drawal of care or for the provision of only supportive care should be avoided. Other factors to consider include resource utilization in the event of multiple illnesses or casualties, identification of specific roles for caregivers, anticipated end points of treatment, and communication with the ground crew to assist in prioritization of care.

Health Care Opportunity 15. Developing a resource-based medical triage system that contains guidelines for the management of individual and multiple casualties during space travel.

ANESTHESIA AND PAIN MANAGEMENT

During long-duration space missions, anesthesia and pain management may be required for unanticipated accidents (e.g., fractures of bones, lacerations, or blunt trauma), medical conditions (e.g., appendicitis or a perforated viscus), and possibly, cardiopulmonary resuscitation. This aspect of health care in microgravity presents major challenges. Inhaled volatile and gaseous anesthetics must be avoided because of leakage of sub anesthetic doses in a controlled environment, limited knowledge of gas diffusion in zero gravity, and the necessity for endotracheal intubation.

The spacecraft poses many challenges that need to be resolved before anesthesia and pain management can be delivered safely. First, the limited amount of physical space available not only will dictate the use of smaller equipment but also may preclude the use of some instrumentation that is standard during anesthesia delivery on Earth. The second challenge will be the selection of an astronaut(s) who has the technical skills necessary to administer the various components of anesthesia.

Airway Management in Space

It will be essential to have on board spacecraft astronauts who have requisite training in airway management, along with strategies for retaining these skills. However, success in applying some of the most effective methods of airway management requires frequent and regular practice, in the opinion of members of the committee who as part of their professional activities have expertise in airway management, and it is not likely that an individual with such characteristics will be on board the spacecraft. Therefore, techniques that are based on the likelihood of success should be chosen, and these should be consistent with the skills of the individuals on board. The types of airway equipment and techniques required will partly



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