4
Emergency and Continuing Care

Dreams are like stars: you choose them as your guides and following them, you reach your Destiny.

Inscription on the wall of the science laboratory Destiny revealed on the opening day for Destiny on the International Space Station, February 11, 2001, accompanied by signatures of those who assembled the module

One or more acute severe emergency medical events such as a traumatic injury, toxic exposure, or acute cardiopulmonary decompensation will probably occur on a long-duration space mission. Some will resolve or at least improve quickly with treatment, others may require continuing care, and others may require resuscitative measures. The decision to initiate resuscitation or determine end points is complex and must be based upon the best judgment of the medical command on the International Space Station (ISS) and future spacecraft. Factors to be considered include whether there are single or multiple incidents, the resources available to treat the patient, and the operational impact upon the crew of the potential loss or extended disability of the patient. Case reports from the Australian National Antarctic Research Expeditions experience (Pardoe, 1965; Priddy, 1985; Taylor and Gormly, 1997) suggest that ingenuity and determination can be used during the treatment of unusual situations, so restrictive guidelines for the with-



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