Responsible Center: NSBRI
Solicitation / Funding Source: 2015-16 HERO NNJ15ZSA001N-Crew Health (FLAGSHIP, NSBRI, OMNIBUS). Appendix A-Crew Health, Appendix B-NSBRI, Appendix C-Omnibus
Grant/Contract No.: NCC 9-58-HFP04501
Project Type: GROUND
No. of Post Docs: 1
No. of PhD Candidates: 0
No. of Master's Candidates: 0
No. of Bachelor's Candidates: 0
No. of PhD Degrees: 0
No. of Master's Degrees: 0
No. of Bachelor's Degrees: 0
|| 1) Original Project aims and objectives: The success of the next phase of space exploration is dependent on the ability of training programs to prepare crews to manage a range of events, medical and technical, which may occur during spaceflight. Long-duration exploration missions (LDEMs) will require crewmembers to be more autonomous than on previous missions, making the development of countermeasures to mitigate the effects of in-flight medical events essential to both survival and mission success. In line with the research topic, "Operationalize Customized Refresher and Just-In-Time Training Products for Deep Space, Long Duration Spaceflight Crews," the project had two specific aims to add to knowledge about the risk of team performance errors resulting from a lack of medical focused non-technical skills, as follows:
Specific aim 1: Identify objective measures of non-technical skills that enhance crew management of in-flight medical emergencies
Specific aim 2: Develop a simulated spacecraft medical bay, and run a series of simulation scenarios to measure crew behavior during high acuity, low frequency medical emergencies
To achieve these aims, we recruited a panel of 28 experts from the fields of Space Medicine, Teamwork, Human Factors, and Emergency Medicine. They participated in online tasks as well as a 2-day in person panel meeting at the Lunar and Planetary Institute, Houston. This study was exploratory in nature, as team performance during medical emergencies has not been extensively studied in simulated spaceflight environments. However, based on the experience from developing similar tools in other industries and in prior studies, a unique set of specific behaviors relevant to the demands of the profession have always been identified. Our guiding hypothesis was that we can optimize outcomes, including task success in medical events, and the outcome of the patient, by supporting crew non-technical skills in a deliberate and strategic fashion. The project adopted a quasi-experimental design that allowed us to test the hypothesis that it is possible to identify a unique set of objective measures of crew non-technical skills to manage medical emergencies.
2) Key findings and their impact on hypotheses, technology requirements, objectives and specific aims of the original proposal: The key finding in specific aim 1 was development of a non-technical skills taxonomy and objective measurement tool (called ASTRONOTSS) that identifies the essential astronaut crew behaviors for effective medical emergency management. This includes a set of objective measures for onboard training of the specific skills that enhance crew cohesion, performance, and safety when faced with an unanticipated medical emergency in flight. The expert panel recommended developing separate skills taxonomies for each medical event. This also allowed us to identify common behavioral skills across medical events which were: (i) Situation Assessment; (ii) Crew-Ground Communication; (iii) Stress Management; (iv) Team Coordination; (v) Calling for Help; (vi) Conflict Management; and (vii) Leadership Transition. We were also able to gain consensus on other LDEM specific features relevant to in-flight medical care such as training of Crew Medical Officer (CMO), the duration of training, crew composition, inflight vs ground training, just-in-time training, measurement scale for behavioral skills, and retention/ decay of skills training.
The key finding in specific aim 2 was development of a simulation-based training platform to replicate the spacecraft environment and provide crews with valid medical emergency scenarios on which to gain experience. We built the simulation platform at the STRATUS Center for Medical Simulator at Brigham & Women's Hospital in Boston. We also set up a simulated Mission Control desk to include interactions of the in-flight crew with Capcom and the flight surgeon, which allows us to focus on the key behavioral skills required for effective communication between crew and the ground. During this process we identified the main technological requirements to set up a spacecraft medical simulator with sufficient fidelity for training drills in medical event management. To demonstrate the capabilities of the simulator and for the purpose of reliability testing, we storyboarded, scripted, and filmed four diverse potential medical events: Cardiac Arrest, Toxic Exposure, Eye injury and Pneumothorax. We incorporated input on space and medical contexts from expert panelists to ensure the scenarios were clinically relevant and authentic.
3) Impact of key findings on hypotheses, technology requirements, objectives and specific aims of the original proposal: Our initial plan was to demonstrate quantitative assessment of generic set of behaviors but after discussions with the expert panel, it was determined that to best support for crew health, a specific set of behavior markers for key medical emergencies would be most applicable. To this end, we created the ASTRONOTSS taxonomy, which depicts specific medically focused behaviors in line with current spaceflight crew resource management framework. Video examples of behavior and clinical training scenarios that could be used for drills to enhance team management and debriefing on performance were also created.
4) Proposed research plan for the coming year: Our intention is to establish inter-rater reliability of observers using the ASTRONOTSS taxonomy. We will achieve this using the video scenarios filmed in the space simulator and also test for the impact of time delay on crew-ground coordination during management of medical events. This will allow us to demonstrate which behaviors are observable, reproducible, and lead to better outcomes during management of in-flight medical events before implementing in HERA (Human Exploration Research Analog) and other space analogue environments.