Lectures

The International Space Station: A Day in the Life & Experiments

Recording

Q&A

What is the percentage of proposed experiments that are accepted to be performed on the ISS/what is the general timeline from experiment inception to completion?

I don’t have any readily available information re: the first question, because astronauts are not at all involved in the experiment selection process. Sorry! For the second question, there simply is no general timeline, for many reasons. The time from inception to completion will depend on: Complexity of the experiment; Risks (material, flammability, toxicity, containment requirement etc); Hardware (mass, size etc); Testing; Crew availability. All these (and other) factors will influence the timeline, so it’s impossible to cluster.

Do astronauts take prophylactic medications to prevent osteoporosis like bisphosphonates, or is prevention entirely nutrition/exercise?

We are not offered any prophylactic medication against osteoporosis. I can’t tell you if individual astronauts have asked for it, but I didn’t even know there were any – I always relied on the nutrition/exercise combo.

What level of trauma treatment can be handled on the ISS? Such as surgery, paramedic level, etc.?

We have a very complete pharmacy on orbit, so we could in theory take care of complex treatment. If there are physicians in the crew (it’s quite common between the partners to have one) we obviously have more choices/capabilities, otherwise we might be more limited. A crew members, we’re trained on: IV, Sutures, CPR (with meds, O2 and AED), Tooth repair/extraction, Blood draws, Physical checks (ear, fundoscopy), Tonometry, OCT scans, Ultrasound scans. Also, we can ask for flight surgeon support from ground in case of need.

What is sleeping like on the ISS considering the loudness and other strange, unexpected factors?

I’d say that, once you get used to microgravity and some peculiarities, it’s quite nice. We usually wear some sort of ear protection and eye cover. It may take some adjusting not to have a pillow or anything to rest your back on, as you float. We tend to sleep a bit less on orbit than on ground, I think.

Have there been studies of injury/trauma and wound healing in microgravity?

They don’t want to inflict wounds. They observe the wounds they unintentionally inflict. Luca has banged his head multiple times. Scraped his head on the top of the hatch and it hurt for a week, but resolved. Sensation that it takes longer to heal cuts and bruises. Muscle recovery is much faster after a workout due to complete relaxation.

Space Adaptation Syndrome developments:

It’s not a big deal. Everybody reacts differently and adjusts differently. Usually upon second exposure, body is able to adjust. Sometimes has an affect upon returning to ground, but it resolves relatively quickly. Medications are an option.

Medication and medical capability on ISS:

Medications expirations are closely tracked and disposed of upon expiration. Space station is only 250 miles away. Expedition to moon is not the same. Gateway is a habitat to get 90% of the way, get to the moon, and come back. Those missions will be 30-45 days. Everything will be taken with them and be stored on the Gateway. Eventually they intend to be able to 3D print things they need, until then, they will be replaced. Shelf life of items will be the same, there is no intention of trying to extend them. BFF is the eBioFabricationFacility is a facility that uses biological tissues to build things and can be done a lot easier than in can on ground in a microgravity environment. Water is one of the things that is most sustainable, 95% is recycled on the ISS on a 10 day cycle. One liter of water is more expensive than Perrier.

Mars and radiation countermeasures:

Systems haven’t been developed that would allow us to go to Mars. First limitation is engines. We are reliant of chemical engines, liquid or solid fuels, reliant on combustion. We can achieve impulses of 15km/s, which is pushing it, could be 18km/s if we push really hard. Natural, physical thermodynamic limit you can generate via combustion. Every two years, Mars and Earth are aligned correctly. One year mission for a two week stay, extreme radiation from cosmic rays will make you crispy. We haven’t developed a system that is self-repairing, capable of detecting damage and repairing it without intervention. Also need a system that can protect humans, or create a human that can hibernate biological activity for six months. Ethical questions relating to adapting human body to space travel.

Gravitas: Medical Emergencies in Space

Recording

Q&A

Is there a risk of aspiration when eating/drinking/brushing teeth? Is GERD an issue?

Person with achalasia ended up with sphincterotomy. Cannot be an astronaut post procedure. Case reports of astronauts having something end up in their airway somewhere. If something is floating, it continues until it settles somewhere. Aspiration case to LUL due to lack of gravity, Mike Barrett is an astronaut physician and wrote Principles of Clinical Medicine Space Medicine 2nd Edition and course at UT.

Are there thoughts of using devices like a Lucas or AutoPulse for CPR to alleviate the challenges with CPR or is the weight cost too high?

I asked this question 2 years ago at Texas, answer is no - weight is an issue. Has a power requirement to. Very low probability event. There may be a change in this due to different cohorts going into space in the future. Must consider post CPR care availability once CPR is effective. Defibrillators are used only with shockable rhythms.

How does one compensate for no activation of otoliths and proprioception that orients one to gravity?

High proportion get space adaptation sickness. Worse in high volume (wide open space) environments. There is no up or down. High performance fighter pilots who are used to intense G forces will still get super sick in space. Upon return, the otoliths respond and the astronauts will not turn their heads, they turn at hips or divert eyes to avoid getting sick, especially when removing their spacesuits. Phenergan is the general treatment, but sedation is challenging side effect, especially for pilots.

How much emergency medical training do the non-medical astronauts receive in training?

Basic First Aid, and very minimal. Somewhat of an afterthought due to low risk groups being sent up and several other responsibilities.

Biggest medical problem you worry about:

Radiation. Jeff Chancellor is the guy to read papers from. Think about reproductive organs, can cause GI cancer easily, cataracts, etc. Shielding with lead, cement, or water

How do we model treatment of space med scenarios on earth?

Eric Kerstman does the medical model system to develop medical capabilities for the ISS> Being revised for what we need to send for Orion. Based on probability, medication overlap, i.e. send a second line med that can treat multiple conditions rather than the most specific medication for an issue. NASA has clerkships and he often assigns projects related to this

Is there any leg up to become a space doc from being a military flight surgeon?

Doesn’t know the answer off the top of head. Not a ton of aerospace med programs out there; UTMB is the major feeder to NASA flight surgeons. Some military flight surgeons have transitioned laterally later in career. Does not think any are active duty

Edge of Space: Stratospheric Balloon Mission Past, Present and Future

Recording

Q&A

Was Felix getting 100% oxygen or air during his fall?

Capsule was 16,000 foot equivalent altitude. Combination of oxygen and nitrogen and given 100% oxygen at all times. Suit at 3.5 PSI 35,000 foot equivalent. Breath o2 several hours before to denitrogenate and reduce risk of decompression sickness. See atmospheric pressure table.

How much of this was derived from dive physiology?

A lot, I got a lot of experience from running a hyperbaric chamber in the navy and that informed our work a lot. Only 18 ppl have died from altitude decompression sickness but many hundreds to thousands have died from DCS when diving.

What was the rough overall budget of this project? Are government approvals necessary?

No official announcement, rough math- pressure suits were 350k a piece, helium is 100k per mission x 8 flights, ballpark of 35-40 million for Red Bull. For Allans, about half that and half the time. Learned a lot from red bull and did not have the complexity of a capsule system. Space perspectives is targeting 125k per 6h space balloon flight. Virgin Galactic is charging about 450k for suborbital

What sort of upper body training can you do to resist these types of forces?

Aerobic capacity and endurance, need great upper body strength. Hard to move in a pressure suit. Denitrogentating on the way up in capsule. In pressure suit only, suit pressure was 5.8 PSI. In free fall, need to pull parachute release system.

What is the environmental impact of this?

Propellants like rocket propellants leave contaminants from combustion. We are currently using helium which is a finite resource so trying to change to hydrogen from electrolysis. We recover the balloons and reprocess them to recycle. Space Perspectives is also attempting to do the same. We have a helium reserve in the US, but in many other countries, they don’t have that access and use hydrogen

Is the flat spin in part due to the coriolis effect?

Coriolis effect is when the earth we are on is spinning one revolution per day. Take the circumference of the equator, traveling 1000 mph from east to west. That’s why sun rises in east and sets in the west. Spin is from aerodynamics. As the speed increases with fall, like when you put your hand out the window, when you’re free falling, you can control just by moving your hands. When you are in free fall or trans sonic, there is control reversal. Spin is caused by aerodynamic flow irregularities. Force is relatively consistent when you enter. Land is somewhat irregular and are much more problematic. Terrain features are more variable than ocean.

Aerospace Medicine and the FAA

Recording

Coming Soon!

Q&A

What is the process for deciding if a certain medication / diagnosis is safe to fly?

On average, we wait for a year (barring certain medications, such as statins or antivirals.) We look at the efficacy of the medication -- if we look at the side effects and they are minimal enough to allow for flight we approve it. We have a dedicated pharm committee that looks at the results of clinical trials to identify effects that would hinder one’s ability to operate a plane.

Is a motivation for expanding medication exemptions that there were people not seeking treatment in the past due to fear of denial?

Omni directional meeting plan -- in general there are options and we encourage pilots to meet with their own physicians as well as their AMEs. There are many pilots' rights unions and advocates and we try very hard to find a treatment that is acceptable to keep pilots flying. Bottom line, if a pilot is knowledgable

Are there opportunities for med students to perform research with the FAA?

Yes! This past summer we had our most robust internship class. There are several ways.

Is the training at the facility in Oklahoma City is open to individuals to sign up for?

Once it's fully constructed, yes!

Space Medicine: From the Outback to Outer Space: Upskilling for Space Medicine in Remote and Austere Locations

Recording

Q&A

Do you think the pandemic has inadvertently helped push forward the capabilities of telemedicine with regard to space medicine?

Yes, it has helped push forward telemedicine. In Australia there has been a push for telemedicine for rule and remote areas but also in times of COVID providing general healthcare for citizens in cities that are in lockdown.

What advice would you give to medical students/people early in their career that are interested in space medicine?

If you live in the States lots of universities have space chapters (look on social media for free online talks). I would recommend getting involved in ASMA/AMSRO check out the Ad Astra Vita project. Keep an eye out for opportunities and work on developing a diverse skill set. You can also volunteer to help within the space medicine community!

From your opinion do you think it makes more sense to potentially send a medical doctor with each spaceflight or instead train astronauts basic medical care?

A combination of the two. With a long duration mission (such as a mission to mars) it would be important to send a broadly skilled medical doctor but also train the crew on basic care (just incase the physician gets injured or needs assistance in treating).

With all the talk of sending humans to Mars, how feasible of an idea is that? Do you think this generation will see the first humans on Mars?A

Yes, I think your generation will see the first humans on mars but there is a long way to go (there are unknowns that need to be addressed)

Space Medicine: Emergency Medicine in Space

Recording

Q&A

Are some/most of the astronauts vegetarian/vegan? What can you tell us about their diet, in general

Care is taken to optimize nutritional value of the food, and to avoid small individual pieces. As for dietary preferences, astronauts fill out a food preference form and they can make it work. Protein is mainly legumes and nuts.

Hoping you get to touch on the Healthcare Simulation side of EM in space

Simulation focuses around basic medical procedures that are most likely to happen, with the chief medical officer of the mission. There are more extravagant simulations with the entire crew that recreate multiple emergencies, both medical and environmental at the same time.

What are the surgical/anaesthesia considerations in space medicine?

Zero gravity causes a lot of issues with surgical fluids. Surgery has never been performed in space but will be a bigger consideration with increasing travel to moon and mars. One solution will be to activate thrusters temporarily to generate gravity so fluids aren’t floating around in zero gravity. Intubation is often simulated and the best position is to put the patient’s head between the physician’s knees for stabilization.

As someone in the USAF and applying EM+Aerospace Medicine and Flight Surgery, I would love to know if you interact with the military on a regular basis? (Follow-up) Do you find that your version of Aerospace Medicine is in great contrast to the military’s version?

All members in aerospace medicine residency get some cross-training with air force training programs (AMP training program). Some military members have gone through the aerospace medicine program at UTMB.

What is the level of medical training provided to astronauts (without a physician background)?

ACLS in space with equipment present in space. Debate between too much and two little training. Mission control is also on call to coach through other crew members for

My understanding of the Artemis missions is they’re one (small) step toward NASA’s goal of putting a human on Mars. From a medical perspective, what do you see as the biggest obstacles to putting someone on Mars (i.e. radiation, bone density, psychology)?

NASA’s plan is to go to the moon first, figure things out, then go to mars.

What is one piece of advice you would give a medical student who wants to pursue a career in aerospace medicine?

I only got interested halfway through medical school, and only got involved halfway through residency. I got my foot in the door from the aerospace medicine clerkship. You get paired with a mentor and work on a project that becomes a poster or publication. There are also associations like Aerospace medicine student and resident organization (AMSRO) and Aerospace medical association (ASMA). Yes and no to participate in the field of aerospace medicine. It is important training in order to lead organizations in these fields

Do drugs work differently in space? How do they decide how to stock a pharmacy on a spaceship?

There are a number of antibiotics stocked aboard the space station, and foreign bodies are the most common source of infection. Other medications are limited, for example ketamine is the only drug available for anesthesia procedures.

What is the NASA’s solution to reduced wound healing in space?

Abrasions are the main issue due to friction in the space suit. Larger lacerations have not been an issue yet, but wound healing is about 2x slower. We don’t know why yet but there are contingencies for larger wounds (sutures, dermabond)

Space Medicine: ED to ISS - Journey to 130,000'

Recording

Space Medicine: Designing Medical Systems for Space Exploration

Recording

This recording is protected per request of the speaker. To view, please email shilpiganguly@med.miami.edu for the link, and please do not disseminate it. Thank you for your understanding!

Are there thoughts of using devices like a Lucas or AutoPulse for CPR to alleviate the challenges with CPR or is the weight cost too high?

I asked this question 2 years ago at Texas, answer is no - weight is an issue. Has a power requirement to. Very low probability event. There may be a change in this due to different cohorts going into space in the future. Must consider post CPR care availability once CPR is effective. Defibrillators are used only with shockable rhythms.

How does one compensate for no activation of otoliths and proprioception that orients one to gravity?

High proportion get space adaptation sickness. Worse in high volume (wide open space) environments. There is no up or down. High performance fighter pilots who are used to intense G forces will still get super sick in space. Upon return, the otoliths respond and the astronauts will not turn their heads, they turn at hips or divert eyes to avoid getting sick, especially when removing their spacesuits. Phenergan is the general treatment, but sedation is challenging side effect, especially for pilots.

How much emergency medical training do the non-medical astronauts receive in training?

Basic First Aid, and very minimal. Somewhat of an afterthought due to low risk groups being sent up and several other responsibilities.

Biggest medical problem you worry about:

Radiation. Jeff Chancellor is the guy to read papers from. Think about reproductive organs, can cause GI cancer easily, cataracts, etc. Shielding with lead, cement, or water

How do we model treatment of space med scenarios on earth?

Eric Kerstman does the medical model system to develop medical capabilities for the ISS> Being revised for what we need to send for Orion. Based on probability, medication overlap, i.e. send a second line med that can treat multiple conditions rather than the most specific medication for an issue. NASA has clerkships and he often assigns projects related to this

Is there any leg up to become a space doc from being a military flight surgeon?

Doesn’t know the answer off the top of head. Not a ton of aerospace med programs out there; UTMB is the major feeder to NASA flight surgeons. Some military flight surgeons have transitioned laterally later in career. Does not think any are active duty