Many thanks to our special guest authors: Krishi Korrapati and Cooper Lytle.
Krishi is a second year medical student at Chicago Medical School at Rosalind Franklin University. During the night, he dreams of poetry as politics and interstellar exploration one day alleviating inequity on earth. During the day, he is training for an Ironman, interpreting Spanish, doing theater, and trying to learn how to fly a plane. He likes to gild everything with lightheartedness and with gravity.
Cooper is a second year medical student at Chicago Medical School at Rosalind Franklin University. He is an aspiring bread maker and maple syrup connoisseur, who enjoys seeing his house plants grow and spending long days at art museums with his wife.
As humanity sets its sights further into space, space organizations are seeking to improve the medical capabilities of their vessels. NASA has created a set of levels of care for space exploration missions in order to establish a standardized model of care depending on the level of risk. The levels 1-5 range from basic first aid to basic surgical procedures (1). The medical needs of the crew, as well as the specific hurdles to providing that care, will continue to evolve as space programs aim to go from space stations, to space bases, to longer voyages to Mars or beyond. While planning for future medical needs there are many lessons that can be learned right here on Earth by examining how medicine is practised in extreme or isolated conditions. Analogs such as submarines, Antarctic or underwater research bases, combat prehospital practices, and wilderness environments provide many lessons that can be applied to the medicine practised in space. Though this is not intended to be a comprehensive analysis, we hope that they will help to illustrate the value in studying these analogs.
Antarctic research bases are a valuable analog because of its isolated circumstances and extreme climate. Antarctica boasts one of the coldest and windiest climates on Earth, is shrouded in darkness for half the year, and its bases are hundreds of miles away from the nearest source of help (2). Another example of isolation that can be compared to space is that of submarines. Like a space vessel, submarine crews are isolated from others for an extended period of time in an enclosed capsule. From these examples lessons can be learned about how to provide medical treatment to isolated populations. Both the research bases and submarines judge that the best method is to have medical personnel on hand.
For the Antarctic research bases, different countries have different strategies for the types of doctors they send, with some favoring surgeons over generalists and vice versa. For the countries who do not prioritize sending surgeons, they provide basic surgical and dental training. These doctors are relied upon to treat the medical needs of the populations. When situations arise where the doctor is asked to do something outside of their training they use telemedicine to either walk them through a procedure or to provide diagnostic aid. If the needs of the patient cannot be met at the site then an evacuation is called in (3).
On submarines, Independent Duty Corpsmen (trained for 16 months at the Naval Undersea Medical Institute) take care of the primary care needs of the corpsmen and stabilize patients when needed. When needed a doctor on land can be consulted and if necessary a medevac can be requested. However, due to the sensitive nature of submarines’ missions it may not always be possible to immediately call for guidance or request an evacuation (4).
Much like Antarctica and submarines, evacuation from space may not always be immediately possible. One solution to minimize these events is already being used by both Antarctica and submarines: telemedicine. At both of these locations, doctors or medical personnel are able to receive guidance in diagnosis and treatment, or in extreme cases being taught how to do a needed procedure. In a dramatic example from 1961, through radiotelegram, a neurosurgeon in Melbourne was able to guide the doctor at an Antarctic research station successfully through an emergency craniotomy to treat a ruptured intracranial aneurysm (2). The military has also used telemedicine to decrease the number of evacuations. In an analysis of MEDEVAC from Iraq and Syria before and after the implementation of asynchronous teleconsultation, both surgical and non-surgical evacuations decreased significantly (5). This correlation is also shown in a 2004 study when teleconsultation was used by soldiers in Iraq, Kuwait, and Afghanistan (6). If this trend could be applied to space it would be a promising sign that telemedicine could diminish the frequency that a space station or base would have to attempt evacuation back to Earth. The fact that it was asynchronous is even more compelling, because the farther away from Earth an expedition travels, the more the delay in communication would be. However as a voyage tests the limits of how far humanity can go, telemedicine’s efficacy will also be tested as it becomes extensively more asynchronous.
Submarines have an intriguing solution to this problem as well. Medical personnel could be aided in diagnosis and treatment by computer programs. These algorithms are also used to provide cognitive behavioral therapy as a mental health resource (4).
Aside from solving logistical challenges, analogs can provide insight into prevention and treatment of disease. For instance in order to qualify to be a researcher in Antarctica one must have a psychology test, dental exam, as well as a thorough physical examination that screens for chronic conditions such as diabetes, asthma, hypertension etc (1). On submarines, drinking water is frequently tested for bacterial contamination to limit chances of infection. In order to track radiation exposure, crew members wear dosimeters (4). With the increased radiation exposure in space, this precaution would be a useful aid to protect space travelers from exceeding dangerous levels. Medical treatment in wilderness settings provide treatment options that are effective in low resource environments, for example, the use of glue and surgical tape to close wounds, and using hemostatic dressings or agents to stop bleeding (7). In austere environments burns resuscitation can be achieved using oral resuscitation fluid with salt in place of intravenous fluids (8). This solution could be helpful in a microgravity environment.
Just as research bases and submarines differ in the medical resources and equipment based on their needs, so will space vessels or bases have to increase their capacity for treatment based on their expedition needs. As space exploration is advanced, the need for Earth-independent medical treatment will increase. While extreme injuries or illnesses at the analogs listed here ultimately end at a hospital, for space travel to expand, there will have to be a hospital-equivalent either onboard or nearby. For this to be a possibility, surgeries will have to take place in space. Although research is being done in this field, it is still some distance from being able to meet the needs of long term space travel or settlement (9). Although these analogs have this limitation, they remain valuable resources to help space agencies learn how to meet the demands of first response situations in extreme environments, one day serving as a model for in-house space surgery as well.
1. Hailey, Melinda, et al. Interpretation of NASA-STD-3001 levels of care for Exploration Medical System Development. No. JSC-CN-39515. 2017.
2. Taylor, David McD, and Peter J. Gormly. “Emergency medicine in Antarctica.” Emergency Medicine 9.3 (1997): 237-245.
3. Lecordier, Manon, et al. “Surgical training strategies for physicians practicing in an isolated environment: an example from Antarctica. International survey of 13 countries with active winter stations.” International Journal of Circumpolar Health 82.1 (2023): 2236761.
4. Beardslee, Luke A., Erica T. Casper, and Ben D. Lawson. “Submarine medicine: An overview of the unique challenges, medical concerns, and gaps.” Undersea & Hyperbaric Medicine 48.3 (2021).
5. Nguyen, Charles, Jennifer Mbuthia, and Craig P. Dobson. “Reduction in medical evacuations from Iraq and Syria following introduction of an asynchronous telehealth system.” Military medicine 185.9-10 (2020): e1693-e1699.
6. McManus, John, et al. “Teleconsultation program for deployed soldiers and healthcare professionals in remote and austere environments.” Prehospital and disaster medicine 23.3 (2008): 210-216.
7. Quinn, Robert H., et al. “Wilderness Medical Society practice guidelines for basic wound management in the austere environment.” Wilderness & environmental medicine 25.3 (2014): 295-310.
8. Peck, Michael, James Jeng, and Amr Moghazy. “Burn resuscitation in the austere environment.” Critical care clinics 32.4 (2016): 561-565.
9. Pantalone, Desiree. “Surgery in the Next Space Missions.” Life 13.7 (2023): 1477.
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