The preceding information and examples illustrate the accelerating integration of engineering and biology. The committee encourages the National Aeronautics and Space Administration (NASA) to track these and other emerging opportunities closely to apply them to space medicine as the technology develops to meet the need.

Prevention of Infection

Accidental wounds (such as lacerations and open fractures) are considered contaminated and require therapeutic administration of antibiotics as well as judicious surgical management to prevent devastating infectious complications in the best of circumstances (Singer et al., 1997; Luchette et al., 2000). Infection is possible even after clean, elective surgery. This may be more likely when surgery is performed during a mission. Breaks in sterile technique may be more likely in microgravity, the microflora is altered among individuals in close confinement (i.e., individuals share microorganisms), and there may be alterations in immune function in astronauts. Prophylactic antibiotics have been shown to decrease the probability of wound infection and are commonly used in current surgical practice (McCuaig, 1992; Bold et al., 1998; Weigelt and Faro, 1998). Selection of antibiotics for prophylactic and therapeutic purposes should be based upon knowledge of the microfloras that colonize the skin and gastrointestinal tract, coupled with pharmacological considerations (e.g., frequency and ease of administration and potential toxicity).

Management of Common Surgical Emergencies

Although one can anticipate the most common surgical emergencies from demographic and analog-environment data, unanticipated events can and do occur. A subarachnoid hemorrhage was managed by physicians in Antarctica, despite inadequate facilities, through ingenuity and innovation (Pardoe, 1965). Whether such a heroic effort could be undertaken or should be undertaken in the context of a space mission is doubtful, but it serves to show the human drive to preserve life, even against all odds. It also demonstrated how improvisation led to a successful outcome. Although it is not possible to plan for all emergencies, it may be possible to facilitate improvisation by providing the basic materials.

Fairly good data on the incidence of likely surgical emergencies are available from demographic and analog environments (Lugg, 2000). Anticipated

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