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Project Title:  Simulation-Based Countermeasure Development to Mitigate Team and System Vulnerabilities During Medical Event Management on Long Duration Space Missions Reduce
Images: icon  Fiscal Year: FY 2020 
Division: Human Research 
Research Discipline/Element:
HRP HFBP:Human Factors & Behavioral Performance (IRP Rev H)
Start Date: 03/26/2019  
End Date: 03/25/2020  
Task Last Updated: 01/08/2021 
Download report in PDF pdf
Principal Investigator/Affiliation:   Yule, Steven J. Ph.D. / Brigham and Women's Hospital/Harvard Medical Center 
Address:  75 Francis Street 
STRATUS Center for Medical Simulation 
Boston , MA 02115-6110 
Email: syule@partners.org 
Phone: 781-960-3228  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: Brigham and Women's Hospital/Harvard Medical Center 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Lipsitz, Stuart  Sc.D. Brigham and Women's Hospital, Inc. 
Pozner, Charles  M.D. Brigham and Women's Hospital, Inc. 
Robertson, Jamie  Ph.D. Brigham and Women's Hospital, Inc. 
Smink, Douglas  M.D. Brigham and Women's Hospital, Inc. 
Thorgrimson, Joelle  M.D. Northern Ontario School of Medicine, Canada 
Doyle, Thomas  Ph.D. McMaster University, Canada 
Musson, David  M.D., Ph.D. Northern Ontario School of Medicine, Canada 
Dias, Roger  M.D., Ph.D. Brigham and Women's Hospital, Inc. 
Project Information: Grant/Contract No. 80NSSC19K0745 
Responsible Center: NASA JSC 
Grant Monitor: Williams, Thomas  
Center Contact: 281-483-8773 
thomas.j.will1@nasa.gov 
Solicitation / Funding Source: 2017 HERO 80JSC017N0001-Crew Health and Performance (FLAGSHIP1, OMNIBUS). Appendix A-Flagship1, Appendix B-Omnibus 
Grant/Contract No.: 80NSSC19K0745 
Project Type: GROUND 
Flight Program:  
TechPort: No 
No. of Post Docs:  
No. of PhD Candidates:  
No. of Master's Candidates:  
No. of Bachelor's Candidates:
No. of PhD Degrees:  
No. of Master's Degrees:  
No. of Bachelor's Degrees:  
Human Research Program Elements: (1) HFBP:Human Factors & Behavioral Performance (IRP Rev H)
Human Research Program Risks: (1) Bmed:Risk of Adverse Behavioral Conditions and Psychiatric Disorders
(2) HSIA:Risk of Adverse Outcome Due to Inadequate Human Systems Integration Architecture (IRP Rev L)
(3) Medical Conditions:Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures (IRP Rev M)
(4) Team:Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, Communication, and Psychosocial Adaptation within a Team (IRP Rev F)
Human Research Program Gaps: (1) BMed-102:Given exposures to spaceflight hazards (space radiation, isolation), how do we identify individual susceptibility, monitor molecular/biomarkers and acceptable thresholds, and validate behavioral health and CNS/neurological/neuropsychological performance measures and domains of relevance to exploration class missions? (IRP Rev L)
(2) HSIA-101:We need to identify the Human Systems Integration (HSI) – relevant crew health and performance outcomes, measures, and metrics, needed to characterize and mitigate risk, for future exploration missions (IRP Rev L)
(3) Medical-501:We need to develop integrated exploration medical system models for the Moon and Mars (IRP Rev L)
(4) Medical-701:We need to increase inflight medical capabilities and identify new capabilities that (a) maximize benefit and/or (b) reduce “costs” on human system/mission/vehicle resources (IRP Rev L)
(5) Team-102:We need to identify a set of quantifiable and validated measures, based on 5-12 key indicators of mission-relevant and identified spaceflight acceptable thresholds (or ranges) of team function, to effectively monitor and measure team health and performance of integrated NASA and commercial/private crews, during shifting autonomy in increasingly earth independent, long duration exploration missions (IRP Rev L)
(6) Team-103:We need to identify psychological and psychosocial factors, measures, and combinations thereof for use in selecting individuals and composing highly effective crews most likely to maintain team function during shifting autonomy in increasingly earth independent, long duration exploration missions (IRP Rev L)
(7) Team-104:We need to identify validated ground-based and in-flight training methods for both preparatory and sustaining team function during shifting autonomy in increasingly earth independent, long duration exploration missions (IRP Rev L)
(8) Team-105:We need to identify a set of countermeasures to support team function and enable multiple distributed teams to manage shifting levels of autonomy for all phases of increasingly earth independent, long duration exploration missions (IRP Rev L)
Task Description: One of the risks of long duration exploration missions that needs further investigation is the potential for unanticipated medical events to affect crew health and capacity in-flight, and potentially compromise mission success. Like technical problem solving, medical emergencies require rapid diagnosis of probable cause, concurrent treatment, and containment of problems. Effective crew dynamics are essential to both. However, when there is a medical emergency one of the team members is incapacitated by the nature of the event, crew members must rapidly coordinate themselves to deal with an ill-defined event that may be outside of their primary technical expertise, and the impact of time delay means that real-time communications and data flow between crew and medical emergency specialists on Earth may not be possible.

The central objective of our proposal is to provide guidance for the development of evidence-based countermeasures against these vulnerabilities. This is important to determine so we can add the right behavioral skills to astronaut training. We plan to implement the study and measure interactions during a medical emergency in a space analog setting that replicates some features of long-term isolation, crew autonomy, and time-delay as experienced on long duration missions. We propose to do this by studying capacity to manage medical emergencies in space using a range of methods. We will use high fidelity simulation to study how the astronaut crew performs together to resolve simulated medical emergencies in a lab setting. We will measure adherence to key processes, team behavior, mental workload, and physiological metrics to better understand the demands faced by space crew and ground personnel.

Research Impact/Earth Benefits: We developed and implemented four simulation scenarios for acute medical conditions that may be used for training crew (team) behavioral skills in rural and remote settings, or medical contexts with limited/ variable resources: a. Pneumothorax; b. Eye injury; c. Cardiac arrhythmia; d. Smoke inhalation.

These scenarios include detailed and standardized running orders with triggers, patient vitals, patient cues, expected participant actions, and facilitator notes. Variants of the scenarios to include available communications with/ without mission control are included. The focus is on crew coordination and behavioral skills rather than medical or technical proficiency. The method used for scenario creation is scalable and could be used to develop scenarios for medical crew training in terrestrial settings.

The second impact with relevance to Earth is the development of a multimodal method to integrating multiple sources of data (physiological, video, observational, survey) for measurement and support of crew performance.

Task Progress & Bibliography Information FY2020 
Task Progress: FINAL REPORTING JUNE 2020 (Ed., compiled December 2020 from final progress report)

A total of 59 subjects were enrolled in this study, including graduate and undergraduate students from STEM (Sciene, Technology, Engineering, and Mathematics) disciplines, paramedics, and emergency medical technicians (EMT). A total of 16 teams were randomly assigned to one of two conditions: 08 teams with support from flight surgeon (with FS) vs 08 teams without support from flight surgeon (without FS). Each team was composed of 4 participants, from which 3 members at a time were assigned to participate in 4 consecutives simulated scenarios.

We planned and implemented this study to measure interactions during a medical emergency in a space analog setting that replicates some features of long-term isolation, crew autonomy, and time-delay as experienced on long duration missions. By using high fidelity simulation, we were able to study how the astronaut crew performs together to resolve simulated medical emergencies in a lab setting. We gathered video recordings of 16 flight crews each managing 4 unique medical events in a spacecraft simulator. Our primary aim was to understand how teams performed with and without support from a flight surgeon at mission control center. We assessed differences in behavioral skills, technical performance, and cognitive load between groups.

ANNUAL REPORTING JANUARY 2020

1. Developed and designed 4 medical event simulation scenarios

2. Conducted dry run and debugged each scenario

3. Upgraded space medicine simulator to include resources consistent with International Space Station (ISS) medical checklist

4. Trained an actor to participate in the scenarios as injured crew member

5. Recruited 16 multidisciplinary teams (N = 60) to participate in the study

6. Gathered multimodal data (personality, physiological, video) for subsequent analysis.

Bibliography Type: Description: (Last Updated: 11/29/2021) 

Show Cumulative Bibliography Listing
 
Abstracts for Journals and Proceedings Dias RD, Robertson JM, Doyle T, Mormann B, Smink DS, Musson D, Pozner C, Yule S. "Development of a Space Simulator for Studying Team Performance and Behaviors During In-Flight Medical Emergencies." International Meeting on Simulation in Healthcare, San Diego, CA, January 18, 2020 - January 22, 2020.

Abstracts. International Meeting on Simulation in Healthcare, San Diego, CA, January 18, 2020 - January 22, 2020. , Jan-2020

Abstracts for Journals and Proceedings Dias RD, Robertson JM, Mormann B, Thorgrimson JL, Suresh R, Smink DS, Lipsitz S, Doyle T, Musson D, Pozner C, Yule S. "Investigating Autonomous Crew Performance and Behavioral Skills During In-Flight Medical Event Management." 2020 NASA Human Research Program Investigators’ Workshop, Galveston, TX, January 27-30, 2020.

Abstracts. 2020 NASA Human Research Program Investigators’ Workshop, Galveston, TX, January 27-30, 2020. , Jan-2020

Abstracts for Journals and Proceedings Mormann B, Dias RD, Yule S. "Using Deep Learning-Enabled Computer Vision to Measure Team Dynamics During Simulated Medical Emergencies in Space: A Feasibility Study." 91st Aerospace Medicine Association Meeting, Atlanta, GA, May 2020. NOTE meeting was later cancelled; abstract was accepted for eventual meeting in 2021.

91st Aerospace Medicine Association Meeting, Atlanta, GA, May 2020. NOTE meeting was later cancelled; abstract was accepted for eventual meeting in 2021. , May-2020

Abstracts for Journals and Proceedings Dias RD, Doyle T, Robertson JM, Thorgrimson JL, Gupta A, Mormann B, Pozner C, Smink DS, Lipsitz S, Musson D, Yule S. "Development of a Web-Based Rating Platform for Measurement of Crew Behavioral Skills During Simulated Medical Emergencies in Space." 90th Aerospace Medicine Association Meeting, Las Vegas, NV, May 5-19, 2019.

Aerospace Medicine and Human Performance. 2019 Mar;90(3). , Mar-2019

Project Title:  Simulation-Based Countermeasure Development to Mitigate Team and System Vulnerabilities During Medical Event Management on Long Duration Space Missions Reduce
Images: icon  Fiscal Year: FY 2019 
Division: Human Research 
Research Discipline/Element:
HRP HFBP:Human Factors & Behavioral Performance (IRP Rev H)
Start Date: 03/26/2019  
End Date: 03/25/2020  
Task Last Updated: 05/24/2019 
Download report in PDF pdf
Principal Investigator/Affiliation:   Yule, Steven J. Ph.D. / Brigham and Women's Hospital/Harvard Medical Center 
Address:  75 Francis Street 
STRATUS Center for Medical Simulation 
Boston , MA 02115-6110 
Email: syule@partners.org 
Phone: 781-960-3228  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: Brigham and Women's Hospital/Harvard Medical Center 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Lipsitz, Stuart  Sc.D. Brigham and Women's Hospital, Inc. 
Pozner, Charles  M.D. Brigham and Women's Hospital, Inc. 
Robertson, Jamie  Ph.D. Brigham and Women's Hospital, Inc. 
Smink, Douglas  M.D. Brigham and Women's Hospital, Inc. 
Thorgrimson, Joelle  M.D. Northern Ontario School of Medicine, Canada 
Doyle, Thomas  Ph.D. McMaster University, Canada 
Musson, David  M.D., Ph.D. Northern Ontario School of Medicine, Canada 
Dias, Roger  M.D., Ph.D. Brigham and Women's Hospital, Inc. 
Project Information: Grant/Contract No. 80NSSC19K0745 
Responsible Center: NASA JSC 
Grant Monitor: Williams, Thomas  
Center Contact: 281-483-8773 
thomas.j.will1@nasa.gov 
Solicitation / Funding Source: 2017 HERO 80JSC017N0001-Crew Health and Performance (FLAGSHIP1, OMNIBUS). Appendix A-Flagship1, Appendix B-Omnibus 
Grant/Contract No.: 80NSSC19K0745 
Project Type: GROUND 
Flight Program:  
TechPort: No 
No. of Post Docs:  
No. of PhD Candidates:  
No. of Master's Candidates:  
No. of Bachelor's Candidates:  
No. of PhD Degrees:  
No. of Master's Degrees:  
No. of Bachelor's Degrees:  
Human Research Program Elements: (1) HFBP:Human Factors & Behavioral Performance (IRP Rev H)
Human Research Program Risks: (1) Bmed:Risk of Adverse Behavioral Conditions and Psychiatric Disorders
(2) HSIA:Risk of Adverse Outcome Due to Inadequate Human Systems Integration Architecture (IRP Rev L)
(3) Medical Conditions:Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures (IRP Rev M)
(4) Team:Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, Communication, and Psychosocial Adaptation within a Team (IRP Rev F)
Human Research Program Gaps: (1) BMed-102:Given exposures to spaceflight hazards (space radiation, isolation), how do we identify individual susceptibility, monitor molecular/biomarkers and acceptable thresholds, and validate behavioral health and CNS/neurological/neuropsychological performance measures and domains of relevance to exploration class missions? (IRP Rev L)
(2) HSIA-101:We need to identify the Human Systems Integration (HSI) – relevant crew health and performance outcomes, measures, and metrics, needed to characterize and mitigate risk, for future exploration missions (IRP Rev L)
(3) Medical-501:We need to develop integrated exploration medical system models for the Moon and Mars (IRP Rev L)
(4) Medical-701:We need to increase inflight medical capabilities and identify new capabilities that (a) maximize benefit and/or (b) reduce “costs” on human system/mission/vehicle resources (IRP Rev L)
(5) Team-102:We need to identify a set of quantifiable and validated measures, based on 5-12 key indicators of mission-relevant and identified spaceflight acceptable thresholds (or ranges) of team function, to effectively monitor and measure team health and performance of integrated NASA and commercial/private crews, during shifting autonomy in increasingly earth independent, long duration exploration missions (IRP Rev L)
(6) Team-103:We need to identify psychological and psychosocial factors, measures, and combinations thereof for use in selecting individuals and composing highly effective crews most likely to maintain team function during shifting autonomy in increasingly earth independent, long duration exploration missions (IRP Rev L)
(7) Team-104:We need to identify validated ground-based and in-flight training methods for both preparatory and sustaining team function during shifting autonomy in increasingly earth independent, long duration exploration missions (IRP Rev L)
(8) Team-105:We need to identify a set of countermeasures to support team function and enable multiple distributed teams to manage shifting levels of autonomy for all phases of increasingly earth independent, long duration exploration missions (IRP Rev L)
Task Description: One of the risks of long duration exploration missions that needs further investigation is the potential for unanticipated medical events to affect crew health and capacity in-flight, and potentially compromise mission success. Like technical problem solving, medical emergencies require rapid diagnosis of probable cause, concurrent treatment, and containment of problems. Effective crew dynamics are essential to both. However, when there is a medical emergency one of the team members is incapacitated by the nature of the event; crew members must rapidly coordinate themselves to deal with an ill-defined event that may be outside of their primary technical expertise, and the impact of time delay means that real-time communications and data flow between crew and medical emergency specialists on Earth may not be possible.

The central objective of our proposal is to provide guidance for the development of evidence-based countermeasures against these vulnerabilities. This is important to determine so we can add the right behavioral skills to astronaut training. We plan to implement the study and measure interactions during a medical emergency in a space analog setting that replicates some features of long-term isolation, crew autonomy, and time-delay as experienced on long duration missions. We propose to do this by studying capacity to manage medical emergencies in space using a range of methods. We will use high fidelity simulation to study how the astronaut crew performs together to resolve simulated medical emergencies in a lab setting. We will measure adherence to key processes, team behavior, mental workload, and physiological metrics to better understand the demands faced by space crew and ground personnel.

Research Impact/Earth Benefits:

Task Progress & Bibliography Information FY2019 
Task Progress: New project for FY2019.

Bibliography Type: Description: (Last Updated: 11/29/2021) 

Show Cumulative Bibliography Listing
 
 None in FY 2019