Space Medicine: Human Physiological Changes and Health Care Strategies During Space Travel, Slides of Human Resource Management

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„„ The general charge to theThe general charge to the Committee on Creating aCommittee on Creating a Vision for Space MedicineVision for Space Medicine During Travel Beyond EarthDuring Travel Beyond Earth Orbit was to develop aOrbit was to develop a vision for space medicinevision for space medicine for longfor long--duration spaceduration space travel.travel. Publication date: 2001

SAFE PASSAGE SAFE PASSAGE

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To support safe human exploration of space,To support safe human exploration of space, NASA should pursue a two component strategy:NASA should pursue a two component strategy:

(1) A comprehensive health care system for(1) A comprehensive health care system for astronauts to capture all relevant epidemiologicalastronauts to capture all relevant epidemiological data.data. (2) Pursue a long term, focused health care(2) Pursue a long term, focused health care research strategy to capture all necessary data onresearch strategy to capture all necessary data on health risks and their amelioration.health risks and their amelioration.

An occupational health model should apply in theAn occupational health model should apply in the first case.first case.

Executive Summary

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““Today I Announce a new plan to explore space andToday I Announce a new plan to explore space and extend a human presence across our solar system.extend a human presence across our solar system. We will begin the effort quickly, using existingWe will begin the effort quickly, using existing programs and personnel. Weprograms and personnel. We’’ll make steady progress,ll make steady progress, one mission, one voyage, one landing at a time.one mission, one voyage, one landing at a time. ……to return to the moon by 2020, as the launchingto return to the moon by 2020, as the launching point for missions beyond.point for missions beyond.””

President Bush;President Bush; January 14, 2004January 14, 2004

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Michael Griffin, administrator of the US space agency statedMichael Griffin, administrator of the US space agency stated on September 25, 2007 at the International Aeronauticalon September 25, 2007 at the International Aeronautical Congress that:Congress that:

““We have a long term plan to put a man on mars by 2037.We have a long term plan to put a man on mars by 2037.””

September 2009September 2009

Panel: Return to Moon is NoPanel: Return to Moon is No--Go!Go!

ƒƒ An additional $3,000,000,000 per year, aAn additional $3,000,000,000 per year, a

mismatch between resources and rhetoric.mismatch between resources and rhetoric.

NASA is unable to get beyond lowNASA is unable to get beyond low--earthearth

orbit without more $$$! Other options areorbit without more $$$! Other options are

to be considered.to be considered.^ - -Seth Borenstein (AP)Seth Borenstein (AP)

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Sputnik Sputnik

„ „ October 4,1957October 4, „ „ 23 inch sphere23 inch sphere „ „ 184 pounds184 pounds

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“Ham” Radio Operator – listens to Sputnik I

W4RRVW4RRV

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First US Manned Flight May 5, 1961

Project Mercury 1958 - 1963

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Project Gemini

1962 - 1966

Space walk, extended weightlessness, docking

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Project Apollo 1960 - 1972

1 st^ manned flight to moon December 1968

Final lunar flight December 1972

Twelve men walked on the moon.

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Skylab MissionsSkylab Missions

May 14May 14^ thth^19731973 Mission duration:Mission duration: 28,59,84 days28,59,84 days

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Challenger

January 18, 1986

Columbia February 1, 2003 Seven fatalities (^) Seven fatalities

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Work on the ISSWork on the ISS

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Human Physiological Change Resulting from Human Physiological Change Resulting from

Extended Travel in SpaceExtended Travel in Space

„„ Musculosketical System:Musculosketical System: Loss of bone mineral densityLoss of bone mineral density Loss of skeletal muscleLoss of skeletal muscle ‰‰ Cardiovascular System:Cardiovascular System: Orthostatic hypotensionOrthostatic hypotension Loss of hydrostatic pressureLoss of hydrostatic pressure ‰‰ Pulmonary System:Pulmonary System: Changes in circulation and gas exchangeChanges in circulation and gas exchange ‰‰ Alimentary System:Alimentary System: IleusIleus Decrease absorption or malabsorptionDecrease absorption or malabsorption

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Human Physiological Change Resulting fromHuman Physiological Change Resulting from

Extended Travel in Space (ContExtended Travel in Space (Cont’’ed)ed)

„„ Nervous System:Nervous System: AtaxiaAtaxia Motion sicknessMotion sickness Disturbed fine motor functionsDisturbed fine motor functions Altered circadian rhythmAltered circadian rhythm ‰‰ Reproductive Systems:Reproductive Systems: Effect of radiation on gametesEffect of radiation on gametes ‰‰^ Urinary System:Urinary System: Renal CalculiRenal Calculi ‰‰ Hematological & Immunological system:Hematological & Immunological system:

AnemiaAnemia Potential immunologic depressionPotential immunologic depression

Work on the ISS 2020

Human Space Flight ExperienceHuman Space Flight Experience

ƒƒ 220 Astronauts current in the corp220 Astronauts current in the corp ƒƒ 460 Astronauts/Cosmonauts have flown460 Astronauts/Cosmonauts have flown ƒƒ 775 Individual space flights775 Individual space flights ƒƒ Over 128 STS missions up to 17 daysOver 128 STS missions up to 17 days ƒƒ Longest duration in space: Female: 188Longest duration in space: Female: 188 Male: 400 daysMale: 400 days ƒƒ^ 12 men have walked on the lunar surface12 men have walked on the lunar surface ƒƒ Aborts: Russia 3 –Aborts: Russia 3– USA 1USA 1 ƒƒ Deaths: US has lost 17 crew in mission relatedDeaths: US has lost 17 crew in mission related accidentsaccidents 2121

Medical Events on Space ShuttleMedical Events on Space Shuttle

Flights (STS) 1Flights (STS) 1--89 198189 1981 -- 1998^1998

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Medical Event Number Percent

SAS (motion sickness) 788 42

Nervous & sense organs 318 17

Digestive system 163 8.

Injuries 141 7.

MS System 132 7.

Respiratory System 83 4.

Behavioral 34 1.

Infectious disease 26 1.

Medical Events (Cont’ Medical Events (Cont’ed)ed)

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Medical Event Number Percent GU System 23 1. Circulatory Sys. 6 0. Endocrine, etc. 2 0.

Over 128 space shuttle flights by Sept. 2009

In Summary, puffy, constipated and tall.In Summary, puffy, constipated and tall.

Effects of Spaceflight on Infectious

disease

„„ Changes in microbial virulence. ImmuneChanges in microbial virulence. Immune

system may be compromised. Salmonellasystem may be compromised. Salmonella

typ. virulence is increased. Pathogenictyp. virulence is increased. Pathogenic

Organisms have been cultured withOrganisms have been cultured with

recycled air and water with risk ofrecycled air and water with risk of

increased events.increased events.

Effects of Spaceflight on Infectious

disease (Cont’ed)

„„^ Latent Herpes Virus EvidenceLatent Herpes Virus Evidence

„„ EBV, CMV, VZV reaction occurredEBV, CMV, VZV reaction occurred

„„ EBV, VZV both shed in saliva and urineEBV, VZV both shed in saliva and urine

inin ¼¼ astronautsastronauts

Observations from Observations from

SAFE PASSAGESAFE PASSAGE

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ƒƒ Space is the most extreme environment that humansSpace is the most extreme environment that humans have ever entered and beyond orbit is bothhave ever entered and beyond orbit is both quantitatively and qualitatively different.quantitatively and qualitatively different.

ƒƒ^ For the past 40 years NASA has missed criticalFor the past 40 years NASA has missed critical opportunities to collect & analyze clinical data.opportunities to collect & analyze clinical data.

ƒƒHealth data is considered private, and has resulted inHealth data is considered private, and has resulted in under reporting of relevant information.under reporting of relevant information.

Observations from Observations from

SAFE PASSAGESAFE PASSAGE

„„ Participation in clinical research has beenParticipation in clinical research has been considered voluntary.considered voluntary.

„„ Astronauts are a highly privileged group withAstronauts are a highly privileged group with rare and valuable opportunity who haverare and valuable opportunity who have aa responsibility to contribute to the safety andresponsibility to contribute to the safety and health of others.health of others.

„„ (^) Astronauts must be considered a uniqueAstronauts must be considered a unique population of research participants (lab rats).population of research participants (lab rats).

Observations fromObservations from

SAFE PASSAGESAFE PASSAGE

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ƒƒ Physician (Flight surgeon) plays multiple roles: coach, clinician,Physician (Flight surgeon) plays multiple roles: coach, clinician, researcher, and fellow Astronaut.researcher, and fellow Astronaut.

ƒƒ Make the collection of individual medical data an expected partMake the collection of individual medical data an expected part of participation in all space missions.of participation in all space missions.

ƒƒ “NASA should develop and use an occupational health model for“NASA should develop and use an occupational health model for collection and analysis of Astronaut health data.collection and analysis of Astronaut health data.””

ƒƒ^ Crew likely to be multicultural, international & both sexes.Crew likely to be multicultural, international & both sexes.

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Long Duration Space Flight

‰‰Astronauts will live and work for longer periods of time.Astronauts will live and work for longer periods of time. The longer in that environment, the more it resembles aThe longer in that environment, the more it resembles a workplace.workplace. ‰‰Issues of health and safety are more likely to arise.Issues of health and safety are more likely to arise. ‰‰In the occupational health context, medicalIn the occupational health context, medical confidentiality becomes less important.confidentiality becomes less important. ‰‰The occupational health model will need to transcendThe occupational health model will need to transcend astronaut personal concerns.astronaut personal concerns. ‰‰The occupational health model will become the primaryThe occupational health model will become the primary driver of medical services.driver of medical services.

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Important health issuesImportant health issues

„„ RadiationRadiation „„ (^) Loss of bone mineralLoss of bone mineral densitydensity „„ Cardiovascular effectsCardiovascular effects „„^ Behavioral adaptationBehavioral adaptation

Health Care StrategyHealth Care Strategy

„„ Expected incident ofExpected incident of health conditionshealth conditions

„„ Institute preventiveInstitute preventive measuresmeasures

„„^ Match healthMatch health condition with medicalcondition with medical managementmanagement

„ „ Level of skill on boardLevel of skill on board „ „ (^) Necessary diagnosticNecessary diagnostic technologiestechnologies „ „ Necessary treatmentNecessary treatment technologiestechnologies „ „ Measures to stabilizeMeasures to stabilize „ „ (^) Disposition plan inDisposition plan in case of deathcase of death

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Health Care Strategy (Cont'ed) Health Care Strategy (Cont'ed)

„„ Long-Long-term careterm care „„^ Medical surveillanceMedical surveillance „„ Strategy reviewStrategy review

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Purposes of Purposes of

Occupational Health SurveillanceOccupational Health Surveillance

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ƒ ƒ Incidence & Prevalence of disease and injury.Incidence & Prevalence of disease and injury.

ƒ ƒ (^) Identify individual causes of disease and injury.Identify individual causes of disease and injury.

ƒ ƒ Find and evaluate others who may be at risk.Find and evaluate others who may be at risk.

ƒ ƒ Discover new associations between agent andDiscover new associations between agent and diseasedisease ..

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New crew systemNew crew system Logistic lift systemLogistic lift system Establish a habitatEstablish a habitat Research laboratoryResearch laboratory Expendables generatorExpendables generator Dependable Bus liftDependable Bus lift

The Moon by 2020?

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The Moon by 2020?

Orion Moon Transportation Capsule

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Orion transporter Logistics (Ares I) transporter (Ares V)

Constellation System

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The Moon by 2020?

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The Moon by 2020?

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The Moon by 2020?

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The Moon by 2020?

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? To Mars By 2040 ?? To Mars By 2040?

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Human Expedition to Mars Human Expedition to Mars

Risk AreasRisk Areas

‰‰^ Advanced life supportAdvanced life support ‰‰ Environmental healthEnvironmental health

‰‰^ Human performanceHuman performance ‰‰ Bone lossBone loss ‰‰ (^) CardiovascularCardiovascular alternationsalternations ‰‰ Muscle alternationsMuscle alternations and atrophy'sand atrophy's

‰‰^ ImmunologyImmunology interaction andinteraction and hematologyhematology ‰‰ NeurovestibularNeurovestibular adaptationadaptation ‰‰ (^) Space medicineSpace medicine ‰‰ Food and NutritionFood and Nutrition

NASANASA -- Critical Path RoadmapCritical Path Roadmap

Space Radiation RiskSpace Radiation Risk

„„ (^) Long term exposureLong term exposure to Solar particleto Solar particle events and galacticevents and galactic cosmic radiationcosmic radiation „„ Cancer, NeurologicCancer, Neurologic effects, Reproductiveeffects, Reproductive alterations.alterations.

„„ Short term high-Short term high-energy, charged particlesenergy, charged particles

(HZE) –(HZE)– Death.Death.

„„ Estimates of events are based on largeEstimates of events are based on large

uncertainties.uncertainties.

ƒƒ Operational shieldingOperational shielding

ƒƒ Screening (genetic predisposition)Screening (genetic predisposition)

ƒƒ PreventionPrevention

ƒƒ InterventionIntervention

Countermeasures:Countermeasures:

Food for long duration Space flight

„„ Food packages have been tested for:Food packages have been tested for:

taste, texture, digestibility, residual andtaste, texture, digestibility, residual and

ease of preparation.ease of preparation.

„„ Main courses, desserts and drinks:Main courses, desserts and drinks:

1200 kcal and 550 kcal.1200 kcal and 550 kcal.

„„ 29 selections include: main courses, rice,29 selections include: main courses, rice,

soups, beverages, protein bars, chocolate,soups, beverages, protein bars, chocolate,

fruits and chewing gum.fruits and chewing gum.

Something more than a takeout or picnic basket

Food for long duration Space flight

(Cont’ed)

„„^ Main Courses of: beef, pork, chicken, fish,Main Courses of: beef, pork, chicken, fish,

bean curd, mushroom, cabbage.bean curd, mushroom, cabbage.

„„^ Sampling satisfaction rates of 86%Sampling satisfaction rates of 86% -- 100%100%

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Outbound Surface Stay Inbound

? To Mars By? To Mars By 2040 ?2040?

Transfer to Mars and return

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? To Mars By 2040 ?? To Mars By 2040?

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? To Mars By 2040 ?? To Mars By 2040?

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? To Mars By 2040?? To Mars By 2040?

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? To Mars By 2040 ?? To Mars By 2040?

First photograph of Earth and the moon taken from Mars.

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? To Mars By 2040?? To Mars By 2040?

High resolution photograph taken from Mars orbit.

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