Severe traumatic injury during long duration spaceflight: Light years beyond ATLS

Abstract

Traumatic injury strikes unexpectedly among the healthiest members of the human population, and has been an inevitable companion of exploration throughout history. In space flight beyond the Earth's orbit, NASA considers trauma to be the highest level of concern regarding the probable incidence versus impact on mission and health. Because of limited resources, medical care will have to focus on the conditions most likely to occur, as well as those with the most significant impact on the crew and mission. Although the relative risk of disabling injuries is significantly higher than traumatic deaths on earth, either issue would have catastrophic implications during space flight. As a result this review focuses on serious life-threatening injuries during space flight as determined by a NASA consensus conference attended by experts in all aspects of injury and space flight.In addition to discussing the impact of various mission profiles on the risk of injury, this manuscript outlines all issues relevant to trauma during space flight. These include the epidemiology of trauma, the pathophysiology of injury during weightlessness, pre-hospital issues, novel technologies, the concept of a space surgeon, appropriate training for a space physician, resuscitation of injured astronauts, hemorrhage control (cavitary and external), surgery in space (open and minimally invasive), postoperative care, vascular access, interventional radiology and pharmacology.Given the risks and isolation inherent in long duration space flight, a well trained surgeon and/or surgical capability will be required onboard any exploration vessel. More specifically, a broadlytrained surgically capable emergency/critical care specialist with innate capabilities to problemsolve and improvise would be desirable. It will be the ultimate remote setting, and hopefully one in which the most advanced of our societies' technologies can be pre-positioned to safeguard precious astronaut lives. Like so many previous space-related technologies, these developments will also greatly improve terrestrial care on earth.

Emergency medicine in space

“…The crew will need to rely solely on itself for the management of severe incidents and urgent medical events. The main concerns involve the management of severe medical conditions [17,18], radiation exposure [19], cardiovascular deconditioning [8], demineralisation and infections [20], as well as the psychological effect of isolation and chronic stress.…”

“…one emergency during a flight to Mars) [10,16]. Management of severe trauma and surgical conditions will be of the highest concern, which implies the capability to provide anaesthesia [17,18].…”

Prophylactic surgery prior to extended-duration space flight: Is the benefit worth the risk?

“…[8][9][10][11][12][13][14][15] Given both equipment and manpower constraints, the challenges include restricted perioperative imaging capabilities, limited availability of surgical equipment owing to payload weight constraints, nonsurgeon crew medical officers (CMOs) with limited medical training, and potential inability to provide basic perioperative or postoperative anesthesia or nursing and rehabilitation care. [16][17][18] These expected limitations do not begin to address the potential need for critical care support of a crew member with a surgical emergency. 4,[17][18][19][20] In addition to the inherent hostility of their environment, CMOs and flight surgeons must also consider the potential impact on mission objectives when assessing a crew's response to an ill crew member.…”

“…[16][17][18] These expected limitations do not begin to address the potential need for critical care support of a crew member with a surgical emergency. 4,[17][18][19][20] In addition to the inherent hostility of their environment, CMOs and flight surgeons must also consider the potential impact on mission objectives when assessing a crew's response to an ill crew member. Unlike the past "scoop and run" strategy that required only stabilization and rapid evacuation, the reality of a "stand and fight" scenario is much more involved.…”

The anaesthetic management of microgravity-exposed individuals

“…4,5 Although radiation, loss of bone mineral density and behavioural adaptation have been identified as the three most important health issues relating to long-duration missions, traumatic injury causes the most concern with regard to probable incidence versus its impact on the mission and health. [4][5][6] The National Aeronautics and Space Administration (NASA) has predicted that one medical emergency will require evacuation per 68 personmonths. 4 As the space tourist population increases, these numbers will rise.…”