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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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SAFE PASSAGE

Astronaut Care for Exploration Missions

John R. Ball and Charles H. Evans, Jr., Editors

Committee on Creating a Vision for Space Medicine During Travel Beyond Earth Orbit

Board on Health Sciences Policy

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, DC

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
×

NATIONAL ACADEMY PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by the National Aeronautics and Space Administration. The views presented in this report are those of the Institute of Medicine Committee on Creating a Vision for Space Medicine During Travel Beyond Earth Orbit and are not necessarily those of the funding agency.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on Creating a Vision for Space Medicine during Travel Beyond Earth Orbit.

Safe passage: astronaut care for exploration missions/John R.Ball and Charles H.Evans, Jr., editors; Committee on Creating a Vision for Space Medicine during Travel Beyond Earth Orbit, Board on Health Sciences Policy, Institute of Medicine.

p.; cm.

Includes bibliographical references.

ISBN 0-309-07585-8 (pbk.)

1. Astronauts—Health and hygiene. 2. Space medicine.

[DNLM: 1. Aerospace Medicine—standards. 2. Health Services Needs and Demand. 3. Astronauts. 4. Radiation Effects. 5. Space Flight. 6. Weightlessness—adverse effects. WD 751 I59s 2001] I. Ball, John, 1944- II. Evans, Charles H. (Charles Hawes), 1940- III. Title.

RC1135 .I576 2001

616.9’80214–dc21

2001005443

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Copyright© 2001 by the National Academy of Sciences. All rights reserved.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
×

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE

Shaping the Future for Health

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
×

THE NATIONAL ACADEMIES

National Academy of Sciences

National Academy of Engineering

Institute of Medicine

National Research Council

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm.A.Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I.Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M.Alberts and Dr. Wm.A.Wulf are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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COMMITTEE ON CREATING A VISION FOR SPACE MEDICINE DURING TRAVEL BEYOND EARTH ORBIT

JOHN R.BALL (Chair), Executive Vice President Emeritus,

American College of Physicians, Havre de Grace, MD

JOSEPH V.BRADY, Director,

Behavioral Biology Research Center, The Johns Hopkins University, Baltimore, MD

BRUCE M.COULL, Head,

Department of Neurology, University of Arizona College of Medicine, Tucson, AZ

N.LYNN GERBER, Chief,

Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD

BERNARD A.HARRIS, President,

The Harris Foundation, Houston, TX

CHRISTOPH R.KAUFMANN, Colonel MC (USA),

Division of Surgery for Trauma, Uniformed Services University of the Health Sciences, Bethesda, MD

JAY M.McDONALD, Professor and Chair,

Department of Pathology, University of Alabama at Birmingham, Birmingham, AL

RONALD D.MILLER, Professor and Chair of Anesthesia and Perioperative Care,

University of California at San Francisco, San Francisco, CA

ELIZABETH G.NABEL, Scientific Director,

National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD

TOM S.NEUMAN, Professor of Medicine and Surgery and Associate Director,

Department of Emergency Medicine, University of California at San Diego, San Diego, CA

DOUGLAS H.POWELL, Senior Partner,

Powell and Wagner Associates, Cambridge, MA, and

Clinical Instructor in Psychology,

Harvard Medical School, Boston, MA

WALTER M.ROBINSON, Assistant Professor of Pediatrics and Medical Ethics,

Harvard Medical School, Boston, MA

CAROL SCOTT-CONNER, Professor and Head,

Department of Surgery, University of Iowa College of Medicine, Iowa City, IA

JUDITH E.TINTINALLI, Professor and Chair,

Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

Committee Liaisons:

Institute of Medicine Board on Health Sciences Policy

GLORIA E.SARTO, Professor of Obstetrics and Gynecology,

National Center of Excellence in Women’s Health, University of Wisconsin, Madison, WI

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Institute of Medicine Board on Neuroscience and Behavioral Health

STEVEN M.MIRIN, Medical Director,

American Psychiatric Association, Washington, DC

National Research Council Space Studies Board

MARY JANE OSBORN, Professor and Head,

Department of Microbiology, University of Connecticut, Farmington, CT

Institute of Medicine Staff

CHARLES H.EVANS, JR., Study Director and Institute Senior Adviser for Biomedical and Clinical Research

MELVIN H.WORTH, JR., Scholar-in-Residence

JUDITH RENSBERGER, Senior Program Officer

VERONICA SCHREIBER, Research Assistant

SETH M.KELLY, Project Assistant to August 2000

TANYA M.LEE, Project Assistant from August 2000

GREG T.SHERR, National Research Council Intern (Summer 2000)

Institute of Medicine Board on Health Sciences Policy Staff

ANDREW POPE, Director

CARLOS GABRIEL, Financial Associate

ALDEN CHANG, Administrative Assistant

Institute of Medicine Auxiliary Staff

MICHAEL EDINGTON, Managing Editor to March 2001

PAIGE BALDWIN, Managing Editor from March 2001

SUSAN FOURT, Librarian to December 2000

WILLIAM McCLOUD, Librarian from December 2000

Copy Editor

MICHAEL K.HAYES

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Reviewers

The report was reviewed by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments to assist the authors and the Institute of Medicine in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. The committee wishes to thank the following individuals for their participation in the report review process:

JAMES P.BAGIAN, Director, National Center for Patient Safety, Veterans Administration, Arlington, VA

SAMUEL BRODER, Executive Vice President, Celera Genomics, Rockville, MD

EDNA FIEDLER, Manager, Federal Aviation Administration, Civil Aeromedical Institute, Federal Aviation Administration, Oklahoma City, OK

JOHN C.FLETCHER, Professor Emeritus of Biomedical Ethics, University of Virginia School of Medicine, Keswick, VA

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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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LAZAR J.GREENFIELD, Frederick A.Coller Distinguished Professor and Chair, Department of Surgery, University of Michigan, Ann Arbor, MI

JOHN P.KAMPINE, Professor and Chairman, Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI

NICK KANAS, Professor, Psychiatry, University of California San Francisco, San Francisco, CA

STEPHEN I.KATZ, Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD

RUSSELL B.RAYMAN, Executive Director, Aerospace Medical Association, Alexandria, VA

JAMES L.REINERTSEN, Chief Executive Officer, Care Group, Boston, MA

DANNY A.RILEY, Professor, Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI

RICHARD H.TRULY, Director, National Renewable Energy Laboratory, U.S. Department of Energy, Golden, CO

DEBORAH J.WEAR-FINKLE, Forensic Psychiatrist/Flight Surgeon, United States Navy, Pensacola, FL

Although the individuals listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Robert A.Frosch, Harvard University, and Robert M.Epstein, University of Virginia, Charlottesville, VA. Appointed by the National Research Council and the Institute of Medicine they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments are carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Foreword

Many American astronauts have participated in space shuttle missions which kept them in space for periods of 1–2 weeks. A few American astronauts participated in missions on the Russian space station Mir during which they spent substantially longer periods of time in space, missions measured in months rather than weeks. Some Russian cosmonauts spent substantially longer periods of time in space. For all of these missions, there was the potential to bring an acutely ill participant back to earth in a relatively short period of time.

Exploration missions into deep space, such as a journey to Mars, raise a series of new questions about the health of human participants. Some of the physiologic effects of shorter periods in space such as loss of bone calcium are likely to continue indefinitely during longer missions. Some risks such as radiation exposure may be increased as humans proceed further into space. Psychological and mental health issues will grow increasingly important during longer missions in a confined space, often involving individuals of very different social and cultural backgrounds. For prolonged missions, it will not be feasible to return an acutely ill individual to earth in a timely manner.

The Institute of Medicine convened a committee of experts to examine the issues surrounding astronaut health and safety for long duration space missions. At the request of the National Aeronautics and Space Administration (NASA), the committee was asked to make recommendations regard-

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
×

ing the infrastructure for a health system in space, the principles that should guide such a system to provide an appropriate standard of care for astronauts, and to identify the nature of the clinical and health services research required before and during such long-term missions for astronauts.

The committee was faced with an extraordinary spectrum of issues related to prolonged travel into deep space. It focused its efforts upon the available data with regard to astronaut health and upon the areas where the evidence base was deficient. It particularly focused on areas that were amenable to investigation and development in preparation for human exploration of deep space.

The committee was selected with the intention of including some individuals with significant direct experience with space travel, but it included other experts in health care delivery and clinical research who could bring some fresh perspectives to the subject. We are deeply indebted to this volunteer committee expertly chaired by Dr. John Ball for their dedicated commitment to this project. We believe that the ideas, conclusions, and recommendations contained in this report should be helpful to NASA, as it prepares for further space exploration, as well as being of use to others who are concerned about the care of individuals in isolated locations on earth.

Kenneth I.Shine, M.D.

President, Institute of Medicine

July 2001

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Preface

The National Academies, particularly the Space Studies Board of the National Research Council (NRC), have contributed substantial information on a full range of issues focused on basic aerospace research that has been a principal source of scientific advice to NASA. For example, the Space Studies Board recently provided guidance on a biomedical research strategy (SSB and NRC, 1998a, 2000). The present study by the Committee on Creating a Vision for Space Medicine During Travel Beyond Earth Orbit is the first time that the National Academies has addressed clinical issues through an analysis of the clinical research and health care practice evidence base for space medicine. In presenting its request to the Institute of Medicine (IOM) for the study presented in this report, NASA leadership noted that efforts to develop a more capable medical care delivery system in space have been internal to NASA itself, as documented in Chapter 1 of this report. The request used the language “create a vision” for health care for astronauts traveling on long-duration missions beyond Earth orbit. What was intended by the request was that a perspective beyond that internal to NASA and different from that provided by NRC be applied to the issues.

Those issues are reflected in the charge to the committee, which were (1) to assess what is known about the effects of space travel on health (which is the focus of Chapter 2 of this report), what is not known, and what might be done about the latter; (2) to suggest how health care during space travel

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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might be approached (which is the focus of Chapters 3 and 4); and (3) to suggest how a system of health care for astronauts might be organized (which is the subject of Chapter 7 and, to some extent, of Chapters 3 and 4). The committee has sought to bring to its task the fresh perspective that NASA requested. That perspective has, for example, identified at least two specific areas on which we believe NASA’s focus has been less than that which is now necessary. The first area involves a set of issues that are behavioral and cultural, including crew selection and training (Chapter 5). The second area is the collection of clinical data on astronauts, for which a new ethical approach is needed (Chapter 6).

What is the committee’s perspective, then? Although the committee members come from diverse professional backgrounds, each with specialized knowledge, the diversity is within a relatively narrow range relative to the diversity of knowledge held by the general population or even the scientific community as a whole. Only a quarter of the committee members have had any previous experience with the space program, and only one has flown in space. The committee members do, however, have similar backgrounds, in that almost all are physicians (and those who are not are involved in clinical fields) and all have had experience in academic medicine. The committee thus brings a common perspective informed by the shared individual backgrounds of its members and the shared experiences of each of the members of the committee as it reviewed the evidence relative to its task. That perspective is largely, although not absolutely, that of the academic clinician and clinical researcher.

How these clinical and academic perspectives play out in the chapters of this report is illustrated by the following examples. In Chapter 2, the committee uses a biological systems approach to examine the data on what is known about clinical information, a systems approach that is based on an understanding of fundamental processes. In addition, the committee’s approach reflects the academic perspective, one that values openness of dialogue and processes of peer review, particularly of research proposals. The committee’s perspective is thus reflected in its conclusions and recommendations in Chapter 2 that relate to NASA’s research process. In Chapter 3, the committee uses the perspective of the clinician, using the principle of continuity of care in its conclusions and recommendations.

Although Chapter 7, on planning an infrastructure for a system of astronaut health care, was prepared from the committee’s perspective of academic clinician and clinical researcher, it differs from the other chapters in one important way. Whereas for the other chapters the committee reviewed

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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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hundreds of pages of NASA policies and procedures, cast a practiced eye on the evidence, analyzed that evidence, and reached conclusions that led to recommendations supported by the evidence in the individual chapters, for Chapter 7 the committee focused on principles drawn from the evidence examined throughout the study to support the conclusions and recommendations that the committee advances in Chapter 7. Thus, the committee suggests from its particular perspective what principles should be taken into account in the creation and evolution of a health care system for astronauts who will travel on long-duration missions beyond Earth orbit.

None of the committee members is a practicing engineer, and none is a physicist. Thus, we do not believe that our conclusions and recommendations should replace those of others. We hope, instead, that this report will add to the richness of NASA’s approach to solving some of its most vexing issues.

As with all IOM reports, this one was a collaboration of the committee and IOM staff. The committee especially thanks Charles Evans for his excellent management of the project and leadership of the staff and for the staff support of Mel Worth, Judy Rensberger, Veronica Schreiber, Tanya Lee, and Seth Kelly. NASA staff, both at NASA headquarters and at the Johnson Space Center, gave generously of their time and energy; without the information that they provided, this report would not have been possible. Chapters of the report were developed by working groups of the committee headed by Lynn Gerber, Carol Scott-Conner, Doug Powell, and Walter Robinson; their dedication to the project was substantial. Lastly, the chair wishes personally to thank the committee members for the collegial manner in which they approached the task and for their responsiveness to the demands that such a complex project requires.

John R.Ball

Chair

June 2001

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Acronyms


ADA

American Dental Association

AHRQ

Agency for Healthcare Research and Quality

ANARE

Australian National Antarctic Research Expeditions

ART

atraumatic restorative treatment


CAD-CAM

computer-aided design-computer-aided manufacturing


DCS

decompression syndrome


EVA

extravehicular activity


FAA

Federal Aviation Administration


IOM

Institute of Medicine

ISS

International Space Station


JSC

Johnson Space Center


MeV

million electron volts


NASA

National Aeronautics and Space Administration

NIH

National Institutes of Health

NRC

National Research Council

NSBRI

National Space Biomedical Research Institute

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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PTH

parathyroid hormone


SMAC

spacecraft maximum allowable concentrations

SMS

space motion sickness

SPEs

solar particle events

STS

Space Transportation System


T3

tri-iodothyronine

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Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Musculoskeletal System,

 

42

   

Loss of Bone Mineral Density in Microgravity,

 

42

   

Reversibility, Genetic Variability, and Mechanism of Bone Mineral Density Loss,

 

44

   

Clinical Research Opportunities in Astronaut Physiology and Health,

 

46

   

Effects of Microgravity on Skeletal Muscle,

 

47

   

Circulatory and Pulmonary Systems,

 

48

   

Orthostatic Hypotension,

 

48

   

Other Effects on the Cardiovascular System,

 

49

   

Effects of Microgravity on the Pulmonary System,

 

51

   

Alimentary System,

 

51

   

Nutrition in Space,

 

51

   

Space Motion Sickness,

 

51

   

Nervous System,

 

52

   

Neurovestibular Function,

 

53

   

Sleep and Circadian Rhythm,

 

53

   

Eye-Hand Coordination and Sustained Gross Motor Activity,

 

55

   

Peripheral Nervous System,

 

55

   

Reproductive System,

 

56

   

Effects of Radiation on Gametes,

 

56

   

Human Reproductive Physiology in Space,

 

57

   

Sex Differences,

 

59

   

Urinary System,

 

60

   

Physiological Monitoring,

 

61

   

Monitoring During Space Travel: Development of Technology,

 

61

   

A Strategy for a Space Medicine Clinical Research Program,

 

62

   

A Clinical Research Program for NASA,

 

69

   

Conclusion and Recommendation,

 

71

3

 

MANAGING RISKS TO ASTRONAUT HEALTH

 

75

   

General Principles and Issues,

 

76

   

Medical Events in Extreme Environments,

 

78

   

Health Risk Assessment,

 

86

   

Nutrition,

 

88

   

Pharmacodynamics and Pharmacokinetics,

 

90

   

Environmental and Occupational Health,

 

92

   

Health Care Practice Opportunities,

 

97

   

Cardiovascular Care,

 

97

   

Dental Care,

 

98

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Endocrine Function,

 

101

   

Gastrointestinal Issues,

 

102

   

Gynecological Health Issues,

 

103

   

Hematology, Immunology, and Microbiology,

 

105

   

Mental Health Issues,

 

106

   

Neurological Issues,

 

110

   

Urinary Disorders,

 

111

   

Conclusion and Recommendation,

 

112

4

 

EMERGENCY AND CONTINUING CARE

 

117

   

Anesthesia and Pain Management,

 

118

   

Airway Management in Space,

 

118

   

Anesthetics,

 

119

   

Regional Anesthesia,

 

120

   

Surgery and Trauma,

 

121

   

Physiological Response to Injury,

 

121

   

Surgical Skills and Training,

 

123

   

Surgical Equipment,

 

124

   

Technical Aspects of Surgery,

 

125

   

Prevention of Infection,

 

126

   

Management of Common Surgical Emergencies,

 

126

   

Management of Abscesses and Soft-Tissue Infections,

 

127

   

Rehabilitation for Astronauts on Long-Duration Missions,

 

127

   

Catastrophic Illness, Death, and End-of-Life Considerations,

 

130

   

Personnel and Other Health Care Resources,

 

131

   

Development of a Space Medicine Catalog and Database,

 

132

   

Conclusion and Recommendation,

 

133

5

 

BEHAVIORAL HEALTH AND PERFORMANCE

 

137

   

Astronaut Performance and General Living Conditions,

 

138

   

Background,

 

138

   

Current Practice and Knowledge Base,

 

138

   

Requirements for Additional Knowledge,

 

142

   

Use of Pairs of Transport Vehicles for Small Groups Traveling Beyond Earth Orbit,

 

149

   

Support and Recovery Systems,

 

149

   

Background,

 

149

   

Current Practice and Knowledge Base,

 

150

   

Requirements for Additional Knowledge,

 

152

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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Screening, Selection, and Training,

 

158

   

Background,

 

158

   

Current Practice and Knowledge Base,

 

159

   

Requirements for Additional Knowledge,

 

161

   

Strategic Research Considerations,

 

165

   

Conclusion and Recommendation,

 

167

6

 

EXPLORING THE ETHICS OF SPACE MEDICINE

 

173

   

Ethical Issues in Clinical Care for Astronauts,

 

174

   

Institutional Pressure to Underreport Clinical Signs, Symptoms, and Medical Data,

 

174

   

Current Practice Regarding the Confidentiality of Individual Astronaut Medical Data,

 

175

   

Earth-Based Analogs for Balancing Medical Confidentiality with Public Health,

 

177

   

Justification for Using the Occupational Health Model to Balance Privacy and Safety,

 

178

   

Ethical Issues in the Astronaut-Flight Surgeon Relationship,

 

180

   

Opportunities for Collecting Medical Data Aboard the International Space Station,

 

181

   

Expand the Collection of Occupational Health Data,

 

181

   

Change the Process for Review of Clinical Research Protocols in Space Medicine,

 

182

   

Suggested Changes in the Approach to Review of Proposed Clinical Research or Data Collection for Astronauts,

 

183

   

Ethical Issues and the Special Circumstances of International Crews,

 

186

   

Conclusion and Recommendation,

 

187

7

 

PLANNING AN INFRASTRUCTURE FOR ASTRONAUT HEALTH CARE

 

189

   

Mission and Goals,

 

189

   

Organizational Components,

 

191

   

Leadership,

 

192

   

Critical Elements of the Organizational Framework,

 

193

   

Alternative Organizational Frameworks,

 

195

   

Organizational Structure to Ensure Astronaut Health and Safety,

 

197

   

Conclusion and Recommendation,

 

198

   

Systems Development,

 

199

Suggested Citation:"Front Matter." Institute of Medicine. 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: The National Academies Press. doi: 10.17226/10218.
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LIST OF BOXES, FIGURES, AND TABLES

EXECUTIVE SUMMARY

Box 1

 

Clinical Research Opportunities for Astronaut Health,

 

5

Box 2

 

Health Care Opportunities in Space Medicine,

 

8

Box 3

 

Behavioral Health and Performance Research and Development Opportunities,

 

14

Box 4

 

The Key Elements in the Committee’s Recommendations,

 

21

1 ASTRONAUT HEALTH BEYOND EARTH ORBIT

Figure 1–1

 

Trajectory of a human mission to Mars in 2014,

 

26

Box 1–1

 

Charge to the Committee,

 

31

Box 1–2

 

What Is Space Medicine in Reference to Developing a Vision and Strategy for Astronaut Health?,

 

34

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2 RISKS TO ASTRONAUT HEALTH DURING SPACE TRAVEL

Box 2–1

 

Some Major Human Physiological Changes Resulting from Extended Travel in Earth Orbit,

 

39

Figure 2–1

 

Countermeasure (CM) evolution,

 

41

Table 2–1

 

Average Bone Mineral Density Loss on Mir,

 

44

Box 2–2

 

Altered Sleep Patterns as Example of Multifactorial Problems Arising During Space Travel,

 

54

Box 2–3

 

Elements of the Critical Path Roadmap Project,

 

63

Table 2–2

 

Critical Path Roadmap Project: Critical Risks,

 

64

Figure 2–2

 

Countermeasure (CM) development and evolution,

 

68

Box 2–4

 

What Constitutes Clinical Research?,

 

69

Box 2–5

 

Clinical Research Opportunities for Astronaut Health,

 

72

3 MANAGING RISKS TO ASTRONAUT HEALTH

Box 3–1

 

Major Health and Medical Issues During Spaceflight,

 

77

Table 3–1

 

In-Flight Medical Events for U.S. Astronauts During the Space Shuttle Program,

 

81

Table 3–2

 

Medical Events Among Seven NASA Astronauts on Mir,

 

82

Table 3–3

 

Medical Events and Recurrences Among Astronauts of all Nationalities on Mir,

 

83

Table 3–4

 

Pharmacopoeia Usage During Mir Missions,

 

84

Table 3–5

 

Incidence of Health Disorders and Medical-Surgical Procedures During 136 Submarine Patrols,

 

84

Table 3–6

 

Reasons for 332 Medical Evacuations from All Submarines, U.S. Atlantic Fleet, 1993 to 1996,

 

85

Table 3–7

 

ANARE Health Register Illnesses in Antarctica from 1988 to 1997,

 

85

Box 3–2

 

Potential Methods of Risk Assessment and Screening,

 

86

Box 3–3

 

Breast Cancer as an Example of Risk Assessment in Space Medicine,

 

88

Box 3–4

 

“Normal” Findings on Physical Examination in Microgravity,

 

90

Box 3–5

 

Advances in Preventive Dentistry,

 

99

Box 3–6

 

Health Care Opportunities in Space Medicine,

 

113

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4 EMERGENCY AND CONTINUING CARE

Box 4–1

 

Health Care Opportunities in Space Medicine,

 

134

5 BEHAVIORAL HEATH AND PERFORMANCE

Box 5–1

 

Evidence of Emotional or Social Problems on Short-Duration Missions,

 

139

Box 5–2

 

Recovery and Reintegration,

 

153

Box 5–3

 

Systematic Multiple Level Observation of Groups,

 

156

Box 5–4

 

Potential Uses of Neuroimaging Methods for Astronaut Selection, Training, and Intervention,

 

163

Box 5–5

 

Distributed Interactive Simulation,

 

165

Box 5–6

 

Behavioral Health and Performance Research and Development Opportunities,

 

168

6 EXPLORING THE ETHICS OF SPACE MEDICINE

Box 6–1

 

Examples of Earth-Based Limitations on Doctor-Patient Confidentiality to Decrease Risks to Others,

 

176

Box 6–2

 

The Common Rule and Informed Consent,

 

182

Box 6–3

 

Potential Categories of Clinical Research or Data Collection Protocols for Astronauts,

 

184

Box 6–4

 

Examples of Category 2 Clinical Research or Data Collection Protocols for Astronauts,

 

184

7 PLANNING AN INFRASTRUCTURE FOR ASTRONAUT HEALTH CARE

Box 7–1

 

Infrastructure Elements for Developing a Comprehensive Health Care System for Astronauts,

 

199

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SAFE PASSAGE Astronaut Care for Exploration Missions

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Safe Passage: Astronaut Care for Exploration Missions sets forth a vision for space medicine as it applies to deep space voyage. As space missions increase in duration from months to years and extend well beyond Earth’s orbit, so will the attendant risks of working in these extreme and isolated environmental conditions. Hazards to astronaut health range from greater radiation exposure and loss of bone and muscle density to intensified psychological stress from living with others in a confined space. Going beyond the body of biomedical research, the report examines existing space medicine clinical and behavioral research and health care data and the policies attendant to them. It describes why not enough is known today about the dangers of prolonged travel to enable humans to venture into deep space in a safe and sane manner. The report makes a number of recommendations concerning NASA’s structure for clinical and behavioral research, on the need for a comprehensive astronaut health care system and on an approach to communicating health and safety risks to astronauts, their families, and the public.

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