Telehealth Soars From Sea to Shining Stars

Signal, Mar 2005 by Lawlor, Maryann

In the age of Aquarius, emergency medicine for space exploration starts beneath the waves.

Research being conducted in the depths of the sea is revealing lessons in medicine that will help humankind in remote areas on Earth and allow future generations to travel to the far reaches of space. With capabilities provided by telecommunications, robotic and scuba equipment and an underwater habitat called Aquarius, space program personnel and medical doctors are examining the challenges of telemedicine in extreme environments. The information being gathered runs the gamut-from the unpredictable effects of the ambient atmosphere on devices to the need for improved human-machine interfaces to insights about the skills required to perform surgical procedures. And, while participants have their eyes on the skies, they readily attest that the lessons they learn undoubtedly can be applied in the battlefield to save not only lives but also limbs.

The work in telehealth, surgical telementoring and robotic surgery was the primary focus of the seventh mission of the NASA Extreme Environment Mission Operations (NEEMO) program. The research was supported by the Canadian Space Agency (CSA); McMaster University's Centre for Minimal Access Surgery (CMAS) at St. Joseph's Healthcare in Hamilton, Ontario, Canada; Cisco Systems Incorporated, San José, California; and others. NEEMO 7 allowed NASA scientists to explore how telemedicine could be used in future space missions if an astronaut falls ill while in space. The 11-day training mission took place on Aquarius, an underwater habitat situated off the coast of Key Largo, Florida, and operated by the National Undersea Research Center (NURC) of the University of North Carolina at Wilmington for the National Oceanographie and Atmospheric Administration (NOAA).

The NEEMO program, which is managed by NASA's United Space Alliance, Johnson Space Center, Houston, began in October 2001. It was the brainchild of Bill Todd, whose admiration for the works of Jules Verne led him to craft a designation for the program with an acronym that would spell the name of the main character in 20,000 Leagues Under the Sea. Todd, who is the simulation supervisor of astronaut training for the United Space Alliance, is the NEEMO project lead and commanded the first NEEMO mission. For NEEMO 7, he worked on shore as the mission director.

In general, the purpose of the NEEMO program is to put astronauts in an environment that in effect replicates the conditions they will experience in space. This replica is referred to as an analogue environment. "What we're trying to have is a platform experience that is a real environment, not a simulator. At 5 p.m., you don't get to go home," Todd explains.

Although the closest the astronauts-turned-aquanauts get to experiencing weightlessness is while swimming in the waters around Aquarius, it is about the only difference between living and working in the habitat under the sea and traveling in space. Small teams of individuals must live and work together in confined quarters for long periods of time. Leaving is not an option. Every team member has individual responsibilities that he or she must carry out. Each mission has a series of experiments that must be conducted according to a designated time line, and data must be collected. Both astronauts and aquanauts must learn how to observe the environment closely. And the danger of decompression sickness exists in both settings-when returning from the deep sea to land and when leaving a spacecraft to work "outside"-and cannot be ignored.

Also analogous in both environments is preparing for a mission. Before launch, a team must train to handle not only the scheduled work but also emergencies. Todd notes that this is one area where the NEEMO work has contributed greatly to priming astronauts for space travel. "No matter where you go, you will always find problems. So the real lesson has to do with learning how to solve the problems that are going to come up," he says.

The NEEMO 7 mission dealt with how to handle one of the most serious problems that could arise on a deep space mission: a medical emergency involving a crew member. One option is to include a medical doctor as a permanent crew member. But the number of people who can fit into a spacecraft is limited, and specific specialists must be included as part of the roster to conduct the mission's research. Even when a physician is part of the crew, other limitations must be overcome. The size of the spacecraft restricts both the amount of equipment that can be carried onboard and the room available to perform procedures.

Yet the issue of treating an ill crew member must be addressed as NASA prepares for future trips to the moon and to Mars, and NEEMO offers nearly perfect circumstances to explore one of the solutions: telemedicine.

Like all the NEEMO missions, NEEMO 7 included a six-person crew. Dr. Robert Thirsk, CSA astronaut, commanded the mission. Dr. Craig McKinley, a general surgeon at North Bay General Hospital, was the CSA's co-principal investigator for NEEMO 7. James Talacek and Bill Cooksey, both from NURC. handled Aquarius operations. Dr. Michael Barratt and Lt. Col. Catherine G. Coleman, USAF, both NASA astronauts, were the principal trainees.