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Emergency medicine in space

Notfallmedizin im Weltraum

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Abstract

Background

The management of severe medical events during spaceflight represents an exceptional challenge. Thanks to the intense medical screening performed during astronaut selection, significant medical problems have remained uncommon during training and space missions, despite some 125 person-years of cumulated presence in space. The risk of severe medical events, particularly during long-term missions, e.g. to Mars, is nevertheless significant. Many gaps still remain in our understanding of the human response to the space environment and several critical risks associated with interplanetary space travel—such as protection against radiation exposure or delivery of autonomous medical care—remain unresolved.

Results

Both the expected medical conditions and the acute care capabilities differ greatly between Earth and space. While the options in modern medical facilities on the ground are potentially limitless, the equipment and immediate expertise available in space are very limited. For this reason, an emphasis is put on prevention of emergencies. Even after a successful initial stabilisation in low Earth orbit, postresuscitation care would prove problematic. The International Space Station (ISS) does not have the capability to deliver prolonged life support. Furthermore, evacuation from low Earth orbit with current capabilities may not be possible for an unstable, critically ill or intubated and ventilated patient, because of limited volume in the Soyuz capsule and the high deceleration profile.

Conclusion

Future space exploration missions will push back the limits of human experience in maintaining health and performance of crew members. Many issues will have to be addressed before humanity can venture beyond low Earth orbit with an acceptable level of risk.

Zusammenfassung

Hintergrund

Die Behandlung schwerwiegender medizinischer Vorfälle während eines Raumflugs stellt eine außergewöhnliche Herausforderung dar. Dank der intensiven medizinischen Untersuchungen in der Phase der Kandidatenauswahl sind signifikante medizinische Probleme während des Trainings und der Weltraummissionen bisher selten, obwohl Raumfahrer kumuliert bereits 125 Personenjahre im All verbracht haben. Das Risiko schwerwiegender medizinischer Ereignisse ist dennoch erheblich, besonders bei Langzeitmissionen wie z. B. zum Mars. Es gibt noch viele Lücken in unserem Verständnis der menschlichen Reaktion auf die Weltraumbedingungen und verschiedener kritischer Risiken der interplanetaren Raumfahrt, wie z.B. beim Schutz vor Strahlenexposition oder der autonomen medizinischen Versorgung.

Ergebnisse

Sowohl die zu ­erwartenden medizinischen Beschwerden als auch die akute Versorgungskapazität sind auf der Erde und im Weltraum grundsätzlich unterschiedlich. Während die modernen medizinischen Möglichkeiten auf der Erde potenziell unbegrenzt sind, sind die Ausrüstung und das unmittelbar verfügbare Know-how im Weltraum sehr begrenzt. Daher konzentriert man sich auf die Prävention von Notfällen. Selbst nach einer erfolgreichen initialen Stabilisation wäre eine postreanimative Versorgung im erdnahen Orbit problematisch. Auf der internationalen Raumstation ISS ist eine lebenserhaltende Versorgung über einen längeren Zeitraum unmöglich. Außerdem ist eine Evakuierung aus dem erdnahen Orbit mit den derzeitigen Möglichkeiten bei einem instabilen, kritisch erkrankten oder intubierten und beatmeten Patienten angesichts des begrenzten Volumens der Soyuz-Kapsel und der starken Verzögerung beim Wiedereintritt in die Atmosphäre unter Umständen nicht möglich.

Schlussfolgerung

Künftige Weltraum-Forschungsmissionen werden unsere Kenntnisse über die Erhaltung von Gesundheit und Leistungsfähigkeit der Besatzungsmitglieder erweitern. Viele Fragen sind noch zu lösen, bevor die Menschheit sich mit vertretbarem Risiko auf den Weg in die Tiefen des Weltalls machen kann.

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Compliance with ethical guidelines

Conflict of interest. M. Komorowski, C. Neuhaus and J. Hinkelbein state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Bioengineering, Imperial College London, London, UK

    M. Komorowski

  2. Working group “Emergency Medicine and Air Rescue”, German Society of Aviation and Space Medicine (DGLRM) e. V., Munich, Germany

    C. Neuhaus &  J. Hinkelbein DESA, EDIC, FAsMA

  3. Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany

    C. Neuhaus

  4. Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    J. Hinkelbein DESA, EDIC, FAsMA

Authors
  1. M. Komorowski
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  2. C. Neuhaus
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  3. J. Hinkelbein DESA, EDIC, FAsMA
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Corresponding author

Correspondence to J. Hinkelbein DESA, EDIC, FAsMA.

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This article is available in German at Springer.Link under DOI XXXXXXX.

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Komorowski, M., Neuhaus, C. & Hinkelbein, J. Emergency medicine in space. Notfall Rettungsmed 18, 268–273 (2015). https://doi.org/10.1007/s10049-014-1979-8

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  • DOI: https://doi.org/10.1007/s10049-014-1979-8

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