The committee believes that, according to current standards of practice, the medical community and the general public would expect a physician to be part of a crew during a period of extended space travel and strongly supports that concept. There are, however, hostile remote environments on Earth where medical care is routinely provided by an individual other than a physician (British Antarctic stations and U.S. submarines). Whether or not a physician should be an integral part of a long-duration space mission will be determined by a number of factors including crew number, the length of the mission, the duties of crewmembers, and the standard of health care expected during the mission.

If a physician is part of the crew, however, a number of needs must be met. Cross-training of several or possibly all crew members in selected skills is necessary in the event that there are multiple illnesses or injuries that need simultaneous care or in the event that the physician is disabled or becomes ill in flight. At least one nonphysician on the space crew should be trained to the emergency medical technician-paramedic level by today’s standards. The physician should have broad training and possess the general skill sets required for the evaluation and treatment of major illnesses and injuries involving organ systems and the identification and treatment of environmental illness and injury. The physician should also be trained in the technical procedures that will most likely be needed in the space environment, where evacuation to Earth for treatment is not possible. Methods should be developed for skill maintenance, retraining in those psychomotor skills that are most likely to be affected by microgravity, and the use of instructional and communication technologies such as telemedicine and virtual reality. The special skills actually required for performance of surgery can be acquired, augmented, or practiced by using simulators and a hybrid technology that has been termed “cybersurgery” (Satava, 1997; DiGioia et al., 1998; Satava and Jones, 1998). Training and retraining in clinical decision-making skills, clinical problem solving, and decision making for multiple casualties or illnesses are also necessary.

Health Care Opportunity 18. Developing a mechanism for skill maintenance and retraining in psychomotor skills during long-duration space missions.

The most important resource for care is the physician and the other members of the health care team, who must rapidly synthesize clinical and

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