How to Handle Emergency Medical Care in Space

Just like NASA and other space agencies, Asgardia is looking at the long-term objective of living in space or into long-haul journeys to places like Mars and beyond. But one of the issues they need to address is that of emergency medical care.

Astronauts could possibly break bones, have a heart attack, or various other unexpected medical situations. Scenarios like these have happened in isolated environments, for example, physician Jerri Nielsen found herself treating her own breast cancer after identifying a lump in her breast during winter at the South Pole’s scientific station in 1999. Before she was able to be airlifted to seek medical care, she worked with a welder to perform a biopsy at the station and managed her own hormone and chemotherapy injections by conferencing with doctors in the US.

An astronaut handling a medical emergency in space would also have to use similar resourcefulness.

Matthieu Komorowski, a consultant in intensive care and anesthesia at London’s Charing Cross Hospital, said in a statement that during these long-haul flights, the estimated risk of severe medical and surgical events, in addition to the risk of loss of crew life are significant.  Komorowski added that the exposure to the space environment itself disturbs most physiological systems and can precipitate the onset of space-specific illnesses, like cardiovascular deconditioning, acute radiation syndrome, hypobaric decompression sickness and osteoporotic fractures.

For instance, the microgravity environment of space often weakens bones over time, leading to osteoporotic fractures. Plus, astronauts are exposed to radiation and at risk for decompression sickness, given that they rely on a pressurized environment.

Komorowski is no stranger to working in isolated environments. Four years ago, he worked as the on-site doctor for a two-week mission to the Mars Desert Research Station (MDRS), a Mars Society facility in Utah where mock astronaut teams simulate procedures and experiments for the Red Planet.

Komorowski conducted a medical study on site where untrained crew members were taught how to insert tubes in a mannequin, simulating a common medical procedure. A study based in part on this work was published in 2014 in Extreme Physiology & Medicine.

Another possible scenario on such a long voyage to Mars, could be that even the doctor falls ill. Thus, Komorowski advocates for a few ways to deal with this situation.

The first is to have duplicated skills among the crew, which means requiring that everyone have at least basic medical training. The second — although less accessible on a trip to Mars — would be telemedicine. However, because of the minutes-long time lag between Earth and Mars communications, having a conference call in an emergency would not really be feasible but this could be a better option for long-term care issues.

Moreover, there are preventative steps that can be taken, like having on-demand 3D printing of medical equipment, or matching crew members by blood type, which would be an easier solution for transfusions, since the right blood type would be available for everyone.

Komorowski also warned that in some cases it may be best not to make an attempted medical intervention, especially if a lot of consumables would be used on a medical procedure where the person is not likely to survive.

Even common procedures, including cardiopulmonary resuscitation (CPR), may necessitate a rethink in space. Seeing as you can’t use your body weight in microgravity, and there are restrictions on how much medical equipment you can take on board.

After performing tests with CPR techniques aboard aircraft and underwater space simulators, a group led by Jochen Hinkelbein proposed that the “handstand technique” is the most effective method for CPR in space. Another option, especially in a microgravity environment, is to wrap the legs around the patient (known as the Evetts-Russomano method) while performing compressions to stop them from floating away.

But, in good news, Hinkelbein, an executive senior physician of anesthesiology and intensive care at the University Hospital of Cologne in Germany, explained in a statement that seeing as astronauts are carefully chosen, are usually young, and are intensively observed before and during their training, relevant medical problems are, fortunately, rare in space.

But, in the context of future long-term missions, such as to Mars, with durations of several years, the risk for severe medical problems is much higher, Hinkelbein added, thus, there is also a substantial risk for a cardiac arrest in space requiring CPR.

Emergency medicine in space was recently discussed at this year’s Euroanaesthesia congress, which was held in Geneva, Switzerland, in June.

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