Principles of Crew Health Monitoring and Care

Abstract

Our ability to deliver adequate and necessary healthcare during human space flight is a vital component of getting to space, living and working in space, and coming home safely. There are many facets to the delivery of healthcare in support of this endeavor. Each of these facets has evolved over the past six decades. Our collective experience on mission profiles (scope and duration), NASA’s evolving medical requirements to support short- and long-duration space missions, and the rapid advancement in space flight and medical technology have provided no shortage of lessons learned. The knowledge gained through repeated space flight missions and the revolutionary steps in terrestrial medicine over the past several decades provides ample reason to explore better ways of improving healthcare, especially if we are to venture to locations farther away from Earth. The facets of healthcare delivery are influenced by challenges in system design, constraints in systems and resources, crew selection, space craft, and mission duration. The human in the system is just as critical as the space craft and rocketry for human space flight. So the crew must be healthy over the entire duration to support any space and planetary missions. The systems that support crew health include medical kits that contain diagnostic and therapeutic components, medical imaging device(s), telemedicine capability, and all life support systems within the space craft as well as ground-based programs that include occupational surveillance, longitudinal studies of astronauts, and an effective health stabilization program. Throughout human space flight, these medical resources have always been limited, and therefore, the approach has been tempered with risk assessment and utilization of efficient systems and protocols. This chapter describes the many facets of healthcare delivery in space. It describes the crew selection process from the earliest missions through the International Space Station Program. It summarizes the evolution of medical standards for crew selection in the U.S. with concomitant comparison to those of the Russian Space Program. The aspects of pre-flight, in-flight, and post-flight healthcare and activities are presented. In addition, this chapter also describes the evolution and current status of NASA’s crew healthcare programs from the perspective of preventive and occupational medicine under the auspices of Health and Medical Technical Authority. Specific descriptions of the risk-management program, the in-flight medical systems, and integration of technology are provided. This includes a discussion on smart/intelligent systems, informatics, autonomous care, and telemedicine. This chapter closes with a discussion about long distance missions away from the Earth and the future initiatives in space medicine.