As part of its ongoing preparations for a possible contribution to the NASA led Lunar Orbital Platform-Gateway, the Canadian Space Agency (CSA) has awarded four health technology concept contracts.
The contracts are from the CSA Request For Proposals (RFP) titled Technology Concept Studies and Prototyping of Health Technologies for Deep Space Missions – Decision Support Systems from last October.
Four $100k contracts have been awarded to;
- Thales Canada Inc.
- Photon etc. Inc.
- Lunar Medical Inc.
- Carré Technologies inc.
Details on what each company plans to do with technology concept studies has yet to be released by the CSA.
In the RFP statement of work, the CSA defines the objectives of the concept studies as follows;
The objective of this Statement of Work (SOW) is to enable the completion of Technology Concept Studies that will improve the crew’s health during future Canadian deep space missions.
The health and well-being of space crews is of critical importance in the achievement of long- duration space missions and a key area of interest for all the international partners, as they plan the next steps in space exploration beyond the International Space Station (ISS). Due to greater physical distances and mission durations as well as communication delays, future deep space human spaceflight missions will require the development of medical systems and support technologies that provide the crew with enhanced medical autonomy.
Each company will participate in two phases. Phase 1 is for the Technology Concept Study itself.
Phase 2 will see each company develop a prototype based on the Phase 1 Technology Concept Study.
The Phase 1 contract runs for seven months from the award while the Phase 2 runs from the end of Phase 1 for up to 12 months.
The CSA provided the following detail related to this RFP. It’s quite an interesting read in understanding the needs and challenges of humans working in deep space. It also provides a list of possible solutions as examples that could be developed.
Space Hazards and Health Risks Associated with Deep Space Missions
Space exploration is a very challenging and risky endeavour, exposing crew to extreme hazards. These hazards include high accelerations during launch and landing, exposure to variable gravity environments, exposure to galactic and solar radiation, high sound exposures in the spacecraft, living in an enclosed, isolated and confined environment for extended periods of time, and a difficult work/life schedule. Such hazards expose humans to health risks that may jeopardize missions or result in long-term health consequences. These risks are largely related to the effects of the spaceflight environment on human health (space radiation, variable gravity and the isolated and confined environment of space). Many risks are associated with the specific challenges of providing healthcare in the spaceflight environment. Risks have been identified and are detailed in a number documents such as the NASA Human Health and Performance Risks of Space Exploration Missions (RD-4), and NASA Human Health and Performance Risk of Adverse Health Outcomes and Decrements in Performance due to In-flight Medical Conditions (RD-5).
In general, Health risks of spaceflight are the result of multiple impact factors such as:
- The impact of the space environment on human health, wellbeing and performance. For example, this includes physical risks (e.g. musculoskeletal, sensorimotor, ocular, immune system, cardiovascular, carcinogenesis, etc.) and psycho-social risks (cognitive, behavioral,
psychiatric conditions, cooperation, team dynamic, etc.);
- The risks associated with mission infrastructure and design, such as the vehicle habitat design,
extravehicular activities, exposure to toxic environment, work overload, sleep conditions,
- The available medical capabilities to manage crew health and performance, such as the
occurrence of inflight medical conditions, consumables’ availability and shelf life, autonomous medical capabilities, etc.
Challenges in Provision of Healthcare and the Need for Medical Autonomy
As future human spaceflight missions extend beyond Low Earth Orbit (LEO), greater physical distances and mission durations, volume and mass constraints, as well as limited crew medical training, will result in numerous challenges in the provision of healthcare:
1) Reduced opportunity for the quick return of a sick or injured crewmember to definitive medical treatment on Earth;
2) Increased communications time delays, and fewer communication opportunities, making real- time telemedicine interactions impossible for much of the mission;
a. Up to 40 minute round-trip communications delay characteristic of a Mars-class missions as a consequence of distance;
b. The likelihood of rationed communications time due to the large amount of data that needs to be transmitted to the ground and the limited bandwidth (crew communications may be limited to specific periods of time during the day);
c. Loss of communications (hours, days) due to limited coverage by telecommunications satellites;
d. Potential loss of communications due to failure of the telecommunications infrastructure or loss of signal.
3) Limited medical resources;
4) Limited mass, volume, computing and power generation capabilities result in limitations with
respect to medical equipment availability on board ;
5) Limited medical specialist expertise by crewmembers, and the potential rendering of medical care
6) Limited time available for pre-flight training;
As a result, future exploration-class missions will require the development of advanced concepts of operations, technologies and procedures that will provide the crew with enhanced medical autonomy.
Autonomy, in this case describes the requirement for the spacecraft and its crew to function independently from terrestrially-based medical ground control. Autonomy does not imply the absence of human interaction with the system, rather the medical/health system is primarily a support system to aid the Crew Medical Officer (CMO) in medical decisions. The system will also support individual crewmembers in decisions related to maintaining optimal health and fitness for duty. Even though some data acquisition and analysis will be performed automatically, i.e. transparent to the crew, the decision-making process and subsequent interventions will imply interaction between the CMO/crewmember and the system. Data would also be sent to mission control, on Earth, for further analysis and overall mission oversight.
Critical to the provision of medical autonomy, deep space missions will require a highly integrated medical system with the following components:
1) Data collection: Health data collection will consist of diagnostic devices for laboratory analysis (bio- analytics), continuous and periodic crew health monitoring (bio-monitoring), and imaging, as well as tools to capture medical event histories and physical exams. Health data would also include periodic health surveys and self-assessments (fitness, nutrition, behavioural) as well as environmental data. Data collection should be highly automated, and intuitive, requiring minimal interaction from the crew.
2) Data integration and management: All health-related data would be integrated and stored in a common health database (electronic medical record). The data management system would have crew and CMO interfaces as well as visualisation tools to aid in the evaluation of health status.
3) Data analysis and decision support: To allow for crew medical autonomy, the medical system must provide the capability to support the CMO in decisions related to the diagnosis and treatment options in the event of illness or injury, as well as to support the crew in decisions pertaining to maintaining or improving health status. The decision support system should be able to recognize indicators of early disease onset. In addition, the system would also assist the CMO in the management of medical consumables.
4) Treatments and countermeasures: In cases where the likelihood and consequence of an illness or injury justify the in-flight ability to prevent, detect, treat or manage the medical condition adequate in- flight countermeasures and treatment technologies and consumables must be provided.
5) Crew medical training: Due to extended durations of exploration-class missions, the medical system must also provide medical training capabilities to allow the CMO to maintain his/her medical knowledge and skills, as well as allow the crew to acquire new knowledge and skills should the risks of disease or injury change.
Due to power, mass and volume constraints, data sources and devices would serve both health maintenance, as well as research functions, and must be integrated with in-flight procedures and guidelines. In addition, although the CMO is likely to be a physician, the possibility that the CMO becomes sick or injured would require that the medical system be able to accommodate non-medical health care providers.
Solutions sought will be part of this integrated set of capabilities necessary to support medical autonomy.
The exploration medical capabilities required for a particular mission profile are dependant on the set of medical conditions that are most likely to occur during the mission. To this end, NASA’s Exploration Medical Capability team developed spaceflight medical condition lists. The Space Medicine Exploration Medical Condition List (EMCL) in 2012, and the Integrated Medical Model, Medical Conditions List (IMMMCL) in 2017. These lists identify conditions that occur as a consequence of human space flight and human habitation of space, in addition to injuries that result from hardware or vehicle failure (RD-01 and RD-02). Medical conditions that have a likelihood of occurrence in the astronaut population should be considered. All medical conditions listed have either occurred in flight, or have the potential to occur in flight.
Management of events not compatible with such a delay will need an autonomous model, requiring specific skills, technologies (decision support capabilities) and consumables in order to effectively deal with those medical conditions with little or no assistance from ground-based medical experts. Non critical, less emergent and slowly evolving medical conditions can likely continue to be managed, at least in part, with long-delay telemedicine ground support.
During deep space missions where communications with Earth may be delayed or non-existent and where medical evacuation is not an option, the medical infrastructure must assist the CMO (or the crewmembers themselves in certain cases) in the management of crew health and determination of fitness for duty, as well as in the diagnosis and treatment of injury and disease. Crew health status would be monitored with limited or no ground support. The CMO would be able to maintain the crews abilities to perform the space mission, and should medical conditions occur, s/he would be able to diagnose and treat the medical condition such that the impact to the mission would be minimal. To date, medical autonomy during spaceflight is minimal, and medical authority rests with the flight surgeon on Earth.
Future exploration missions will require the crew to be independent from the ground in health and medical decisions from identifying changes in health and performance, to diagnosis of illness and injury, to the prescription of countermeasures and treatments. This capability will require decision support systems (DSS) for spaceflight that are currently not available. In order to achieve this level of autonomy in the management of crew health and medical care delivery, advanced technologies will be required.
The CSA is requesting Technology Concept Studies for solutions that will address autonomy of the crew in decisions related to crew health and medical care. Section 4.1 highlight some examples of solutions to guide the bidders; other solutions aligned with these categories are also welcomed. The CSA is looking for innovative solutions from the Canadian community.
Decision Support System for the Management of Astronauts’ Health
As part of the autonomous crew healthcare system for deep space missions, a space medicine decision support system (SMDSS) is aimed at supporting the CMO in the development of a diagnosis and relevant treatment plan(s), as well as the continuous health monitoring and early detection and prediction of disease states. The SMDSS is foreseen to include a set of modular solutions to address the various needs. DSS solutions would interface with health-related databases which would include real-time and periodic data acquisition (medical and non-medical; e.g. radiation, CO2 levels) as well as references to the crewmembers’ history and access to the literature and guidelines. Advances in medical technologies will enable continuous monitoring, ongoing tracking of health indicators, and early disease warning through the development of a variety of techniques and tools such as DNA sequencing, diagnostic biomarkers, genomics, miniaturized and portable bioimaging, bio-MEMS, etc. In addition, by tracking medical consumables and treatment plans, the SMDSS would also assist in the management of medical consumables, offering treatment options depending on the availability or predicted future need of the consumables. As such, the SMDSS would interface with a medical inventory management system.
It is foreseen that two main categories of decision support will make up the SMDSS of the future:
1. Diagnostic and Treatment: This component would allow an assessment of crewmember health, and if required, a diagnosis and prescribed treatment plan. This could refer to the analysis of health data, signs and symptoms as well as other relevant health data (e.g. family history) in order to develop a differential diagnosis, and eventually a definitive diagnosis. The prescribed treatment plan would include guidance through medical procedures as well as use of
medications as required.
2. Health State Monitoring and Early Onset Detection: This component would allow for continuous monitoring of health metrics for the purposes of identification of changes in a crewmembers health state, and eventually the detection of early onset and/or the prediction of potential disease states. The goal of health state monitoring would be to allow for early intervention in order to minimize the impact of a potential disease, the crew downtime and the amount of medical consumables required to return the crewmember to a healthy state.
Examples of solutions
Under this Request for Proposal, the CSA is looking for a variety of solutions. The proposed solution could target different aspects of astronauts’ health, based on the risks and needs for deep space missions. Here is a non-exhaustive list of potential applications:
- A computer-based solution that can analyze health related data (signs, symptoms, imagery, lab results and other relevant data) and provide a differential diagnosis as well as the most likely diagnosis;
- A solution addressing one or more health concerns. For example, this could be a solution that autonomously:
o Assesses mental and cognitive health;
o Identifies early on-set of medical conditions;
o Provides trends and the associated potential health outcomes;
o Determines fitness for duty;
o Provides assessments of sleep quality and quantity, physical fitness and nutrition; o Assesses health state and detect potential anomalies;