Extraterrestrial TelemedicineKolkata India

September 2014

Ronald Merrell, MD, FACSEmeritus Professor of Surgery

Virginia Commonwealth UniversityRichmond, Virginia

Laika: Telemedicine First

11/3/57 sputnik2

Why Space Telemedicine?

• Distance/Time

• No possibility for physical interfention

• Extraordinary Risk

• Prediction and Risk Mitigation

What Telemedicine?

• Sensors

• Transmission

• Effectors

• Process Simulation

Direct management at a distance in real time

Human Space Flight

• 536 people. 38 countries. Kalpana Chawla 2003, Rakesh Sharma 1984 from India

• First Yuri Gagarin 4/12/61 0ne hour 48 minutes

• Valery Polyokov MIR 437 days 18 hours

• 2015 routine stays of one year.

International Space Station

• Continuous human occupation since 2000• 419,455kg. Habitable volume 388 meter sq.

pressurized volume same as Boeing 777• Solar array 73 meter sq. 84 kilowatts• Orbit about every 93 minutes. Velocity

27,600 km/h• Usual gas tensions, one atmosphere

pressure

ISS: Extended observation and experimentation in a realistic setting

Expedition 39 landingMay 14, 2014

Commander Mikata. Expedition 39. May 14, 2014

Health Risks for Exploration

• Radiation. Low earth orbit as opposed to deep space beyond the van Allen Belt

• Bone mineral loss• Visual problems• Deconditioning• Pharmacokinetics• Neurovestibular and autonomic adaptation• Behavioral issues• INJURY. Work related and MMOD• INTERCURRENT ILLNESS

The extraordinary opportunity to work with Russian colleagues

Health Maintenance

• Monitor

• Daily Health Interview

• Countermeasures

• Return to earth. Not really

• Early intervention. No crew physician!

• Semiautonomous telemedicine

A Problem of Time: long distance travel

• Mars apogee 54,000,000 km. perigee 401,000,000km

• Therefore telcom at speed of light average 28 minutes round trip. Max 44 minutes.

• Travel time 150 to 300 days each way.

• No possibility to return or even for robotic intervention.

Imhotep Designed Step pyramid at Saqqara

2630-2611 BCEAuthor of the Edwin Smith Papyrus

"Thou should say concerning him [the patient] . . ."

1. An ailment which I will treat. 2. An ailment with which I will contend.3. An ailment not to be treated.

Semiautonomous Medical Care

In long distance space travel real time or synchronous health management is not feasible. Return to earth for health issues is not feasible either. The inspiring safety record of space medicine is about to be challenged and cannot be sustained with optimism and anecdote.

Tools

• Physiologic Sensors

• Software for data including analysis and prompts

• Video

• Ultrasound

• Evolving surgical capability

•Telemedicine as telemetry was defined in the needs for space travel

•Extraterrestrial medicine has been evolving for over 50 years

•Space medicine has been remarkably successful win identifying and

mitigating risk

•The challenges of medicine in space offers many opportunities to

solve probl4emjs of patients in remote and isolated areas. And for

HOME!!

•THANK YOU!!!

Conclusions