How long before we have full-time medical staff in space?

[willpittenger]

Any ideas? Please state how long you think it will be for LEO, the Lunar surface, and the Martian surface. For now, the definition of "full-time" would be at least one trained MD in orbit whose priority would be the welfare of the crew. Other crew members with some medical training might serve as nurses or medical assistants in a pinch. <div class="Discussion_UserSignature"> <hr style="margin-top:0.5em;margin-bottom:0.5em" />Will Pittenger<hr style="margin-top:0.5em;margin-bottom:0.5em" />Add this user box to your Wikipedia User Page to show your support for the SDC forums: <div style="margin-left:1em">{{User:Will Pittenger/User Boxes/Space.com Account}}</div> </div>

 

[docm]

Sraight medicine is no problem; "phone home" and get the proper meds out of stores. Complementing this at least 2 crew members should be trained as medics for redundancy. They can handle minor surgical needs and help with more invasive surgeries if necessary.<br /><br />Yes, full-blown surgeries. One crew member with appendicitis is all it takes.<br /><br />The solution comes out of todays medical reality: robotic telesurgery. <br /><br />In telesurgery the surgeon could be on one side of the world and the patient the other. The surgeon operates a robotic surgery unit that gets its stereo video from the remote unit. Whatever he does with his manipulators is precisely duplicated by manipulators at the remote. The only difference between this and in-room robotic surgery (commonplace) is the distance and the remote link, which could be internet, satellite, optical or whatever. IIRC it even has force-feedback.<br /><br />For use on Mars the delay between actions would be long of course, which unfortunately lengthens the procedure and increases the risk. <br /><br />A way around this lag is being worked on around the world, but progress in Italy by Dr. Carlo Pappone has been interesting; the development of autonomous robotic surgery - the robot does it all in real time without human intervention. This was a catheterisation procedure and not open heart, but it shows the possibilities. <div class="Discussion_UserSignature"> </div>

 

[bpfeifer]

For the most part I agree. With some basic medical training, you can go a long way with "phone home" and video support. The NEMO crews have done some good experiments of this kind with a Canadian physician, I believe. One of the ISS expeditions also did some tests using ultrasound equipment for diagnostic purposes while guided by groundside experts.<br /><br />I suspect we won't see a full blown doctor in LEO or onthe Moon until we have crew sizes approaching 50. Mars is a different beast because of the time lag, durration, inability to send anything "as needed." A Mars mission is more likely to have a fully qualified astronaut who also is an MD. I know that's an awful lot of knowledge to keep in anyone's head, but I'm sure NASA will be able to track down a few. <div class="Discussion_UserSignature"> Brian J. Pfeifer http://sabletower.wordpress.com<br /> The Dogsoldier Codex http://www.lulu.com/sabletower<br /> </div>

 

[earth_bound_misfit]

"The solution comes out of todays medical reality: robotic telesurgery. "<br /><br />Damn straight, A surgeon wouldn't want to become an astronaunt, because they wouldn't want to take a pay cut <img src="/images/icons/rolleyes.gif" /> <div class="Discussion_UserSignature"> <p> </p><p> </p><p>----------------------------------------------------------------- </p><p>Wanna see this site looking like the old SDC uplink?</p><p>Go here to see how: <strong>SDC Eye saver </strong>  </p> </div>

 

[docm]

Agreed <img src="/images/icons/wink.gif" /> <div class="Discussion_UserSignature"> </div>

 

[jimfromnsf]

Is there a full time doctor in Antarctica?<br /><br />Also I find these types of threads, silly or a waste of time since there is no right answer and what does happen probably isn't going to be posted.

 

[Boris_Badenov]

<font color="yellow"> I find these types of threads, silly or a waste of time </font><br /><br />Then why did you reply? <div class="Discussion_UserSignature"> <font color="#993300"><span class="body"><font size="2" color="#3366ff"><div align="center">. </div><div align="center">Never roll in the mud with a pig. You'll both get dirty & the pig likes it.</div></font></span></font> </div>

 

[jimfromnsf]

to point out that they are silly

 

[willpittenger]

<blockquote><font class="small">In reply to:</font><hr /><p>Is there a full time doctor in Antarctica?<p><hr /></p></p></blockquote><br />Good question. When do you expect to get back from your research trip in Antarctica to find out the answer?<br /><br /><blockquote><font class="small">In reply to:</font><hr /><p>Also I find these types of threads, silly or a waste of time since there is no right answer and what does happen probably isn't going to be posted.<p><hr /></p></p></blockquote><br />The idea is to get people, like you, thinking about the problem. <div class="Discussion_UserSignature"> <hr style="margin-top:0.5em;margin-bottom:0.5em" />Will Pittenger<hr style="margin-top:0.5em;margin-bottom:0.5em" />Add this user box to your Wikipedia User Page to show your support for the SDC forums: <div style="margin-left:1em">{{User:Will Pittenger/User Boxes/Space.com Account}}</div> </div>

 

[Boris_Badenov]

<font color="yellow"> to point out that they are silly </font><br /><br />Why is your opinion of what is silly more important than every other persons opinion on this board? <div class="Discussion_UserSignature"> <font color="#993300"><span class="body"><font size="2" color="#3366ff"><div align="center">. </div><div align="center">Never roll in the mud with a pig. You'll both get dirty & the pig likes it.</div></font></span></font> </div>

 

[thereiwas]

Three weeks ago I myself was a subject of "robotic telesurgery" and it works extremely well. In my case the surgeon was only 10 feet away at his console but there is no reason that distance could not be extended. A catch is that you need some well trained technicians at bedside as well to set up the equipment. (Lots of details on the present state of the art at this link.)<br /><br />During the Vietnam War it was discovered that additional training for the "medics" improved survival of patients in the field until they could get to an MD. That concept is visible in today's medicine as the "certified physician's assistant" or "PA-C". Something like that might make sense for near term space missions. I am sure astronauts get some amount of medical training (otherwise they would not have had that stapler on board last time) but I am talking about something more formal, where one member of each mission would have had a more focussed training.

 

[earth_bound_misfit]

I'm sure there is (though my option means nought), but there definately wasn't a surgen a couple of years back, when a woman had to be rushed back in a daring flight, as she was found to have cancer. <div class="Discussion_UserSignature"> <p> </p><p> </p><p>----------------------------------------------------------------- </p><p>Wanna see this site looking like the old SDC uplink?</p><p>Go here to see how: <strong>SDC Eye saver </strong>  </p> </div>

 

[thereiwas]

That was Dr Jerri Nielsen. She <i>was</i> the doctor. It's a story of incredible courage.

 

[jimfromnsf]

"The idea is to get people, like you, thinking about the problem."<br /><br />There are many problems to solve before this is even an issue. <br /><br />Basically, it is like worrying about how you are going to dig the foundation of your second house when you haven't even purchased your first house

 

[willpittenger]

Which brings up a rather bad possibility. Suppose you are on the Martian surface (or, worse, visiting Ganymede) when your doctor comes down with a bad case of cancer, possibly caused by the radiation. Unlike we had with the Antarctica doctor, you have no options for return the person to Earth for treatment. So you need a second doctor. You can't just say "Doctor, heal thyself" because the doctor might die first. Don't tell me you would ensure the spacecraft systems all had backups, but forget to backup the doctor. <div class="Discussion_UserSignature"> <hr style="margin-top:0.5em;margin-bottom:0.5em" />Will Pittenger<hr style="margin-top:0.5em;margin-bottom:0.5em" />Add this user box to your Wikipedia User Page to show your support for the SDC forums: <div style="margin-left:1em">{{User:Will Pittenger/User Boxes/Space.com Account}}</div> </div>

 

[thereiwas]

In LEO I think on-mission technicians backed up from the ground would be enough in most cases. Stop the hemmorage until you can get them down. Serious internal injuries - I think you're a gonner. <br /><br />Clearly for trips to Mars and further out you would want a lot of the people to have had enough training to assist, plus redundant MD's. Dr Nielsen had to do a biopsy on herself!

 

[docm]

<font color="yellow">Is there a full time doctor in Antarctica?<br /><br />Also I find these types of threads, silly or a waste of time since there is no right answer and what does happen probably isn't going to be posted.</font><br /><br />Jim, there is a right answer but you're ignoring it. I understand that you're not a medical person, so please take it from those who are that this is NOT "silly" or a "waste of time". <br /><br />The applications are not just for space but also emergency medicine, in remote regions where doctors are scarce or even Antarctica so people don't have to be cut by the maintenance man <img src="/images/icons/tongue.gif" /><br /><br />NASA has been supporting research beneficial to robotic surgery for years and for good reason; they're planning ahead. <br /><br />Link....<br /><blockquote><font class="small">In reply to:</font><hr /><p><b>Involvement of NASA and the U.S. Army</b><br /><br />As robots developed in the medical field, researchers at the NASA (National Air and Space Administration) Ames Research Center began working on a concept called teleprescence surgery (telesurgery) which combined virtual reality, robots, and medicine. <font color="yellow">In the early 1990's, the scientists from the NASA-Ames team joined the Stanford Research Institute (SRA) to develop a telemanipulator for hand surgery. Eventually, surgeons and endoscopists joined the development team to give their project a full spectrum of experts.<br /> /></font>p><hr /></p></blockquote><br />By aiding the basic research and nursing it to fruition, which is just what they did, evolved (read smaller & cheaper) versions of the devices they need will be commercial by the time they need it. They're getting <b>real close</b>.<br /><br />This from April 19, '07;<br /><br />http://uplink.space.com/newreply.php?Cat=</safety_wrapper <div class="Discussion_UserSignature"> </div>

 

[holmec]

Will, I think you bring up a good point. The obvious answer would be to train every crew member on basid surgery and treatement of disease. <br /><br />That way they have some skill to work on and have communications with surgeons and doctors on earth.<br /><br />I guess that would be like a naval corps-man. <div class="Discussion_UserSignature"> <p> </p><p><font color="#0000ff"><em>"SCE to AUX" - John Aaron, curiosity pays off</em></font></p> </div>

 

[thereiwas]

Whatever the cause of Dr Nielsen's cancer, it happened long before she got to Antarctica. You can miss cancer for many years, and then suddenly there it is. I speak from experience.<br /><br />More likely problems to turn up on a long space mission are things like appendicitis, or trauma due to some accident.<br />

 

[docm]

<font color="yellow">Why would a medical crew get a cancer in space?</font><br /><br />99% of surgeries are not for cancer, but radiation exposure in space could induce one and you never can tell where, when or if it's operable, therefore CYA.<br /><br />Also; because of microgravity an astronaut could develop a kidney or gall stone that doesn't pass. It's also possible one could suffer trauma that requires surgical repair (ex: blood vessel repair, herniated disc etc.), needs an angioplasty or other clot removal (another thing microgravity could induce) or a examine/repair damage from a meteoroid penetration. It's also possible an antibiotic resistant infection, alien or Earth bug, in an extremity could need surgery to save the limb. I had this happen from a 1/4" sliver and it took 4 surgeries over 4 weeks. Fun <img src="/images/icons/tongue.gif" /><br /><br />The list is almost endless. <div class="Discussion_UserSignature"> </div>

 

[vulture2]

There is a full-time physician at the South Pole station, but this is a base with more than 25 personnel even during the winter. There is no capability for major emergency surgery, nor has there been a case where anyone has ever died because it was not available. While there are several astronaut physicians, there is currently no requirement to have a physician as a member of the crew. <br /><br />The primary facor affecting whether a physician is likely to be permanently assigned is the number of personnel at an isolated location. If there is a crew of three, practically no one would feel there has to be a physician. If there is a crew of 20, practically everyone agrees it is a good idea. <br />

 

[bpfeifer]

vulture 2, I think you hit the nail on the head. It completely depends on how many people are assigned to the mission. <br /><br />Astronauts are extremely capable individuals who are excellent at following complex directions: for small crews, similar to Apollo, STS, and ISS missions, Astronauts can handle many situations with support from ground side experts. <br /><br />As crew sizes expand, there will be more reasons to pick Astronauts with mission specific expertese. Commanders with command experience, geologists with geology experience, etc. At some point a crew will become so large that you will even want a designated chef/cook. Somewhere along that continuim you will want to add a medical professional.<br /><br />At an exploration and risk seminar held a few years ago by NASA (2004?), there was a good discussion about this topic. Many of the participants are actively involved in exploring remote locations on earth including long expeditions in caves, arctic/antarctic regions, high altitude deaserts, etc. Also included were researchers on polar explorers of previous centuries. They generally said the two most important medical skills were trauma surgery, and dental practice. If you have doctors with these two skill sets in your expedition, you have the best chance for survival. Plus with today's communication systems, remote specialists can guide your local doctor through most problems outside their experience. <div class="Discussion_UserSignature"> Brian J. Pfeifer http://sabletower.wordpress.com<br /> The Dogsoldier Codex http://www.lulu.com/sabletower<br /> </div>

 

[Boris_Badenov]

<font color="yellow"> At some point a crew will become so large that you will even want a designated chef/cook. </font><br /><br />I volunteer, I volunteer!!! <div class="Discussion_UserSignature"> <font color="#993300"><span class="body"><font size="2" color="#3366ff"><div align="center">. </div><div align="center">Never roll in the mud with a pig. You'll both get dirty & the pig likes it.</div></font></span></font> </div>

 

[docm]

Mission specific expertise? 2 words: Harrison Schmitt in a 3 man crew.<br /><br />As for scaling as to crew size; sure...that should be one criteria but co-equal should be mission <i><b>duration</b></i>, IOW person/hours (or for Mars: person/years). The more person/hours in a mission the greater the likelihood a medical issue will arise. <div class="Discussion_UserSignature"> </div>

 

[vulture2]

My feeling is that the emphasis on appendicitis and trauma surgery is somewhat unrealistic. There's an unconfirmed report of a Russian doctor in the Antarctic performing an appendectomy on himself, but in reality most appendicitis in adults can be stabilized indefinitely with antibiotics, although surgery may be needed eventually. <br /><br />Trauma surgery is dramatic but requires extensive facilities and an experienced staff, and most survivable trauma is due to careless driving, falls, and intentional violence, which we can hopefully avoid in space. Moreover, there has never been a life-threatening trauma in spaceflight that left anyone alive to provide treatment. <br /><br />The physician will have other jobs, and his medical skills will mostly be needed for recognizing and treating routine problems before they become life-threatening. Navy subs have not carried doctors since the early Polaris era, and the only Navy vessel that has full surgical capability is an aircraft carrier, which has a crew of about 5000.<br /><br />The most productive way to reduce the medical risks of spaceflight may be to develop propulsion that can reduce travel time. <br /><br />Finally, if they had to choose between a capable doctor and a capable cook, I don't need to tell you which one most sea captains would consider more vital in their crew!