Congreso Internacionalde Seguridad Aerea 2019

Factores Humanos y Tecnologia

Emmanuel Urquieta, M.D., M.S., AFAsMAScientistNASA funded Translational Research Institute for Space HealthAssistant ProfessorDepartment of Emergency Medicine and Center for Space MedicineBaylor College of Medicine

OUTCOMES IN US LAUNCH SYSTEMS

Apollo 17Last Moon landing(December 1972)

EARTH-MOON-MARS

Distance: 238,900 milesTravel: 3 daysComms delay: 1.3 secondsGravity: 1/6 Earth (10lb = 1.66lb)

Not to scale

Distance: 141,700,000 milesTravel: 150-300 daysComms delay: 3-21 minutesGravity: 3/8 Earth (10lb = 3.77)

Low<0.1 %

High>1.0%

Mission Health and Performance (OPS)

Minor injury/illness that is self-limiting

OR

Minor impact to performance and operations-

requires additional resources (time, consumables)

Likelihood

Likelihood

Quality of Life is defined as impact on

day to day physical and mental functional

capability and/or lifetime loss of years

• Return to baseline values within 1

year with nominal intervention

(time, exercise, nutrition, lenses)

• Negligible effect on quality of life

Temporary discomfort

OR

Insignificant impact to performance and

operations - no additional resources required

• Return to baseline values within 3

months with limited intervention

• No effect on the quality of life

Significant injury, illness, or incapacitation –

may affect personal safety

OR

Significant reduction in performance results in

the loss of some mission objectives

• Return to near baseline requires

extended medical intervention w/

known clinical methods/technologies

(pharmaceuticals, etc.)

• Moderate impact on quality of life

Death or permanently disabling injury to one or

more crew (LOC)

OR

Severe reduction of performance that results in

loss of most mission objectives (LOM)

• Unknown and improbable return to

baseline (requires drastic

intervention surgery & therapy)

• Major impact on quality of life

(permanent reduced function,

premature death)

Long Term Health (post mission) (LTH)

2 x 1

2 x 2

2 x 3

2 x 4

Consequence

Lo

wM

ed

ium

Hig

hV

ery

Lo

w

Lo

wM

ed

ium

Hig

hV

ery

Lo

w

Medium<1 %

1 x 1

1 x 2

1 x 3

1 x 4

3 x 1

3 x 2

3 x 3

3 x 4

CM = Countermeasure

LOC = Loss of Crew

LOM = Loss of Mission

Human System Risks – Likelihood vs Consequence

Mission type Duration Crew Total Medical

Shuttle 14 days 7 1 in 83 1 in 1,333 2%

Orion, cis-lunar 21 days 4 1 in 156 1 in 2,500 6%

Deep Space Gateway 42 days 4 1 in 130 1 in 1,111 12%

Shuttle-ISS 6 months 6 1 in 53 1 in 217 24%

Deep Space Transport, shakedown 1 year 4 1 in 46 1 in 145 32%

Deep Space Transport, Mars flyby 2 years 4 1 in 25 1 in 79 31%

LOSS OF CREW LIFE

THE 5 HAZARDS OF HUMAN SPACEFLIGHT: Integrated Human Health & Performance Effects

Physiological

EffectsIsolation/ConfinementBehavioral aspect of isolation ♦︎ ♦︎

Sleep disorders ♦︎ ♦︎ ♦︎

Hostile Closed EnvironmentVehicle Design ♦︎ ♦︎ ♦︎

Environmental – CO2 Levels, Toxic Exposures, Microbiome ♦︎ ♦︎ ♦︎

Food/Nutrition ♦︎ ♦︎ ♦︎

Distance from EarthCommunication delay ♦︎ ♦︎ ♦︎Autonomous medical care ♦︎ ♦︎ ♦︎

No emergency evacuation ♦︎ ♦︎ ♦︎

Altered Gravity FieldsDisorientation & Balance Disorders ♦︎ ♦︎

Fluid Shifts & Visual Alterations ♦︎

Cardiovascular Deconditioning ♦︎

Exercise & Fracture Risk ♦︎

Radiation Effects Acute, in-flight effects ♦︎ ♦︎

Long-term cancer risk ♦︎

CNS and Cardiovascular ♦︎ ♦︎

Cognitive

Effects

Psychological

Effects

COGNITIVE

PERFORMANCE

Radiation

High Workload

Microgravity Noise

Nutrition

CO2 O2Medications

Confinement & Isolation

MonotonySlam-Shifts

Non-24-h Light-Dark Cycles

ICP

Exposure Sources•Carbon dioxide•Celestial dust•Toxic•Sunlight •Radiation

Work•Sleep loss•Circadian desynchronization• Work overload

Preparedness•Food and nutrition•Inflight medical conditions•Medication

Injury sources•Dynamic loads•EVA•Electrical shock

Isolation•Cognitive, behavioral, psychiatric disorders•Cooperation, coordination, psychosocial adaptation

Altered body function •Immune response•Hypobaric hypoxia•Decompression•Renal stone•Bone fracture•Host-microorganism interactions•Urinary retention•Orthostatic intolerance•Cardiac rhythm•Back pain

Reduced capacities •Hearing loss•Intracranial hypertension/vision alteration•Vestibular/sensorimotor alteration •Muscle mass, strength, endurance•Aerobic capacity

Anomaly Response

Causal Diagnostics

Complex Procedure ExecutionRisk Assessment /

Time to Criticality

Next Worst Outcome Analysis Knowledge

Integration

Contingency Planning

Enabling Unique Human Capabilities for Earth-Independent Ops

Mitigating Impacts on Human Health & Performance

How Crew Is Impacted by Mission How Crew Is Impacting Mission

Barger LK, et al. Learning to Live on a Mars Day: Fatigue Countermeasures during the Phoenix Mars Lander Mission. Sleep. 2012: 35: 1423-35B.

Hailey, M., Bardina, J., McGuire, K., Urbina, M., Hanson, A., Cerro, J., & Mindock, J.

(2019). Exploration Medical Capability Medical System Recommendations for Gateway.

21

With TRISH funding

To date:

Pilot...compiled date for training

AMRA to diagnose headache and

respiratory medical conditions

Model has been tested and initial

characterization is complete

A “virtual physician” for deep space applications

Innovation Through Partnership with a Small Company:AMRA has created an application using a Bayesian dynamic model that gives crew a “virtual physician” experience that includes list of symptoms, diagnosis, treatment, monitoring and follow-up.

PI: Jayant Menon (Nahlia)

1. Describe medical issue to

the “virtual doctor”

2. Follow a series of

questions to identify the

diagnosis

3. The model will prescribe

appropriate countermeasure

4. A series of questions will

be asked for monitoring,

follow-up and

recommendations for next

steps if needed

Screenshot of the diagnosis questionnaire for

headache

Next Steps:

Improve user interface/user experience

and expand to other medial conditions

AMRA Process

Using augmented intelligence to diagnose dermal medical conditions

Innovation Through Partnership with a Small Company:VisualDx combines machine learning and vision science with structural clinical data and clinical question sets to let non-specialist healthcare providers (1) enter patient-specific findings (2) build custom differentials (3) and then view images, treatment recommendations and management information.

PI: Art Papier (Visual Dx)

Building on established

technology, TRISH invested in:

• Modifying the system to operate in a

stand-alone environment without

internet access

• Training the system to maximize

efficacy in space applications

• Developing space-specific content

based on the Space Medicine

Exploration Medical Condition List

1. Home screen 2. Choose photo of lesion from file machine’s native file system

3. Enter additional findings relevant to the case

4. View differential diagnosis list, ordered by match strength

5. Click on a diagnosis to read a full summary

Add ultrasound image recognition

module

Stand alone application for mobile

platforms (iOS and Android)

Additional AI modules for eye and

orthopedic conditions

Level Ex, in collaboration with TRISH, NASA, and domain experts have proposed the following project objectives:• Simulate and render the environmental physics of a spacecraft (physical modeling of volume, interiors,

mass, and ambient variables such as gravity, temperature, light, radiation, barometric pressure, sound, and gas mixture).

• Develop an adaptive visual virtual human simulation to include anatomical and physiological changes, in varying degrees of complexity in space environments, including long-duration exposure to space.

• Demonstrate the use of medical procedures and technology in this virtually simulated space flight environment.

• Explore and report on “next targets” or use cases for this platform.

Virtual Human Simulation FrameworkPI: Erik Funkhouser

Simulation on a mobile

device

Realistic imagery of

airway with and without

obstruction

Retinal Imager• PI: Bob Main• Project finished August 2018• Intended for ISS operations

Multifunctional Ophthalmic Device

• PI: Bob Main• Project finished July 2019• Intended for exploration-class

missions

Butterfly iQ Ultrasound• PI: Ashot Sargsyan• Project finishes March 2020• Intended for ISS operations• Manifested for flight, will

launch February 2020

MOD replaces (top left, clockwise) retinal imager, perimetry/visual field, objective refractor, and OCT.