Dr Sophie Saul / Clinical Fellow in Emergency Medicine, NHS Fife
Two years ago in a galaxy far, far away a final year medical student went on elective. Sophie Saul, runner up in our 2015 Elective Competition, describes her elective at NASA’s Johnson Space Center in Houston, Texas.
There is no environment more remote than space and the challenges of providing health care for astronauts who live and work there are numerous. However, space also offers great potential for medical advancement as the microgravity environment produces a unique setting for medical research and is continually providing new and interesting information. It is the ultimate in wilderness medicine.
I spent four weeks of my elective working with the company Barrios Technology, on site, at the Johnson Space Center in Houston, Texas. This is a small aerospace engineering services company who work with NASA to support the development of space exploration. I spent time working within MAPI (Mission and Program Integration contract) reviewing research papers of investigations carried out on board the International Space Station (ISS).
At any one time a staggering number of experiments are underway on board the ISS with data collected by the six crew members. The subjects of these experiments vary widely from deeply technical projects in biology, human biology and physics to the deeply optimistic: school children finding out if aliens exist by sending biscuits to the ISS and seeing if they return uneaten (they don’t). I was tasked with simplifying and condensing research papers into a few paragraphs that would be suitable for publication on the NASA website to give the public insight into the research being carried out.
I was also involved in writing a number of scripts to accompany educational videos explaining some of the health consequences faced by astronauts after a period living on board the ISS. I wrote scripts for bone disease and eye changes related to increased intracranial pressure.
This work really expanded my knowledge of the effects of microgravity on the skeletal, cardiac and immune systems as well as on bacterial and plant growth. It also enhanced my skills of critical thinking and problem solving as I had to ensure that the important information was conveyed succinctly, simplified to a level that could be understood by non-experts. Not only was the work hugely interesting, but so was the office in which it took place. I was co-located with the people responsible for finding space on board ISS for all of the experiments and necessary equipment, which included Robonaut’s legs!
I was fortunate during my time in Houston to spend some time shadowing one of the Flight Surgeons. Flight Surgeons are typically from a military background and have the responsibility for providing care to the astronauts and their immediate families. They are assigned to astronauts who have been selected for a mission and work with them through the two years of preparation and training. They then sit in mission control during the period the astronauts are on the ISS and hold daily consultations with each crew member. When the astronauts return to Earth, the Flight Surgeons then work with them through rehabilitation and manage their recovery from any health issues developed through exposure to micro-gravity.
This was a fantastic opportunity to discover how people begin careers in flight medicine and also an insight into their main duties. I was able sit in on meetings to discuss the latest research to determine the causes of some of the health problems faced by astronauts living in space.
I also had the opportunity to observe two different types of astronaut training. All astronauts are taught how to carry out simple medical procedures, both for emergencies on board the ISS and also for recording measurements required by researchers. I was able to observe a refresher session for one astronaut who wanted to run through the procedure for checking intraocular pressure. This is an important skill as, when in space, there is a cephalic fluid shift which raises intracranial pressure and causes changes in the eye which can affect astronauts’ vision.
The second training session took place inside a full scale model of the ISS within the astronaut training facility. The model allows astronauts to participate in simulation-based training scenarios in an environment where everything is exactly as they will find it in space. The particular scenario I observed involved teaching the astronauts how to preserve their health when confronted with a situation involving loss of containment of hazardous materials. Definitely an example of teamwork and communication in a challenging situation!
Whilst on site, I was given the opportunity to tour some of the many buildings at the Space Center. One of the employees took me to see the Mission Control Center (MCC) where the Flight Surgeons sit on console and communicate with the astronauts on board the ISS. My visit to the MCC coincided with a number of particularly interesting ISS activities. First, the crew were planning to conduct a spacewalk to fix a troublesome ammonia leak in the ISS cooling system and second, three crew members were preparing to make their return journey to Earth within the next few days. The team had astronauts in the Neutral Buoyancy Laboratory (a large indoor pool 12m deep containing modules of the ISS) working through different solutions to fix the suspected problem and were then relaying the developed methods to the astronauts in orbit.
Seeing ‘behind the scenes’ at the Johnson Space Center was both a unique and amazing opportunity to learn about the history of NASA and the challenges that they have faced to make space travel possible. It was also a good opportunity to observe the multidisciplinary nature of its work. In order for missions to be successful large numbers of teams specialising in different areas need to be able to communicate and work together to ensure the best outcome. This includes different Space Centers within the USA but also across the globe as the international space agencies work collaboratively to further space research.
I was fortunate to be at the Johnson Space Center during the time of a crew change on the ISS. The returning astronauts landed safely in their Soyuz capsule in Kazakhstan and were then flown back to the Johnson Space Center to begin the long process of debriefing and medical evaluation. I had the opportunity to meet two of the astronauts the day after they returned. It was very strange to be standing talking to two people who, just a few days before, I had been watching do weightless somersaults over the satellite link to Mission Control. They were equally curious to lean how a Scottish Medical Student had managed to end up in their Space Center!
Back on Earth
When considering a medical elective, remember that it is an amazing opportunity to go and explore the world of possibilities that a degree in medicine opens up. Electives offer an opportunity during our degree to think outside the world of hospital medicine and see what else is possible.
The Johnson Space Center elective was an incredible experience and one which I would not have changed for the world. However, if you wish to do something similar, be aware that arranging it may require a great deal of planning and perseverance. As you can imagine security at the Johnson Space Center is incredibly tight and the process to obtain security clearance as a ‘foreign alien’ is time consuming. I was required to make trips to the Center a year in advance of my elective to provide them with proof of identity, photographs and finger prints. There is also the matter of acquiring an American Visa appropriate for the work you will be doing. This can be expensive and require a trip to London for an interview at the American Embassy.
1. Canadian Space Agency, author. http://www.asc-csa.gc.ca/eng/astronauts/osm_training_candidates.asp. Accessed February 22, 2010.
2. Needs and Capacity Study: Provision of Medical Care Solutions for Long Duration Human Space Flight Missions. NORTH Network., author http://www.asc-csa.gc.ca/pdf/CSEW2008_Medical_Care_Solutions.pdf. Accessed February 22, 2010.
3. Ball JR, Evans CH, editors. Committee on Creating a Vision for Space Medicine During Travel Beyond Earth Orbit, Board on Health Sciences Policy, Institute of Medicine. Safe Passage: astronaut care for exploration missions. Washington, DC: National Academy Press; 2001. [PubMed]
4. Fogleman G, Davis JR, Stegemoeller CM. Bioastronautics Roadmap: A risk reduction strategy for Human Space Exploration. Houston, TX: JSC; 2005.
5. Baisden DL, Beven GE, Campbel MR, Charles JB, Dervay JP, Foster E, Gray GW, Hamilton DR, Holland DA, Jennings RT, et al. Ad Hoc Committee of Members of the Space Medicine Association; Society of NASA Flight Surgeons. Human health and performance for long-duration spaceflight. Aviat Space Environ Med. 2008 Jun;79(6):629–635.[PubMed]
6. Buckey JC. Space Physiology. New York, NY: Oxford University Press; 2006.
7. NASA Fiscal Year 2011 Budget.http://www.nasa.gov/news/budget/index.html Accessed February 22 2010.
8. Billica RD, Simmons SC, Mathes KL, McKinley BA, Chuang CC, Wear ML, Hamm PB. Perception of medical risk of spaceflight. Aviat Space Environ Med. 1996 May;67(5):467–473.[PubMed]
9. Grantcharov TP, Reznick RK. Teaching Procedural Skills. BMJ. 2008;336:1129–1131.[PMC free article][PubMed]
10. Wang EE, Quinones J, Fitch MT, Dooley-Hash S, Griswold-Theodorson S, Medzon R, Korley F, Laack T, Robinett A, Clay L. Developing Technical Expertise in Emergency Medicine – The Role of Simulation in Procedural Skill Acquistion. Acad Emerg Med. 2008 Nov;15(11)[PubMed]
11. Gurusamy K, Aggarwal R, Palanivelu L, Davidson BR. Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopics surgery. Brit Journ Surg. 2008;95:1088–1097.[PubMed]
12. Lammers RL. Learning and Retention Rates After Training in Posterior Epistaxis Management. Acad Emerg Med. 2008 Nov;15(11)[PubMed]
13. Kovacs G, Bullock G, Ackroyd-Stolarz S, Cain E, Petrie D. A Randomized Controlled Trial on the Effect of Educational Interventions in Promoting Airway Management Skill Maintenance. Ann Emerg Med. 2000 Oct;36(4):301–309.[PubMed]
14. Campbell MR, Billica RD, Johnston SL, III, Muller MS. Performance of ATLS procedures in microgravity. Aviat Space Environ Med. 2002 Sep;73(9):907–911.[PubMed]
15. McFarlin K, Sargsyan AE, Melton S, Hamilton DR, Dulchavsky SA. A surgeon's guide to the universe. Surgery. 2006 May;139(5):587–590.[PubMed]
16. Doerr H, Murray WB, Cuttino M, Broderick TJ. Training Astronauts to Manage Trauma (Emergencies): Integrating Human Patient Simulation into Medical Operations for NASA. Trauma Care. 2006 Winter;16(1):26–30.
17. Sinclair D, Croskerry P. Patient safety and diagnostic error. CFP. 2010;56:28–30.[PMC free article][PubMed]
18. Helmreich RL. On error management: lessons from aviation. BMJ. 2000;320:781–785.[PMC free article][PubMed]
19. Amalberti R, Wioland L. Human error in aviation. In: Soekha H, editor. Aviation safety: human factors, system engineering, flight operations, economics, strategies, management. Brill Academic Publishers: 1997. pp. 91–108.
20. Rathjen T, Whitmore M, McGuire K, Goel N, Dinges DF, Tvaryanas AP, Zehner G, Hudson J, Dismukes RK, Musson DM. An introduction to human factors in aerospace. In: Davis JR, Johnson R, Stepanek J, Fogarty JA, editors. Fundamentals of Aerospace Medicine. LWW: 2008. pp. 491–515.
21. Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams AL, Love LJ, Sexton JB, Tyson JE, Helmreich RL. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. Journ of Perin. 2007;27:409–414.[PubMed]
22. Hales BM, Pronovost PJ. The checklist – a tool for error management and performance improvement. Journ of Crit Care. 2006;21:231–235.[PubMed]
23. Kubose TT, Patel VL, Jordan D. Dynamic adaptation to critical care medical environment: error recovery as cognitive activity. Proceedings of the 2002 Cognitive Science Society. 2002:43–43.
24. Patel LP, Cohen T. New Perspectives on error in critical care. Cur Opin Crit Care. 2008;14:456–459.[PubMed]
25. Stone R, McCloy R. Ergonomics in Medicine and Surgery. BMJ. 2004;328:1115–1118.[PMC free article][PubMed]
26. Schlachta CM, Sorsdahl AK, Lefebvre KL, McCune ML, Jayaraman S. A model for longitudinal mentoring and telementoring of laparoscopic colon surgery. Surgical Endoscopy. 2009;23:1634–1638.[PubMed]
27. Foale CM, Kaleri AY, Sargsyan AE, Hamilton DR, Melton S, Martin D, Dulchavsky SA. Diagnostic Instrumentation Aboard ISS: Just-In-Time Training for Non-Physician Crewmembers. Aviat Space Environ Med. 2005 Jun;76(6):594–598.[PubMed]
28. Kwon D, Bouffard JA, Holsbeeck M, Sargsyan AE, Hamilton DR, Melton SL, Dulchavsky SA. Battling fire and ice: remote guidance ultrasound to diagnose injury on the ISS and the ice rink. Am J Surg. 2007;193:417–420.[PubMed]
29. Otto C, Hamilton DR, Levine BD, Hare C, Sargsyan AE, Altshuler P, Dulchavsky SA. Into thin Air: Extreme Ultrasound on Mt Everest. Wild Env Med. 2009;20:283–289.[PubMed]