As you’ve probably heard lately, July 20, 2019 marks the 50th anniversary of humans’ first moon landing via the Apollo 11. Since then, NASA and other space agencies have successfully launched many astronauts and brought them back home safely and in good health. But considering the limited space and resources onboard spacecraft and the International Space Station, how do astronauts handle medical issues? To address this question, NASA developed space telemedicine—one of the earliest adopters of the technology. Some of the key lessons learned from these experiences are proving useful in medical clinics here on terra firma, particularly in resource-constrained environments.
For each space mission, a comprehensive medical team of physicians, nurses, biomedical engineers, and other specialists plan the medical care according to the “mission profile.” Factors that could influence medical risks or needs are taken into account, such as medical evacuation capability or flight duration. The team determines what assets will be needed in terms of medications, instruments, medical knowledge, protocol, and so on.
On earth, emergency care in remote areas that lack easy access to medical care may mimic space telemedicine due to the highly limited resources, equipment, medicines, and personnel on hand. This suggests that perhaps a medical team could evaluate the region’s most likely medical incidents in order to train and equip emergency medical technicians (EMTs) accordingly. Other medical situations could be addressed through a telemedicine consult.
Before launch, some astronauts are trained as paramedics to serve as a crew medical officer. All astronauts are taught how to use the medical instruments onboard. Some equipment has been modified for easy use by international astronauts, such as an ultrasound machine with specially marked buttons so that a directive from earth can say, “Press the green three.” If a situation arises that goes beyond a paramedic’s expertise, then a telemedicine call is placed with a physician on earth.
On the ground, many remote areas do not have enough physician coverage for their populations. In these areas, well-trained paramedics, nurse practitioners, and physician assistants may be able to handle most common ailments; more involved issues would warrant a telemedicine visit with a doctor in another city, clinic, or hospital.
Astronauts, Mission Control, and members of the medical team train together through classes and simulations, developing strong operational and communication skills along the way. If an emergency occurs during flight, the crew members will communicate and act according to their training. Afterward, or as needed, they will use space telemedicine to consult with a physician on the ground.
On the ground, medical teams and paramedics also benefit from going through training and simulations together; these opportunities to build rapport and strengthen communication skills also help to boost each team member’s confidence in one another and in the team as a whole. These “touchy-feely” details might seem trivial, but in an emergency situation, every moment counts—and a team whose members trust and communicate well with one another is a team that works more quickly, efficiently, and successfully. Sometimes, this might mean setting up a telemedicine call to an emergency physician; depending on the familiarity of the team members, imagine the difference between “Call Dr. Smith!” and “Set up a telemedicine video call with Dr. Smith now!”
NASA has done a great job pioneering the telemedicine industry—out of necessity, since astronauts floating in space have no access to doctors. Still, many people have health conditions and/or live in rural areas, and the logistics of getting to a doctor’s office make access to medical care very difficult. If we can apply some success principles from space telemedicine to telemedicine in general, then don’t our patients also deserve the best care we can give them?