Gap ExMC 4.24: Lack of knowledge regarding the treatment of conditions on the Exploration Medical Condition List in remote, resource poor environments (Closed)
Last Published:  07/30/21 01:05:31 PM (Central)
Responsible Element: Exploration Medical Capability (ExMC)
Status: Closed
Closure Rationale
Gap Closure Synopsis
Austere environments can serve as analogs for spaceflight, including military aviation and submarine duty, polar habitats and high altitude expeditions.  These environments present similar challenges to spaceflight, helping to address the knowledge gap regarding the austere treatment of conditions on the Exploration Medical Conditions List (EMCL). For example, clinicians in austere environments must address the lack of knowledge regarding disease prevalence, evidence-based preventive medicine, and diagnostic, treatment and communication capabilities (in both equipment and personnel).   Evidence from published reports on how these challenges are addressed in austere environments has been documented in the white paper “Anaphylaxis, Intra-abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a Near Earth Asteroid Mission” (Chough et al., 2012), and in the Integrated Medical Model (IMM) Clinical Findings Forms (CliFFs) for analog populations, which provides sufficient closure to this gap and is summarized below.


Military aviation and submarine personnel undergo preventive screening for disqualifying medical conditions prior to assignment. NASA has adopted and modified these requirements for the purposes of the astronaut corps for selection criteria.  Both military aviation and NASA routinely re-examine personnel after initial selection for health maintenance and personnel retention.  Antarctic expeditions undergo similar screening to mitigate evacuation and mission impact.  In addition, many countries have required prophylactic appendectomies of Antarctic expedition personnel, reducing their incidence of appendicitis by approximately ten-fold.  However, prophylactic surgery increases the risk of small bowel obstruction (SBO).  Though more research is needed, ultrasound may be useful in selecting-out patients with adhesions who are therefore prone to SBO.


Diagnostic capabilities of ultrasound and physiologic monitoring are well-established in analog and spaceflight environments.  Advancements in portable X-ray technology and innovations in point-of-care testing of blood, urine, and saliva may be useful for future diagnostics in austere and spaceflight environments.


Military aviation treatment capabilities encompass remote point-of-injury and evacuation of major medical emergencies, including Advanced Trauma Life Support and treatment for anaphylaxis and cardiac dysrhythmias.  Antarctic and Mount Everest Base Camp treat only those conditions for which the supplies similar to those found in many community emergency departments may stock. Other wilderness scenarios rely on improvisational care based only on available resources.  The equipment available for treatment at many of these remote environments, while low compared to the terrestrial standard of care in many clinical settings, is likely beyond the capacity of current launch manifest estimates for exploration missions.


Rationale for Closure

A review of prevention, diagnosis, and treatment of medical conditions in remote, resource poor environments closes the gap in knowledge by providing information on how these conditions can be feasibly and appropriately treated in spaceflight.  The existing treatment paradigms in these austere environments provide insight into treating similar conditions in-flight.  As the technologies for the pre-flight and inflight screening, prevention, diagnosis, and treatment of conditions on the EMCL evolve, ExMC will identify new advancements in care via the technology watch gaps, Gaps 1.01 and 3.03. The IMM team will continue to input new information regarding incidences in analog populations into the model while documenting the occurrences in the CliFFs.

 

Tasks and Supporting Reports Completed

Natacha Chough; Sharmi Watkins; Anil Menon. Anaphylaxis, Intra-abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a Near Earth Asteroid Mission. 8/1/2012, NASA Technical Reports Server.

 

Integrated Medical Model Clinical Findings Forms (CliFFs) for analog populations.


Closure Documentation:
Description
This gap seeks to understand how medical conditions are treated in remote parts of planet Earth.  These environments have similar operational constraints in that resources are limited. Understanding how medical care is conducted in these locations will aide in development of a medical system for the remote environment of outer space.
Target for Closure
No Target for Closure available.
Mappings
Risk Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures
You are here! Gap ExMC 4.24: Lack of knowledge regarding the treatment of conditions on the Exploration Medical Condition List in remote, resource poor environments (Closed)
Completed

Multi-Disciplinary Research Plans

Documentation:
No Documentation Available