Healthcare on the journey to Mars: The missing piece of the puzzle

Space is a phenomenally dangerous place to be, and once we venture beyond low-Earth orbit we'll no longer be able to hop back to Earth for care. But there's a long ahead if we're to make long-term space travel medically safe

If we’re to get to Mars, we have a huge array of challenges to overcome, but while the headlines are often full of food supply solutions and life-support systems, how we tackle medical issues can often be forgotten by the space-covering media.

nasaspacehealthHowever, for those who wil  l be blasting into space, the issue of emergency medicine is of great importance; when you’re a year’s travel away from Earth, it’s pretty vital to be able to treat health issues that arise, and avoid the dangers of space from causing more problems.

A recent paper, published in the German medical journal Notfall + Rettungsmedizin,  tackled this very issue, and concluded something rather concerning: we are a long way from being able to provide the level of medical care that would be desired in space, and improving this knowledge is going to be vital if we are to “venture beyond low Earth orbit with an acceptable level of risk”.

Radiation: space’s biggest threat

“There is a long list of potential medical issues that could arise during a mission to Mars, for example, and many of them are quite serious,” explains study co-author Dr Matthieu Komorowski, a practicing anaesthesiologist, and researcher in Imperial College London’s Department of Bioengineering.

“If I had to pick only one, I believe it would be the risk of acute radiation syndrome, resulting from a solar particle event, where high energy protons are ejected by the Sun. On the ISS, the astronauts are relatively shielded from these particles by the Van Allen belts, thanks to the Earth’s magnetic field.”

Komorowski referenced Ernie Ray, a colleague of van Allen, whose exclamation upon hearing of the discovery of the radiation belts surrounding Earth in 1958 rather sums it all up. “My God, space is radioactive!” he said.

To date, we have not been able to design a countermeasure capable of protecting the crew against radiation

On the ISS, this has obviously not been of great concern, but once we leave the safety of low-Earth orbit we’ll have to tackle this properly, or face some seriously unwell astronauts.

“To go beyond low Earth orbit for an extended period of time, the spacecraft design will have to include a ‘safe haven’; a module equipped with an effective physical and / or magnetic shielding,” said Komorowski.

“To date, we have not been able to design a countermeasure capable of protecting the crew against this risk, and the medical effects could be major, and include nausea, vomiting, hair loss, skin desquamation, bone marrow suppression, and death.  Late effects include increased risk of cancer, cataract and brain damage.

“As a mitigation strategy during a mission to Mars, NASA scientists have recently advised to carry frozen bone marrow for self-transplant.”

Dangerous journey to Mars

We have a long way to go before long-term human missions beyond low Earth orbit are achievable. If NASA were to pack some astronauts in a rocket and launch them to Mars tomorrow, the dangers to their health would be wide-ranging and severe.

“Space is an extreme and unforgiving environment that can lead to the onset of specific medical conditions that come on top of everything else that can happen to you on Earth,” said Komorowski.

“Of major concern are the cardiovascular deconditioning and bone loss occurring as a result of microgravity. Our body adapts to weightlessness, and the return to gravity can be poorly tolerated.”

Space is an extreme and unforgiving environment that can lead to the onset of specific medical conditions that come on top of everything else that can happen to you on Earth

Once they arrived, they’d be faced with yet more issues that could accumulate to pose major health concerns.

“On Mars, we expect to perform a lot of extra-vehicular activities – ‘spacewalks’ – for surface exploration,” he said.

“Each time you put on a space suit and leave the habitat, there is a significant risk of decompression sickness, which is the formation of nitrogen bubbles in your blood that can lead to ischaemic events: stroke, seizures, paralysis, myocardial infarction, etc.”

And that’s just the risks we’re certain about – the Red Planet may have other hazards up its sleeve that we cannot be sure about until we arrive.

“The effect of the prolonged exposure to planetary dust is not well known, but there is concern of potential irritating effects, in particular for the skin and lungs,” said Komorowski.

Of course, this is just the physical effects – there are serious mental health concerns to consider as well.

“A medical condition that may not seem obvious but is actually a major concern is the psychological effect of long-term isolation and extreme stress,” said Komorowski.

“This has well been documented in analogue environments; submarines, Antarctic bases, etc.  It is clear now that this type of situation leads to a decrease in cognitive performance and mood disorders. “

“For example, I invite you to read the personal diary of cosmonaut Lebedev, published under the title Diary of a Cosmonaut: 211 Days in Space.  In 1982, he spent 211 days in the Salyut 7 space station (90m³) with only one other person (Berezovoy).”

“It’s a fascinating insider view of what it was like to be a cosmonaut in the 70s and 80s, and it contains patent indications of psychological burnout and depression, for example: ‘Humming to myself, I float through the station. […] Is it possible that someday I’ll be back on Earth among my loved ones, and everything will be alright?’”

“You can seriously question the psychological wellbeing of this person and his ability to appropriately carry on the mission objectives,” he added. “So selecting the right people and making sure they can keep functioning optimally together for several years of isolation and stress will certainly be a huge challenge.”

Making space travel safe

While we are aware of what the health risks are in space, finding appropriate solutions to them is still some way off. However, in many cases, this is more about prevention than treatment.

“I would say that a lot of the challenges that we need to address are rather engineering-related and will actually prevent, rather than treat, medical conditions,” said Komorowski.

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“For example, engineers need to come up with spacesuits that minimise the risk of decompression sickness, design and build spacecrafts with artificial gravity (for example with rotating modules) or shielding against radiation. All these advances will minimise the risk of actually developing medical problems.”

When it comes to direct medical research, there are still things to be done, but, according to Komorowski, these are “not showstoppers”.

“We will have to define what profile and training is the most appropriate for the crew medical doctor and the other crew members,” he said.

“What happens if the doctor gets very sick, or even worse, dies? We still need to make progress in terms of provision of anaesthesia and surgery with a very limited crew and no possibility for evacuation or tele-medicine. The risk of needing a surgery during a three-year mission to Mars is not null, and you definitely don’t want to end up like the Russian doctor Leonid Rogozov who had to operate himself from appendicitis in 1961, while he was stranded in a base in Antarctica during a storm.”

Komorowski, among others, is working on projects to tackle these issues, hopefully resulting in a system that keeps astronauts safe from perilous situations like Rogozov’s.

“The idea is to develop simplified protocols and training for the most common and the most severe medical conditions,” he said.

“With my colleague Dr Susan Jewell, we are focusing on high fidelity medical simulations in analogue environments like the Mars Desert Research Station in Utah (The Mars Society) or the Concordia base in Antarctica (European Space Agency). There is a lot we can learn from this research.”

A long way to go

However, as it stands, there is a long road ahead for the people working on space medicine, and even with Earth serving as a safety net, being in need of medical care on the International Space Station is still highly risky.

“If anything serious happens currently on the ISS  – a severe infection or anything requiring surgery – the astronauts would have to be evacuated immediately on Earth. And coming back to Earth while severely ill is certainly not risk-free, as the only option currently available is a very bumpy ride in a Soyuz capsule (potentially up to 9Gs), while wearing a pressurised Sokol suit, so it’s impossible to administer IV medications or evacuate an intubated crew member.

“In this respect, the Shuttle would have been a much preferable option (only around 2Gs during re-entry and a larger cabin).”

For ISS’ limited population, however, it isn’t a bad solution, but we are talking about a group of people who are the best of the best when it comes to health and capability, travelling a short distance back to Earth.

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All images courtesy of NASA

“For the current population of astronauts – strictly selected, very fit and healthy – and remoteness of space flight (always within 24h of a medical facility on Earth), the level of medical support is appropriate and the very small number of serious medical events corroborates this,” said Komorowski.

“This level of medical care will not be sufficient for a mission beyond low Earth orbit, like extended flights to the Moon or Mars.”

Despite where we are now, Komorowski believes there will come a time when medical care in space matches what is available to us here on Earth, and when that happens, we will be in a position to reach far further into the stars.

“It is only a matter of time before we become a multi-planetary species,” he said.

“I am confident that we will not destroy ourselves before this happens, and at this point in time, humanity will have two or more independent and self-sustaining habitats, with matching levels of technology.

“There is a lot of enthusiasm in the general population to see this happening, but a strong political drive is essential and, unfortunately, peaceful collaboration and safeguarding humanity does not seem to be the top priority for everyone.”

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