Introduction to Aerospace Medicine Short Course 2005
Taxi to the ISS - Medical Guidelines for Space Tourists
With Respect to Gastro-Intestinal Diseases
Dr. Anis Karim
Individual Project Report submitted to the University of Texas Medical Branch in partial
fulfillment of the requirements of the Introduction to Aerospace Medicine Short Course
August, 2005
Department:
Preventive Medicine and Community Health
Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
ABSTRACT
Introduction: The objective of this study is to give an insight into the medical guidelines
to be followed for the selection of space tourists for taxi flights, with respect to the gastrointestinal diseases, and the inflight countermeasures, monitoring and treatment that can be
provided. This study follows a previous study of the same parameters with respect to the
cardiovascular and neurological diseases (Karim 2005). Methods: For every disease, the
possible countermeasures, monitoring and treatment that could be provided onboard the
International Space Station were studied. Results: Upon analysis of the information
obtained, it was inferred that simple countermeasures could be effectively provided on the
ISS for space tourists with gastro-intestinal diseases, without extra onboard hardware. In
this respect, gastro-intestinal diseases are like cardiovascular diseases (Karim 2005). The
monitoring is mainly symptom-centric, which also eliminates the need for extra hardware.
In the case of treatment measures, they are disease-specific; so a general line of
management cannot be undertaken. A practical guideline is also proposed for passenger
selection. Conclusions: This study shows that diseases are not obstacles in the path of
people who want to enjoy the excitement of spaceflight. Most of the gastro-intestinal
diseases can have practical countermeasures, monitoring and treatment equipment onboard
the ISS.
Keywords: space tourists, taxi flight, selection guidelines, fitness to fly.
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
TABLE OF CONTENTS
ABSTRACT…………………………………………………………………....i
INDEX OF FIGURES………………………………………………………..iii
INDEX OF TABLES…………………………………………………………iii
1
2
INTRODUCTION………………………………………………….…...1
1.1
THE NEED……………………………………………………………1
1.2
THE OBJECTIVE……………………………….……………….…..1
METHODS……………………………………………………………..2
2.1
TERMINOLOGY……………………………………………………..2
2.2
METHOD OF STUDY……………………………………………….2
3
RESULTS……………………………………………………………...3
4
DISCUSSION……………………………………………………...…..4
4.1
COUNTERMEASURES………………………………………...…..4
4.2
MONITORING……………………………………………………..…4
4.3
TREATMENT…………………………………………………...4
4.4
PROPOSED SELECTION GUIDELINE………………………..…5
5
CONCLUSIONS & RECOMMENDATIONS………….………...…..6
6
REFERENCES……………………………………………………...…8
7
APPENDIX A………………………………………………………...10
8
APPENDIX B……………………………………………………...…13
9
APPENDIX C…………………………………………………………18
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
INDEX OF FIGURES
Figure 4-1: Flowchart showing the proposed guideline for passenger
selection…………………………………………………….........5
INDEX OF TABLES
Table 3-1: Results for gastro-intestinal diseases…………………………3
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
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INTRODUCTION
The age of Space Tourism has dawned with the flights to the International Space Station,
of Dennis Tito and Mark Shuttleworth. The so-called ‘Taxi Flight’ is a round-trip to the
ISS, on the Russian Soyuz spacecraft, with stays of 6 to 8 days on the ISS. The crew goes
up on a new Soyuz with the provisions to the ISS; and returns in the old Soyuz that had
been attached to the ISS during the previous mission. With more and more individuals
ready to pay for the third seat on the Soyuz for an unforgettable journey of their lifetime,
there is an inherent demand for widening the selection criteria for space travelers, so as to
allow the ‘not-so-perfectly-healthy’ aspirants also to feel the excitement of spaceflight. The
lack of established guidelines for space tourists poses a great difficulty for passenger
selection.
1.1 THE NEED
In 2001, when the financially-constrained Russian Aviation and Space Agency decided to
launch US millionaire, Dennis Tito, on a Soyuz taxi mission to the ISS for USD 20 million,
NASA immediately opposed the plan, citing a number of reasons. One reason was that the
station partners had not yet agreed upon a guideline policy for selecting visiting
crewmembers to the ISS. Despite the objections, the Russians went forward with the
launch, and thus Dennis Tito became the first paying space tourist (April 2001). However,
the station partners made headway on selection criteria for ‘spaceflight participants’, and
came up with a nine-page document entitled ‘Principles Regarding Processes and Criteria
for Selection, Assignment, Training and Certification of ISS (Expedition and Visiting)
Crewmembers’ (Halvorson 2002). Surprisingly, the criteria lacked detail on medical and
training requirements, and were focused more on behavior and conduct. This leaves room
for the involved space agencies to define their own medical criteria. To this end, new
selection criteria for spaceflight participants is the need of the hour.
1.2 THE OBJECTIVE
The objective of this study is to give an insight into the medical guidelines to be followed
for the selection of space tourists for taxi flights, with respect to the gastro-intestinal
diseases, and the inflight countermeasures, monitoring and treatment that can be provided.
This study follows a previous study of the same parameters with respect to the
cardiovascular and neurological diseases (Karim 2005).
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
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METHODS
The primary data for disease disqualification/exception was obtained from the Aerospace
Medical Association Task Force on Space Travel report (2001). The exception cases were
further evaluated to propose possible inflight countermeasures, monitoring and treatment.
2.1 TERMINOLOGY
For the purpose of this study, the following terminology was used:
•
A cause for disqualification is defined as ‘any medical condition or treatment
regimen which could endanger the health of the passenger, fellow passengers, or
crew; compromise safety inflight or on the ground; or pose a threat to completion of
the flight’ (Aerospace Medical Association Task Force on Space Travel 2001).
•
An exception means ‘further evaluation has to be performed, depending on the
condition of the passenger and the circumstances of the flight.’
•
Countermeasures means ‘the possible measures that could be undertaken inflight, to
prevent the worsening or recurrence of the disease or its complications.’
•
Monitoring refers to ‘the symptoms and the possible means, by which the passenger
can be monitored inflight, for any worsening or recurrence of the disease.’
•
Treatment is defined as ‘the possible inflight treatment measures to control the
symptoms, if they occur, and thus control the disease, until the passenger returns to
ground for normal treatment procedures.’
2.2 METHOD OF STUDY
First, for a particular disease or condition, the possible countermeasures that could be
provided on the ISS were probed. Then, the onboard facilities for periodic or continuous
monitoring were looked into. Then, the onboard treatment measures that could be
provided, if the disease worsens in spite of all the undertaken countermeasures, were
explored.
As the Soyuz spacecraft used for taxi flights has only limited workspace and minimal
onboard medical equipment (to measure pulse, blood pressure, etc.), the countermeasures,
monitoring and treatment procedures proposed here are more applicable to the ISS,
although some may fit to Soyuz also (Zak 2005). As such, the medical risks related to the
Soyuz phase of the flight (2 days to go to ISS and 3 hours to come back) have not been
evaluated.
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RESULTS
The results of the study are given in the table 3-1.
Disease /
Condition
Gastro-Intestinal
Counter
measures
Onboard
Monitoring
Onboard
Treatment
Avoid NSAIDs;
Continue
medication
Abdominal pain,
nausea, vomiting,
heartburn, indigestion,
belching, chest pain
Antacids, H2
blockers,
Omeprazole,
Sucralfate,
Misoprostol,
Antibiotics
Inflammatory
Bowel Disease
(Asymptomatic)
Continue
medication; Wellbalanced diet
Abdominal pain,
fever, diarrhea,
constipation, nausea,
vomiting, abdominal
fullness, tenesmus,
joint pain
5-aminosalicylate,
Corticosteroids,
Immunomodulators
(Azathioprine),
Antibiotics
Irritable Bowel
Syndrome
(Asymptomatic)
Continue
medication and
dietary
modifications;
Exercise
Abdominal pain,
diarrhea, constipation,
nausea, vomiting,
abdominal fullness,
bloating
Anticholinergics,
Anti-diarrheals
(Loperamide),
Promotility drugs,
Smooth muscle
relaxants
Peptic Ulcer
Disease
(Asymptomatic)
Gall Bladder
Disease
(Asymptomatic)
Continue low-fat
diet and
medication
Cirrhosis
(Certified fit after
evaluation)
Continue
medication; Fluid
and salt-restricted
diet
Abdominal pain,
fever, jaundice,
nausea, vomiting,
heartburn, abdominal
fullness, indigestion
Abdominal pain,
jaundice,
hemetemesis, nausea,
vomiting, indigestion,
fever
Analgesics,
Antibiotics
Antibiotics
Table 3-1: Results for gastro-intestinal diseases
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DISCUSSION
The gastro-intestinal diseases were studied in detail to get a clear picture.
4.1 COUNTERMEASURES
With regard to the gastro-intestinal diseases studied, it was found that there are common
onboard countermeasures that could be provided to all the diseases. These include exercise,
continuing medication and having a well-balanced diet, with the exception of Gall bladder
disease and Cirrhosis, which require low-fat diet and fluid and salt-restricted diet
respectively.
The inference is that simple countermeasures can be effectively provided on the ISS for
space tourists with gastro-intestinal diseases, without extra onboard hardware. In this
respect, gastro-intestinal diseases are like cardiovascular diseases (Karim 2005).
4.2 MONITORING
The onboard monitoring for all the gastro-intestinal diseases is mainly by their symptoms.
Moreover, the diseases have many symptoms in common, like abdominal pain, nausea,
vomiting, etc. Abdominal fullness and fever are to be looked for in Inflammatory bowel
disease and Gall bladder disease. Appearance of jaundice has to be monitored for Gall
bladder disease and Cirrhosis. Irrespective of the status of the passenger, the pulse and
blood pressure are regularly monitored.
This leads to the inference that the monitoring is mainly symptom-centric, which also
eliminates the need for extra hardware.
4.3 TREATMENT
As treatment is disease-specific, a generalization cannot be applied. Every disease has to
be controlled by its specific oral, intravenous or intramuscular therapy. But, as many
diseases have common symptoms, a general symptomatic line of management can be
undertaken. The positive factor is that, with the current medical facilities on the ISS,
efficient therapy can be initiated to control the symptoms, well before the passenger is
moved to a hospital upon returning to Earth. The negative factor lies in the fact that the
multi-million dollar mission will most probably not be shortened just to save the life of the
passenger. This brings into light the undeniable reality that the passenger should accept the
personal risks associated with spaceflight.
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
4.4 PROPOSED SELECTION GUIDELINE
Fig. 4-1 shows the flowchart describing the proposed guideline for passenger selection.
When the status of the passenger falls in the ‘exception’ category, and after further
evaluation, he is certified fit for the flight, the next step would be looking into the
countermeasures that could be provided onboard the ISS. If the required countermeasures
cannot be provided onboard, the passenger becomes disqualified even if he is medically fit.
If the required countermeasures can be provided, the next step is evaluating the required
onboard monitoring measures. As in the case of countermeasures, qualification for flight
depends on the availability of onboard monitoring measures. Likewise, the required
onboard treatment measures are also evaluated. Only when all these requirements are met,
can the passenger be certified ‘Medically Qualified for Flight.’
Fig. 4-1: Flowchart showing the proposed guideline for passenger selection
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CONCLUSIONS & RECOMMENDATIONS
This study shows that certain diseases need not be obstacles in the path of people who want
to enjoy the excitement of spaceflight. Most of the gastro-intestinal diseases can have
practical countermeasures, monitoring and treatment equipment onboard the ISS.
However, the implementation of the following general recommendations would help more
aspirants to realize their dreams (Karim 2005).
(1) Improvements in the countermeasures, monitoring and treatment measures
onboard the ISS to include most, if not all, of the diseases. These disease-specific
measures will help to accommodate every aspiring space tourist. For example, use of
EEG (Electroencephalogram) to monitor tourists with a controlled history of Epilepsy.
Another option could be a customizable onboard medical system capable of being
adaptable to different passenger needs.
(2) More time should be devoted to train astronauts for managing common diseases
and emergencies. This would in turn help to provide better onboard medical care to
the tourist.
(3) Measures to manage medical emergencies should be greatly enhanced, so as to
cope with any situation that may endanger the life of the tourist. It will in turn help
to control the complications, in the case of an unprecedented delay in moving him to a
hospital on Earth. For example, use of defibrillator to manage ventricular fibrillation.
(4) Development of new and compact automated diagnostic and monitoring systems
should be accelerated. For example, ‘Heartache’ is an automated chest pain diagnostic
system for distant space travel, being designed at San Jose State University, USA
(Wesley 2002).
(5) Miniaturization of equipment is highly desired. The current advances in microtechnology and nano-technology should be able to make this happen sooner rather than
later. Nanobots and molecular robots are in the horizon. Results of research in these
fields should be readily incorporated into the medical sector.
(6) Another option could be modification of existing medical equipment to measure
multiple parameters. For example, Blood Glucose Monitors can be upgraded to
measure cholesterol, ketone bodies, etc. ECG (Electrocardiogram) equipment can be
upgraded to measure EEG (Electroencephalogram). This in turn saves space and time,
which are limited in spaceflight. Moreover, this provides easy use and management of
the equipment.
(7) One option for easy drug delivery is to use new methods like skin patches and
implants. This makes the onboard life easier for the tourists, since they don’t have to
worry about periodic medicine intake and dosage. For example, use of Lidocaine skin
patch to treat local pain.
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
(8) The tourists should be allowed to take along with them small instruments and
medicines that are not available on the ISS. For example, Blood Glucose Monitors.
(9) Regulations regarding space qualification of instruments and technology should
be liberalized. The current regulations impose unwanted restrictions to the space
qualification of new technologies. As such, new and very efficient medical equipment
are not allowed to be flown. The opposite would have made the onboard medical
management dramatically better. For example, wireless diagnostic and monitoring
equipment, wireless electrodes, etc.
(10) The proposed guideline for passenger selection can be used effectively for taxi
flights, with modifications, if necessary, in the future. As the linear method of
selection is simple and efficient, it can be applied to all diseases. The guideline, along
with the existing astronaut selection criteria, could be developed into new space tourist
selection criteria.
The results of this study are in agreement with and complement the report of the Aerospace
Medical Association Task Force on Space Travel (2001). However, further study and
research are needed to establish efficient space tourist selection criteria. In the coming
years, technological advancements would help more and more people to go to space, and
ultimately, medical problems may not be a constraint for spaceflight.
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REFERENCES
Aerospace and High Technology Database (Database) 2005,
[Online] Available at: http://www.csa.com
Aerospace Medical Association Task Force on Space Travel 2001, ‘Medical
Guidelines for Space Passengers’, Aviation, Space, and Environmental
Medicine, vol. 72, no. 10, pp. 948-950.
Karim, A. 2005, ‘Taxi to the ISS - Medical Guidelines for Space Tourists With
Respect to Cardiovascular and Neurological Diseases’, International
Space University
MedicineNet.com (Medical Dictionary) 2005, [Online] Available at:
http://www.medterms.com
Medline Plus (Medical Encyclopedia) 2005, [Online] Available at:
http://www.nlm.nih.gov/medlineplus/encyclopedia.html
Space Passenger Task Force 2002, ‘Medical Guidelines for Space Passengers-II’,
Aviation, Space, and Environmental Medicine, vol. 73, no. 11, pp. 1132-1134.
Wesley, L. P. 2002, ‘An Automated Chest Pain Diagnostic System for Distant Space
Travel’, 2002 IEEE Aerospace Conference proceedings, vol. 7, pp. 7-3311 –
7-3315.
Halvorson, T. 2002, ‘Partners Set Standards for Station Tourists; Miscreants
Need Not Apply’, space.com, [Online]
Available at: http://www.space.com/missionlaunches/iss_guests_020131.html
‘Planned Launch for ISS Expedition 7 Crew and an EVA for Expedition 6’ 2003,
starryskies.com, [Online] Available at:
http://starryskies.com/articles/2003/04/expedition7.html
HeartCenterOnline 2005, [Online] Available at:
http://www.heartcenteronline.com/myheartdr/home/index.cfm
EEG Research 2005, [Online] Available at:
http://www.eegresearch.com/index.htm
‘More Products’ 2005, National Nanotechnology Initiative, [Online] Available at:
http://www.nano.gov/html/facts/MoreProds.htm
National Digestive Diseases Information Clearinghouse 2005, ‘What I Need to Know
about Peptic Ulcers’, [Online] Available
at: http://digestive.niddk.nih.gov/ddiseases/pubs/pepticulcers_ez/index.htm
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
Spechler, S. J. 2002, ‘Peptic Ulcers’, Feldman, M., Friedman, L. S.,
Sleisenger, M. H., eds. ‘Gastrointestinal and Liver Disease’, 7th ed.
W.B. Saunders Company, pp. 2002:747-772.
Zak, A. 2005, ‘SPACECRAFT: Manned: Soyuz’, RussianSpaceWeb.com,
[Online] Available at: http://www.russianspaceweb.com/soyuz.html
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APPENDIX A
Results for Cardiovascular and Neurological Diseases
(Karim, A. 2005, ‘Taxi to the ISS - Medical Guidelines for Space Tourists
With Respect to Cardiovascular and Neurological Diseases’,
International Space University)
Disease /
Condition
Cardiovascular
Counter
measures
Onboard
Monitoring
Onboard
Treatment
Low-fat diet,
exercise, control
blood pressure,
stress
management
ECG
(Electrocardiogram),
echocardiogram, blood
pressure, pulse,
respiratory rate
Medication (betablockers, Calciumchannel blockers,
ACE inhibitors,
etc.), low-fat diet
Arrythmias /
Conduction
Defects
(Nonhemodynamically
significant)
e.g.: Atrial
fibrillation
A well-balanced, lowfat diet, regular
exercise
ECG, echocardiogram,
blood pressure,
respiratory rate, heart
rate and rhythm
(pulse)
Anti-arrhythmic
medication
Pericarditis /
Myocarditis
(6 months postrecovery)
Medication,
exercise, relieve
stressful and
riskful activities,
salt restriction
ECG, echocardiogram,
blood pressure, pulse,
respiratory rate,
temperature
Hypertension
(Well controlled)
Medication,
exercise, relieve
stressful and
riskful activities,
low-salt diet
Blood pressure, pulse
Antibiotics to
prevent infection
ECG, echocardiogram,
doppler examination,
blood pressure,
respiratory rate, heart
rate and rhythm
(pulse)
Exercise, salt
restriction
ECG, echocardiogram
Coronary Artery
Disease
(Asymptomatic)
Structural /
Valvular Defects
(Asymptomatic)
e.g.: Mitral valve
prolapse
Cardiomyopathy
(Asymptomatic)
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Corticosteroids,
aspirin, salt
restriction,
diuretics, ACE
inhibitors
Emergency:
sodium
nitroprusside,
labetalol.
Continue
medication
Antibiotics, antiarrhythmics,
vasodilators,
digitalis, diuretics,
propranolol,
anticoagulants
Digoxin, diuretics,
vasodilators, ACE
inhibitors, beta
blockers,
cordarone
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
Disease /
Condition
Neurological
Onboard
Monitoring
Onboard
Treatment
Exercise, wellbalanced diet,
avoid fatigue and
stress, reduce
factors that may
trigger an MS
attack
Abnormal reflexes,
decreased movement,
speech and vision
changes, nystagmus,
tremor, weakness
Interferon,
glatiramer acetate,
corticosteroids
(prednisone),
benzodiazepines,
amantadine.
Exercise, adequate
rest and relaxation
Exercise, wellbalanced diet,
avoid stress,
Regular rest
periods
Tremor, Rigidity,
Depression, Emotional
changes (Anxiety,
stress, and tension),
Difficulty in
swallowing and
chewing, Speech
changes, Urinary
problems or
constipation, Excessive
sweating, Sleep
problems, Dyskinesias,
Muscle aches and pains
(myalgia)
Medication
(levodopa +
carbidopa,
amantadine,
Deprenyl,
Anticholinergics,
Selegiline,
Bromocriptine,
pergolide,
pramipexole and
ropinirole)
Cerebral
Vascular Disease
(Stroke)
(Certified fit after
evaluation)
Control blood
pressure,
cholesterol,
diabetes and any
heart disease.
Continue
medication, lowfat diet. Exercise
regularly.
Tissue
Plasminogen
Weakness, or paralysis, Activator, early use
speaking, swallowing,
of Heparin and
or vision, breathing,
Aspirin. Oxygen
consciousness level.
may be
Carotid Doppler, Echo, administered when
ECG (EKG), Holter
necessary.
monitor, Heart rate &
Analgesics & antiRhythm
hypertensives.
Nutrients and
fluids
Seizure disorder
(Epilepsy)
(A reasonable
seizure-free
period)
Adequate diet and
sleep, medication,
prevent triggering
factors. Avoid
risk of head
injury.
NA
(Electroencephalogram
[EEG] in research
phase)
Multiple Sclerosis
(Certified fit after
evaluation)
Parkinson’s
Disease
(Certified fit after
evaluation)
Counter
measures
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Oral anticonvulsants
(Phenobarbital)
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
Disease /
Condition
Neurological
Dementia
(Certified fit after
evaluation)
e.g.: Alzheimer's
disease
Intracerebral
Neoplasm (Brain
Tumor)
(Certified fit after
evaluation)
Fixed
Neurological
Deficit Due to
Any Cause
(Certified fit after
evaluation)
Counter
measures
Onboard
Monitoring
Onboard
Treatment
Medication (Antipsychotics,
Serotonin-affecting
Control high
drugs (trazodone,
blood pressure
buspirone),
and diabetes. Eat a
Dopamine blockers
low-fat diet.
(haloperidol,
Regular exercise.
Risperidal,
olanzapine,
clozapine))
Corticosteroids
Changes in personality (dexamethasone),
or memory, speech,
osmotic diuretics
Continue
vision, weakness,
(urea or mannitol),
medication,
seizures, headaches,
anticonvulsants
reduce fluid intake
alertness, muscle
(phenytoin),
to decrease the
strength, coordination, analgesics, antacids
chance for edema
reflexes, and response
or histamine
to pain
blockers to control
stress ulcers
Impairment of
attention, orientation,
memory, judgment,
language, aaltered
sleep patterns,
personality changes,
motor and spatial
skills, and function
Continue
medication
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Changes in function of
the part affected
Specific
medication for the
cause
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APPENDIX B
Medical Guidelines for Space Tourists
(Adapted from: Aerospace Medical Association Task Force on Space Travel 2001,
‘Medical Guidelines for Space Passengers’, Aviation, Space, and Environmental
Medicine, vol. 72, no. 10, pp. 948-950)
Disease / Condition
Cardiovascular
Coronary Artery Disease
Arrythmias / Conduction
Defects
Disqualify
Exception
✓
(Symptomatic)
✓
(Hemodynamically
significant)
✓
(Asymptomatic)
✓
(Non-hemodynamically
significant)
Pacemaker / Implantable
Defribillators
✓
Pericarditis / Myocarditis
✓
Heart Transplant /
Replacement
✓
Hypertension
Structural / Valvular Defects
Cardiomyopathy
✓
(Severe or poorly
controlled)
✓
(Symptomatic)
✓
(Symptomatic)
✓
(6 months post-recovery)
✓
(Well controlled: Qualified
with possible exceptions)
✓
(Asymptomatic)
✓
(Asymptomatic: Evaluate
for qualification)
Neurological
Multiple Sclerosis
✓
(Active)
Parkinson’s and Other
Movement Disorders
✓
Cerebral Vascular Disease /
Malformations / Aneurysms
✓
Seizure disorder
✓
Dementia
✓
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✓
(Evaluate condition and
neurological deficit)
✓
(Evaluate degree and
extent of impairment)
✓
(Evaluate for neurological
dysfunction and
musculoskeletal disability)
✓
(A reasonable seizure-free
period)
✓
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
(Evaluate cognitive
impairment related to
organic disease)
Headaches
✓
(Frequent, severe or
incapacitating,
particularly migraine)
Syncope or Other
Disturbance of
Consciousness
✓
(Recent or Unexplained)
Intracerebral Neoplasm
✓
Fixed Neurological Deficit
Due to Any Cause
✓
✓
(Evaluate for exception)
✓
(Evaluate for exception)
Ophthalmological
Visual Acuity
Narrow Angle Glaucoma
Any Acute Condition
✓
(Legally blind)
✓
✓
(Pain, Discomfort or
Interference with ability
to see)
Ear / Nose / Throat
Any Acute Disease
✓
(Pain or Discomfort)
Meniere’s and Other
Vertiginous Conditions
✓
✓
(Treated and there is
reasonable vertiginous-free
period)
Orthopedic
Musculoskeletal Integrity
(Amputations,
Malformations, Arthritides,
Use of Appliances)
Osteoporosis
Cervical or Lower Spinal
Cord Disease
Diathesis for Pathological
Fractures
Acute Injury or Pain
✓
(Structural and functional
integrity preclude
capability of emergency
ground egress and use of
life support systems)
✓
(Severe)
✓
(Significant)
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✓
✓
✓
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(Until Asymptomatic)
(Evaluate for exception)
Genito-Urinary
Calculi
✓
(Symptomatic)
Chronic Renal Failure /
Renal Insufficiency
✓
✓
(Evaluate level of
insufficiency)
Pregnancy (including loss or
termination of known
pregnancy for any reason)
✓
✓
(6 weeks post-partum)
Dysmenorrhea
✓
(Significant functional
impairment)
Acute Infection or Urinary
Tract Obstruction
✓
Dermatology
Any severe Skin Disease
(Psoriasis, Chronic Pruritis,
Skin Tumors)
✓
(Interferes with use of life
support equipment)
Psychiatry
Any Psychotic Episode
✓
Bipolar Disease
✓
Suicide Attempt / Gesture
✓
Claustrophobia
Substance Abuse /
Dependence
Miscellaneous Conditions
(Phobias, Anxiety, Panic
Attacks, Depression)
✓
(If there are no immediate
means of relieving
apprehension from
confinement)
✓
(Ongoing)
✓
(Reversible Cause)
✓
(Evaluate for exception)
✓
(History)
✓
(Evaluate history of
stability)
Oncology
Cancer
✓
(Any active or treated
cancer which interferes
with function of any
system or has the
University of Texas Medical Branch, IASM 2005
✓
(Evaluate for exception)
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
potential for
incapacitation)
Gastro-Intestinal
Peptic Ulcer Disease
Inflammatory Bowel Disease
Irritable Bowel Syndrome
Acute Pancreatitis
Gall Bladder Disease
✓
(Symptomatic)
✓
(Symptomatic)
✓
(Symptomatic)
✓
✓
(Symptomatic)
Active Abdominal Pain,
Nausea/Vomiting, Diarrhea
of Any Etiology
✓
(Asymptomatic)
✓
Hepatitis
✓
(Acute)
Cirrhosis
✓
Ostomies
Abdominal Surgery
✓
(Asymptomatic)
✓
(Asymptomatic)
✓
(Asymptomatic)
✓
(Evaluate for exception)
✓
(Evaluate for qualification)
✓
(Until complete recovery)
Pulmonary
COPD (Chronic Obstructive
Pulmonary Disease)
✓
Asthma
✓
Pneumothorax
Pulmonary Function
✓
(Current or Recurrent)
✓
(Significantly decreased
due to any cause)
✓
(Evaluate for exception)
✓
(Evaluate for exception)
✓
(Evaluate all others)
Miscellaneous
Diabetes mellitus
✓
(Unstable, Brittle or
Poorly Controlled)
Infectious / Contagious
Disease
University of Texas Medical Branch, IASM 2005
✓
(Active)
✓
(Evaluate all Type I
Diabetics)
✓
(Blood-borne diseases like
Hepatitis B & HIV/AIDS:
Evaluate for qualification
based upon risk of
transmission)
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
Anemia
Medication
Dental
✓
(Severe / Symptomatic)
✓
(Significant Side-Effects
like Somnolence, Nausea
/ Vomiting or
Exacerbation of Illness, if
dosages are missed or
poorly absorbed)
✓ (Significant Discomfort)
University of Texas Medical Branch, IASM 2005
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
9 APPENDIX C
Aspects of Space Tourist Safety
Space
Tourist
Safety
Technical
Neurologi
cal
Cardiovas
cular
Orthopedi
c
Training
GastroIntestinal
Psycholo
gical
GenitoUrinary
Medical
Pulmonar
y
University of Texas Medical Branch, IASM 2005
Economic
Psychiatr
y
Legal
Ophthalm
ological
Mission
Design
Ear/Nose/
Throat
Risks
Dermatol
ogical
Oncology
Miscellan
eous
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Taxi to the ISS – Medical Guidelines for Space Tourists With Respect to Gastro-Intestinal Diseases
Taxi to the ISS - Medical Guidelines for Space Tourists
With Respect to Gastro-Intestinal Diseases
Dr. Anis Karim
Introduction to Aerospace Medicine Short Course 2005
University of Texas Medical Branch
Galveston, Texas, USA
University of Texas Medical Branch, IASM 2005
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