uled events, such as illness or injury, and the medical resources brought to bear should be those that best conform to an adapted terrestrial standard of care. In contingency conditions, therefore, only approved medical devices and accepted treatment guidelines are employed, while unproven equipment or monitoring of novel parameters is eschewed as the information thus provided lacks an appropriate clinical context. Given the numerous confounding factors and unknowns about pathology and pathophysiology in the microgravity environment, it is imperative that, to the greatest extent possible, medical care on orbit proceeds from accepted practices.

Conversely, nominal operations, which can include activities such as spacewalks, exercise, or research studies to define “space-normal” physiology, can and often do use new tools and monitor novel parameters. Often associated with research activities, nominal operations utilize both proven and innovative technologies to gather data, develop predictive models, and validate these predictions.

Under nominal operations the goal of metabolic monitoring is to intervene before a medical event occurs. Some of the on-orbit conditions that could be prevented in this way include dehydration, fatigue, heat stress, hyperventilation, and hypothermia. In addition, monitoring can also assist in the evaluation of specific performance metrics, such as cognition, workload, situational awareness, memory, and concentration, to ensure that critical or complex tasks are performed by competent operators. Fatigue is a constant concern in space operations because circadian cues are disrupted and sleep shifting is common, and it is thus considered ideally suited to monitoring. Fatigue was implicated as a factor in the collision of a Progress resupply rocket with the Mir space station, and crewmembers aboard the International Space Station (ISS) have also cited occasions where they performed complex and dangerous tasks (e.g., moving a Soyuz from one docking port to another) when extremely fatigued. The applicability of these concerns to military operations is readily apparent.

Also similar to military operations, space missions have very limited personnel. Space shuttle missions generally have seven-person crews, while the ISS crew complement is only three. (In the wake of the Columbia tragedy, there are currently only two crewmembers aboard the ISS. When the Shuttle fleet returns to flight status, it is anticipated that the program will return to a three-person crew.) Because of these tight personnel constraints, any tasks that can be transferred from human to artificial intelligence will free crewmembers for other mission-critical tasks. In addition, by transferring skill sets from personnel to equipment, medical decision-making, targeted assessment, and clinical judgment can be standardized and moved farther forward (onto the battlefield or on orbit) than otherwise possible. During nominal operations this “smart” technology can utilize predictive algorithms in order to analyze captured data and avoid preventable medical events.

As shown in Figure B-1, the concept of operations for this technology calls for the acquisition of data from a variety of sensors. This information is then integrated and delivered to an analytic program that can provide immediate

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