The committee reviewed two documents that provide a portion of the conceptual framework for this section. The two documents, Resources for the Optimal Care of the Injured Patient (ACS, 1999) and Model Trauma Care System Plan (DHHS, 1992), address Earth-based care for a specific category of patient: patients with acute injuries. These documents are relevant because they describe acute care for the most urgent medical needs that may occur during space travel and because they describe the framework or infrastructure that an adequate health care system must have to meet those needs. The documents also represent examples of what may be learned from fields outside those to which NASA has normally turned for advice and, in the case of the document from the American College of Surgeons, emphasize the importance of periodic updating of standards and procedures on the basis of new knowledge and theory.

Leadership

The committee’s perspective on leadership is based on the training and experience of its members. That background emphasizes two values relevant to the issue of leadership: that someone is in charge and that continuity is a key component of health care. “In charge” requires both accountability for and authority over the funding needed to make all pertinent decisions with respect to the health of the astronaut corps. “Continuity” means that the health care system provides for the continuity, over time and space, of the health care of astronauts.

It is the intent of the committee to address the principles that it believes are necessary for an effective system for astronaut health care. The committee intends no judgment, positive or otherwise, of the current structure or of the individuals currently holding positions within NASA. Indeed, the NASA organizational structure dealing with astronaut health underwent substantial changes during the time of the committee’s study. These include a Johnson Space Center (JSC) proposal for a Bioastronautics Institute to coordinate research and health care and the designation of a NASA chief medical and health officer to provide health and medical policy oversight. Although the committee renders no opinion on the validity of these specific steps, it commends NASA for recognizing the need for change and believes that these steps could be appropriate in meeting the concerns that the committee developed in the course of its discussions. The committee is concerned, however, that the present organizational structure has not yet evolved to the level necessary to ensure astronaut health and safety during travel in deep space.



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