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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

Derivation of the Most Influential Medical Conditions for An Extended Duration Artemis Mission

BACKGROUND: The risk of loss of mission due to medical conditions may be influenced by loss of crew life (LOCL), need for evacuation (RTDC; return to definitive care), and crew task time lost. Predicting what medical conditions are most likely to lead to crew morbidity and mortality may influence medical system design, clinical capability prioritization, and research strategies. NASA’s Informing Mission Planning via Analysis of Complex Tradespaces tool (IMPACT) applies Probabilistic Risk Assessment (PRA) methodology to assess these risks. OVERVIEW: A team of subject matter experts (SME) from a variety of medical disciplines developed a consensus-based process to determine 120 of the most clinically relevant medical conditions for long-duration exploration missions (LDEMs) . This IMPACT Condition List (ICL) expanded upon previous work done for Integrated Medical Model (IMM). For each condition a best-case and worst-case definition were derived. These definitions were used to identify probability of occurrence, proportion of cases that are best case vs. worst case, clinical phase duration, and risk of outcomes (task time loss [TTL], RTDC, and LOCL) for both treated and untreated states. These data were sources from existing spaceflight databases (e.g. Longitudinal Survey of Astronaut Health), relevant models (e.g. the ISS fire model), and/or terrestrial literature. Each condition was then tied to diagnostic and therapeutic resources and capabilities. IMPACT was then run for the LDLOLS DRM (see Abstract #2 for this panel). DISCUSSION: This abstract will present the process for generating the IMPACT condition list, the relevant data for each clinical condition, and present results for the ten most influential conditions impacting LOCL, RTDC, and TTL for a representative extended duration Artemis mission.

A Nelson↗

NASA NTRSDate not supplied

IMPACT-ing Exploration Spaceflight Risk Prediction and Medical System Design

Human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in-mission medical care. Compared with the ISS, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to: a) quantitatively estimate human system risk attributable to medical conditions, a process known as Probabilistic Risk Analysis, and b) use these estimates to inform medical system design. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a PRA and medical trade space analysis tool developed by NASA to advance exploration mission medical system design. IMPACT improves upon and will soon replace NASA’s existing tool, the Integrated Medical Model, with: a novel evidence base baselined to exploration environments; an expanded list of 120 medical conditions; a significant increase in the number of medical resources that can be utilized and in the flexibility of their use; and the modelling of time lost performing mission-specific tasks due to medical conditions. IMPACT provides evidence-based, mission-specific PRA estimates of in-flight medical risk and an initial list of clinical capabilities and medical resources/hardware to be considered. In addition, sophisticated trade space capabilities estimate how human system risk varies with changes to the mission architecture or medical capability set (e.g., if the system mass constraint decreases by 10% or ultrasound is removed). This panel will provide an overview of IMPACT, its intended use cases, and future development plans. The panel will be the first public presentation of IMPACT results, including medical risk estimates for extended duration Artemis missions, the medical conditions most influencing medical risk metrics, and the clinical capabilities that have the largest effect on medical risk.

Ben Easter↗

NASA NTRSDate not supplied

Introduction to the IMPACT Probabilistic Risk and Tradespace Analysis Tool for Medical System Design

Background: Probabilistic risk analysis (PRA) is a method for estimating risk in complex engineered systems that, at a basic level, focuses on what can go wrong and the likelihood and consequences of those occurrences. NASA has used PRA as an integral component of medical system risk estimation and design for spaceflight. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a novel tool to meet these goals for exploration missions. Overview: IMPACT performs hundreds of thousands of Monte Carlo simulations of missions to build aggregate pictures of medical risk. These simulations are based on 120 possible medical conditions (the IMPACT Condition List) selected in a consensus-based process because they are of highest likelihood and/or consequence for exploration spaceflight. The conditions are then tied to clinical capabilities which can be used for management (e.g., inserting an IV) and then to over 600 specific resources needed to deliver a capability (e.g., an angiocath or an ultrasound). Different mission profiles can be simulated with user-specified inputs such as mission duration, destination, number of crew and pre-existing medical conditions, and EVA frequency. While the IMPACT evidence base is designed for exploration environments, these user inputs allow the tool to be used across a broad range of missions. IMPACT’s primary outcome metrics include loss of crew life (LOCL, a measure of in-flight mortality due to medical conditions), need for evacuation (RTDC, return to definitive care), and crew disability (TTL, task time lost based on how medical conditions impact the ability to perform over 1000 specific exploration mission crew tasks). In addition to modeling medical risk, IMPACT also accepts user-specified constraints, such as limitations of mass or volume, and will output a recommended clinical capability set and specific medical resources that meet the mission constraints. Discussion: This abstract will provide an introduction to IMPACT and describe the nature of the underlying medical evidence. It will also detail potential use cases for how this tool can be utilized by NASA or commercial spaceflight providers.

Ben Easter↗

NASA NTRSDate not supplied

Coordinated NASA Development of Medical Capabilities and Technologies for Deep Space Exploration

Building upon the success of the last two decades of human spaceflight medical operations onboard the International Space Station (ISS), NASA now must start to evolve to a deep space medical operations paradigm. This new paradigm will include myriad challenges including communication delays and blackouts, infrequent or unavailable resupply, potentially significant vehicle resource constraints, and delayed or non-existent evacuation options. To overcome these challenges, two separate but highly coordinated NASA groups are working together to develop and test solutions to these problems: the Exploration Medical Capability (ExMC) Element of the NASA Human Research Program and the Exploration Medical Integrated Product Team (XMIPT) of the Environmental Control and Life Support System – Crew Health and Performance Systems Capability Leadership Team. Although the work of these two groups is very complementary, ExMC generally focuses more on research and early technology development work while the XMIPT works on maturing and integrating new medical capabilities for exploration. During this panel, these two groups together will present details on how medical capability gaps are defined and addressed, a new work plan in development to increase medical autonomy in spaceflight, a technology maturation effort to generate intravenous fluids from potable water onboard a spacecraft, multiple new technology demonstrations of in-situ laboratory analysis capabilities, and new onboard tools to advance medical care for deep space missions.

Kris Lehnhardt↗

NASA NTRS2021

Exploration Medical Capability Clinical Decision Support System Concept of Operations

The Clinical Decision Support (CDS) project supports the Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP). Specifically, the CDS project addresses the ExMC gap, Medical-701: Enhance medical capabilities within an exploration medical system. For long-duration, deep space missions, computational and data resources will play an important role in maintaining crew health, wellness and performance where the crew will need to be more self-reliant as we enter a new era in space exploration to return to the moon and explore Mars. These ambitious goals will require significant change in in-flight medical care due to constraints on mass, volume, power, crew time, skills reduction over time and medical evacuation capabilities. These constraints make it absolutely necessary to develop transformative solutions using new technologies. Unlike the current paradigm for crew health in low-Earth orbit missions that rely on constant communication with Mission Control, the deep space missions will experience communication delays and possibly, no communications for finite periods of time. Hence, crew health management will benefit from analytics’ capabilities to augment decision support. A comprehensive, multi-functional on-board clinical decision support system (CDSS) will help crews assess and diagnose conditions, decide appropriate responses, and guide the provision of tailored and evidence-based treatments, while reflecting contextual factors and constraints. The context may include present and historical data, viable diagnostic equipment, available supplies and medications, and vehicle and environmental health. Communication time with ground-based personnel is delayed or non-existent during significant portions of the mission so the crew will need to autonomously respond to health, performance and medical situations, particularly those that are unplanned. The CDSS must also provide additional capabilities as complex as training for an emergency situation while augmenting non-expert practitioner skillsets if the Crew Medical Officer (CMO) is incapacitated, and as routine as facilitating delayed communication with flight surgeons on the ground. The CDSS must connect complex issues involving health, wellness, task performance and environmental domains. Furthermore, CDSS functionality will focus on semi-autonomous and autonomous decision-making by the crew that is necessary to address challenges in executing a self-contained medical system that enables health care without assistance from ground clinical experts. The document, ExMC CDSS Architecture Recommendation, (HRP- 48032) establishes a description of the envisioned CDSS architecture. The analytics, descriptive or advanced, contained in a CDSS will interface with the integrated crew health and performance architecture that provides the appropriate data sets. The aim of the CDS project is to develop requirements for a CDSS through a series of test-bed prototype developments and demonstrations.

HRP↗

NASA NTRS2023

Exploration Medical Capability Clinical Decision Support System Architecture Recommendation

A new era in space exploration has arrived with the goal of establishing a long-term presence on the Moon and using those learning to take the next giant leap: sending the first astronauts to Mars. These ambitious goals will require significant changes in in-flight medical care due to constraints on mass, volume, power, crew time, and medical evacuation capabilities. Furthermore, while crews currently rely on real-time communications with ground-based medical providers, as distance from Earth increases, so do communication delays and disruptions. The crew will need to autonomously detect, diagnose, treat, and prevent medical events. These constraints require development of transformative solutions and new technologies. Through participation in the Human Research Program’s (HRP) Exploration Medical Capability (ExMC) research, NASA has developed and demonstrated a Medical Data Architecture (MDA), a platform upon which a robust capability of Clinical Decision Support (CDS) can be built. As a result, NASA is now positioned to build an advanced autonomous CDS System (CDSS) which will aid in crew health decision-making. The CDSS combines data management aspects of a system that would lead to the autonomy required by NASA-STD-3001, Section 3, Health and Medical Care Standards. The project addresses the ExMC gap Medical-701: We need to increase inflight medical capabilities and identify new capabilities that (a) maximize benefit and/or (b) reduce “costs” on human system/mission/vehicle resources. This architecture recommendation document introduces an integrated data architecture that provides self-sufficient medical care for crews on long-duration spaceflight missions.

ExMC↗

NASA NTRS2023

Identifying and Closing Medical Capability Gaps for Human Spaceflight Missions Beyond Low Earth Orbit

BACKGROUND: Features of human space missions beyond low Earth orbit such as increasing distance from Earth, lack of real-time communication, and limited or no evacuation or resupply capability are expected to drive an increase in medical risk and require crews to operate in an increasingly autonomous fashion. A diverse set of stakeholders at NASA are seeking to fund the development of concepts of operations, medical requirements, and medical capabilities for such missions. However, a systematic approach to identification of current medical capability gaps and a strategic framework to gap closure is needed. OVERVIEW: The Exploration Medical Integrated Product Team (XMIPT) has developed a list of nine high-level medical capability gaps and associated activities required for gap closure. The list was derived based on inputs from subject matter experts at NASA including flight surgeons, other clinical providers, as well as operational and research communities regarding medical capabilities required to support human missions to the Moon and the Mars surface. Responses were reviewed and distilled to identify common themes across capabilities. To ensure alignment with established human system risks, the gap list was further refined based on inputs from NASA’s Human System Risk Board. Relevant medical gap closure activities outside of those funded by the XMIPT were identified through solicitation of inputs from Elements of NASA’s Human Research Program (particularly Exploration Medical Capability), the broader medical operations community, and other stakeholders. This medical capability gap list is reviewed and updated regularly as new information becomes available or new stakeholders are identified. DISCUSSION: The medical capability gap list has matured to include a large group of NASA stakeholders and development activities. This has enabled articulation of priorities to funding entities and programmatic stakeholders, while serving as an accessible resource summarizing gap closure activities, relevant programmatic infusion points, and opportunities for collaboration between stakeholders. This presentation will provide an overview of the nine NASA medical capability gaps and their associated gap closure activities.

Moriah Thompson↗

NASA NTRS2020

Identifying Hurricane Impacts on Barbuda Using Citizen Science Ground Observations, Drone Photography and Satellite Imagery

Barbuda is a low-lying leeward island in the West Indies. In September 2017 Hurricane Irma battered the island with 185 mph winds. Damage to housing and infrastructure was so extensive that all 1800 residents of the island were immediately evacuated post hurricane to the neighboring island of Antigua. Our research is focused on documenting and analyzing the landscape scale changes that took place on the island as a result of the hurricane using a nested methodology. Ground level observations were recorded using a beta version of the Global Learning and Observation to Benefit the Environment (GLOBE) Observer Land Cover tool. Aerial photographs provide medium scale landscape resolution. Satellite images were processed to provide NDVI values. We describe how nested data at several spatial scales enable detailed description of Hurricane Irma’s impact across the landscape of this 62 sq. mile island. Here we are connecting observations at different spatial scales, using citizen science observations, aerial drone photography and satellite imagery to document and analyze hurricane impacts on the island of Barbuda, eastern Caribbean.

Barbuda↗

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↗

NASA NTRS2021

Development of Ice-Shelf Estuaries Promotes Fractures and Calving

As the global climate warms, increased surface meltwater production on ice shelves may trigger ice-shelf collapse and enhance global sea-level rise. The formation of surface rivers could help prevent ice-shelf collapse if they can efficiently evacuate meltwater. Here we present observations of the evolution of a surface river into an ice-shelf estuary atop the Petermann Ice Shelf in northwest Greenland and identify a second estuary at the nearby Ryder Ice Shelf. This surface-hydrology process can foster fracturing and enhance calving. At the Petermann estuary, sea ice was observed converging at the river mouth upstream, indicating a flow reversal. Seawater persists in the estuary after the surrounding icescape is frozen. Along the base of Petermann estuary, linear fractures were initiated at the calving front and propagated upstream along the channel. Similar fractures along estuary channels shaped past large rectilinear calving events at the Petermann and Ryder ice shelves. Increased surface melting in a warming world will enhance fluvial incision, promoting estuary development and longitudinal fracturing orthogonal to ice-shelf fronts, and increase rectilinear calving. Estuaries could develop in Antarctica within the next half-century, resulting in increased calving and accelerating both ice loss and global sea-level rise.

Cryospheric science↗

NASA NTRSDate not supplied

Overlapping Conditions in IMPACT

Introduction The IMPACT 1.0 model assumes independence of 119 different medical conditions. That is, it is assumed that one medical event maps to a single medical condition. However, it is often the case that a single medical event may lead to several different concurrent conditions (e.g., a single accident resulting in multiple fractures, chest/abdominal trauma, and sepsis). There is a significant overlap between many of the conditions in ICL 1.0. For example, depression and anxiety are two separate conditions but often co-exist. This overlap may lead to an overestimation in the incidence calculation. In future iterations of the model, we plan to address progression of medical conditions. Methods There are two possible methods to approach progression of a medical condition. The first is to take any medical condition in ICL, calculate its incidence and determine its outcomes no matter what sequelae occur. For example, calculate the incidence of prostatitis and determine its metrics (e.g., loss of crew life, risk of medical evacuation or task time affected) no matter what the sequelae might be (sepsis, hydronephrosis, renal failure, etc.). The second approach is to take any medical condition in the ICL and calculate the outcomes based on transitions to any other condition. For example, calculate the incidence of nephrolithiasis and determine the incidence of each possible transition (e.g., hydronephrosis, renal failure, UTI, pyelonephritis, sepsis) and then determine its metrics. With perfectly informative evidence, the answers should be the same using either method. The question is which approach best reduces the opportunity for overlapping. Results The team identified 31 conditions that were the most likely to transition to a secondary condition such as sepsis and respiratory failure. It was felt that the first approach, as described above, would be the easiest to implement and would have the greatest reduction in overlapping conditions. The identified conditions were primarily infectious conditions, like UTI and pneumonia (which could lead to both respiratory failure and sepsis), toxic inhalations, cardiac arrest, seizures, and trauma. Once these conditions were identified, the conditions were divided between the four clinicians on the team to identify those that were not consistent with the others in way they were approached. There were 13 conditions that were found to be problematic. Some condition definitions needed to be changed to eliminate references to transitions or to update them in cases where the definitions were out of date. Some conditions required new evidence to correct the loss of crew life, and one condition was felt to have so much overlap that it was recommended for elimination. A second effort required modification of the sepsis incidence calculation to prevent double counting of the conditions, such as prostatitis, that could progress to sepsis. Conclusion The team made significant progress in clarifying the method for dealing with transitions from one medical condition to another. In addition, errors were found and corrected in definitions, incidence, and loss of crew life as well as a condition in which reference was made to a CLiFF that was no longer included. These modifications will provide greater fidelity in the IMPACT model and reduce overlap.

Arian Anderson↗

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 NTRSDate not supplied

The Exploration Crew Health and Performance System of the Future - A Shared Mental Model

The challenges involved in vehicle/habitat design and operation for long-duration deep space missions are complex, and the needs of a human crew must be considered in the context of all the system trades required to enable such missions. An exploration Crew Health and Performance (CHP) system complements all the other vehicle/habitat systems to achieve one specific and critical endpoint – ensuring that the astronauts can perform the job that they were sent into space to do. This includes accounting for all aspects of the physiological, psychological, medical, and environmental realities that the human crew must face in deep space. Along with this system complexity comes the additional need for increased autonomy of the crew due to the immense distance from Earth. The design of future systems must respect the real human capabilities and limitations within the context of a mission to the Moon or Mars. The NASA Moon to Mars Objectives document outlines the need for advanced CHP system designs: • Develop systems that monitor and maintain crew health and performance throughout all mission phases, including during communication delays to Earth, and in an environment that does not allow emergency evacuation or terrestrial medical assistance. • Evaluate and validate progressively Earth-independent crew health & performance systems and operations with mission durations representative of Mars-class missions. • Validate readiness of systems and operations to support crew health and performance for the initial human Mars exploration campaign. This presentation will outline the initial work that Exploration Medical Capability is leading on the development of a prototype design for an exploration Crew Health and Performance (CHP) system for future NASA human deep space long-duration missions. This effort will require commitment from all stakeholders to a shared mental model of what a future exploration CHP system should look like, one that will address the needs, goals, and objectives of the Agency and help to ensure mission success in deep space.

K R Lehnhardt↗

NASA NTRSDate not supplied

Supply and Resource Management to Progressively Enable EIMO

BACKGROUND: Current medical operations in Low Earth Orbit (LEO) allow for real-time audio-video communication with a flight surgeon at mission control, resupply, and medical evacuation to earth on the order of hours. As mission profiles change from LEO to the Moon, Mars, and beyond, medical risk as a contribution to overall mission risk is anticipated to rise substantially. Concurrently, due to the distance, the medical systems on board vehicles proposed for these mission types are expected to have reduced mass and volume allocation. Together, astronaut crews will be at a higher risk of major medical events, be required to perform a broader set of tasks, and have substantially reduced resources and support to do so. Earth Independent Medical Operations (EIMO) aims to identify and fill the gaps present in this progressively changing paradigm. OVERVIEW: Medical supplies, resources, and skills are central to spaceflight medical systems. Vehicles used for non-LEO missions are anticipated to be smaller and thus the medical system will also need to have reduced mass, volume, and power. Medical resources are another form of consumable and may need resupply or pre-deployment to meet crew needs. One particular concern is the degradation of medications which become less efficacious and potentially toxic with time, particularly given environmental conditions such as temperature, humidity, oxygen, and radiation which have not yet been fully studied. Supply and resource management in LEO is dependent on resupply, however the supply chain of transporting equipment does not yet have a clear infrastructure for missions beyond LEO. DISCUSSION: EIMO is intended to systemically identify and fill these gaps with forward-looking solutions. In mission monitoring of resources with technology like RFID, improving medical resource longevity, targeted resupply and careful pre-mission planning will be central to facilitate crew health and performance. One approach to optimizing resources is the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool, which uses probabilistic risk assessment (PRA) to quantitatively predict medical risk and identify resources and skills that mitigate this risk. This evidence based, quantitative analysis prediction tool and several other approaches to meeting the challenge of supply and resource management are discussed.

Arian Anderson↗

NASA NTRSDate not supplied

Crew Medical Training to Progressively Enable EIMO

Background. Onboard medical capabilities have greatly expanded over the history of the US space program. Newly identified space-related medical conditions, technological advances, and longer mission durations have led to an increasing need for on-demand medical expertise. Lengthy communications delays, lack of resupply and evacuation opportunities on exploration-class missions place an ever-increasing burden on the crew to provide medical care. Having adequate knowledge, skills, and abilities (KSA) available is an essential component of successful Earth Independent Medical Operations (EIMO). Without appropriate crew training and KSA, cutting-edge medical equipment has little value. Presumably, the crew will include a qualified physician; however, if the physician is incapacitated, a non-physician crew medical officer (CMO) will be needed. While more crew time is needed for medical training, there will be concomitant increases in preflight training demands for vehicle system management, operations, science, and contingencies. In truly independent operations, onboard resources such as just-in-time training, mixed reality, decision support tools, and AI-enabled chatbot “consultants” will be needed to augment KSA. Overview. Because of crew time constraints, topical priorities must be determined for preflight training. Curricula should be developed that emphasize management of conditions with relatively high incidence and morbidity/mortality. Defining the required KSA levels to treat each condition is essential, but all crewmembers should have basic lifesaving skills. Procedural and diagnostic training on live patients and simulators should be prioritized over classroom lectures. Crews must be trained with onboard equipment, resources, mixed reality, and AI-based decision support tools. Mission simulations should include medical problems with/without ground support and with appropriate communication delays. Certification guidelines for each level of KSA must be established. Skills rapidly decay for non-physician CMO’s; both pre-flight and in-flight refresher training will be needed. During spaceflight just-in-time training, simulations, and onboard CME with crew physician can help retain skills. Discussion. Medical technology, simulation design, mixed reality, and AI are advancing at a dizzying rate. Recognizing the severe constraints on crew time, it is critical that astronaut training is highly efficient and adapted to keep pace with new innovations both pre-flight and during exploration missions. These challenges will be discussed during this panel session.

Jay Lemery↗

NASA NTRSDate not supplied

Development Testing of the Gateway Integrated Bipropellant Refueling Subsystem

The Lunar Gateway is a deep space orbiting outpost being developed by the National Aeronautics and Space Administration (NASA) in partnership with the European Space Agency (ESA) and other domestic and international partners. Because Gateway is a vital component of NASA’s Artemis program supporting long-term human exploration of the moon, it is designed for on-orbit refueling to allow for a longer life performance. The reaction control system (RCS) bipropellant refueling system onboard the station will have the capability to transfer propellants, monomethyl hydrazine (MMH) and mixed oxides of nitrogen-3 (MON-3), under controlled conditions and will span across three modules: the European System Providing Refueling Infrastructure and Telecommunication Refueling Module (ESPRIT-RM or ERM), the Habitation and Logistics Outpost (HALO), and the Propulsion and Power Element (PPE). These propellant transfers are complex operations with known hazards, and one of the risk areas is exceeding the flight system’s maximum design pressure (MDP) in priming and refueling pause/stop operations. In priming, liquid propellant is transferred from a pressurized source tank to evacuated transfer lines, which could result in excessive transient surge pressures and potentially damage hardware. In refueling pause/stop operations, fast-acting isolation valves (IV) are closed, which could lead to damaging water hammer. To mitigate these risks and develop the system, a collaborative NASA/ESA/Thales Alenia Space – United Kingdom (TAS-UK) test program was completed at TAS-UK on a simplified refueling breadboard representing ERM, HALO, and PPE bipropellant transfer systems. The objectives of the integrated breadboard testing were to (1) gather performance data to characterize and demonstrate critical refueling operations, (2) help inform flight designs, and (3) to validate numerical models that can be extended to predicting flight system performance. Integrated breadboard test data has shown the architected system performance is closing initial design assumptions. Further testing with propellant on a higher fidelity fluid simulator and analysis are planned.

Adela D Han↗

NASA NTRSDate not supplied

Development Testing of the Gateway Integrated Bipropellant Refueling Subsystem

Adela D Han↗