Rebecca S. Blue

Commercial Spaceflight Participant G-Force Tolerance During Centrifuge-Simulated Suborbital Flight

INTRODUCTION Medical knowledge of the human body in microgravity and hypergravity is based upon studies of healthy individuals well-conditioned for such environments. Little data exist regarding the effects of spaceflight on untrained commercial passengers. We examined the responses of potential spaceflight participants (SFP) to centrifuge G-force exposure. METHODS There were 77 individuals (65 men, 12 women), 22-88 yr old, who underwent 6 centrifuge runs over 48 h. Day 1 consisted of two +Gz runs (peak = 3.5+Gz, run 2) and two +Gx runs (peak = 6.0+Gx, run 4). Day 2 consisted of two runs approximating a suborbital spaceflight profile. Data included blood pressure, electrocardiogram, and postrun questionnaires regarding motion sickness, disorientation, greyout, and other symptoms. RESULTS Of the 77 participants, average age was 50.4 +/- 12.7 yr. Average heart rate (HR) varied by sex and direction of G-exposure (+Gz: F 150 +/- 19, M 123 +/- 27; +Gx: F 135 +/- 30, M 110 +/- 27). Age and peak HR were inversely related (HR < 120 bpm: 60.2 +/- 12.2 yr, HR > 120: 47.1 +/- 10.9 yr). HR during peak G-exposure for the final run was associated with post-run imbalance (no imbalance: HR 126 +/- 26, imbalance: HR 145 +/- 21); no other significant hemodynamic change, sex, or age variation was associated with imbalance. Age and greyout were inversely associated; there was no association between greyout and vital sign change, sex, or G-force magnitude. Baseline/pretrial mean arterial pressure (MAP) was not associated with any symptoms. DISCUSSION The results suggest that most individuals with well-controlled medical conditions can withstand acceleration forces involved in launch/landing profiles of commercial spaceflight vehicles. Further investigation will help refine which conditions present significant risk during suborbital flight and beyond.

Tolerance of centrifuge-simulated suborbital spaceflight by medical condition.

INTRODUCTION We examined responses of volunteers with known medical disease to G forces in a centrifuge to evaluate how potential commercial spaceflight participants (SFPs) might tolerate the forces of spaceflight despite significant medical history. METHODS Volunteers were recruited based upon suitability for each of five disease categories (hypertension, cardiovascular disease, diabetes, lung disease, back or neck problems) or a control group. Subjects underwent seven centrifuge runs over 2 d. Day 1 consisted of two +G(z) runs (peak = +3.5 G(z), Run 2) and two +G(x), runs (peak = +6.0 G(x), Run 4). Day 2 consisted of three runs approximating suborbital spaceflight profiles (combined +G(x) and +G(z), peak = +6.0 G(x)/+4.0 G(z)). Data collected included blood pressure, electrocardiogram, pulse oximetry, neurovestibular exams, and post-run questionnaires regarding motion sickness, disorientation, grayout, and other symptoms. RESULTS A total of 335 subjects registered for participation, of which 86 (63 men, 23 women, age 20-78 yr) participated in centrifuge trials. The most common causes for disqualification were weight and severe and uncontrolled medical or psychiatric disease. Five subjects voluntarily withdrew from the second day of testing: three for anxiety reasons, one for back strain, and one for time constraints. Maximum hemodynamic values recorded included HR of 192 bpm, systolic BP of 217 mmHg, and diastolic BP of 144 mmHg. Common subjective complaints included grayout (69%), nausea (20%), and chest discomfort (6%). Despite their medical history, no subject experienced significant adverse physiological responses to centrifuge profiles. DISCUSSION These results suggest that most individuals with well-controlled medical conditions can withstand acceleration forces of launch and re-entry profiles of current commercial spaceflight vehicles.

Pathophysiology, prevention, and treatment of ebullism.

INTRODUCTION Ebullism is the spontaneous evolution of liquid water in tissues to water vapor at body temperature when the ambient pressure is 47 mmHg or less. While injuries secondary to ebullism are generally considered fatal, some reports have described recovery after exposure to near vacuum for several minutes. The objectives of this article are to review the current literature on ebullism and to present prevention and treatment recommendations that can be used to enhance the safety of high altitude activities and space operations. METHODS A systematic review was conducted on currently available information and published literature of human and animal studies involving rapid decompression to vacuum and ebullism, with subsequent development of an applicable treatment protocol. RESULTS Available research on ebullism in human and animal subjects is extremely limited. Literature available identified key pathophysiologic processes and mitigation strategies that were used for treatment protocol design and outlining appropriate interventions using current best medical practices and technologies. DISCUSSION Available literature suggests that the pathophysiology of ebullism leads to predictable and often treatable injuries, and that many exposures may be survivable. With the growing number of high altitude and space-related activities, more individuals will be at risk for ebullism. An integrated medical protocol can provide guidance for the prevention and treatment of ebullism and help to mitigate this risk in the future.

Astronaut medical selection during the shuttle era: 1981-2011.

INTRODUCTION U.S. astronauts undergo extensive job-related screening and medical examinations prior to selection in order to identify candidates optimally suited for careers in spaceflight. Screening medical standards evolved over many years and after extensive spaceflight experience. These standards assess health-related risks for each astronaut candidate, minimizing the potential for medical impact on future mission success. This document discusses the evolution of the Shuttle-era medical selection standards and the most common reasons for medical dis-qualification of applicants. METHODS Data for astronaut candidate finalists were compiled from medical records and NASA archives from the period of 1978 to 2004 and were retrospectively reviewed for medically disqualifying conditions. RESULTS During Shuttle selection cycles, a total of 372 applicants were disqualified due to 425 medical concerns. The most common disqualifying conditions included visual, cardiovascular, psychiatric, and behavioral disorders. During this time period, three major expert panel reviews resulted in refinements and alterations to selection standards for future cycles. DISCUSSION Shuttle-era screening, testing, and specialist evaluations evolved through periodic expert reviews, evidence-based medicine, and astronaut medical care experience. The Shuttle medical program contributed to the development and implementation of NASA and international standards, longitudinal data collection, improved medical care, and occupational surveillance models. The lessons learned from the Shuttle program serve as the basis for medical selection for the ISS, exploration-class missions, and for those expected to participate in commercial spaceflight.

Flat spin and negative Gz in high-altitude free fall: pathophysiology, prevention, and treatment

INTRODUCTION Red Bull Stratos was a commercial program that brought a test parachutist protected by a full pressure suit to 127,852 ft (38,964 m), via a stratospheric balloon with a pressurized capsule, from which he free fell and subsequently parachuted to the ground. In light of the uniqueness of the operation and the medical threats faced, medical protocols specific to distinctive injury patterns were developed. One unique threat was that of a flat spin during free fall with resultant exposure to -Gz (toe-to-head) acceleration. In preparation for stratospheric free fall, the medical team conducted a review of the literature on the spectrum of human and animal injury patterns attributable to -Gz exposures. Based on the findings, an emergency medical field response protocol was developed for the rapid assessment, diagnosis, and treatment of individuals suspected of -Gz injury. METHODS A systematic review was conducted on available literature on human and animal studies involving significant -Gz exposure, with subsequent development of an applicable field treatment protocol. RESULTS The literature review identified pathophysiologic processes and mitigation strategies that were used to develop a prevention and treatment protocol, outlining appropriate interventions using current best medical practices. A medical field treatment protocol was successfully established for the high-altitude balloon program. DISCUSSION Available literature provided insight into best medical practices for the prevention and treatment of significant -Gz exposures during high-altitude parachute activity. Using the protocol developed for the field medical response, injuries from sustained -Gz exposure can be effectively managed in similar high-altitude and space operations.

Physiological monitoring and analysis of a manned stratospheric balloon test program.

INTRODUCTION The Red Bull Stratos Project consisted of incremental high altitude parachute jumps [maximum altitude 127,852 ft (38,969 m)] from a pressurized capsule suspended from a stratospheric helium-filled balloon. A physiological monitoring system was worn by the parachutist to provide operational medical and acceleration data and to record a unique set of data in a supersonic environment. METHODS Various physiological parameters, including heart rate (HR), respiratory rate (RR), skin temperature, and triaxial acceleration, were collected during the ascent, high altitude float, free fall, and parachute opening and descent stages of multiple low- and high altitude jumps. Physiologic data were synchronized with global positioning system (GPS) and audiovisual data for a comprehensive understanding of the environmental stressors experienced. RESULTS HR reached maximum during capsule egress and remained elevated throughout free fall and landing. RR reached its maximum during free fall. Temperature data were unreliable and did not provide useful results. The highest accelerations parameters were recorded during parachute opening and during landing. During each high altitude jump, immediately after capsule egress, the parachutist experienced a few seconds of microgravity during which some instability occurred. Control was regained as the parachutist entered denser atmosphere. DISCUSSION The high altitude environment resulted in extremely high vertical speeds due to little air resistance in comparison to lower altitude jumps with similar equipment. The risk for tumbling was highest at initial step-off. Physiological responses included elevated HR and RR throughout critical phases of free fall. The monitoring unit performed well despite the austere environment and extreme human performance activities.

Overview of medical operations for a manned stratospheric balloon flight.

INTRODUCTION Red Bull Stratos was a commercial program designed to bring a test parachutist protected by a full-pressure suit via a stratospheric balloon with a pressurized capsule to 120,000 ft (36,576 m), from which he would freefall and subsequently parachute to the ground. On March 15, 2012, the Red Bull Stratos program successfully conducted a preliminary manned balloon test flight and parachute jump, reaching a final altitude of 71,581 ft (21,818 m). In light of the uniqueness of the operation and medical threats faced, a comprehensive medical plan was needed to ensure prompt and efficient response to any medical contingencies. This report will serve to discuss the medical plans put into place before the first manned balloon flight and the actions of the medical team during that flight. METHODS The medical operations developed for this program will be systematically evaluated, particularly, specific recommendations for improvement in future high-altitude and commercial space activities. RESULTS A multipronged approach to medical support was developed, consisting of event planning, medical personnel, equipment, contingency-specific considerations, and communications. DISCUSSION Medical operations were found to be highly successful when field-tested during this stratospheric flight, and the experience allowed for refinement of medical operations for future flights. The lessons learned and practices established for this program can easily be used to tailor a plan specific to other aviation or spaceflight events.

Emergency medical support for a manned stratospheric balloon test program

INTRODUCTION Red Bull Stratos was a commercial program that brought a test parachutist, protected by a full-pressure suit, in a stratospheric balloon with pressurized capsule to over 127,582 ft (38,969 m), from which he free fell and subsequently parachuted to the ground. Given that the major risks to the parachutist included ebullism, negative Gz (toe-to-head) acceleration exposure from an uncontrolled flat spin, and trauma, a comprehensive plan was developed to recover the parachutist under nominal conditions and to respond to any medical contingencies that might have arisen. In this report, the project medical team describes the experience of providing emergency medical support and crew recovery for the manned balloon flights of the program. METHODS The phases of flight, associated risks, and available resources were systematically evaluated. RESULTS Six distinct phases of flight from an Emergency Medical Services (EMS) standpoint were identified. A Medical Support Plan was developed to address the risks associated with each phase, encompassing personnel, equipment, procedures, and communications. DISCUSSION Despite geographical, communications, and resource limitations, the medical team was able to implement the Medical Support Plan, enabling multiple successful manned balloon flights to 71,615 ft (21,828 m), 97,221 ft (29,610 m), and 127,582 ft (38,969 m). The experience allowed refinement of the EMS and crew recovery procedures for each successive flight and could be applied to other high altitude or commercial space ventures.

Biometric identification of cardiosynchronous waveforms utilizing person specific continuous and discrete wavelet transform features

In this paper we explore how a Radio Frequency Impedance Interrogation (RFII) signal may be used as a biometric feature. This could allow the identification of subjects in operational and potentially hostile environments. Features extracted from the continuous and discrete wavelet decompositions of the signal are investigated for biometric identification. In the former case, the most discriminative features in the wavelet space were extracted using a Fisher ratio metric. Comparisons in the wavelet space were done using the Euclidean distance measure. In the latter case, the signal was decomposed at various levels using different wavelet bases, in order to extract both low frequency and high frequency components. Comparisons at each decomposition level were performed using the same distance measure as before. The data set used consists of four subjects, each with a 15 minute RFII recording. The various data samples for our experiments, corresponding to a single heart beat duration, were extracted from these recordings. We achieve identification rates of up to 99% using the CWT approach and rates of up to 100% using the DWT approach. While the small size of the dataset limits the interpretation of these results, further work with larger datasets is expected to develop better algorithms for subject identification.

Sleep stability and cognitive function in an Arctic Martian analogue.

INTRODUCTION Human performance is affected by sleep disruption and sleep deprivation can critically affect mission outcome in both spaceflight and other extreme environments. In this study, the seven-person crew (four men, three women) lived a Martian sol (24.65 h) for 37 d during a long-term stay at the Flashline Mars Arctic Research Station (FMARS) on Devon Island, Canada. Crewmembers underwent cardiopulmonary monitoring for signs of circadian disruption and completed a modified Pittsburgh Sleep Diary to monitor subjective fatigue. Crewmembers underwent cognitive testing to identify the effects, if any, of sleep disruption upon cognitive skill. METHODS A Martian sol was implemented for 37 d during the Arctic mission. Each crewmember completed an adapted version of the Pittsburgh Sleep Diary in tandem with electrocardiograph (ECG) cardiopulmonary monitoring of sleep by the Cardiac Adapted Sleep Parameters Electrocardiogram Recorder (CASPER). Crewmembers also underwent cognitive testing during this time period. RESULTS Sleep diary data indicate improvement in alertness with the onset of the sol (fatigue decreasing from 5.1 to 4.0, alertness increasing from 6.1 to 7.0). Cardiopulmonary data suggest sleep instability, though trends were not statistically significant. Crewmember decision speed time scores improved from pre-Mars to Mars (average improving from 66.5 to 84.0%), though the remainder of cognitive testing results were not significant. DISCUSSION While subjective data demonstrate improved sleep and alertness during the sol, objective data demonstrate no significant alteration of sleep patterns. There was no apparent cognitive decline over the course of the mission.