Medical treatment during spaceflight

It is inevitable that medical conditions of varying complexity, severity and emergency will occur during spaceflight missions with human participants. Different levels of care are required depending on the problem, available resources and time required to return to Earth.

All medical problems have the potential to affect the mission, but significant illnesses or trauma will result in a high probability of mission failure or loss of crew. As the distance that missions travel from Earth increases, more possible medical conditions and types of trauma need to be evaluated.^{[by whom?]} Return to Earth will be highly unlikely or very difficult depending on the distance traveled.^{[not verified in body]} Emergency health care will, and psychological support may, have to be self-administered and could possibly be completely autonomous. The most effective way to provide adequate support is to establish a thorough pre-flight health status assessment and develop a systematic approach to autonomous health care in space.^[1]

For NASA, specific provisions and requirements for medical services during space missions are outlined in NPD 8900.5B NASA Health and Medical Policy for Human Space Exploration, NPD 8900.1G Medical Operations Responsibilities in Support of Human Space Flight Programs and NASA-STD-3001 NASA Spaceflight Human Systems Standard - Volume 1, Crew Health.

In flight

Non-emergencies

Most medical conditions that occur while in flight do not constitute a medical emergency and can be treated with medication, if available. Some documented non-emergency conditions that have occurred while in space include,

The use of medication relating to sleep loss and circadian rhythmicity is widespread amongst astronauts.^[4] According to an observational study of 79 early U.S. shuttle missions, hypnotic drugs accounted for 45% of all medication dispensed to astronauts in space.^[5]

Emergencies

Potential medical emergencies during space flight

To date, arrhythmias, renal colic, venous thrombosis, and infections have been documented during space flights. The documented arrhythmias were mostly mild abnormalities, but potentially serious arrhythmias have been reported.^[3][6]

The manifestation of coronary artery disease has not been registered during any human space flight, but considering the risk of coronary events in older people and the increasing age of crew members, the possibility of complications during long-duration missions should not be ignored.^[3] Other medical emergencies that have been observed in space include rare but real cases of urological ^[7][8] and dental emergencies.^[9][10]

Additional consideration substantiates the risk of the inability to treat crew members on long-duration missions.^[3]

Radiation

Radiation exposure may affect the general health of crew members and cause radiation specific pathological processes. Emergencies due to radiation exposure would most likely be catastrophic and mission ending.^[3]

Other risks

Other considerations for designing space medical care systems

A 2006 Space Shuttle experiment found that

On the ground

Ground-based incidences of illness encountered by individuals exposed to harsh environments (

bone fractures. Cases of cancer and psychiatric illness were also documented.^[16]

Dental problems were the most common emergency during submarine and Antarctic expeditions and were a cause for transfer in the U.S. Polaris submarine program.^[16]

Risk estimates made from data provided by analog studies have certain limitations for long duration missions. Unique problems that are inherent to the space environment include the effects of radiation, exposure and physiological adaptation to low gravity. Cardiovascular events are of particular interest for long duration space missions and other harsh environments. To use

United States Air Force (USAF) aviators as an example, even though they undergo a very rigorous health screening, the first manifestation of CAD (coronary artery disease) is a cardiac event. Even though the health assessment for an astronaut is more extensive than USAF aviators, data collected from USAF aviators are applicable to the astronaut corps and emphasizes the risk of occurrence of sudden death or heart attack in space despite thorough screening.^[16]

traumatic amputations, fractures, dislocations, depression and anxiety.^[16]

Exploration scenarios

These documented conditions serve as a basis for the Exploration medical list. This list is currently under development and will assist in planning research and development activities. A medical support system is being developed to ensure that adequate medical care can be administered autonomously or with support from ground crews on Earth.

Computer based simulators

The Integrated Medical Model (IMM), a computer based simulator that quantifies the probability and consequences of medical risks, is currently being developed.^[17]

See also

• Astronautical hygiene
• Bioastronautics
• Effect of spaceflight on the human body
• Human analog missions
• Illness and injuries during spaceflight
• Space adaptation syndrome
• Space colonization
• Space exposure
• Space medicine § Ultrasound microgravity
• Space survival

References

1. ^ Risin, Diana. "Risk of Inability to Adequately Treat an Ill or Injured Crew Member" (PDF). Human Health and Performance Risks of Space Exploration Missions: Evidence reviewed by the NASA Human Research Program. p. 241. Retrieved 23 May 2012.
2. ISBN 978-0-309-50009-8
   .
3. ^ ^{a b c d e f g} Risin, Diana. "Risk of Inability to Adequately Treat an Ill or Injured Crew Member" (PDF). Human Health and Performance Risks of Space Exploration Missions: Evidence reviewed by the NASA Human Research Program. pp. 241–244. Retrieved 23 May 2012.
4. PMID 25127232
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5. PMID 10417009
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6. PMID 31893522
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7. PMID 4153403
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8. ^ Lebedev, V. (1983). Diary of a cosmonaut. 211 days in space. New York: Bantam Books.
9. ^ Newkirk, D. (1990). Almanac of Soviet manned space flight. Houston: Gulf Publishing Company.
10. ^ Brown, L.R.; Frome, W.J.; Handler, S.; Wheatcroft, M.G.; Rider, L.J (1977). "Skylab oral health studies". Biomedical Results from Skylab. Washington, D.C.: NASA. Archived from the original on 2012-09-26.
11. ^ Caspermeyer, Joe (23 September 2007). "Space flight shown to alter ability of bacteria to cause disease". Arizona State University. Retrieved 14 September 2017.
12. PMID 23658630
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13. ^ Dvorsky, George (13 September 2017). "Alarming Study Indicates Why Certain Bacteria Are More Resistant to Drugs in Space". Gizmodo. Retrieved 14 September 2017.
14. PMID 11542696
    .
15. PMID 11542695
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16. ^ ^{a b c d} Risin, Diana. "Risk of Inability to Adequately Treat an Ill or Injured Crew Member" (PDF). Human Health and Performance Risks of Space Exploration Missions: Evidence reviewed by the NASA Human Research Program. pp. 244–246. Retrieved 23 May 2012.
17. ^ Risin, Diana. "Risk of Inability to Adequately Treat an Ill or Injured Crew Member" (PDF). Human Health and Performance Risks of Space Exploration Missions: Evidence reviewed by the NASA Human Research Program. p. 246. Retrieved 23 May 2012.

External links

• Scott Dulchavsky trains astronauts to diagnosis their injuries in space
• Musculoskeletal injuries and minor trauma in space: incidence and injury mechanisms in U.S. astronauts
• Human Research Facility Ultrasound on the International Space Station (Ultrasound)
• Virtual display could diagnose illness in space
• Prophylactic surgery prior to extended-duration space flight: Is the benefit worth the risk?

 This article incorporates public domain material from Human Health and Performance Risks of Space Exploration Missions (PDF).

National Aeronautics and Space Administration

. (NASA SP-2009-3405).