Survey of astronaut opinions on medical crewmembers for a mission to Mars

Abstract

A survey was submitted to all active members of the US Astronaut Corps to determine their opinions on the need for and qualifications of a crew medical officer (CMO) for a mission to Mars. The majority of respondents felt that health problems will occur during such a mission and that if there are more than four crewmembers, a physician should be included. Responses favored a physician with 4–6 years clinical experience, and a second CMO with paramedic-level training. Extensive training in emergency medicine, aerospace medicine, and internal medicine was considered desirable for a physician CMO, with more limited training in surgery, psychiatry, gynecology, dentistry, and other fields, as well as training in space analog environments on Earth. The astronauts felt that a physician would spend most of the his/her time, both during training and during the mission, in non-medical duties and must be fully capable of contributing other essential skills to the team.

Introduction

A human mission to Mars will be an extraordinary undertaking demanding preparation to a level beyond that currently used for missions to low earth orbit. Exploration class missions returning to the Moon or going to Mars are the current focus for NASA's future and the next big step in human space exploration.

The health risks to the crew will be dependent on mission architecture but are not entirely predictable. For Mars missions, medical autonomy will play a critical role should a health problem occur, since returning to Earth is not a viable option. Real-time telemedicine will be limited due to round-trip signal delays of up to 45 min, depending on the distance from the Earth, and there may be periods when communication is not possible.

The inclusion of appropriately trained medical officers in the crew is critical to achieve medical autonomy. The number and training of medical personnel for a Mars mission is yet to be determined, and both initial training and skill maintenance will present unique challenges as crews prepare for missions that may last up to three years. Exploration missions will include specific training in the skills required to operate spacecraft systems, perform spacecraft rendezvous, planetary EVA, and operate habitat systems. Astronauts will also require more generic exploration skills such as first aid, navigation, and photography, as well as expeditionary behavioral skills. Wilderness training and terrestrial analogs are currently being employed to train individuals in leadership, teamwork, and survival skills in addition to self-care and self-management skills. The combination of generic and mission-specific exploration training will give astronauts the necessary skills to optimize mission success. Future crew medical officers (CMOs) will require additional medical training to prevent, diagnose, and treat illness and injury to mitigate the health risks associated with long-duration exploration missions.

Several authors have discussed the need for a physician to provide medical care on spacecraft [1], [2], [3], [4], [5], [6], [7], [8], [9]. While the medical requirements for a mission to Mars will ultimately be developed in consultation with a spectrum of specialists, the perspective of astronauts on the desired crew skill sets to optimize mission success is important.

Exploration missions beyond low earth orbit will be associated with a number of potential risks to crew health, safety, and mission success. Determination of the fact that the level of risk is acceptable will be based on a wide range of risk management strategies to mitigate risks associated with vehicle design, mission architecture, systems operation, and human performance in extreme, harsh, isolated environments. As in the case of the Apollo lunar missions, exploration astronauts will play a critical role in assisting engineers, mission planners, and crew training teams in developing the hardware, procedures, and training requirements for generic and mission-specific exploration training. Similarly, the astronaut's perspective on the requirements for exploration clinical capability is of considerable importance, since they are all potential patients accepting risks to their health in unpredictable and new environments, and so their opinions should be integrated with recommendations of other expert groups.

Historically, there has been considerable discussion about the need for physicians on exploration missions and the type of medical training required [3], [6], [8]. There is a lack of consensus on the level of medical care required for exploration missions. While the predominant opinion is that physician-astronauts should be part of an exploration crew, Zubrin [9] has taken the position that having a dedicated physician on a mission to Mars is “cumbersome” and “unnecessary”. On the other hand, Hamilton [3] was one of the first to consider the need for a physician as a primary medical provider in a spacecraft crew and stated that “where man goes, his illness will follow, and so must physicians.”