Jamie M Robertson1, Roger D Dias2, Avni Gupta3, Thomas Marshburn4, Stuart R Lipsitz5, Charles N Pozner2, Thomas E Doyle6, Douglas S Smink7, David M Musson8, Steven Yule9. 1. STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts. 2. STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts. 3. Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts. 4. National Aeronautics and Space Administration, Johnson Space Center, Houston, Texas. 5. Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts. 6. Department of Electrical and Computer Engineering, McMasters University, Hamilton, Ontario, Canada. 7. Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts. 8. Division of Clinical Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada. 9. STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: syule@bwh.harvard.edu.
Abstract
BACKGROUND: Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs). We sought to identify medical events with potential for rescue, range them according to the potential impact on crew health and mission success during LDEMs, and develop a list of NTSs to train for management of in-flight medical events. MATERIALS AND METHODS: Twenty-eight subject matter experts with specializations in surgery, medicine, trauma, spaceflight operations, NTS training, simulation, human factors, and organizational psychology completed online surveys followed by a 2-d in-person workshop. They identified and rated medical events for survivability, mission impact, and impact of crewmember NTSs on outcomes in space. RESULTS: Sudden cardiac arrest, smoke inhalation, toxic exposure, seizure, and penetrating eye injury emerged as events with the highest potential mission impact, greatest potential for survival, and that required excellent NTS for successful management. Key NTS identified to target in training included information exchange, supporting behavior, communication delivery, and team leadership/followership. CONCLUSIONS: With a planned Mars mission on the horizon, training countermeasures need to be developed in the next 3-5 y. These results may inform policy, selection, medical system design, and training scenarios for astronauts to manage in-flight medical events on LDEMs. Findings may extend to surgical and medical care in any rural and remote location.
BACKGROUND: Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs). We sought to identify medical events with potential for rescue, range them according to the potential impact on crew health and mission success during LDEMs, and develop a list of NTSs to train for management of in-flight medical events. MATERIALS AND METHODS: Twenty-eight subject matter experts with specializations in surgery, medicine, trauma, spaceflight operations, NTS training, simulation, human factors, and organizational psychology completed online surveys followed by a 2-d in-person workshop. They identified and rated medical events for survivability, mission impact, and impact of crewmember NTSs on outcomes in space. RESULTS: Sudden cardiac arrest, smoke inhalation, toxic exposure, seizure, and penetrating eye injury emerged as events with the highest potential mission impact, greatest potential for survival, and that required excellent NTS for successful management. Key NTS identified to target in training included information exchange, supporting behavior, communication delivery, and team leadership/followership. CONCLUSIONS: With a planned Mars mission on the horizon, training countermeasures need to be developed in the next 3-5 y. These results may inform policy, selection, medical system design, and training scenarios for astronauts to manage in-flight medical events on LDEMs. Findings may extend to surgical and medical care in any rural and remote location.
Authors: Stefan Riwaldt; Thomas J Corydon; Desiré Pantalone; Jayashree Sahana; Petra Wise; Markus Wehland; Marcus Krüger; Daniela Melnik; Sascha Kopp; Manfred Infanger; Daniela Grimm Journal: Front Bioeng Biotechnol Date: 2021-06-17