NASA’s unprecedented decision to prematurely end a mission to the International Space Station (ISS) due to an ill astronaut is shining a spotlight on how the agency prepares for medical problems and emergencies in space.
The decision, announced by new NASA Administrator Jared Isaacman during a press briefing Thursday, is the first time a space agency has ordered a medical evacuation of an ISS mission.
“Statistically, there must have been a number of times by now in the last 25 years that we’ve had people on the International Space Station,” says former NASA astronaut Andrew Feustel, who was ISS mission commander during his time at the agency and is now astronaut in chief. private space company giant“But that has not happened, and part of that explains the level of medical screening that is performed, at least currently, on government professional career astronauts before they fly in space,”
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It also explains the preparedness of the astronauts and the space station to deal with medical issues that may arise. Orbiting at least 370 kilometers above Earth, the ISS carries a variety of medical equipment, from ultrasound to IVs to defibrillators, that can be used to diagnose and treat crew members who become ill or injured. It also has a wide range of medications available, including anesthetics, antisickness medication, hydration fluids and antibiotics.
“You can do things like give someone oxygen. You can do wound care. There’s basically a whole pharmacy on board,” says Jordan Beam, a space historian and assistant professor at the University of Chicago.
However, there are limits to how much equipment can be placed on the station. There is neither a magnetic resonance imaging (MRI) machine to scan the crew members nor enough supplies or space to perform extensive surgery. Nevertheless, Katherine Coleman, a former astronaut and author of the book location sharing, Says that despite not being a medical professional, she practiced gallstone removal as part of her training. (The ISS currently does not have the equipment to perform such surgery in orbit.)
Crews are extensively briefed on how to use all the equipment on the ISS and when needed they work with teams of doctors on the ground to talk through any medical issues that come up – a system Coleman compares to telemedicine on Earth.
Coleman says astronauts lining up to go to the ISS spend weeks meeting with doctors from a variety of disciplines, including emergency medicine and dentistry. He and his colleagues learned how to place an IV, insert a catheter, perform a tracheostomy to create an airway and perform life-saving techniques such as cardiopulmonary resuscitation (CPR).
“We’re doing things like this with great caution, but we’re really doing it so that, if it does come up, we’re prepared to do it,” she says. Once astronauts board the ISS, surgeons on the ground routinely talk to them about their health and tell them how to perform medical procedures as needed. Importantly, she says, such close communication was likely critical to the care and decision to bring the injured Crew-11 member home.
Yet even with such coaching, being in the microgravity environment of orbit complicates even the most routine of procedures, says Coleman. The station is equipped with a stretcher with straps to keep crew members in place if they require it for a procedure. And on her first day at the station, Coleman remembered how she would perform CPR in near weightlessness.
“Some people put their knees under the stretcher, and then they apply pressure from above using their abdominal muscles,” she says. “It depends on the individual whether that will be enough force or not.”
Microgravity also messes up the body’s baseline for health. The movement of fluids in the body varies while in space, causing many crew members to feel suffocated, for example, or experience headaches and back pain. The space station environment is also known to alter the vision of some astronauts in orbit or upon return to Earth, and can also cause cardiovascular changes. Crew members regularly collect blood and urine samples, and they often participate in medical experiments while in orbit, keeping them in tune with their health.
“We’re lab rats there, and so we’re taught to really actively think about how we’re doing,” Coleman says.
But well-laid plans can go awry. And perhaps nowhere is this more true than in an extreme environment like space.
“We don’t have an operating room on the ISS, and we don’t really have all the supporting infrastructure needed for anything of major complexity,” says Feustel, a former ISS mission commander. “The fallback method for a low-Earth-orbit station, which is, you know, more than 350 kilometers above the surface, is to just come home.”
And that’s what’s happening for Crew-11. While the ailing crew member’s condition was described as “stable” by NASA chief Isaacman on Thursday, the decision to return them to Earth may not have been taken lightly.
“It obviously went all the way to the top of the organization,” Coleman says. “It’s non-trivial to decide whether you’re going to terminate a space mission, given how much effort has gone into executing it in the first place.”
