more advanced means of transmission during missions beyond Earth orbit, it is anticipated that clinical protocols (practice guidelines) will be the basis for medical decision making. Significant advances in guidelines development have occurred in the past two decades. The Agency for Healthcare Research and Quality (AHRQ) within the U.S. Department of Health and Human Services has been a leader in this area; cooperation between NASA and AHRQ could enhance NASA’s work in this area. In addition, DOD has substantial practical experience with clinical protocols. The committee heard specifically of the utility of clinical protocols administered by corpsmen in submarines. Further collaboration between NASA and DOD would similarly be useful, as would collaboration with the U.S. Department of Veterans Affairs with its experience with clinical guidelines, clinical protocols, informatics, and performance measures.

The health care systems for individuals in extreme isolated terrestrial environments—Antarctica, submarines, and the deep sea where divers work (see Appendix A)—share common structural characteristics. The committee believes that NASA could continue to learn from these analogs in developing its own health care system. In addition, the branches of the armed services have a long history of working in extreme situations and in developing model systems (IOM, 1999a). For example, most of what is known today about trauma surgery was developed on the battlefield. Furthermore, the military model of the organization and delivery of medical care may provide further insights into NASA’s nascent organization of a model for health care during long-duration space missions.

Communicating Necessary Information

Although exploration and discovery hold special places in the human psyche, space holds a fascination. Symbols of that fascination abound, from the National Air and Space Museum, to the NASA-dedicated cable television channel, to hit films such as Apollo 13, to programs about space on The Discovery Channel. Nor was the committee immune to that fascination. NASA has done an excellent job in building on this fascination, from the first lunar landing to the construction of the ISS.

NASA should pay increased attention to two areas of public communication, however. These are the communication of the benefits of research in space and the communication of risk. Both research support and research cooperation are often dependent on the perception of benefit. The committee heard from NASA staff that support for biomedical research was lacking



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