tent of the BR and provide a framework for thinking that will benefit NASA strategists, managers, and operations personnel as they focus on risk reduction related to the ambitious objectives outlined in the President’s initiative of January 2004 (White House, 2004). Specific areas in which additional attention would be of great benefit include the following:

  • Reclassification of behavioral health risks

  • Psychological and physical impacts of space flight on performance, including use of crew selection criteria (social, demographic, and preexisting health status of astronauts, and their response to stress) to minimize adverse responses, especially in the context of longer-term missions

  • Radiation effects—establishing risk-specific radiation exposure levels

  • Assessing the sources and impact of long-duration space flight on crew health and incremental risk

  • Autonomous medical care and self-care

OVERARCHING ISSUES

Overarching issues are those factors that, in the committee’s view, deserve wide review and application throughout the current BR and in future revisions of the BR. They should be viewed as guiding principles or strategic approaches to the revision and management of the BR.

The Time Factor and Its Impact on Risk

Time is a factor that has the potential to increase risk significantly, particularly in the context of long-duration space flight such as the 30-month Mars mission outlined in the President’s initiative. Time has several dimensions that must be considered in the definition and mitigation of risk. Duration of the mission is one component. Clearly, the potential for the development of a health problem, such as new disease or injury, increases progressively from the 1-month lunar mission to the 12-month International Space Station (ISS) mission, to the 30-month Mars mission. Similarly, the consequences and countermeasures associated with disease or injury will differ depending on the time of appearance of the human health problem within the mission time frame (consider, for example, the discovery of a breast mass that appears 2 months after launch on a planned 30-



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