Safe Passage Astronaut Care for Exploration Missions (2001) / Chapter Skim
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Pages 189-220
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From page 189... ...
Traditionally, the National Aeronautics and Space Administration (NASA) has depended on a preventive approach to astronaut health, re189
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From page 190... ...
With long-duration space missions the number and variety of health conditions facing astronauts who may require medical intervention before, during, and after space travel will continue to expand. There are medical conditions that have the potential to seriously impair the ability of astronauts to function in the spacecraft, during egress, while working outside the spacecraft, and upon the return to Earth.
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From page 191... ...
The committee strongly believes that the success of the mission and the successful return of healthy individuals demand, on the basis of risk analysis and management of the evidence base, the highest reasonably attainable standard of health care with the resources available before, during, and after such a mission. ORGANIZATIONAL COMPONENTS Providing the highest reasonably attainable standard of health care for astronauts during long-duration missions beyond Earth orbit will require an effective organizational framework that integrates health care for astronauts with an effective health care research strategy.
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From page 192... ...
These documents are relevant because they describe acute care for the most urgent medical needs that may occur during space travel and because they describe the framework or infrastructure that an adequate health care system must have to meet those needs. The documents also represent examples of what may be learned from fields outside those to which NASA has normally turned for advice and, in the case of the document from the American College of Surgeons, emphasize the importance of periodic updating of standards and procedures on the basis of new knowledge and theory.
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From page 193... ...
Important to the committee in this regard are the elements of coo ruination with other organizational units within NASA, integration of astronaut health with other components of the space mission, and authority to determine what is in the best interests of astronaut health. Coorc~ination The committee learned of numerous examples of a lack of coordination among different organizational components of NASA.
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From page 194... ...
Furthermore, the individual accountable for astronaut health must have authority sufficient to ensure that all appropriate steps are taken to maintain the health of astronauts. The committee believes that the element of authority is of sufficient importance to require that the individual have both operational authority and budgetary authority, with checks and balances provided in part by internal NASA mechanisms and supplemented by an external advisory group modeled on advisory groups of the National Institutes of Health (NIH)
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From page 195... ...
The greatest disadvantage of an external system is its diminished capability to coordinate with the health care research strategy of NASA to produce clinically relevant information so that NASA can provide the highest reasonably attainable standard of health care for astronauts during long-duration missions beyond Earth orbit. Astronaut health care established through a contractual arrangement NSF is providing health care in Antarctica through a contractual arrangement.
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From page 196... ...
Contracting with an established nonfederal health care system or organization to provide comprehensive health care for astronauts would have a mixture of the advantages and disadvantages described above for an established federal health care system, particularly the diminished capability for integration of clinical information and clinical research into the health care research strategy of NASA. Astronaut health care as part of a public-private group NSBRI is responsible for research in countermeasure development.
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From page 197... ...
After considering the evidence and testimony presented to it during the meetings conducted for preparation of this report, the committee strongly believes that a major revision of NASA's organizational structure is needed to provide for the optimum health and safety of astronauts for future longduration missions beyond Earth orbit. The committee believes that NASA needs a single organizational component whose head has overall responsibility for the health and safety of astronauts.
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From page 198... ...
The change will, in the considered judgment of the committee, allow NASA and the international space community to build a better-integrated comprehensive system of health care to provide for the best possible health and safety of all astronauts who travel beyond Earth orbit. CONCLUSION AND RECOMMENDATION Conclusion The challenges to humans who venture Iseyond Earth visit are complex Iseca?
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From page 199... ...
The official who heads the organizational unit should be assisted by officials who are separately responsible for clinical care and health care research. The proposed organizational component should · have authority over basic, translational, and clinical biomedical and behavioral health research; · foster coordination between NASA and the external research community; and · be overseen by an external advisory group, modeled on advisory groups of the National Institutes of Health and other federal external advisory groups, to provide program review, strategic planning, and leverage to assist NASA in meeting its goals for astronaut health.
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From page 200... ...
The committee believes that the interaction of humans and machines will be even more critical during longduration space missions than on short-term spaceflights. Operations There should be a clear description of the process for establishing, implementing, and updating policies, procedures, and protocols.
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From page 201... ...
NASA staff have cited two federal statutes, the Privacy Act and the Freedom of Information Act, and principles of medical confidentiality as constraints on the collection and full analysis of astronaut clinical data. Either the acts themselves or overly conservative interpretation of them has limited the acquisition of data necessary for the protection of astronauts and future space crews.
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From page 202... ...
Given the committee's conclusion that unless critical clinical problems are solved humans cannot safely "fly" on long-duration missions beyond Earth orbit, NASA should reconsider its research funding priorities. internal Relationships The role of the human component of space missions needs to be upgraded.
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From page 203... ...
These interactions should be encouraged and enhanced to address the important issue of bone loss during space missions and to help provide information about osteoporosis in general. The research resources of NIH, both in terms of funding and in terms of infrastructure for biomedical research, are far greater than those of NASA and could appropriately be used to support basic and clinical research that meets the priorities of both institutions.
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From page 204... ...
There is a need for information on the actions of pharmaceuticals in microgravity. As noted by the National Research Council's Space Studies Board and in information provided to the committee, there have been anecdotal reports of altered drug efficacy on short-duration space missions.
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From page 205... ...
Furthermore, the military model of the organization and delivery of medical care may provide further insights into NASA's nascent organization of a model for health care during long-duration space missions. Communicating Necessary Information Although exploration and discovery hold special places in the human psyche, space holds a fascination.
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From page 206... ...
Long-duration space travel, especially that beyond Earth orbit, entails known as well as unknown risks. The committee believes that there is a profound professional and ethical responsibility to evaluate honestly the risk to human life that will be incurred as a result of extended space travel.
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From page 207... ...
781: "Mechanisms are needed to ensure that protocols and facilities for pre- and postflight monitoring and testing are consistent across national boundaries. There have to be common criteria for evaluation and utilization of countermeasures and international cooperation in their development." The committee would add that medical care, as practiced on the ISS and on long-duration missions beyond Earth orbit, must also be consistent for individuals of all nationalities.
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From page 208... ...
OPERATIONAL AND CLINICAL COMPONENTS On the basis of the committee's perspective that deep space represents a unique environment and that the health and safety of astronauts are paramount, the committee recommends a comprehensive, integrated health care
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From page 209... ...
Care for the family is justified both for the reasons defined by the military for example, as a benefit that augments low pay and that is a necessity in areas where health care may otherwise be unavailable and in a profession where personnel are often subject to geographical moves and because of the interrelationship between family health (both physical and psychosocial) and astronaut health during the stressful separation while the astronaut is on long-duration space missions.
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From page 210... ...
For care during the mission, the standard of care must, of necessity, evolve. For example, should a long-duration mission beyond Earth orbit occur in the near future, the standard would likely be less ideal than it would be if the mission occurred farther in the future, when new knowledge and the further development of prevention and treatment measures, care protocols, and skills could be incorporated.
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From page 211... ...
Tertiary prevention is dependent on having welltrained medical personnel and databases on board the spacecraft and access to qualified personnel and other resources on the ground. An additional point of importance is that of triage, which, to some degree, will govern care during long-duration missions beyond Earth orbit.
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From page 212... ...
Although it is theoretically possible that a planned long-duration mission beyond Earth orbit could be aborted because of the medical condition of a crewmember, the committee considers this unlikely because of the practical difficulty of doing so. Nevertheless, it is valuable to develop guidelines prospectively to address this issue.
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From page 213... ...
to exploring the larger role of medical informatics in the space program. Although this conceptual leap and its practical implications will be helpful on the ISS, medical informatics will be a necessity on any long-duration mission beyond Earth orbit.
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From page 214... ...
It will be important to incorporate continuing and future developments in medical informatics at all levels to ensure future success during travel beyond Earth orbit. Issues of Capability The committee's perspective causes it to have concern about three issues related to the clinical capability within the primary health care system: the small n problem, the flight surgeon, and continuing competence.
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From page 215... ...
The committee believes, because of the evidence that it heard and reviewed, that the role of the flight surgeon as counselor and primary care physician is a key one. One of the most important reasons for this is the isolation experienced by the astronaut during space travel and the lack of privacy that demands the availability of a confidential channel of information.
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From page 216... ...
Navy has had substantial experience with having a highly trained medical corpsman as the principal clinician on board a submarine. Furthermore, the time frame is distinctly different for travel beyond Earth orbit: telecommunication can be virtually instantaneous with a submarine, and when necessary, evacuation can and has taken place; that will not be the case in deep space.
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From page 217... ...
These examples represent ways in which NASA might go about evaluating the results of a health care system for astronauts. Moreover, the use of state-of-the-art methodologies of quality measurement and performance improvement would make a significant statement that, when NASA is in fact ready to send humans deep into space, astronaut health and safety would be its top priority.
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From page 218... ...
Recommendation NASA should develop a comprehensive health care system for astronauts for the purpose of collecting and analyzing data while providing the full continuum of health care to ensure astronaut health. A NASA-sponsored health care system for astronauts should · care for current astronauts, astronauts who are in training, and former astronauts, as well as, where appropriate, their families; · cover all premission, intramission, and postmission aspects of space travel; · incorporate innovative technologies and practices including clinical practice guidelines into prevention, diagnosis, treatment, and rehabilitation, including provision for medical care during catastrophic events and their sequelae;
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From page 219... ...
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From page 220... ...
Postmission debriefings ant! longitudinal behavioral health monitoring also provide the opportunity to evaluate the long-term effectiveness of premission training and intramission behavioral interventions, as well as to collect data on behavioral, social, and cultural issues that may not have been obvious during the premission and intramission phases.
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