Where no man has been before! – The challenges of medical preparation for future interplanetary space missions

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During exploration missions into unknown territories, medical diseases and trauma have accounted for more failures than technical and environmental causes. For example, only 18 men out of 272 survived the first circumnavigation of the globe led by Magellan in 1519-1522, with malnutrition, scurvy, starvation and illness being the main causes of death, surpassing violent causes. The case of Russian surgeon Leonid Rogozov is also very famous since that day of 1 May 1961, when he had to cut out his own appendix while he was the only physician stationed at a polar base in Antarctica. During a 900-day 6-crewmember Mars mission, the projected risk of such severe medical events is significant. Estimations of at least one event requiring surgery have been proposed.

In these circumstances, anaesthesia may have to be provided in extremely scarce conditions, with minimal equipment and consumables, possibly by individuals with a very limited training and on an unstable patient. The risk of death from suboptimal medical management is huge. How can such a challenge be addressed? How could we prepare for a scenario so alien to our daily practice?

Access to space is currently very restricted, so options for prospective medical research are limited. In addition, current medical contingency plans do not include the option to deliver anaesthesia on orbit. Rather, evacuation of the patient back to a facility on the ground would be attempted.

We are left with the option to use space analogue environments, such as submarine crews, polar stations in Antarctica, or expeditions in the wilderness. These settings have been and are still being used extensively to probe hazards, develop crew proficiency and validate medical technologies and countermeasures for prospective space missions. This was the basis of this research, where we analysed the relevant literature in environments that represent partial analogues to future space missions, to Mars in particular.

Our team comes from all over Europe and blends individuals with expertise in clinical medicine, space medicine and anaesthesia but first and foremost who share a common vision of the greater good of space exploration. Together, we studied how anaesthesia was being delivered where there is no anaesthetist, no state-of-the art equipment, sometimes no hospital! This allowed us to inform this critical gap in space medicine knowledge.

Sending a human crew to Mars and keeping them healthy and performing for 900 days is a tall order. Preparing for such a bold endeavour requires a multitude of teams of engineers and scientists closing all critical gaps one at a time. Among all the remaining medical challenges, the provision of anaesthesia had been little studied to this day, owing to the low operational risk it represents for current space activities. However, we demonstrate that important information can be gathered from space analogue environments and may improve the chances of crew survival and success of future interplanetary space missions.

If this has sparked your interest at all, or you would like to find out more about the topic please have a read of our full paper. We hope you enjoy it and please get in touch if you want to discuss it further!

Matthieu Komorowski

Anesthesiologist , Imperial College London