UTMB ASM Residency
Grand Rounds
The Practice of Aerospace Medicine in
the Age of Commercial Space Tourism
James M. Vanderploeg, MD, MPH
University of Texas Medical Branch
Chief Medical Officer, Virgin Galactic
September 25, 2007
Objectives
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Identify the challenges presented by the broad
range of individuals wishing to fly to space on
commercial vehicles
Describe the pre-flight testing and training used
to identify and quantify the medical risks for
commercial space flight participants
Describe the regulatory and legal climate
affecting preparations for flying commercial
space flight participants
Commercial Space Tourism
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Who’s doing what?
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Space Adventures – $25M for 10 days on ISS
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Launch & Return on Soyuz
Extensive medical evaluations and training
Commercial space vehicle operators
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Virgin Galactic – SpaceShip Two ($200,000)
Bigelow – Hotel / Lab in orbit
Rocket Plane
Space X
Planet Space
Blue Origin
Potential Evolution of Civilian Space Flight Markets
Market Expansion / Contraction (not to scale)
Milestones
Virgin Galactic
Inaugural Flight From
Mohave Space Port
VG Inaugural Launch
From NM Space Port
Suborbital Tourism
RocketPlane
Inaugural Flight From
Burns Flat, OK Space Port
Space Adventures
Inaugural Launch
From UAE Space Port
1st
SpaceX
Failed
Launch of Falcon I
Rocket Plane
Orbital Capability
1st Agreements
Executed
P2P Suborbital
SpaceX $100M DoD
Contract Complete
RocketPlane 1st Crewed
Orbital Flight
Inaugural Crewed Flight
to Orbit Using low-cost
technology
Orbital Tourism
NASA COTS
RocketPlane Launches
Japanese1 Satellite to Study
Drug Development
Orbital R&D
NASA CEV
Phase II Award
2006
2007
1st China
Spacewalk
2008
Space Shuttle Retired
2009
2010
Int’l Space Station
Retired
Beyond 2011
Medical Challenges
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No medical standards – only guidelines
Population of space flight participants
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Age: mid 20’s to mid 70’s (outliers to near 90)
Average Age: ~ 55
Gender: 80% male and 20% female
Medical status: healthy to debilitated
Psychological status: ???
Very little data on which to base “standards” or
passenger acceptance criteria
Medical Considerations
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Acceleration
z Launch:
+3.5 Gx and Gz (or more?)
z Re-entry: +6 Gx (or more?)
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Cabin pressurization
z Sea
level vs. 5,000 to 8,000 feet
z Pressure suits – yes or no
On board medical capability – not likely
z Cardiovascular, Pulmonary, Neurological,
Psychological, Musculoskeletal concerns
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Pre-flight Testing & Training
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Purposes
z Identify
and quantify medical risks
z Ameliorate risk through training and
“hardening”
z Provide “informed consent” for risks identified
z Advise operators on “passenger acceptance”
criteria
Pre-flight Testing & Training
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Acceleration – increased G exposure
z Centrifuge
z NASTAR
(ETC)
z Brooks City Base (Wyle)
z QinetiQ
z Others
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Microgravity – decreased G exposure
z Zero-G
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Flights
Altitude Physiology – decreased O2 levels
z Hypobaric
chambers
Virgin Galactic Activities
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SpaceShip Two and White Knight Two under
construction by Scaled Composites (Burt Rutan)
in Mohave, CA
Founders Group (first 100 passengers who pay
$200,000 in advance)
Medical workshops – panel of Aerospace
Medicine experts convened
Medical screening ongoing – history and
physical by personal physicians
Centrifuge testing/training started
Virgin Galactic Flight Profile
SpaceShip Two
Regulatory & Legal Climate
Uncertain to Unknown
Philosophy Behind Medical
Standards/Guidelines
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Government Programs
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Exclusion – many
disqualifying conditions
No medical mission
impact
Limit risk of medical
events
Maintain safety
Longer term clearance
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Commercial Programs
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Inclusion – maximize the
number of passengers
Accept limited mission
impact
Accept some risk of
medical events
Maintain safety
One-time flyers
ISS and Soyuz Criteria
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Will not need emergency care during flight and
a medical condition will not negatively affect
the completion of the flight program while on
board the Soyuz or the ISS
Can safely perform emergency egress
No physical handicaps that prevent standard
use of flight equipment
Can participate in all pre-flight training and inflight operations that may be required in
contingency situations
Three-phased Medical Certification
Medical Screening – medical history and
records review, screening exam
z Medical Evaluation – in-depth examination
and evaluation by the JSC Flight Medicine
Clinic or IBMP/GCTC
z Medical Certification
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z Initial
z Recertification
Waiver of Standards
Definition and cause of condition
z Stability of condition
z Sequelae of condition
z Risk of recurrence – especially during flight
z Risk to mission success
z Impact on condition from space flight
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z environmental,
duration of mission, acceleration
exposure, medical care on board, impact of
emergency evacuation
Medical Standards Documents
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System-by-system description of
examination and evaluation tests
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Ancillary tests: centrifuge, hypobaric
chamber, vestibular tests, zero-G flight
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Extensive system-by-system list of
disqualifying conditions
Are Waivers Possible?
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Yes – for example, Greg Olsen
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Extensive medical evaluation to “prove”
that the waiver criteria can be met
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Review and approval by MSMB and
Russian SFCB of IBP and the GCTC
Commercial Space Flight
Participants
Aerospace Medical Association Space
Passenger Task Force published two
reports in ASEM
z October 2001
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z Considered
both sub-orbital and orbital SFPs
z Long list of disqualifying conditions
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November 2002
z Considered
only sub-orbital flights
z Broad guidelines based on 5 assumptions
AsMA Space Passenger Task
Force Report - II
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Assumptions:
1.
2.
3.
The space vehicle interior will be small and
confining with a capacity for 4 – 6 passengers
The flight will be suborbital of 1 to 3 hours
duration including about 30 minutes in
microgravity
The cabin will be pressurized to sea level with
an 80% nitrogen, 20% oxygen atmosphere
and no life support equipment will be
necessary for nominal flight
Task Force Report II (continued)
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Assumptions (continued)
4.
5.
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Acceleration will range between 2 – 4.5 +Gz
or Gx (depending on the space vehicle)
There will be different emergency egress
procedures (depending on the space
vehicle)
Other considerations:
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Space motion sickness, pregnancy, sudden
incapacitation, and age
Task Force Report II Summary
“In summary, the 2nd Task Force on Space
Travel offers only broad guidelines, rather
than specifics, for short-duration flights.
The application of these guidelines should
be left to the discretion of the companies,
physicians, and passengers. In cases of
passengers with significant illness, sound
medical judgment will be essential.”
FAA Documents
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March 2003 – Guidance for Medical Screening
of Commercial Aerospace Passengers
February 2005 – Draft Guidelines for
Commercial Suborbital Reusable Launch
Vehicle Operations with Space Flight
Participants
February 2005 – Draft Guidelines for
Commercial Suborbital Reusable Launch
Vehicle Operations with Flight Crew
FAA Documents (cont.)
December 2005 – NPRM: Human Space
Flight Requirements for Crew and Space
Flight Participants; Proposed Rule
z January 2006 – Guidance for Medical
Screening of Commercial Aerospace
Passengers (DOT/FAA/AM-06/1)
z December 2006 – Human Space Flight
Requirements for Crew and Space Flight
Participants; Final Rule
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So we’re OK now, right?
Not so fast
z FAA Final Rule – medical requirements
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z Crew
Members: those with a safety-critical
role must posses and carry an FAA secondclass airman medical certificate
z Space
Flight Participants: nothing
FAA Final Rule
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Space Flight Participants must
z Sign
informed consent after education about
the risks
z Sign waiver of claims against the U.S.
Government
z Have training for emergency situations –
smoke, fire, depressurization, emergency exit
z Meet security requirement – the SFP may not
carry on board any explosives, firearms,
knives, or other weapons
Commercial SFP
Medical Standards
There aren’t any!
FAA Medical Guidance – Jan. 2006
Categorizes passengers into suborbital
and orbital, but the G force definitions
associated with each will put some
operators’ passengers into the orbital
category for suborbital flights
z Assumptions:
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z Cabin
pressure <= 8,000 feet
z G level limits: +4 Gz, -2 Gz, +/- 4 Gx, +/- 1 Gy
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Recommendations for medical history and
pre-flight physical exam
Basis for SFP Medical Standards
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Commercial SFP Profile
z Age:
mid 20’s to mid 70’s (ave. age = 55)
z Gender: 80% male and 20% female
z Medical status: Healthy to ???
z Psychological status: ???
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Very little data
z Virtually
no centrifuge data for this population
z John Glenn’s space flight
z Space Adventures SFPs
Where to Set the Bar
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Too High
z Limits
pool of customers
z Makes entry too onerous
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Too Low
z Risk
of injury or death
z Bad outcome could severely hamper
development of the industry
What Are Operators Doing?
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Concerned about the lack of standards and the
liability they are incurring
Working with Aerospace Medicine consultants
Convening medical panels to help them define
their medical screening and training programs
Planning training/testing activities using
centrifuge rides, microgravity flights, etc.
Using FAA required “informed consent” to limit
liability
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Considering “tailoring” flights for specific
individuals with limiting medical conditions
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Lower altitude flights to limit G levels
Use (or not) of pressure suits
Medical monitoring equipment
Medical attendant / Flight attendant
Allowing for (or providing) medical “tune up” to
meet passenger acceptance criteria
Accepting possibility of aborting flight for medical
event
Examples of AM “Patients”
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Mid 70’s
z World
explorers
z Treks
to both North and South Poles
z Climbed mountain peaks above 14,000 ft.
z Visited the Titanic
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Mid 50’s to mid 60’s
z High
health risks
z Coronary
bypass surgery
z Hypertensive on multiple meds
z Diabetes
z COPD
Stephen Hawking Zero-G Flight
April 26, 2007 from Kennedy Space Center
z Practice flight the previous day with body
double (14 y/o 8th grader) – simulated
various medical scenarios
z Four physicians on board
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z Pulmonary
specialist
z Critical care specialist / anesthesiologist
z Zero-G Chief Medical Officer
z Aerospace medicine specialist
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Two caregivers – RNs
Medications and Monitoring
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Preflight medications:
glycopyrrolate 200 mg, dexamethasone 8 mg and
ondansetron 4 mg intravenously 1 hour before flight
Monitoring:
non-invasive blood pressure measurement every 2
minutes with continuous 3-lead electrocardiography,
and respiratory rate; transcutaneous SaO2 and
PcapCO2.
Supplemental oxygen was available at 2 or 4 l/min
delivered via a standard tracheostomy mask.
IV access in place with heparin lock
The picture says it all
Questions
???