In this chapter, the committee tries to begin answering those questions by looking at the only evidence available: the morbidity and mortality experiences of U.S. astronauts and Russian cosmonauts, U.S. Navy submariners, and Australian scientists and explorers in the Antarctic. This look back includes findings from physical examinations conducted in space to see what is normal, or baseline, in microgravity. The committee also examines potential health problems in each of several medical practice areas—cardiology, neurology, surgery, and psychiatry, to name a few—in which critical risks have been identified (see Table 2–2).

The committee anticipates that long-duration missions beyond Earth orbit will be qualitatively different from short spaceflights. Medical and behavioral issues that have not been particularly problematic on short flights may loom large on exploration-class missions. It is not possible to accurately predict the treatment innovations, technological advances, and shifting standards of care that may occur over the next 20 years and prove relevant to medical practice in space.

GENERAL PRINCIPLES AND ISSUES

The focus of this chapter is the care of the individual patient in space. Premission evaluation should include assessments of both the astronaut’s health status (including the status of specific organ systems at risk, such as the musculoskeletal system [see Chapter 2 for the risks involved]) and other risks. The general principles of care are the maintenance of normal health status in microgravity and, if illness or injury occurs, restoration of normal function as quickly and efficiently as possible during and upon the return from the space mission. As part of a responsible space crew, each crewmember should be expected to participate in routine surveillance to be able to measure the health status of other members of the crew at regular intervals. Resources should be available for the diagnosis and treatment of the most common minor and major illnesses and injuries that are anticipated to occur in the Earth environment, as well as to diagnose and treat conditions that are unique to microgravity and the particular space mission. The crew should be prepared to treat a wide variety of conditions of various degrees of severity during a space mission and, most of all, be prepared to treat the unexpected.

The major health and medical issues related to exploration-class missions have been of little risk or concern to NASA up to the present for short-duration space travel (e.g., space transportation system [STS] space shuttle missions) (Box 3–1). All of the major health and medical issues are pro-



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