Author: Paul Zilberman MD
I was born in 1960.
As a child I was thrilled to witness the first man in space, as per stories, in those years a direct TV transmission was still a dream. And even if it had been possible, I was one year of age, so…
But later on, I was able to see the launch of the Apollo missions and the common US-Soviet programs Soyuz- Apollo.
As many other terrestrials I was thrilled to watch, both from distance and close up, those “white pencils” with the painting of “The United States of America” climbing faster and faster, leaving behind a huge ball of fire… Then the first carrying rocket segment detaching and falling back to Earth…
I was amazed seeing how only after a short time those “people out there” were floating and smiling, waving their hands and telling us everything is ok.
I was reading about the many experiments that were carried out during the flights, I was even able to look now and then at the flight path, little understanding what were the sinusoidal lines appearing on the huge Command Center screen, where so many people were sitting in front of the computers with the microphones and earpieces connected. I didn’t understand then, exactly, why so many people were dealing with so few in space.
Well, time went on, Skylab appeared, then the ISS, the shuttles…wow…all in a lifetime.
As time went on and understanding grew, on top of my medical school and, later on, anaesthesia residency, other questions arose: how do the astronauts eat, drink, wash, use the toilets? And many other daily mundane things we take for granted down here.
Modern medicine is all about numbers. Not in the dry sense of how many patients we see or haw many beds a hospital has; that’s the headache of the medical administrators. In my education “numbers” are pressures, concentrations, volumes etc.
One question I was asking myself for a long time was how the astronauts breathe in those confined spaces for such long periods of time. After all you have several people in a closed artificial environment. Exactly like in the submarines, but with a critical difference. A submarine can produce its needed oxygen by water hydrolysis; and usually there’s plenty of it in the oceans. In case of problems a submarine can surface, problem solved.
Not so in space. And here come into play those numbers: how much oxygen an astronaut needs, how many astronauts are in that space, how much CO2 is produced, how it is removed, and how is oxygen produced when, think of it, you don’t have it around the spaceship or station. Metabolic issues are studied to the tiniest detail, and experience is gathered with every new mission. In many fields.
I would like to bring here only one aspect: the removal of CO2. This text is not intended to explain in detail all the process, but just to make the reader raise a brow and say “I never thought of that”! And open his appetite to search for more.
The CO2 we produce is related to many physiological factors. Once exhaled it needs to be taken away from our faces, otherwise we inhale it back, a process known in anaesthesiology (and not only) as “rebreathing”. Think of this specific issue in space where there is no wind to wash away the CO2 from your face. Well, another problem, the need for cabin fans to circulate the air.
The removal of CO2 and the whole chemical reactions used in order to clean the closed environment of this gas while retaining the oxygen is energy dependent and follows several chemical steps. The whole process is known as “The Sabatier reaction”, from the name of one of the two French chemists that discovered it in 1897, Paul Sabatier and Jean-Baptiste Sendersen.
The moment I got closer to one other way of CO2 removal in space was when I read, post factum, of the almost tragedy of Apollo-13. A faulty contact in the transport module produced an explosion. The astronauts were forced to move quickly to the lunar module but…the CO2 absorbent filters there were not enough to remove enough CO2 in order to keep them alive till return to Earth. Well, you are invited to read the whole story.
But on this occasion, I learned about the LiOH based CO2 filters. The chemical reaction is the same as for any -OH based CO2 absorbent used in the anaesthesia machines only that, at least as a theoretical chemical calculation, their absorbent capacity on a CO2 volume/unit of absorbent mass can go up to five times more than what is commonly used in operating rooms (ORs).
The contribution of a special technology that preserves the spatial configuration of the absorbent helps to prevent a mechanical process called “channeling” that further reduces the lifetime of the other absorbents. Recently, with the Li prices going up, most probably due to its use in electric car batteries, the LiOH absorbent became financially non-competitive. However, the technology of maintaining that spatial configuration was kept. It is used today in the production of the same CO2 absorbents but with CaOH as the active substance. The absorbent is manufactured as cartridges, each type fitting a special anaesthesia machine. It may seem like a drawback, but if we consider the longer lifetime, the almost non-existent dust producing issue, the ease of replacing them, by the end of the day it may be a step forward in making our existing ORs more efficient in all respects.
All that is happening in the space confined “piece of Earth out there” is in fact human activity and use of resources to the maximum. In anaesthesiology we call it “closed circuit”.
The same way we use our experience on Earth to preserve life in space, we can do the reverse, help preserve, or at least improve life here based on the experience gathered from the space missions.
It all depends on us.
Author: Rohan Krishnan
Undergraduate, Bachelor of Science - Statistics & Healthcare Management | The Wharton School, University of Pennsylvania
In 1955, Walt Disney’s “Mars and Beyond” pondered human survival in extraterrestrial environments. The narrator envisions the colonisation of Mars as a feasible reality: a future where cities are encased in pressurised domes on the Red Planet to combat overpopulation and the depletion of natural resources on Earth.
Today, NASA’s Artemis Mission plans to return astronauts to the moon by 2025, this time with an eye toward lunar colonization and human exploration of Mars. The boundaries that once constrained human space exploration are shattering, as technological advancements and ambitious government space programs bring plans for travel to Mars closer to reality. Beyond government space agencies, private companies like Blue Origin and SpaceX are innovating to create faster, more efficient aircraft and bring space travel to the masses through commercial flights. As astronauts inch toward deep space missions, understanding the general health risks of long-distance space travel, as well as the varied conditions between environments, is crucial.
Missions to the International Space Station (ISS) and in low Earth orbit (LEO) have uncovered a variety of consequences for astronaut health, including bone loss, muscle atrophy, and a weakened immune system, amongst others. Radiation, microgravity, the distance from Earth, isolation, and the hostile environment inside spacecraft are the root causes behind the health issues that astronauts experience in space. Space exploration is vital for advancing life on Earth. Future missions across our solar system can help us understand the effects of microgravity and radiation on biological systems, locate valuable natural resources, and even combat overpopulation by exploring space colonisation. Given this need, ensuring the health of humans in space is the bedrock for further discovery.
In this blog, I will describe the significant health challenges associated with with spending time in LEO and on long-distance spaceflight to the Moon and Mars. I have narrowed the focus to the following branches of medicine, to outline and contrast the particular health issues between LEO and long-distance spaceflight: cardiology, ophthalmology, and neurology. Many of the health concerns associated with time spent in LEO persist during long-distance space travel, but there are also challenges specific to the Moon and Mars stemming from their unique environmental characteristics, such as the presence of regolith and varying radiation levels. Understanding these general and environment-specific health concerns will inform planning as we venture deeper into space.
The vast majority of human spaceflight has occurred within low Earth orbit (LEO), with the notable exception of the Apollo program’s lunar missions. All manned space stations, including the ISS, are in LEO. As a result, for more than two decades, countless experiments have been conducted on the ISS to understand how astronauts’ health is impacted in LEO.
Researchers studying the health of astronauts aboard the ISS have uncovered that long-term travel in LEO has notable effects on astronauts’ cardiovascular health. According to Dr. Thais Russomano, a leading expert on space medicine, the absence of Earth’s gravitational force in space causes bodily fluids and blood to shift from the legs and lower abdomen toward the upper torso and head. This phenomenon - referred to as ‘puffy-face and bird-legs syndrome’ - causes swelling in the face and head while reducing astronauts’ circulating blood volume and heart size. As less blood is pumped by the heart in microgravity, astronauts endure muscle loss in the heart, placing them at risk for cardiovascular deconditioning and cardiac myocyte atrophy.
Radiation is another significant concern impacting astronauts’ cardiovascular health. Aboard the ISS, radiation from galactic cosmic rays, solar cosmic rays, and particles from the Van Allen radiation belts are of primary concern. Astronauts are exposed to roughly 40-times more millisieverts of radiation compared to people on Earth. Exposure to space radiation over long-term missions increases astronauts’ risk for cancer and cardiovascular diseases, although effective shielding and radiation shelters aboard spacecraft have helped mitigate those risks.
Cardiovascular issues resulting from microgravity and radiation exposure over long periods aboard the ISS can follow astronauts well after returning to Earth. Some studies have determined that astronauts’ arterial blood pressure decreased throughout space missions due to the loss in circulating blood volume, although there could be many causes behind this change. Similarly, the reduction in circulating blood volume can cause orthostatic intolerance - the inability to stand due to lightheadedness or fainting - once astronauts return to Earth. Although radiation exposure and microgravity cause cardiovascular problems in space, studies on astronaut mortality have concluded that astronauts are at a lower risk of death from cardiovascular diseases relative to the general population on Earth.
The effects of bodily fluid shifting in microgravity extend beyond ‘puffy-face and bird-legs syndrome’, with consequences for the eyes. Following a six-month mission to the ISS in 2005, astronaut John Phillips’s perfect vision was found to have deteriorated due to spaceflight-associated neuro-ocular syndrome (SANS). SANS is formerly known as visual impairment and intracranial pressure (VIIP) syndrome, although the name was updated to reflect the uncertainty over whether increased intracranial pressure is the sole cause of the condition. One explanation is that SANS is caused by cerebrospinal fluid shifting toward the head, increasing intracranial pressure, particularly at eye level. The pressure causes the back of the eye to flatten, resulting in a hyperopic shift and blurred vision.
According to a report from the British Journal of Anaesthesia, a questionnaire of 300 astronauts found that 28% of short-duration mission astronauts and 60% of long-duration mission astronauts experienced degradation of visual acuity. A study of seven long-duration mission ISS astronauts and nine short-duration mission space shuttle astronauts found that the long-duration astronauts had significantly greater post-flight flattening when compared with the short-duration astronauts. Given the increased severity of SANS on long-duration missions, understanding causes and possible treatments are vital for exploration in and beyond LEO.
Microgravity has notable effects on the nervous system, particularly due to the redistribution of bodily fluids in space. Neuroimaging scans show that astronauts’ brains have increased ventricular volumes following long-distance spaceflight. As fluids shift toward the upper torso and head during long-term exposure to microgravity, the volume of cerebrospinal fluid collected in the brain’s ventricles increases, resulting in ventricular expansion. Ventricular expansion could be a possible cause of SANS and may be linked to premature ageing of the brain. One study found that astronauts who spent 12 months in space displayed larger changes in ventricular volume than astronauts who spent 6 months in space, suggesting important implications for long-duration space missions.
The microgravity-induced fluid shift is also associated with alterations to white matter in astronauts’ brains. A study from the journal Science Advances reports that cosmonauts displayed increased white matter in the cerebellum following long-duration spaceflight, with white matter volume returning to roughly pre-flight levels seven months after spaceflight. The cerebellum handles fine motor control, postural balance, and oculomotor control, and white matter changes associated with spaceflight may offer evidence for motor system neuroplasticity. Various studies are employing different techniques to evaluate white matter changes due to spaceflight, which could affect other neurological functions including visual and sensory processing.
The health issues associated with LEO are also relevant for long-distance space travel. However, there are also environment-specific challenges unique to the Moon and Mars - such as high levels of space radiation and varying magnitudes of microgravity - that will be of primary concern to astronauts. Various studies simulate deep space environments to predict the effects of long-distance spaceflight on human health, informing mitigation strategies to keep astronauts safe.
In deep space, the microgravity environment induces similar cardiovascular effects to what astronauts experience in LEO. Blood and bodily fluids shift toward the upper torso and head resulting in ‘puffy-face and bird-legs syndrome’, while the decreased cardiac workload can lead to cardiovascular deconditioning. However, relative to the gravitational force in LEO of approximately 0.95g, the Moon’s gravitational force is 0.16g while Mars’ gravitational force is 0.36g. It is unclear whether varied microgravity conditions will produce additional cardiovascular effects beyond those studied in LEO, however, fluid shifts and cardiovascular deconditioning remain significant concerns.
Radiation-induced cardiovascular disease is another major challenge with traveling to the Moon and Mars. Compared to missions in LEO, the space radiation environment beyond LEO exposes astronauts to higher dose rates of HZE particles, the high-energy heavy ions of galactic cosmic rays. HZE particles are highly penetrating and can cause secondary radiation when interacting with shielding in spacecraft or spacesuits. According to the journal Frontiers in Cardiovascular Medicine, high doses of HZE particles over long-term deep space missions can lead to myocardial remodelling and fibrosis, potentially resulting in heart failure. While current shielding technology may protect astronauts in LEO, the power of HZE radiation makes more advanced shielding essential to protect astronauts in deep space.
Considering the microgravity-induced fluid shifts that astronauts experience in deep space, SANS remains a primary concern for missions to the Moon and Mars. SANS is typically studied on long-duration missions, although astronauts have reported blurred vision after only two weeks aboard the ISS. A mission to Mars would take up to 20 months and would require astronauts to encounter multiple gravity fields. The long duration and complex gravity shifts associated with deep space missions could cause more challenging SANS-related ocular issues compared to those faced by astronauts in LEO. The concerns surrounding radiation beyond LEO extend to ocular health. Galactic cosmic radiation has been linked to the development of phosphenes and cataracts, while studies show that repetitive spaceflights and high-radiation-dose exposure increase the prevalence of both conditions among astronauts. Considering the high volume of HZE radiation that deep space astronauts will be exposed to, the development of phosphenes and cataracts is of major concern for their ocular health.
Previous studies have sought to evaluate the effects of space radiation on the human brain by delivering radiation doses to rodents over a few minutes. However, on missions to the Moon and Mars, powerful radiation will be gradually delivered to astronauts for the duration of the trip, ranging from weeks to years. A 2019 study from the journal eNeuro aims to more accurately simulate long-duration exposure by delivering low-level neutron radiation to mice for six months and evaluating the neurological implications. The study finds that exposure to cosmic rays impairs the brain function of the mice, affecting learning, memory, and mood. Lab tests reveal that following the neutron radiation, neurons are less responsive in the hippocampus - an area critical for the formation of memories and spatial navigation - and the medial prefrontal cortex - an area responsible for accessing preexisting memories, decision-making, and processing social information. Follow-up evaluations of the irradiated mice determine that neural circuitry damage may last for up to one year.
Some researchers dispute the study’s approach, claiming that neutron radiation used in the experiment is not a viable surrogate for the galactic cosmic radiation that astronauts would encounter during deep space missions. Still, the eNeuro study offers a novel analogue to the gradual doses of powerful space radiation that astronauts would face on missions to the Moon and Mars, further emphasising the importance of effective shielding from cosmic rays. Researchers are also studying how microglia - the immune cells of the central nervous system - can be manipulated to prevent the development of cognitive deficits due to galactic cosmic ray exposure, a promising step toward protecting astronauts on deep space missions.
Motivated government leaders and entrepreneurs alike have expressed their commitment to bringing the human race beyond low Earth orbit. As breakthroughs in deep space research and aerospace technology bring this goal closer to realisation, concomitant advancements in space medicine must be made to safeguard astronauts’ health as they travel to and thrive in extraterrestrial environments. Before we can walk on Mars, our first step must be understanding and mitigating the health challenges that await us deeper into the final frontier.
The term 'space sciences' is a conglomeration of almost all of the branches of science known to humanity today. Space fuels exploration and provides enormous opportunities for exploitation to meet societal needs. So much so that one finds the footprint of space technology in almost every aspect of daily life. For example, data received from earth observations help us to understand the global environmental factors and initiate ground-based measures to tackle them. Integrating data with fields like agriculture helped us develop 'Precision Agriculture'. Furthermore, space-driven initiatives drive international cooperation on issues related to humanity.
Thus, it is pretty evident that any new crisis or breakthrough in almost any aspect of society will impact on the space industry. Such was the case when devastating waves of COVID-19 hit the world. Presented below is a bibliometric mindmap that gives us a visual aid to further our understanding of the true nature of the negative impact of the pandemic on the space industry.
Figure: Impact of COVID-19 on the space industry and vice versa
(Adopted with modifications from Palit S et al. - Space Industry and COVID-19: An Insight into Their Shared Relation)
Note: Circles/ovals- Represent institutions affected by the COVID pandemic;
Rectangles- Represent institutional values affected by the COVID pandemic
It can be seen that the pandemic dealt a severe blow to institutions (such as SMEs, academia, the health sector) and their values (such as organisational resilience, etc.). However, as the saying goes, 'every cloud has a silver lining', and such was the case with COVID-19.
Areas in which COVID-19 had positive implications include cases where:
Furthermore, astronauts onboard the International Space Station teach us some of the most valuable lessons. These include instances where the world applied containment measures to restrict the spread of pandemics, leading to the limited provision of healthcare resources. Here, the experiences gained with 3D printing during human spaceflights could help the healthcare industry to produce various tools (dental, medical, or surgical) and pharmaceutical products, and the list is endless.
Therefore, given the recent losses that we have suffered, it would be advisable to adopt space-based technologies as quickly as possible to help prevent the long-standing implications of COVID-19. However, this can only be done if we have collective support from government agencies worldwide.
Author: Hamzah Rahman
Year 3 student - Guy's, King's and St Thomas' School of Medicine & Space Enthusiast!
The General Practitioner (GP) medical professional has undoubtedly played a major role in providing a plethora of care packages and programmes for individuals seeking to travel; from immunisations and vaccinations to advice and even guidance for mothers in the late gestational stage. The advent of jet flight allowed the masses to venture to destinations that only aristocracy could once afford, which in turn generated a greater need for primary healthcare management. The GP is therefore the point of access to these healthcare packages and consequently plays a pivotal role in enabling tourists to travel safely. This responsibility is deeply intertwined with the historic increase in accessibility to affordable flight.
The first British commercial jetliner was the de Havilland Comet in 1949. This aircraft enabled more people to travel further, as well as reducing the price of tickets substantially. The GP during this age would have played an important role in ensuring that passengers were fit to fly, by managing their pre-flight healthcare requirements.
The Boeing 707 soon joined the aviation world in 1957 and dramatically changed the way we travelled; it opened flight corridors that were once untenable, and consequently, accessed a greater consumer market - the working classes. In 1969, Boeing unveiled the revolutionary 747, coined the “Jumbo Jet” due to its sheer size, which resulted in greater passenger capacity and far more affordable tickets.
With such quantum leaps forward in jet aviation, by the mid-70s the British GP was providing care and advice to thousands of travellers from all walks of life, different backgrounds and with all manner of pre-existing health conditions. The workload of the GP thus became much more diverse and they gained great responsibility in permitting the public to exercise their freedom to travel safely.
Just as jet flight was once an exclusive mode of transport for those from higher socio-economic backgrounds, spaceflight has now emerged onto the world market with exclusive and expensive tickets to fly. Undoubtedly, spaceflight will become more affordable in the coming years and decades, and as such will inevitably require a more established initial healthcare access point for travellers- a service that GPs could provide. As space tourism flights become more accessible through lower prices and increased provision, the remit of travel healthcare provided by general practice could evolve in the near future to encompass spaceflight health clearance.
My work as a space medical anthropologist : on boosting acuity, resilience, group morale, and reaching purpose beyond self
Author: Enric Garcia Torrents, MSc, PhD candidate
Medical Anthropology Research Center, Universitat Rovira i Virgili
The main role of a medical anthropologist is to study human health, the whole range of actual and potential care systems, and the ways in which biocultural adaptations emerge, succeed or fail from a transdisciplinary, multidimensional and ecological perspective.
We contemplate the processes and situations from within and outside the limits of our own culture, and even our own civilisation, from a long-range evolutionary perspective to the minute details of small social networks analysis. We dive deep into the complexities and repeating patterns with a skill set and toolkit as sharp, in many cases, as that of a fully trained physician-scientist, being able to engage constructively in laboratory, fieldwork and clinical practice.
“It is possible that the greatest contribution that anthropology can make will be to keep men's imaginations open, as they tend to let the predictable hardware coerce the form of the software.”
Space medical anthropologists, on the other hand, are bound to take the whole field of medical anthropology one step further and even beyond, daring to question what it is to be a healthy human today, what it may mean to be so tomorrow, and indeed, what the near future might bring, depending on what we decide to do at this point in history. Most importantly, space medical anthropologists work on how to achieve this healthy state by skillfully setting the stage here and now, maximising humanity’s chance for a sustainable way onward to the stars.
As for myself, nowadays I'm a scholar working as a doctoral candidate at a Medical Anthropology Research Center while undertaking medical studies (MD-PhD student-researcher, second and third year within the dual degree). I have previous academic background in neuroscience and smart systems, and currently a contract from the Spanish Ministry of Universities to undertake research on mental health and clinical decision making for choosing the best possible treatments for each individual, funded from a future professor’s training programme. My work on space medical anthropology is rather narrow, focusing almost exclusively on figuring out the best ways for people to withstand extreme experiences without losing mental acuity, exploring optimal solutions to boosting cognitive performance, resilience and overall wellbeing in situations of acute and profound distress.
Cardiopulmonary resuscitation (CPR) is a well-established part of basic life support (BLS), having saved countless lives since its first development in the 1960s. External chest compressions (ECCs), which form the main part of BLS, must be carried out until Advanced Life Support can begin. It is essential that ECCs are performed to the correct depth and frequency to guarantee effectiveness. The absence of gravity during spaceflight means that performing ECCs is more challenging.
The likelihood of a dangerous cardiac event occurring during a space mission is remote, however, the possibility does exist. Nowadays, the selection process for space missions considers individuals at ages and with health standards that would have prohibited their selection in the past. With increased age, less stringent health requirements, longer duration missions and increased physical labour, due to a rise in orbital extravehicular activity, the risk of an acute life-threatening condition occurring in space has become of greater concern. The advent of space tourism may even enhance this possibility, with its popularity set to rise over the coming years as private companies test their new technology.
Therefore, space scientists and physicians will have a greater responsibility to ensure space travellers, whether professional astronauts or space tourists, are adequately trained and familiarised with extraterrestrial BLS and CPR methods. Recently, work has been undertaken to develop methods of basic and advanced life support in microgravity and hypogravity, and several CPR techniques have been developed and tested. This blog presents one of these, the Evetts-Russomano MicroG CPR Method.
Evetts-Russomano MicroG CPR Method
In the Evetts-Russomano (ER) method, the rescuer can respond immediately, as it requires no additional CPR equipment/medication or the use of a restraint system. To assume the position, the rescuer places their left leg over the right shoulder of the patient and their right leg around the patient’s torso, allowing their ankles to be crossed approximately in the centre of the patient’s back; this is to provide stability and a solid platform against which to deliver force, without the patient being pushed away. From this position, chest compressions can be performed while still retaining easy access to perform ventilation. When adopting the ER CPR method, the rescuer must be situated in a manner that also allows sufficient space on the patient’s chest for the correct positioning of their hands to deliver the chest compressions.
Extraterrestrial CPR simulation
The main difference between extraterrestrial and terrestrial CPR is the strength of the gravitational field. In microgravity, patient and rescuer are both essentially weightless. When thinking about the technique of terrestrial CPR, with the rescuer accelerating their chest and upper body to generate a force to compress the patient’s chest, it is obvious that this cannot work in microgravity without significant aids. To this end, the ER CPR method has been developed using a ground-based microG simulation, during parabolic flights, and subsequently tested under-water!
Ground-based MicroG Simulation (land) = Space Researcher Lucas Rehnberg, MD (MicroG Center PUCRS, Brazil)
Parabolic Flight MicroG Simulation (air)= Researchers = Thais Russomano, Simon Evetts, Lisa Evetts & João Castro (ESA 29th Parabolic Flight Campaign, Bordeaux, France)
Underwater MicroG Simulation (water) = Sea King Dive Center, Chengdu, China - Instructor Gang Wei;
Chinese Space First Responder & Space Researcher/Instructor Chris Yuan
A project of InnovaSpace, PECA and Guangxi Diving Paradise Club, China
Free Resource: Extraterrestrial CPR and Its Applications in Terrestrial Medicine
Authors: Thais Russomano, Lucas Rehnberg
In book: Resuscitation Aspects, Ed: Theodoros Aslanidis
Publisher: IntechOpen 2017
See Download Link at https://www.innovaspace.org/chapters.html
InnovaSpace Advoga em Defesa do Ensino Acadêmico e do Uso Clínico da Medicina de Aviação e da Fisiologia Aeroespacial em Faculdades de Medicina
Os autores são membros do time da InnovaSpace e possuem vasta experiência profissional em medicina de aviaçāo e fisiologia aeroespacial - ensino, pesquisa e inovaçāo.
Emergências médicas durante voos comerciais de curta ou longa duração, nacionais ou internacionais, estão se tornando cada vez mais comuns. Isso se deve a fatores já conhecidos, como a expansão da indústria da aviação, a popularização dos voos comerciais e a maior diversidade do perfil do viajante, incluindo passageiros idosos, portadores de doenças crônicas ou usuários de medicações. Junta-se aqui o próprio ambiente de cabine, que impõe, por exemplo, o estresse da hipóxia hipobárica, dos disbarismos pela expansão de gases de cavidades corporais, da exposição ao ar frio e seco, a ruídos, a vibrações e a acelerações, da alteração do ciclo circadiano, da fadiga e da imobilidade. Esses fatores afetam pouco ou nada os organismos sadios, mas podem ser danosos em diferentes graus ao passageiro idoso e/ou portador de doenças crônicas.
Exemplo 1 – Uma avaliação clínica ou pré-operatória - Quando o motivo de uma consulta médica é uma avaliação clínica ou pré-operatória, deve-se questionar e considerar vários aspectos durante a anamnese, o exame físico e os exames laboratoriais, para se chegar a melhor decisão clínico-cirúrgica possível, reduzindo ao máximo possíveis eventos adversos, minimizando desfechos não desejados e otimizando a segurança do paciente no voo. Assim, uma pergunta não deve faltar na anamnese - “Existe o plano de uma viagem aérea num futuro próximo?”. Para que esse questionamento, no entanto, produza um impacto positivo na tomada de decisão, é mandatório que o médico assistente detenha conhecimento sobre as condições estressantes do ambiente de cabine de uma aeronave e as condições do passageiro enfermo, objetivando discutir o planejamento de um voo seguro ou até mesmo o cancelamento ou postergação do mesmo.
Exemplo 2 – Médico a bordo? – Incidentes médicos com passageiros em voos comerciais vêm se tornando mais comuns. No entanto, o ambiente de cabine e os recursos médicos disponíveis a bordo de aeronaves são quase sempre de total desconhecimento dos médicos que se tornam voluntários no atendimento a um passageiro durante um voo comercial. Sistemas de auxílio às tripulações a ao médico voluntário incluem o uso da saúde digital e da telemedicina, as quais, nem sempre estão disponíveis para orientação num incidente médico a bordo. Ainda, muitos casos poderiam ter sido evitados, se, durante a avaliação pré-voo por parte do médico clínico, especialista ou cirurgião, fosse incluído na anamnese do paciente questionamentos relativos a planos de viagens de avião.
A InnovaSpace vem adovagar em favor do ensino da Medicina de Aviação e da Fisiologia Aeroespacial na formação de estudantes de faculdades de medicina, através da inserção de uma série de aulas constituindo disciplinas curriculares novas ou integrando disciplinas já existentes no currículo acadêmico.
Esta iniciativa é apoiada pelas Sociedade Brasileira de Medicina Aeroespacial (SBMA) e
Sociedade Portuguesa de Medicina Aeronáutica (SMAPor)
The InnovaSpace team welcome this contribution from Prof. Ganapathy and we send huge congratulations to the team at Apollo Telehealth Services on achieving ISO 13131 certification - a great achievement!
Prof. Krishnan Ganapathy
Past President, Telemedicine Society of India & Neurological Society of India | Hon Distinguished Professor The Tamilnadu Dr MGR Medical University | Emeritus Professor, National Academy of Medical Sciences | Formerly Adjunct Professor IIT Madras & Anna University | Director Apollo Telemedicine Networking Foundation &, Apollo Tele Health Services | URL: www.kganapathy.in
December 10th 2021 was indeed a Red letter day for Indian Telehealth. On this day the ISO 13131-2021, certification for Telehealth Services was obtained for the first time anywhere, by Apollo Telehealth Services. This brief note points out the necessity for raising the bar and setting high standards, so that the world will strive to achieve India class.
For decades, Telemedicine/Telehealth services were not centre stage in the healthcare delivery system. COVID-19 changed this. The world has now accepted that the forced lockdown- enforced acceptance of Remote Health Care - will become the new normal even after the pandemic is de notified. Universal acceptance increases the responsibility of all health care providers deploying technology, to ensure constant high quality while bridging the urban-rural health divide.
Quality is never an accident. It is always the result of deliberate intention, sincere effort, intelligent direction and skilful execution. Though Henry Ford opined that quality means doing it right when no one is looking, in the real world this is difficult to implement. ISO certification ensures that “Big Brother” is watching all the time. The necessity for re certification is like the Sword of Damocles hanging above us. However, it drives home the message that Quality is everyone’s responsibility at all times and not during the audit alone. One has to keep running to stay where you are. To maintain the initial global recognition, maintaining quality needs to become a habit, a unique opportunity to transform one’s DNA if necessary!! Success is the sum of small efforts, repeated day-in and day-out. Standardising systems, processes, documentation and re documentation alone will ensure providing quality remote healthcare for anyone, anytime anywhere.
International Organization for Standardization (ISO) – An OVERVIEW
The, International Standards Organization, TC 215 Health Informatics Committee developed a Technical Specification, ISO/TS 13131 Telehealth services, based on a risk and quality management approach. This standard supports healthcare planning, service and workforce planning, organization responsibilities, financial and IT management. ISO was established in 1947 in Geneva, Switzerland. An Independent, non-governmental international organization it develops standards that are recognized and respected globally. It brings experts together to improve quality and provide world-class healthcare services. Experts are from 166 national standard bodies. ISO standards are developed by various advisory groups. Presently ISO has 255 technical committees, 515 subcommittees, and 2498 working bodies. Since 1947, ISO’s technical experts have created more than 18,800 standards for all possible business. ISO standards ensure that administration and product/workflow systems are carried out legally, safely and effectively. ISO technical experts have developed several assessment protocols to ensure that certified organizations apply these guidelines in their workplace. The approved protocols aid organisations to ensure that their frameworks, devices and workforce are actually in compliance with ISO standards. ISO 13131 provides recommendations on guidelines for Telehealth services deploying Information and Communication Technology (ICT) to deliver quality healthcare services.
Prof. Krishnan Ganapathy
Distinguished Professor at Tamilnadu Dr MGR Medical University, India & a WHO Digital Health Expert. Past President of the Telemedicine Society of India, Neurological Society of India, and Indian Society for Stereotactic & Functional Neurosurgery. Member of the Board of Directors of Apollo Telemedicine Networking Foundation and Apollo Telehealth Services, and InnovaSpace Advisory Board member - Visit: drkganapathy.com
Distance is Meaningless and Geography has become History - paraphrasing Star Trek's Captain Kirk, played by William Shatner (who just flew on a sub-orbital flight on 12th October 2021 at the age of 90 years) and going where No man has ever gone before is not the prerogative of the elite 600 plus astronauts who have left the confines of Terra Firma. In an activity that would have seemed like science fiction just a few years ago, 30 Retinal Specialists have been peering into 2800 eyes a day from a distance of 175 to 350 km, and ensuring that a digitally-signed colour-coded annotated fundus report (assisted with semi-automated diagnosis) is physically provided to each villager within 25 minutes. And this has now been happening daily for the last 43 months, in a service that the beneficiary gets totally free, thanks to a Public-Private Partnership project.
An acute shortage of eye care personnel in rural India results in millions unnecessarily developing visual impairment. Early diagnosis and initiation of corrective measures remotely could be a major public health initiative, whereby the Government fills a large void by providing free, quality eye care services, including spectacles, to the community.
The Andhra Pradesh Government has now been implementing the “Mukhyamantri e-Eye Kendram-MeEK (http://enethraap.phc.ind.in/) program since 1st February 2018. This tele-ophthalmology service is one of the largest Public-Private Partnership projects. In just 43 months 1.7 million patients have had their eyes checked in 115 Eye centres located in 9 districts of Andhra Pradesh, a state in southern India. A total of 1.4 million spectacles have been ordered following 1.7 million refraction checks!
The operational challenges in providing “customer delight” to 2000 + people every day in so many rural centres is indeed a humongous task. Some 0.5 million fundus examinations have been performed remotely and abnormal pathology detected in 83,000 cases, including Diabetic Retinopathy, Hypertensive Retinopathy, Glaucoma and other pathologies.
Continuous quality control and ensuring constant compliance and adherence to strict deliverables is in the DNA of the entire fantabulous team who continued to work even during the height of the pandemic.
Obsession with perfection - where failure is not an option, making the impossible possible - these are the stuff of which astronauts and the entire extended team remotely connected with space exploration are made up of. Who knows, perhaps this project is a good recruiting ground for ISRO, ESA and NASA – after all there are a lot of similarities !!
Final blog from ESA-sponsored Dr Stijn Thoolen, from his series written while spending 12 months at the Concordia research station in Antarctica. Catch up on the rest of his fascinating blogs by following the links: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10, Part 11, Part 12
Dr Stijn Thoolen
Medical Research Doctor, Concordia Research Station, Antarctica
L’Astrolabe icebreaker, December 15, 2020
Sunlight: 24 hours a day, but tomorrow, as we head further north, it will set again
Temperature: Around 0 °C
Mood: not sure how to describe it today. I am excited and just feel very lucky.
It’s midnight. Since our departure some hours ago the sun has steadily moved towards the horizon behind us, and it has started to paint the sky in colours that make me think of winter again. Huge icebergs are slowly passing by, and every once in a while there is a bunch of curious penguins waving us goodbye from their ice floe. Not much earlier I saw a seal chilling, and there have been whales too. In the very far distance I can still recognise the enormous ice mass on which we have been living our lives the past year. It’s my last view of the Antarctic, and it’s perfect.
Standing here alone on the deck of the Astrolabe surrounded by all this beauty I have found myself a special opportunity to appreciate once more where the #$%!! (beep) we have been all this time. It is just so different there on top of the ice, so far away from the rest of the world, that as we are slowly being re-introduced to civilisation I am having a hard time believing it actually happened. With all the changes that we have gone through lately and with all the new impressions time has gone fast, and it has made Concordia feel like a distant, almost unrealistic memory. Like ages ago, even though it has only been eight days since we left…
It started when the ‘orange and fat’ people (and kiwis!) arrived at Concordia about a month ago. With the start of the summer campaign our winterover isolation had come to an abrupt end, and I remember the calm, safe and familiar environment of the ESA lab feeling surprisingly pleasant after some intense hours of new social interactions. As a positive summer energy took hold of the station and fresh ESA MD Nick gradually took over the lab, there was no way for me to hide anymore. Unavoidable steps out of our rigid routines, but at that ‘c’est l’Antarctique’ rate of change that isn’t always easy to keep up with.
Our departure from Concordia last week was much the same. Emotionally numb from a lack of realisation of what was happening (or a lack of sleep the night before…) it just passed by so quickly, and surprisingly smooth. I said my goodbyes without any affection for the tears around me. I gave the station a good last look for the sake of memory. But when the plane started accelerating for lift-off, suddenly that strong desire came up to make it stop and bring me back safely into the station. Apparently part of me wasn’t ready to leave at all. Too big steps too quickly I guess, but lucky for me there were pilots taking care of that...
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