Safe Passage Astronaut Care for Exploration Missions (2001) / Chapter Skim
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Pages 75-116
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From page 75... ...
Committee on Creating a Vision for Space Medicine During Travel Beyond Earth Orbit was this: what can usefully be said, so far in advance, about providing day-to-day health care in space, while on the Martian surface, and during the return trip to Earth? What types of illnesses and injuries might reasonably be anticipated on long-duration space missions?
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From page 76... ...
The crew should be prepared to treat a wide variety of conditions of various degrees of severity during a space mission and, most of all, be prepared to treat the unexpected. The major health and medical issues related to exploration-class missions have been of little risk or concern to NASA up to the present for shortduration space travel (e.g., space transportation system I STS I space shuttle missions)
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From page 77... ...
, and opportunities and ethical and infrastructure concerns (Chapters 6 and 7) that it believes is necessary to promote the needed attention to the safe passage and the health of astronauts during travel beyond Earth orbit and into deep space.
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From page 78... ...
None of these medical conditions have required the mission to end, have been life threatening, or have required intensive medical treatment; they are bothersome but are not medical emergencies. Explorationclass missions, however, because of their lengths of as many as 3 years beyond Earth orbit, raise in NASA's current judgment the probability of a major medical event, a condition requiring intervention by a medical practitioner, during the mission (Billica, 2000~.
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From page 79... ...
This is a good example of the importance of training to prevent medical injury. The microgravity environments of long-duration space missions will also be associated with overexertion, strains, and sprains, because backaches and effects from the physical demands of EVAs have been reported during shorter missions and require pharmacological treatment (Putcha et al., 19991.
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From page 80... ...
. These data relate to the type and incidence of medical-surgical and behavioral health events that occur in these environments and are needed to best gauge and plan for future needs during extended space travel before commencement of exploration-class space missions with astronaut crews.
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From page 81... ...
data are extrapolated to extended space travel or habitation, the psychosocial support needs may well be just as important as the medical needs in a long-duration space mission. The medical reasons for submarine evacuations from 1993 to 1996 varied (Table 3-61.
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From page 82... ...
The spectrum of disorders was very broad and included cases of arrhythmia, paroxysmal superventricular tachycardia, infectious hepatitis, gastrointestinal hemorrhage, meningococcemia, paranoid schizophrenia, appendicitis, pilonidal abscess, perirectal abscess, ureteral calculi, testicular torsion, and crush injuries, further emphasizing that the scope of anticipated medical conditions on long-duration space missions will be very broad (Tansey et al., 19791. The incidence of the types of illnesses observed during extended submarine missions is generally similar to the incidence encountered during spaceflights.
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From page 83... ...
SOURCE: Marshburn, 2000b. NOTE: Further information on symptom duration, functional impact, or recurrences, especially the nature of arrhythmias and the number of astronauts who experienced them, is important for assessment of the potential impacts of such events on prolonged space missions.
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From page 84... ...
NOTE: This list reaffirms the discomforts experienced by crew of previous missions and suggests the probability that nasal congestion, sleep disorders, pain, and constipation will afflict the crews of longer-duration space missions. TABLE 3-5 incidence of Health Disorders and Meclical-Surgical Procedures During 136 Submarine Patrols Disorder Number/100,000 Person-Days Injury (includes accidents)
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From page 85... ...
Each of these is a possible medical event on a spacecraft, indicating the wide variety of medical emergencies that can occur and that must be considered in planning for health care management in TABLE 3-7 ANARE Health Register Illnesses in Antarctica from 1988 to 1997 Disorder Number Percent Injuryand poisoning 3,910 42.0 Respiratory 910 9.7 Skin, subcutaneous 899 9.6 Nervous system or sensory organs 702 7.5 Digestive 691 7.4 Infection or parasitic 682 7.3 Musculoskeletal or connective tissue 667 7.1 III-defined symptoms 335 3.6 Mental 217 2.3 SOURCE: Lugg, 2000.
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From page 86... ...
For example, certain abnormal lipid profiles are an identified risk factor for atherosclerosis, elevated blood pressure is an identified risk factor for stroke and heart disease, and osteoporosis is a risk factor for hip fracture. As a result of the Human Genome Project, investigators are also identifying DNA sequences that correlate with an increased risk for a particular disease or syndrome, and the basis for this increased risk is being elucidated.
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From page 87... ...
and promote the health and safety of astronauts for longduration space travel. While on a long-duration mission beyond Earth orbit the starting point for medical care will most often be a description of the chief complaint and a physical examination.
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From page 88... ...
Health Care Opportunity 1. Expanding validating and standardizing a modified physical examination, the microgravity examination technique, and incl?
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From page 89... ...
, a degree of malnutrition is anticipated in nearly all astronauts during space travel without the use of countermeasures and is expected in even 61 to 94 percent of astronauts with the use of countermeasures. Just as the effects of zero gravity or microgravity on the pharmacodynamics and metabolism of pharmaceuticals are unknown (see below)
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From page 90... ...
Clinical research on the pharmacokinetics en cl pharn~acodynamics of drugs in space is limited by the small numbers of participants, limited opportunities for clinical study (i.e., few space missions) , and the lack of a reasonable
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From page 91... ...
Health Care Opportunity 2. Developing an easily accessible database for medications on the spacecraft, including dosage, indications, adverse effects, and anticipated changes in the pharmacokinetic profile in .
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From page 92... ...
Finally, the committee is confident that advances in materials will allow the inclusion of a lightweight, lowvolume recompression chamber in the manifest for missions beyond Earth
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From page 93... ...
. Internal Environment During long-duration space missions, the internal environment of the spacecraft will offer its own unique challenges, ranging from chemical and microbial contamination to noise and vibration.
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From page 94... ...
Fifteen species of bacteria were recovered from samples collected during space missions. Staphylococcus, Micrococc?
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From page 95... ...
. The noise levels on a number of space missions has exceeded this baseline limit, exposing the crew to noise levels far greater than normal terrestrial noise levels.
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From page 96... ...
of energy can penetrate a space suit, and 25- to 30-MeV protons can penetrate the space shuttle (Lemaire et al., 19961. Beyond Earth orbit, the issue of radiation exposure presents a major challenge for NASA as the quantities of solar and galactic radiation and the potential for exposure increase.
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From page 97... ...
Some of the cardiovascular symptoms and abnormalities that astronauts may present with during a long-duration space mission include high blood pressure with or without symptoms; atrial and ventricular premature beats; atrial arrhythmias, such as atrial fibrillation, atrial flutter, and supraventricular tachycardia; sustained and nonsustained ventricular fibrillation; chest pain, ischemic and nonischemic; shortness of breath, cardiac and noncardiac; orthostatic hypotension; syncope; vasovagal and other cardioneurogenic responses; and edema, cardiac and noncardiac. A strategy must be in place to deal with these on a risk-assessed priority basis and with the possible occurrence of myocardial infarction, whose incidence may increase with the generally increasing age of astronauts at the start of space missions and the extended lengths of missions beyond Earth orbit.
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From page 98... ...
It also focused attention, including that of NASA, on the need to address the possibility of debilitating dental emergencies in space. In April 2000, the IOM Committee on Creating a Vision for Space Medicine During Travel Beyond Earth Orbit held a public workshop entitled Space Dentistry: Maintaining Astronauts' Oral Health on Long Missions (see Appendix A)
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From page 99... ...
MANAGING RISKS TO ASTRONAUT HEALTH 99 ties. For these reasons, the crew should be prepared to use restorative techniques and materials in microgravity, and NASA should support the development of new restorative techniques and materials that can be used in .
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From page 100... ...
Also, although no human data exist in the current database, microgravity-induced decreases in bone density might also contribute to tooth and gum disease. Health Care Opportunity 10.
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From page 101... ...
levels, exaggeration of increases in TSH levels in response to a challenge with thyroid-releasing hormone, and more rapid production and clearance of T3 and thyroxin but normal levels of both in serum (Reed et al., 19901. Thyroid axis kinetics should be further studied during space missions (Lovejoy et al., 1999)
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From page 102... ...
Many astronauts who develop symptoms of SMS also seem to develop a transient ileus, diagnosed by an absence of bowel sounds. Although motility may remain decreased throughout the space mission and the bacterial population may change, the etiologies are unclear and data from short-duration space missions do not suggest that these lead to significant medical problems.
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From page 103... ...
will be performed on long-duration missions beyond Earth orbit. At this time development of specific countermeasures related to the gastrointestinal tract does not appear to be required before long-duration space travel.
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From page 104... ...
Not only are oral contraceptives an effective way to manage dysfunctional uterine bleeding or bleeding associated with anovulation, should that occur in space, oral contraceptives are also effective treatment for the estrogen deprivation associated with hypogonadotropic hypogonadism and prevention of the bone mineral density loss associated with this condition. Hormone replacement therapy is known to be effective in preventing osteoporosis among women of certain ages on Earth.
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From page 105... ...
Although the clinical significance of these alterations has not been determined, the effects on skin and wound infections and wound healing during long-duration space missions could become clinically important. Preflight isolation techniques for spaceflight crewmembers are reported to have decreased the infection rate for the 3 weeks preflight from about 50 percent to only occasional events (Ferguson, 1977; Ferguson et al., 19771.
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From page 106... ...
Mental Health Issues The transition to long-duration space missions will require greater emphasis on ways to prevent and successfully manage an array of challenges to the cognitive capacities and emotional stabilities of astronauts who will find themselves in an isolated, confined, and hazardous environment. They will be devoid of much of what supports their emotional well-being on Earth and will need to develop and maintain new coping strategies appropriate to the unique environment of space beyond Earth orbit.
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From page 107... ...
On missions beyond Earth orbit, in which spacecraft crews will be isolated and confined to a relatively small living space and in which medical evacuation will not be an option, the development of these and other mental health problems may exert cumulative detrimental effects both on individual astronauts and on their fellow crewmembers sufficient to jeopardize the mission. Meeting this challenge will require a reassessment of the mental health needs of astronauts in the context of NASA's overall health care program.
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From page 108... ...
In addition, personal and family history data coupled with laboratory testing may identify individuals at increased risk for mental disorders (e.g., depression) that may emerge over the course of longduration space travel and may be included in the database on which crew selection and flight assignments are based.
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From page 109... ...
Technology offers promise for maintaining behavioral health when professional assistance is millions of miles away. One type of countermeasure is software designed to self-diagnose and relieve emotional symptoms before they become a psychiatric condition.
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From page 110... ...
and Russian manned space missions suggest that minor neurological problems are frequently encountered (Tables 3-2 and 3-31. These include headache and vestibular dysfunction, particularly upon the initial entry into microgravity.
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From page 111... ...
Establishing a coordinated clinical research program that addresses the issues of neurological safety and care for astronauts during long-ration missions beyond Earth visit. Urinary Disorders Genitourinary disease may present as an infection, obstruction, or malignancy.
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From page 112... ...
As ultrasound devices become smaller, it is likely that an ultrasound device will be standard medical equipment for all long-duration space missions. This would make it possible and desirable to perform in-mission screening for nephrolithiasis (to identify those who require medication or increased levels of hydration to treat calculi)
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From page 114... ...
Recommendation NASA should give increased priority to understanding, mitigating, and communicating to the public the health risks of long-duration missions beyond Earth orbit. · The process of understanding and mitigating health risks should be open and shared with the national and international general biomedical and health care research communities.
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From page 116... ...
Story Musgrave during an EVA, i.e., a space walk, on December 8, 1993, from the space shuttle Endeavor, during STS-61. The space walk to deploy solar arrays on the Hubble Space Telescope lasted 7 hours and 21 minutes.
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