Medical treatment during spaceflight

Last updated

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.

Contents

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

In-flight Medical events for U.S. Astronauts during the Space Shuttle Program (STS-1 through STS-89, April 1981 to January 1998) [2]
Medical Event or System by ICD9* CategoryNumberPercent of Total
Space adaptation syndrome78842.2
Nervous system and sense organs31817.0
Digestive system1638.7
Skin and subcutaneous tissue1518.1
Injuries or trauma1417.6
Musculoskeletal system and connective tissue1327.1
Respiratory system834.4
Behavioral signs and symptoms341.8
Infectious diseases261.4
Genitourinary system231.2
Circulatory system60.3
Endocrine, nutritional, metabolic, and immunity disorders20.1
*International Classification of Diseases, 9th Ed.

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, [3] Space Adaptation Sickness, motion sickness, headache, sleeplessness, back pain, trauma, burns, dermatological conditions, musculoskeletal conditions, respiratory illness and genitourinary problems.

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]

Skylab 2 Commander Charles Conrad is seen undergoing a dental examination by the Medical Officer, Joseph Kerwin in the Skylab Medical Facility. Pete Conrad undergoes dental exam.jpg
Skylab 2 Commander Charles Conrad is seen undergoing a dental examination by the Medical Officer, Joseph Kerwin in the Skylab Medical Facility.

Emergencies

Potential medical emergencies during space flight [3] include arrhythmias, heart attack, stroke, embolism, massive hemorrhage, emergencies related to renal stone formation, infection and thrombotic complications.

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]

Cosmonaut Sergei K. Krikalev, Expedition 11 commander representing Russia's Federal Space Agency, participates in medical training at Johnson Space Center (JSC). Space Medicine Instructor Tyler N. Carruth with Wyle Life Sciences assisted Krikalev. Expedition 11 Crew Medical Training.jpg
Cosmonaut Sergei K. Krikalev, Expedition 11 commander representing Russia's Federal Space Agency, participates in medical training at Johnson Space Center (JSC). Space Medicine Instructor Tyler N. Carruth with Wyle Life Sciences assisted Krikalev.

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 [3] include exposure to toxic substances, chemical burns, electrical burns and trauma (on board and during EVA's). Exposure to a range of hazards including chemical substances, microbes, radiation and noise can be prevented or controlled by the application of effective astronautical hygiene practice.

A 2006 Space Shuttle experiment found that Salmonella typhimurium , a bacterium that can cause food poisoning, became more virulent when cultivated in space. [11] On April 29, 2013, scientists in Rensselaer Polytechnic Institute, funded by NASA, reported that, during spaceflight on the International Space Station, microbes seem to adapt to the space environment in ways "not observed on Earth" and in ways that "can lead to increases in growth and virulence". [12] More recently, in 2017, bacteria were found to be more resistant to antibiotics and to thrive in the near-weightlessness of space. [13] Microorganisms have been observed to survive the vacuum of outer space. [14] [15]

On the ground

NEEMO-9 astronaut/aquanaut Ronald J. Garan Jr. works with a Center for Minimal Access Surgery (CMAS) experiment in the National Oceanic and Atmospheric Administration's (NOAA) Aquarius Underwater Laboratory, located off the coast of Key Largo, Florida, for the NASA Extreme Environment Mission Operations (NEEMO) project. Ron Garan CMAS Experiment.jpg
NEEMO-9 astronaut/aquanaut Ronald J. Garan Jr. works with a Center for Minimal Access Surgery (CMAS) experiment in the National Oceanic and Atmospheric Administration's (NOAA) Aquarius Underwater Laboratory, located off the coast of Key Largo, Florida, for the NASA Extreme Environment Mission Operations (NEEMO) project.

Ground-based incidences of illness encountered by individuals exposed to harsh environments (Antarctic expeditions, submarines and undersea habitats) could be considered as analogs of the space environment. These crews living and working in harsh environments have had medical emergencies such as intracerebral hemorrhage, stroke, myocardial infarction (heart attack), appendicitis and 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]

Appendicitis is the most common general surgical condition for the submarine program and has been the cause of one death on an Antarctic expedition. Other serious conditions reported in the submarine program and Antarctic expeditions include 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

Related Research Articles

<span class="mw-page-title-main">Astronaut</span> Commander, pilot, or crew member of a spacecraft

An astronaut is a person trained, equipped, and deployed by a human spaceflight program to serve as a commander or crew member aboard a spacecraft. Although generally reserved for professional space travelers, the term is sometimes applied to anyone who travels into space, including scientists, politicians, journalists, and tourists.

<span class="mw-page-title-main">Human spaceflight</span> Spaceflight with a crew or passengers

Human spaceflight is spaceflight with a crew or passengers aboard a spacecraft, often with the spacecraft being operated directly by the onboard human crew. Spacecraft can also be remotely operated from ground stations on Earth, or autonomously, without any direct human involvement. People trained for spaceflight are called astronauts, cosmonauts (Russian), or taikonauts (Chinese); and non-professionals are referred to as spaceflight participants or spacefarers.

<span class="mw-page-title-main">Space exploration</span> Exploration of space, planets, and moons

Space exploration is the use of astronomy and space technology to explore outer space. While the exploration of space is currently carried out mainly by astronomers with telescopes, its physical exploration is conducted both by uncrewed robotic space probes and human spaceflight. Space exploration, like its classical form astronomy, is one of the main sources for space science.

<span class="mw-page-title-main">Dafydd Williams</span> Canadian physician, public speaker and retired CSA astronaut

Dafydd Rhys "David" Williams is a Canadian physician, public speaker, author and retired CSA astronaut. Williams was a mission specialist on two Space Shuttle missions. His first spaceflight, STS-90 in 1998, was a 16-day mission aboard Space Shuttle Columbia dedicated to neuroscience research. His second flight, STS-118 in August 2007, was flown by Space Shuttle Endeavour to the International Space Station. During that mission he performed three spacewalks, becoming the third Canadian to perform a spacewalk and setting a Canadian record for total number of spacewalks. These spacewalks combined for a total duration of 17 hours and 47 minutes.

<span class="mw-page-title-main">Effect of spaceflight on the human body</span> Medical issues associated with spaceflight

The effects of spaceflight on the human body are complex and largely harmful over both short and long term. Significant adverse effects of long-term weightlessness include muscle atrophy and deterioration of the skeleton. Other significant effects include a slowing of cardiovascular system functions, decreased production of red blood cells, balance disorders, eyesight disorders and changes in the immune system. Additional symptoms include fluid redistribution, loss of body mass, nasal congestion, sleep disturbance, and excess flatulence. Overall, NASA refers to the various deleterious effects of spaceflight on the human body by the acronym RIDGE.

<span class="mw-page-title-main">Space medicine</span> For health conditions encountered during spaceflight

Space medicine is an area in aerospace medicine that focuses on the medical care of astronauts and spaceflight participants. The spaceflight environment poses many unique stressors to the human body, including G forces, microgravity, unusual atmospheres such as low pressure or high carbon dioxide, and space radiation. Space medicine applies space physiology, preventive medicine, primary care, emergency medicine, acute care medicine, austere medicine, public health, and toxicology to prevent and treat medical problems in space. This expertise is additionally used to inform vehicle systems design to minimize the risk to human health and performance while meeting mission objectives.

<span class="mw-page-title-main">Michael Barratt (astronaut)</span> American aerospace medicine physician and a NASA astronaut with two flights

Michael Reed Barratt is an American physician and a NASA astronaut. Specializing in aerospace medicine, he served as a flight surgeon for NASA before his selection as an astronaut, and has played a role in developing NASA's space medicine programs for both the Shuttle-Mir Program and International Space Station. His first spaceflight was a long-duration mission to the International Space Station, as a flight engineer in the Expedition 19 and 20 crew. In March 2011, Barratt completed his second spaceflight as a crew member of STS-133. Barratt will pilot the SpaceX Crew-8 mission in spring 2024.

<span class="mw-page-title-main">Human mission to Mars</span> Proposed concepts

The idea of sending humans to Mars has been the subject of aerospace engineering and scientific studies since the late 1940s as part of the broader exploration of Mars. Long-term proposals have included sending settlers and terraforming the planet. Proposals for human missions to Mars have come from agencies such as NASA, CNSA, the European Space Agency, Boeing, and SpaceX. Currently, only robotic landers and rovers have been on Mars. The farthest humans have been beyond Earth is the Moon, under the Apollo program.

Astronautical hygiene evaluates, and mitigates, hazards and health risks to those working in low-gravity environments. The discipline of astronautical hygiene includes such topics as the use and maintenance of life support systems, the risks of the extravehicular activity, the risks of exposure to chemicals or radiation, the characterization of hazards, human factor issues, and the development of risk management strategies. Astronautical hygiene works side by side with space medicine to ensure that astronauts are healthy and safe when working in space.

Health threats from cosmic rays are the dangers posed by cosmic rays to astronauts on interplanetary missions or any missions that venture through the Van-Allen Belts or outside the Earth's magnetosphere. They are one of the greatest barriers standing in the way of plans for interplanetary travel by crewed spacecraft, but space radiation health risks also occur for missions in low Earth orbit such as the International Space Station (ISS).

<span class="mw-page-title-main">Serena Auñón-Chancellor</span> American physician, engineer, and NASA astronaut

Serena Maria Auñón-Chancellor is an American physician, engineer, and NASA astronaut. She visited the ISS as a flight engineer for Expedition 56/57 on the International Space Station.

<span class="mw-page-title-main">Astronaut training</span> Preparing astronauts for space missions

Astronaut training describes the complex process of preparing astronauts in regions around the world for their space missions before, during and after the flight, which includes medical tests, physical training, extra-vehicular activity (EVA) training, procedure training, rehabilitation process, as well as training on experiments they will accomplish during their stay in space.

<span class="mw-page-title-main">Effects of ionizing radiation in spaceflight</span> Cancer causing exposure to ionizing radiation in spaceflight

Astronauts are exposed to approximately 50-2,000 millisieverts (mSv) while on six-month-duration missions to the International Space Station (ISS), the Moon and beyond. The risk of cancer caused by ionizing radiation is well documented at radiation doses beginning at 100mSv and above.

<span class="mw-page-title-main">Renal stone formation in space</span>

Renal stone formation and passage during space flight can potentially pose a severe risk to crew member health and safety and could affect mission outcome. Although renal stones are routinely and successfully treated on Earth, the occurrence of these during space flight can prove to be problematic.

Illnesses and injuries during space missions are a range of medical conditions and injuries that may occur during space flights. Some of these medical conditions occur due to the changes withstood by the human body during space flight itself, while others are injuries that could have occurred on Earth's surface. A non-exhaustive list of these conditions and their probability of occurrence can be found in the following sources:

Heart rhythm disturbances have been seen among astronauts. Most of these have been related to cardiovascular disease, but it is not clear whether this was due to pre-existing conditions or effects of space flight. It is hoped that advanced screening for coronary disease has greatly mitigated this risk. Other heart rhythm problems, such as atrial fibrillation, can develop over time, necessitating periodic screening of crewmembers’ heart rhythms. Beyond these terrestrial heart risks, some concern exists that prolonged exposure to microgravity may lead to heart rhythm disturbances. Although this has not been observed to date, further surveillance is warranted.

<span class="mw-page-title-main">Psychological and sociological effects of spaceflight</span>

Psychological and sociological effects of space flight are important to understanding how to successfully achieve the goals of long-duration expeditionary missions. Although robotic spacecraft have landed on Mars, plans have also been discussed for a human expedition, perhaps in the 2030s, or as early as 2024 for a return mission.

<span class="mw-page-title-main">Sleep in space</span> Sleep in an unusual place

Sleeping in space is part of space medicine and mission planning, with impacts on the health, capabilities and morale of astronauts.

Tamarack "Tam" R. Czarnik is an American medical researcher, notable for space advocacy and academic studies of human physiology in extreme environmental conditions. Czarnik is especially known for his scientific contributions to space medicine as well as a better understanding of such phenomena as ebullism and uncontrolled decompression. He is the author of a number of publications in the domain of bioastronautics including "Ebullism at 1 million feet: Surviving Rapid/Explosive Decompression" and "Medical emergencies in space". Czarnik was at the origin of the Mars Society Chapter foundation in Dayton, Ohio, and also served as the chapter's first Chair. From 2001 to 2011, Czarnik served in several missions as Medical Director for the Mars Society's FMARS and MDRS, simulated Mars habitats.

<span class="mw-page-title-main">Translational Research Institute for Space Health</span> Space medicine consortium

The Translational Research Institute for Space Health (TRISH) is a virtual, applied research consortium that pursues and funds translational research and technologies to keep astronauts healthy during space exploration, with the added benefit of potential applications on Earth. TRISH is specifically focused on human health in preparation for deep space exploration efforts, including National Aeronautics and Space Administration's (NASA) Artemis missions to the Moon, and future human missions to Mars. TRISH also supports research to collect and study biometric data gathered on commercial spaceflight missions to better understand the effect of spaceflight on the human body.

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. ↑ Ball, John R.; Evans, Charles H., eds. (2001). Safe Passage : Astronaut Care for Exploration Missions. Washington, D.C.: National Academy Press. ISBN   978-0-309-50009-8.
  3. 1 2 3 4 5 6 7 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. ↑ Barger, Laura K; Flynn-Evans, Erin E; Kubey, Alan; Walsh, Lorcan; Ronda, Joseph M; Wang, Wei; Wright, Kenneth P; Czeisler, Charles A (September 2014). "Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after spaceflight: an observational study". The Lancet Neurology. 13 (9): 904–912. doi:10.1016/S1474-4422(14)70122-X. PMC   4188436 . PMID   25127232.
  5. ↑ Putcha, L.; Berens, K. L.; Marshburn, T. H.; Ortega, H. J.; Billica, R. D. (July 1999). "Pharmaceutical use by U.S. astronauts on space shuttle missions". Aviation, Space, and Environmental Medicine. 70 (7): 705–708. ISSN   0095-6562. PMID   10417009.
  6. ↑ Auñón-Chancellor, Serena M.; Pattarini, James M.; Moll, Stephan; Sargsyan, Ashot (2020). "Venous Thrombosis during Spaceflight". New England Journal of Medicine. 382 (1): 89–90. doi: 10.1056/NEJMc1905875 . PMID   31893522.
  7. ↑ Berry, CA (1974). "Medical legacy of Apollo". Aerosp Med. 45 (9): 1046–1057. PMID   4153403.
  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. ↑ Kim W, et al. (April 29, 2013). "Spaceflight Promotes Biofilm Formation by Pseudomonas aeruginosa". PLOS One . 8 (4): e6237. Bibcode:2013PLoSO...862437K. doi: 10.1371/journal.pone.0062437 . PMC   3639165 . PMID   23658630.
  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. ↑ Dose, K.; Bieger-Dose, A.; Dillmann, R.; Gill, M.; Kerz, O.; Klein, A.; Meinert, H.; Nawroth, T.; Risi, S.; Stridde, C. (1995). "ERA-experiment "space biochemistry"". Advances in Space Research. 16 (8): 119–129. Bibcode:1995AdSpR..16h.119D. doi:10.1016/0273-1177(95)00280-R. PMID   11542696.
  15. ↑ Horneck G.; Eschweiler, U.; Reitz, G.; Wehner, J.; Willimek, R.; Strauch, K. (1995). "Biological responses to space: results of the experiment "Exobiological Unit" of ERA on EURECA I". Adv. Space Res. 16 (8): 105–18. Bibcode:1995AdSpR..16h.105H. doi:10.1016/0273-1177(95)00279-N. PMID   11542695.
  16. 1 2 3 4 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.

PD-icon.svg 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).

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.