Medical treatment during spaceflight
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It is inevitable that medical conditions of varying complexity, severity and emergency will occur during
spaceflight Spaceflight (or space flight) is an application of astronautics to fly spacecraft into or through outer space, either with or without humans on board. Most spaceflight is uncrewed and conducted mainly with spacecraft such as satellites in or ...
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. Return to Earth will be highly unlikely or very difficult depending on the distance traveled. 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. For
NASA The National Aeronautics and Space Administration (NASA ) is an independent agency of the US federal government responsible for the civil space program, aeronautics research, and space research. NASA was established in 1958, succeeding t ...
, specific provisions and requirements for medical services during space missions are outlined i
NPD 8900.5B NASA Health and Medical Policy for Human Space ExplorationNPD 8900.1G Medical Operations Responsibilities in Support of Human Space Flight Programs
an
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, Space Adaptation Sickness, motion sickness,
headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...
,
sleeplessness Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
, back pain,
trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...
, burns, dermatological conditions, musculoskeletal conditions, respiratory illness and genitourinary problems.


Emergencies

Potential medical emergencies during space flight
arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
s,
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tr ...
,
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
, embolism, massive
hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
, emergencies related to
renal stone Kidney stone disease, also known as nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material (kidney stone) develops in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine s ...
formation,
infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
and thrombotic complications. To date, arrhythmias, renal colic,
venous thrombosis Venous thrombosis is blockage of a vein caused by a thrombus (blood clot). A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off (embolizes) and flows to the lungs to ...
, and infections have been documented during space flights. The documented arrhythmias were mostly mild abnormalities, but potentially serious arrhythmias have been reported. The manifestation of
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...
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. Other medical emergencies that have been observed in space include rare but real cases of urological and dental emergencies. Additional consideration substantiates the risk of the inability to treat crew members on long-duration missions.


Radiation

Radiation In physics, radiation is the emission or transmission of energy in the form of waves or particles through space or through a material medium. This includes: * ''electromagnetic radiation'', such as radio waves, microwaves, infrared, visi ...
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.


Other risks

Other considerations for designing space medical care systems include exposure to
toxic substances Poison is a chemical substance that has a detrimental effect to life. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figuratively, with a broa ...
,
chemical burns A chemical burn occurs when living tissue is exposed to a corrosive substance (such as a strong acid, base or oxidizer) or a cytotoxic agent (such as mustard gas, lewisite or arsine). Chemical burns follow standard burn classification and may cau ...
,
electrical burn An electrical burn is a burn that results from electricity passing through the body causing rapid injury. Approximately 1000 deaths per year due to electrical injuries are reported in the United States, with a mortality rate of 3-5%. Electrical bur ...
s and
trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...
(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 Foodborne illness (also foodborne disease and food poisoning) is any illness resulting from the spoilage of contaminated food by pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of mad cow disease) ...
, became more virulent when cultivated in space. On April 29, 2013, scientists in Rensselaer Polytechnic Institute, funded by
NASA The National Aeronautics and Space Administration (NASA ) is an independent agency of the US federal government responsible for the civil space program, aeronautics research, and space research. NASA was established in 1958, succeeding t ...
, reported that, during
spaceflight Spaceflight (or space flight) is an application of astronautics to fly spacecraft into or through outer space, either with or without humans on board. Most spaceflight is uncrewed and conducted mainly with spacecraft such as satellites in or ...
on the
International Space Station The International Space Station (ISS) is the largest modular space station currently in low Earth orbit. It is a multinational collaborative project involving five participating space agencies: NASA (United States), Roscosmos (Russia), JAXA ...
, microbes seem to adapt to the
space environment Space environment is a branch of astronautics, aerospace engineering and space physics that seeks to understand and address conditions existing in space that affect the design and operation of spacecraft. A related subject, space weather, deals ...
in ways "not observed on Earth" and in ways that "can lead to increases in growth and
virulence Virulence is a pathogen's or microorganism's ability to cause damage to a host. In most, especially in animal systems, virulence refers to the degree of damage caused by a microbe to its host. The pathogenicity of an organism—its ability to ca ...
". More recently, in 2017,
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
were found to be more resistant to
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s and to thrive in the near-weightlessness of space.
Microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism'' from the el, ὀργανισμός, ''organismós'', "organism"). It is usually written as a single word but is sometimes hyphenated (''micro-organism''), especially in olde ...
s have been observed to survive the
vacuum A vacuum is a space devoid of matter. The word is derived from the Latin adjective ''vacuus'' for "vacant" or "void". An approximation to such vacuum is a region with a gaseous pressure much less than atmospheric pressure. Physicists often dis ...
of outer space.


On the ground

Ground-based incidences of illness encountered by individuals exposed to harsh environments (
Antarctic expedition This list of Antarctic expeditions is a chronological list of expeditions involving Antarctica. Although the existence of a southern continent had been hypothesized as early as the writings of Ptolemy in the 1st century AD, the South Pole was no ...
s, 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 Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into Intraparenchymal hemorrhage, the tissues of the brain, into its Intraventricular hemor ...
,
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
, myocardial infarction (heart attack),
appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a rup ...
and bone fractures. Cases of cancer and psychiatric illness were also documented. 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. 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.
Appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a rup ...
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 amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individ ...
s,
fractures Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...
, dislocations, depression and
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
.


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

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


See also

*
Astronautical hygiene 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 ...
*
Bioastronautics Bioastronautics is a specialty area of biological and astronautical research which encompasses numerous aspects of biological, behavioral, and medical concern governing humans and other living organisms in a space flight environment; and includ ...
* Effect of spaceflight on the human body *
Human analog missions Human analog missions are activities undertaken on Earth in various environments to simulate aspects of human missions to other worlds, including the Moon, asteroids, and Mars. These remote field tests are performed in locations that are identifie ...
* Illness and injuries during spaceflight *
Space adaptation syndrome Space adaptation syndrome (SAS) or space sickness is a condition experienced by as many as half of all space travelers during their adaptation to weightlessness once in orbit. It is the opposite of terrestrial motion sickness since it occurs when ...
*
Space colonization Space colonization (also called space settlement or extraterrestrial colonization) is the use of outer space or celestial bodies other than Earth for permanent habitation or as extraterrestrial territory. The inhabitation and territori ...
* Space exposure * *
Space survival Venturing into the environment of space can have negative effects on the human body. Significant adverse effects of long-term weightlessness include muscle atrophy and deterioration of the skeleton (spaceflight osteopenia). Other significant eff ...


References


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


* ttp://www.upi.com/Science_News/2012/02/06/Virtual-display-could-diagnose-illness-in-space/UPI-96181328577298 Virtual display could diagnose illness in space
Prophylactic surgery prior to extended-duration space flight: Is the benefit worth the risk?
{{Space medicine Space medicine