Space Medicine: Out of Sight

Outer space is, without a doubt, a dangerous place. Now that we’ve landed a probe on a comet (Yes, a comet! If you haven’t heard about the incredible Rosetta mission yet, check it out here.), venturing out into that great yonder may not seem quite as daunting as it did before. But 53 short years ago, the final frontier was utterly fearsome. While we’d collected data and speculated widely about what might await the brave humans launched out of our atmosphere, we actually had no idea what would happen. What we did know was that lots of things could go wrong. Incidentally, that’s still true.

What’s the worst that could happen?

The concerns raised about the health hazards of space travel were myriad, ranging from engineering issues like maintaining cabin pressure, oxygen levels, and temperature, to coping with the many environmental challenges inherent to spaceflight, such as micrometeorites, radiation, and weightlessness. There was even worry that humans wouldn’t be able to adjust to the 90 minute day/night cycle of space (a 45 minute day followed by a 45 minute night)- thankfully, curtains did the trick- and that they would have abnormal psychological reactions to leaving earth, either from joy (“space euphoria”) or isolation (“break-off phenomenon”)1.

Fortunately, nearly none of these fears have been realized. The most common complaints of crewmembers by far are the symptoms of space adaptation: nasal congestion, back pain, motion sickness, insomnia, headache, and constipation5. Don’t get me wrong, space definitely has an impact on the human body. In zero gravity, body fluids shift toward the head, blood and body fluid volume decrease, bones and muscles begin to atrophy, and hormone levels are altered. Not only can these changes affect human health, they may pose serious challenges to medical care by making it difficult to determine the appropriate treatment and drug dosages for astronauts3.

space medicine
Is there a doctor in the house?

The right stuff

There are three main challenges to providing health care to space crew members: 1) the limited space available for medical equipment in a space shuttle, 2) the absence (usually) of medically trained mission crew members, and 3) potentially unfamiliar medical conditions that may be unique to space. Because of space constraints, the International Space Station (ISS) has a very limited capacity for sterilizing equipment, analyzing bodily fluids, providing suction, providing care after wound closure, dental care, or treating bone fractures5. There are no x-ray or MRI machines, so diagnostics depend on portable ultrasound devices, which, thankfully, are rapid and accurate4. There is no integrated system with ground operations (i.e. Houston) for tracking medical information or medical data collected in spaceflight. This is particularly problematic because the crew is responsible for collecting whatever data is needed to determine the right treatment for an afflicted colleague, which can be difficult, given their limited medical training5.

Because medical care during missions is so restricted, NASA heavily relies on preventative measures: finding the so-called “right stuff”. Astronauts are only allowed to fly if they pass rigorous physical and psychological exams5. If something does go wrong, the ailing crewmember is in the hands of the Crew Medical Officer (CMO). CMOs are usually not physicians, and receive only roughly 80 hours of additional training in medical diagnosis and treatment4. Luckily, the CMOs are not totally on their own. Although there is limited communication with Earth, astronauts are able to regularly consult physicians on the ground2.

Space medicine brought to earth

As spaceflights increase in duration, potentially stretching out for years or even lifetimes, there must be an expansion of extraterrestrial medical resources. Up to this point, there has been- however remote- the possibility of returning to earth in the event of a medical emergency. As we foray farther afield, that will no longer be true.

But even if the telemedicine techniques developed for spaceflight, portable ultrasound for diagnosis and consultation via satellite, become insufficient for life in space, they are incredibly helpful here on earth. Starting in the 1970s with the aid of NASA’s satellites, telemedicine has been used to provide medical care to remote and underserved regions of the world2,4. Since these programs started, they have been used for regular care, disaster relief, and to foster international medical cooperation (in a program delightfully entitled Spacebridge)2. The final frontier may be closer than you think.

References

  1. Berry, C. (1967). Space medicine in perspective. Journal of American Medical Association, 201(4):86-95.
  2. Doarn, CR, AE Nicogossian, & RC Merrell. (1998). Applications of telemedicine in the United States Space Program. Telemedicine Journal, 4(1):19-30.
  3. Garshnek, V. (1993). Astromedine and astrolaw. Space Policy, 95-98.
  4. Kufta, JM & SA Dulchavsky. (2013). Medical care in outer space: a useful paradigm for underserved regions on the planet. Surgery, 154(5):943-945
  5. Palowski, W. Exploration Medical Capability Evidence Report. NASA. 8 November 2013. Web. 15 November 2014. https://humanresearchwiki.jsc.nasa.gov/index.php?title=Exploration_Medical_Capabilites_Evidence_Re port

Image source: Creative Commons, http://en.wikipedia.org/wiki/NASA_Astronaut_Group_16

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Suzi Claflin

I am a postdoctoral fellow studying chronic disease epidemiology.

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