Mission to Mars: Health Risk Mitigation Rich Williams NASA Chief Health and Medical Officer.
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Transcript of Mission to Mars: Health Risk Mitigation Rich Williams NASA Chief Health and Medical Officer.
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Mission to Mars:Health Risk Mitigation
Rich WilliamsNASA Chief Health and Medical Officer
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Societal Imperatives
• National Security Imperative
• Public Safety Imperative
• Human Exploration Imperative
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Risk Mitigation in an Occupational Environment
• Crew selection standards– Waivers are routine
• Engineering controls
• Exposure limits standards– In general, no waivers granted
• Personal protection, countermeasures
• Medical/environmental monitoring
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49,000,000 km
22 minute 1-way communication
g
g
1 yr
1 yr
temperatureextremes
Isolation &confinement
vacuum
Isolation &confinement
temperatureextremes
vacuum
Water & food
availability
Fuel & oxygen
Reduced gravity
New geo-ecosystem
Radiation
circadian
Biorhythms?
Risks: The Space Environment
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Space Flight Experience (continuous)
Space Flight Experience (continuous)
Flights longer than 28 days (May 1973 - June 2012)Flights longer than 28 days (May 1973 - June 2012)
Flight Duration (months)
Nu
mb
er
of
Ex
po
su
res
Most long-duration flights Most long-duration flights are 4-7 months longare 4-7 months long
Mars missions may last Mars missions may last up to 30 monthsup to 30 months
30
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Time Course of Physiological ChangesTime Course of Physiological Changesin Weightlessnessin Weightlessness
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Mars Radiation ExposureComparing Solar Max and Solar Minimun
1 Sv = ~ 100 RemPerson at Sea level ~ 1.4 Rem/yr
ISS Crew member ~ 5.4 Rem/6 monthsMars Crew member ~20-85 Rem
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Visual Impairment/Elevated Intracranial Pressure
Background: 19 known “clinical cases” of 25 evaluated crew membersEach with different degrees of symptoms
MRI Orbital Image showing globe flattening
Normal Globe Flatten Globe
•Choroidal Folds - parallel grooves in the posterior pole
•Globe Flattening
•Optic Disc Edema (swelling)
•Altered Blood flow•“cotton wool” spots
•Hyperopic Shifts-Up to +1.75 diopters
•Increased Optic Nerve Sheath Diameter
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Martian Surface Analysis: Curiosity
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Martian Dust Analysis: Curiosity
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Seeing Earth through a telescope from Mars
Earth and Jupiter from the Martian surface
Behavioral Health
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NASA Health and Medical Policies
• NASA ground workforce health and safety is regulated by OSHA– Executive Order 12196, February 26, 1980, Occupational Safety and
Health Programs for Federal Employees
• NASA environmental health issues are regulated by EPA
• NASA public use vehicle operations (research aircraft, spacecraft) are controlled by NASA policy directives, procedural requirements, standards and requirements
• NASA health and medical policies and standards “regulate” aircrew and space flight crew selection, qualification, and health related requirements in NASA research aircraft and spacecraft
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NASA Health Standards for Human Spaceflight
• NASA STD-3001 Vol. 1: NASA Space Flight Human System Standard - Volume 1: Crew Health– 4.2.3 Fitness-for-Duty Aerobic Capacity Standard – 4.2.4 Fitness-for-Duty Sensorimotor Standard– 4.2.5 Fitness-for-Duty Behavioral Health and Cognition Standard – 4.2.6 Fitness-for-Duty Hematology and Immunology Standard – 4.2.7 Permissible Outcome Limit for Nutrition Standard – 4.2.8 Permissible Outcome Limit for Muscle Strength Standard– 4.2.9 Permissible Outcome Limit for Microgravity-Induced Bone
Mineral Loss Performance Standard (Baseline with Measured Tscore)– 4.2.10 Space Permissible Exposure Limit for Space Flight Radiation
Exposure Standard
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Ethical Considerations of Exploration Class Missions
• Exceeding exposure limits is justified only if the benefit to the population is greater than the risk to the individual
• Examples:– Radiation workers can exceed exposure limits to contain
nuclear power plant contingencies• Generally defined in the radiation exposure standards
– Military members can exceed radiation dosage limits if driven by necessity
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Ethical Considerations of Exploration Class Missions
• How do we approach increased health risks for exploration class missions?– Liberalize exposure limits for exploration class missions
– Waive exposure standards for exploration class missions
– Administrative risk acceptance by higher authorities
• Informed consent?• How is health risk acceptance influenced by overall
mission risk?
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National Academies:Institute of Medicine
• Committee on Aerospace Medicine and the Medicine of Extreme Environments (CAMMEE)– Ethics, Principles and Guidelines for Health Standards
for Long Duration and Exploration Spaceflights
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Institute of Medicine Study
• What factors should be considered in the implementation of current health standards in exploration class missions?
• What ethical considerations are involved when exposures/risks are uncertain and exposures may exceed current standards?
• How should informed consent be applied?
• What are appropriate modifiers for standards when risks/exposures are uncertain?
• Should all crewmembers be protected to the same extent or should potential individual differences be considered?
• Are there models or examples that could inform NASA strategy?
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Human Health & PerformanceHHP
Component30 months Stay total Comments
Physiological Countermeasures
• 0-g transit phases well within experience base (esp. outbound)
• 3/8-g surface phase outside experience base
• Outbound similar to 6 month ISS missions
• How much will the 3/8 surface phase add to human physiologic tolerance?
• Level of Deconditioning leaving Mars and ease of rehab on mission home
Human Factors & Habitability
• Access to Surface Habitat • Atmosphere – supplies, dependability, communications
• Replacement parts
Radiation • Prolonged exposure to poorly-understood surface mixed-field (neutrons and charged particles) environment
• Solar max travel - lower cosmic radiation
• Safe haven for solar flares• Radiation protection on Mars
Behavioral Health & Performance
• Increased risk due to longer overall duration
• Family events
Medical Capabilities
• Increased risk due to longer overall duration
• Anticipation of required health care
• Preparing for the trauma and other unexpected illness
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NASA Policy Formulation
• Federal Government Policy– Statutes, Regulations, Executive Orders/Presidential
Directives
• NASA Agency Policy– NASA Policy Directives
– NASA Procedural Requirements
– NASA Standards
• Plans, Requirements– Programmatic (Space Shuttle, International Space Station)
• Project (External Tank, Shuttle Main Engines, etc)
– Mission Support
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NASA Internal Regulation
• Established by the National Aeronautics and Space Act of 1958 “To provide for research into problems of flight within and outside the earth's atmosphere, and for other purposes.”
• 51 USC 20113(a): In the performance of its functions the Administration is authorized-- – (1) to make, promulgate, issue, rescind, and amend rules and
regulations governing the manner of its operations and the exercise of the powers vested in it by law;
• The NASA Administrator is authorized to promulgate internal NASA policies governing operations within the Agency
• Health and medical policy formulation, promulgation, and oversight is delegated to the Chief Health and Medical Officer
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NASA Health Standards for Human Spaceflight
• “In this document, the Office of the Chief Health and Medical Officer establishes NASA’s space flight crew health standards for the pre-flight, in-flight, and post-flight phases of human space flight.”
• “Although the standards are applicable to the in-flight phase of all space missions, it is anticipated that they will be most relevant during long-duration lunar outpost and Mars exploration missions, since the combined ill effects of exposure to the space environment will be of most concern in those mission scenarios.”