Dealing with situations outside the realm of normal human experience is all part of an astronaut’s job description. Nevertheless, one can imagine the discomfort experienced by the crew member of the International Space Station (ISS) who received the first diagnosis of venous thrombosis during spacecraft. There is no good time and place to discover a blood clot in your vein, but it is particularly uncomfortable to find it while you are more than 200 miles above the earth.
The ISS assisted with blood-thinning drugs that could deal with this potentially life-threatening condition. Yet the dose of the astronaut had to be cut through the treatment a third time until more medicine could come aboard a spacecraft. A few months later, the astronaut – whose identity has not yet been revealed – returned to Earth and fully recovered.
This incident, the details of which in the New England Journal of Medicine had a happy ending in January last year. This was largely because the astronaut was in regular contact here on earth with health workers and could be provided with medicine. At the first missions to Mars, there will be no vehicles or fast phone calls to Earth.
“Ultimately, we will have to take significant risks, especially if we want to go beyond Earth’s orbit,” said Jonathan Scott, head of the European Space Agency’s medical projects and technology team. “It is our job to reduce the risk as far as reasonably possible.”
This is not an easy task because space is a very dangerous place. Even putting on a spacecraft puts astronauts at greater risk of drowning and dropping fingernails. By traveling outside the Earth’s atmosphere, astronauts are exposed to radiation, the consequences of which are not fully understood but are unlikely to be good. Weightlessness can be fun, but it causes a whole host of problems, including wasting bone and muscle. Some astronauts are starting to lose their sight. All these problems become more acute the longer you spend in space.
In addition, astronauts face all the health problems we experience on earth, but without easy access to a hospital. Nasa has a list of about 100 medical conditions that are likely to occur in space, ranging from toothache and nosebleeds to spinal fractures and chemical burns. And while the evacuation of the ISS is possible, it gets tricky when you’re on your way to Mars. A round trip to the red planet takes about three years, which means crew members have to treat each other if there is a medical emergency.
If your heart stops moving to Mars, you can be assured that researchers have considered performing CPR in space. (One option is to plant your feet on the ceiling and extend your arms down to compress the patient’s chest.) Due to their age group and high physical fitness, astronauts are unlikely to have a stroke or their appendix suddenly explode . This is good, because if they do, they’re in the realm of what Scott describes as ‘uselessness in treatment’. In other words: there is nothing anyone can do about it.
On the ISS, when medical incidents occur, astronauts can take advantage of the combined expertise of a myriad of medical experts at Nasa. “The patient is on the space station, the doctor is on the ground. If there is a problem, the patient consults the doctor,” Scott says. By the time astronauts reach Mars, there is a time lapse of 40 minutes in communication if it is at all possible to make contact. “We need to start preparing to not only diagnose things in space, but also to treat them,” says Scott.
Artificial intelligence is probably part of the solution. If you introduce yourself to Star Trek’s holographic doctor, downgrade your expectations, at least for the next few decades. Kris Lehnhardt, the elemental scientist for medical reconnaissance at Nasa, says, “We are many, many, many years away: name the nature of the medical emergency.”
Emmanuel Urquieta is an adjunct chief scientist at the Translational Institute for Space Health (TRISH), a Nasa-funded health research program for deep space missions. Although complete AI may come a way, Urquieta believes that some form of artificial intelligence will still play an important role. “It’s going to be essential for a mission to Mars,” he says. While the crew for a mission to Mars is likely to include a medical doctor, he explains, “No single doctor can know everything.” And of course: “What happens if that astronaut gets sick?
Research projects funded by TRISH include Butterfly iQ, an ultrasound device for use by non-medical personnel to make diagnoses that would otherwise require large equipment, and a trained operator. VisualDx is an AI diagnostic tool originally developed to analyze images and identify skin conditions. The technology is now being adapted to help astronauts diagnose a wide range of conditions that are most common in space without an internet connection.
Reducing the quantity and size of medical equipment, and the level of expertise required to use it, is of great importance if we are to bring it to Mars. The other maintains with a sufficient amount of consumable medical supplies. At the moment, almost everything astronauts in space need is taken off the earth. (Much of the drinking water on the ISS is recycled from wastewater, which includes the astronauts’ own sweat and urine.)
One Nasa study concluded that 248 liters of intravenous (IV) fluids had to be filled in a spacecraft to Mars, which had to take up very valuable space on a small spaceship. In the past decade, therefore, Nasa has been working on the production of IV liquid from drinking water. The technology continues to be refined so that it can be used for a Mars mission. Lehnhardt says: “You can enter a world where someone on the way to Mars has an illness or injury, and an astronaut turns on the water system, attaches a bag to a tap and five minutes later has a full bag sterile IV fluid. ”
As the blood clot incident on the ISS illustrated, maintaining an adequate supply of medication is also a problem. This is partly because spacecraft have limited space for a pharmaceutical cabinet, but also because medicine degrades faster in space than on Earth, possibly due to exposure to radiation. Astronauts also take a lot of drugs. One 2017 study of astronauts on the ISS found that crew members took an average of four medications per week.
Phil Williams is a professor of biophysics at Nottingham University and is head of the world’s first research program on astropharmacy – the study of drugs in space. His team investigates issues such as the immune system and resistance to antibiotics in space and has sent small worms, known as nematodes, to the ISS to investigate how muscles break down in microgravity.
Williams and his colleagues are also investigating how to solve the problem of the medication supply. “We’re looking at ways to make drugs on the premises and on demand,” Williams says. By taking the protein-building machinery of radiation-resistant bacteria and linking it to the DNA of protein-based drugs, Williams’ team has succeeded in growing further drug stocks in test tubes. In the future, using 3D printing technology, Williams says we’ll be able to ” take a black box and type in the box you want, and the medicine will appear. ‘
That technology may or may not be applied to the very first Mars missions. But if humans ever want to colonize other planets, we must go beyond producing medicine in space. This could include medical and surgical tools for 3D printing, or even replacement organs. research is currently underway into whether human hearts can be printed aboard the ISS.
Ultimately, the effects of medical conditions with minimal resources are essential for space exploration, but it also has many terrestrial applications. If we can reduce the ‘futility of treatment’ in space, we can reduce it here on earth as well. “If we can treat people on Mars, we can treat them anywhere,” Williams says. ‘In Antarctica, on a submarine, in a UNHCR camp in Africa, in the local hospital. It does not matter where we are. ”
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