). This tool can quantify risk metrics such as risk of crewmember death, loss of crew task time, and the need for medical evacuation to better inform and augment the more traditional approach to medical system design. The risk metric of Return to Definitive Care (RTDC) represents the likelihood of requiring medical evacuation and has been difficult to quantify in a reliable and standardized manner. Initial development of the RTDC metric was constrained due to the complexity of a medical evacuation decision and the lack of prior spaceflight data and this presentation will discuss the review and improvement process used to increase model accuracy and fidelity.
Prashant Parmar↗