[MUSIC] What I wanted to talk about was some of the enabling technologies and how they've been used in advancing humans in space, but also how they had some major impact on terrestrial applications here on earth. In light of the fact that this was a Women's History Month, I also wanted to include a really neat story that many people probably don't know about. I've entitled this "A funny thing happened on the way to the Moon and technology issues in human spaceflight." I love history and I also love aviation and like Steve, I started out young.
My initial flight was flights were in gliders, so I was taking off without an engine, landing without an engine, and it really actually made a huge difference in my aviation career. I was fortunate to spend 26 years in the Navy and most of which was in flying bullets. I love this quote, "The machine, which at first blush seems a means of isolating man from the great problems of nature actually plunges him more deeply into them. As with the peasant, so for the pilot, dawn and twilight become events of consequence." Antoine de Saint Exupery was a pilot in the post-World War I era who flew male routes in Europe, Africa, and South America. He wrote several books that probably the most famous one was The Little Prince, but he also wrote two books on flying Wind, Sand and Stars and Night Flight.
This is a quote from him, and I'm sorry about that gender bias. Obviously, women do as much as men do and in aviation. What I wanted to just initially talk about, what is it that gets us in trouble in space? Basically, it comes from within and from without.
Those things that come from within are the medical and surgical events that can result from things that just occur either from disease states or sometimes from hereditary states or just bad luck, but the real threats that we face are the extrinsic threats, which I like to break down into three broad categories. The environment of space, which includes the vacuum of space and microgravity and radiation, the vehicle environment. Because we cannot survive for more than several seconds in the absence of pressure, we're totally dependent on life support systems to provide pressure, oxygen, thermal control, and all those things that we take for granted living here on earth. Then the things that we impose on the crew is such as shift schedule changes, workload, etc. I wanted to add this chart even though it seems somewhat of an eye chart, because this is a great reference if you truly are interested in things that happen in space.
This was compiled after the Colombia mishap, which I was a part of the investigation, the spacecraft survival investigation part. What we did was he cataloged all of the events that have happened in space or analog environments that we could learn from in space. The red boxes are loss of crew, the orange ones are significant injuries, the yellow ones are events that affect the mission, and then the white ones are just other things that happen. The point about this chart is that virtually every phase of spaceflight has associated risk and has had events and many people, even at NASA don't realize how many close calls we've had.
The link at the bottom here, when you get the handout, you can actually click on that and the new version of this at NASA is if you click on each of these boxes, it pops up other documents and more useful information. If you're interested in more detail, this is something I spend pretty much my latter part of my career on is crew survival and escape systems. This is just an overview of all the bad things that have happened.
The high-energy transition of launch and assent, and the thermal energy transition of re-entry and landing are in large part why all the fatalities to date have occurred either on launch an asset or re-entry and landing. The real risk we'll get into shortly is the on orbit phase because that's where we will spend longer and longer times, particularly as we go into space activities in deep space region, which we'll talk about. I wanted to also just give a perspective of how much time humans have spent in space since 1961.
This is our 60 year anniversary of the first human in space, Yuri Gagarin and just next month in April, in April of 1961 was when he flew. Today we have 156 crew years, which is something on the order of 56,000 crew days. A majority or at least half that group is made up of Russians because they started flying longer Space Station missions while we were doing planetary lunar exploration.
By comparison, the Apollo program, which sent people to the Moon and also for several of those that got to actually go on the Moon and do things, you can see the appalling less number. If you think 56,000 days, we spent in orbit, though 27 people that went to deep space spent 250 days, so that's about less than 0.5 percent of the total number and even smaller amount has spent time on the moon and the lunar surface itself. Just to give us perspective as we start talking about longer space flights, we've actually had people who have spent time in space, predominately low Earth orbit and microgravity for periods of time that would amount to the time it would take to go to Mars and do a short stay mission and come back.
Many of the longer missions are actually on the order of two-and-half or three years, but we have accumulated a fair number of folks who've had mission days in excessive 500 days. Let's talk a little bit about this, "A Funny Thing Happened on the Way to the Moon." This is a story that came out just a few years ago and when you realize the challenges that this woman overcame, it's really quite amazing. Her name was Margaret Hamilton and she was a programmer, self-taught while working at the MIT instrument lab, which has become the Draper Lab 4, original director Charles Stark Draper.
To get to the Moon, it took three different entities. It took government in the form of NASA, it took industry like ILC Dover who build the Spaceships who were originally bra manufacturers, and it took academia. The role academia played was immense in that they were assigned the mission to build the Apollo Guidance Computers. Now, guidance computers were extremely limited back then, they were made of wire that we would either go through a magnet or node and that would be the definition of a bit of a one or zero, but it really took a lot of folks who could actually learn how to write code for the computer to act on. If you think about the challenges of going to the moon where you had rocket burns, you had rendezvous and docking, you had descent landing on a surface and then return, the software was a major part of it. Here's Margaret, if you look at that bottom picture, that's her standing with all the Apollo codes, which is actually taller than she was.
A funny story came out several years ago where she as a working mom would take her young daughter, Lauren to the lab on weekends and at nights while she was working on various tests and writing code. During one of the tests they were running a code of a software load of the Lunar Module going to the moon and Lauren started to push buttons and caused the whole guidance computer to crash. Margaret recognized that that was a very serious concern and rather than chastise her, she actually dug it out, what was exactly going on and asked to have a software fix made, but NASA administration was very worried about a software fix that would override the crew. She said, "Well, this could happen on a mission." She was told, "Well, astronauts never make mistakes." Well, guess what? The first lunar mission was Apollo 8, which was going to do a flyby at the moon, which was in December of 1968.
During the transit, sure enough for no fault of his own, Jim Lovell made that same computer crash occur. What it did was it took the computer's program from the in-flight phase to the pre-launch phase, and that was the same thing that Margaret's daughter created by pushing some buttons inadvertently. Well, the bottom line is despite the fact that they didn't write a software fix to prevent it, they were able to override it. On Apollo 11 during the descent phase, a alarm went off and later on they found out that it was because the crew had activated the rendezvous radar during descent when it was supposed to be only used for ascend and it basically started jamming the computer. Were it not for Margaret's design of the program logic to override errors and focus on priority tasks and dump loads that were not important, Apollo would never have happened. She actually coined the term software engineering.
She's been finally recognized in 2017 by being awarded the Congressional Medal of Freedom. But this is a really cool story and it really highlights Women's History Month. Astronauts never make mistakes. Any of you skiers put on a boot backwards? If you notice there, the crew had serviced the EVA spacesuit, the extra vehicular mobility suit, and put the boots on backwards.
This is just one of many human factors, incidents, and errors that have happened. Over the course of my career, I've tried to track these just to show we have got to account for humans in complex systems. We know in aviation that 75 percent of the mishaps are human factors related, and sure enough, space is no different.
I don't have time to go through all of the human factors incidents that I've collected, but suffice it to say that we've had some significant issues and close calls. These are just some of the events I gleaned from that overview slide of the serious events. We've had in the Russian program three times that the mission was terminated and the crew was evacuated. You can see that here, combustion event/headache, a urinary tract infection, and a cardiac arrhythmia.
Three other times when the crew was in the process of getting ready to evacuate, when the medical event resolved and they ended up terminating it. There's a whole story behind each of those. We've had combustion events which were a euphemism for a fire. Fire in a closed space, like a space capsule, was a really serious event.
Interestingly enough, some of these were attributed to crew switch errors. Steve, you might remember some of the concern about spacewalks, EVAs, that had to be terminated for various things, such as the torn gloves which has happened. During the Apollo mission, there was high workload and crew injuries, but the thing that's really striking here, and this is the tabulation to date, is that there have been 43 inadvertent releases of tools and cameras and other items. That special drill wrench that Steve showed would probably cost a couple of million dollars, besides the fact that [inaudible] a foreign object and floating in very close proximity to the space station. In addition to some of the medical events that affected virtually every organ system, we've also seen issues with crew performance that could be attributed to a variety of microgravity and space events, including some of the effects on the vestibular system and sensory motor perceptual illusions. They've involved various things such as rendezvous and docking, robotic arm operation, and even shuttle crew shuttle landing performance is not as good as it perhaps would be, considering pilots are highly trained to perform that maneuver.
This is the Mir space station, which had some obvious issues that were crew related. The progress collision in '96 caused the vehicle to depressurize and tumble. Just a brief overview of what we do in space medicine, which is actually a term that was coined in 1948, several decades before we actually flew in space. This is a pretty standard approach for commercial air crew and military air crew, is you always want to start with the crew in the best condition. Pre-mission optimization including exercise and various health enhancing measures are really important. Once you're in space, the goal is to counter the effects of the various disturbing effects of microgravity by various devices such as exercise, etc.
Then finally, if the worst-case scenario happens and they develop a medical condition, then you would use your medical system to stabilize them. But the reality is that we know that we've had some very close calls, we've never evacuated a US crew member back to earth, but we've had crew come back that were in fairly significantly degraded shape. Where this is going to go and when we start flying really long missions is that there's a whole new change of how we're going to have to approach this. This is a great view of the space station, not quite assembly complete. With the solar rays, there would be four more solar rays and several more radiators added. For any health care support system, whether it be on Earth or in space, there are four main components to it: people, equipment, procedures, and training.
These systems over the early phase of NASA, Mercury, Gemini, and Apollo, and throughout the 30 years the space shuttle had been refined ever so much so that now on space station, they have a very robust capability, but it is very limited in the sense that it can take care of a very sick crew member for maybe a couple of days. It's basically like an advanced ambulance capability. What people think of in traditional healthcare settings of what we might have in space is actually not really as robust as we'd like. Where this is going to go when go to deep space as we'll get into is going to be a serious challenge. One of the things that we had in addition to the various crew coordination and human factors issues is a phenomenon that some crew members describe.
These are all terms that I've been actually told by crew members right after landing, that they felt like their brain was in oatmeal, that things were no longer intuitive. It's been well-recognized in the Russian program, they call it neurasthenia or space fog. It's had effects on crew. Some of it may be due to a residual of medications used for motion sickness, but I've had long-duration crew members describe it as well. We now know that there are significant effects on the nervous system in long-duration spaceflight.
They can include fluid shifts and also radiation as we'll get into. Here's another shot of Mir. All expeditions in austere and extreme environments suffer the same concern and Roald Amundsen, who was one of the polar explorers, said, "The human factor is three-quarters of any expedition." That means that you can have the best equipment and the best support and logistics, but if you don't have crew that are resilient and can handle and adapt, it will fail. This are just another list of the performance concerns. Much of it has to do with the interaction of the vehicle environment and the mission architecture and the human systems integration.
We are going more and more with automated systems. Of course, automated systems were used extensively in the Russian program. Yuri Gagarin had virtually no crew duties whatsoever.
He was only 26 years old when he flew. It was not what we would consider an experienced test pilot like our original astronauts were. As we've had advanced systems, we now have advanced complexity, and because of the space fog, crew will lose intuitiveness and they have to follow their checklists much more closely. Let's talk a little bit about the future. We have spent 156 person-years in low Earth orbit and have a lot of experience there, but we are destined to go further.
For those missions that went to the moon and some that landed on the moon and did terrestrial EVAs, they were in deep space and they had a much higher radiation exposure. The Van Allen Belts provide a electromagnetic field around the Earth that reduces our radiation from deep space by probably a factor of 100, maybe even more. Even in low Earth orbit, the crew gets doses of radiation that are about 10 times higher than they would be on the surface of the Earth. One of the major challenges that we're going to face, particularly going to a planet like Mars, being, say, 33 million miles away is com delays. The Earth and Mars can be near each other, so the comm delay maybe is short as 8-10 minutes.
But if it's on the opposite side of the sun from each other, the sun can actually block out communications completely or extend it up to, say, 22 minutes of delay. Because electromagnetic communications travels at the speed of light. You can imagine a mission that instead of months long or even years long, is several years long, and how that is going to affect your proficiency at tasks and training. We're certainly going to have issues with resupply even if we preposition stuff.
Because, for example, medication has a shelf life, and if you look at the label, and food has a shelf life. Even if you preposition something ahead of time, it may not mean that the shelf life allows whatever it is, the food to be nutritious or the medication to be effective. Because just like with the Apollo 13 mission, they could not immediately turn back around and come home, they had to abort to lunar orbit and come back around, that also is a factor in deep space.
This is an actual picture from one of the rovers and that little dot there is the Earth. Now, when you're on the moon and you're looking back at the Earth, the Earth is about the size of your thumb at arm's length, which is a degree or so. But when you're on Mars, 33 million miles away, it's not even a pencil dot. You might be able to enhance it with optical magnification and see that it's blue, but it's a pale blue teeny dot.
We talk about the crew threats [NOISE] hazards. Just like I mentioned earlier, NASA likes to divide these into what they call RIDGE: radiation isolation, distance, gravity, and environments. Each of those has those factors that degrades our traditional posture of how we approach not just a space health care delivery, but also how we approach just the logistics support. This is an interesting chart here. This is during one of the Skylab missions, but it's also been replicated in space shuttle and space station.
This was the Skylab retinal flash study and all those little x's there are when the retinal flashes occur. They're usually at the extreme latitudes because the magnetic poles that protect the Earth bend down and come in at the [NOISE] poles, and so they're very much closer to the surface. So we see retinal flashes at high latitudes. Another area we see them in is a disruption in the magnetic field called the South Atlantic Anomaly. That's another area we actually try to avoid doing spacewalks in that region because that's where high-energy particles from the galactic cosmic radiation can penetrate, and crew will describe light flashes in their eyes.
The South Atlantic Anomaly for some reason is actually enlarging and they think that there might be some perturbation in the Earth's magnetic pole, which is actually not the same as the Earth's geographic pole. Well, what does this correlate with? Retinal flashes are high-energy particles that are hitting the brain, and actually, in animals and whatnot, can show damage. Well, what other thing can also be seriously affected by these high-energy particles? High-density computers circuits. This is a map of a bit flip in computer circuits, particularly high-density integrated circuits, even radiation-hardened ones.
Sure enough, you see a huge hole, a huge area where those bit flips occur around the South Atlantic Anomaly and also in the upper higher latitudes on the North and South Pole. What this tells you is radiation, high-energy particles are bad for the brain and also bad for computer electronics. Some of the missions that NASA has planned are, obviously, we've spent a lot of time in low Earth orbit, but these are some of the missions that are envisioned and the durations of time that they would take, and also how challenging it would be to return.
This is just available for your reference. Like we talked about earlier, the majority of risk in spaceflight for the Shuttle program was in the blue area here. This is launch like in the Challenger miss out, and the yellow area, which is the re-entry and landing. As we start going to longer and longer missions, these are missions in the order of two years or one year. You can see that medical events which made a small part of the risk of loss accrue in short missions, now that area of red, which is the medical risk of loss of crew expands. That's primarily because the duration of the mission is longer.
The other problem that you also see in this gray area is hardware failures, and you can imagine a hardware failure that affected the life support system could certainly be a very serious issue. We're going to have to switch from what we are used to since 1961 to a whole different process for these long deep space exploration class missions. For example, going to Mars, we can't use the current approach that we use to support medical, which is real-time communications and continuous mission control access for troubleshooting and real-time remote guidance and consultation.
If you think about how many vessels go up and resupply the space station. Now we have access to both the progress, that's the sigmas system, and also the SpaceX Dragon. Soon we'll hopefully be Sierra Nevada Dream Chaser. We will not have that immediate or near immediate resupply capability, nor will we have an ability to bring somebody home. Right now in an emergency, if we had lost pressure, we could bring crew home in several hours. For a medical issue, the plan is to treat them for several days and see if they resolve the so-called stand and fight mode, and then return to Earth for definitive care.
None of these are going to be available for exploitation class. Some of the drivers for medical systems, this is a list I've compiled over the years. Many of these are well-known mass power volumes and I don't even have cost and schedule here. Those the more are to deal with the acquisition and sustainability.
But these are all things that are extremely desirable for any human's support system, but certainly for medical system. Technology development, I'll go through a little story here. This is a story that developed after the Colombia mishap in 2003.
The shuttle was grounded for two years and actually, Steve was on the first return to flight mission, which was several years later. During that hiatus of no shuttle, there was no crew exchange that could be done except for the Soyuz. There was a fairly significant up mass and a very significant down mass limitation.
We couldn't get things up, we couldn't get things down and we couldn't get crew up and down. As a result of that, the astronaut office and in conjunction with the Russians went from a three-person crew, which is the early space station era, to a two-person crew. One of the things that was asked was, "Well, is there anything we can do with what we have?" What came to pass was this very rapid turnaround program that said, "Hey, we have an ultrasound machine on the space station and we can train the crew to do diagnostic quality ultrasounds." If you've ever gone to a hospital and had an ultrasound, they are usually done by a trained ultrasonographer and usually, they're organ-specific trainers. They do cardiac echoes or they do abdominal echoes, or they do musculoskeletal exams.
Nasa took a huge gamble and said, let's try a program where we can train the crew how to perform an ultrasound, but with real-time guidance. Somebody on the ground is looking at the image, the crew acts as the hands, and the eyes, and the ears. With four or five hours of training, a crew could go up there and do a diagnostic quality ultrasound. This became the atom program, the advanced diagnostic ultrasound for microgravity. It was a total game-changer.
They came up with a program on for every organ system. This was available because the ultrasound, the Human Research Facility, ultrasound, which was a huge ultrasound, was actually quite capable except that it was just extremely big. This was one of the original articles that came out of that just two years after the program was started. The idea was that you could put this overlay down and the crew were trained how to do all the switch positions for different anatomical studies. Again, this was four hours of training to do the quality ultrasound that an ultrasonography might be trained on for several years. The difference is they had real-time support.
The team on the ground in Mission Control could look at the image in near real-time and say do this, do that. All of this scripted out ahead of time. It was an amazing program that shed incredible fruit, as I'll get into. Here's Peggy Woodson, who was a renal physiologist looking at her kidneys. She could actually see the little squirt of the ureter into her bladder with this. You have scientists that know a lot about the physiology up there doing science in an incredibly robust way.
This was the expedition 10 crew, Leroy Chiao and Salizhan Sharipov, who at the time this was right around when they first started wanting to look at the eye because there was concerns about fluids shift and swelling in the brain. The crew was trained on the ground on how to do this. Here you can see an image that's the actual pupil constricting, which is an assessment tool that we do in neurology. Now, this is a really cool slide. This is the HRF, the Human Research Facility ultrasound. It was a ATL1000, and that was the ultrasound that we would have available in the '90s.
If you went to a hospital and they needed to do an ultrasound on you, they'd have this big, huge card like this rack panel here and move around and the Ultrasonographer would hook all these wires up. Well, obviously, technology is evolving and in 2011, GE came up with a laptop-based system shown here in this slide, the GE Vivid q. That came up, I think on the last shuttle flight.
Now the crew could use this much smaller system and much easier to do, and obviously, it gave us good or better quality images as they could get with this older system. Well, fast forward a couple years now, GE has the Vscan, a handheld ultrasound, and there's another one called the butterfly system that can plug into a laptop or a phone and give you almost as good quality as you could get with this laptop-based system. Ultrasound is also been now used to do directed energy for coagulation of bleeding vessels. It's called high-frequency focused ultrasound. Now, the developer of the atom program who was head of trauma surgery at Henry Ford Hospital in Detroit thought, gosh, we can train somebody who's not a technical person to do diagnostic quality ultrasounds, maybe we could use this in other applications. He was from Detroit and he was already working with the various teams there like the Detroit Red Wings hockey team and Detroit Lions and some of the Olympic teams.
What they would do was they would do the same training protocol that was developed at NASA, and they would train the athletic trainers or the strength and conditioning folks to do diagnostic quality ultrasounds. Obviously, their focus there would be more on muscular skeletal exams. But it turned out it was a huge success. Scott and his team ended up going both at the Olympic Training Center and to several Olympics where they could do real time ultrasonography assessments on high-performance athletes.
The story goes that Scott's team was able to use this technology with the trainers and they were able to get Lindsey Vonn back up after she'd taken a fall. The ultrasound showed that it was not a serious injury and that they only needed to do is ice it and put her back in the game. This is now one of the major spin-offs of technology and procedure that was developed for space. It's also now been expanded to remote and Austere health care in underserved arenas, such as Africa and Asia. Using the same techniques, they can have a nurse midwife do a diagnostic quality ultrasounds to determine if the maternal health of the mother is at risk and she needs to be transferred to a hospital or whether they can manage it there.
The story goes on and on about the enhancements of ultrasound, which now because of its portability, has significantly improved healthcare throughout the world. Then I like to tell another story that is, this is a cool story. This was a NASA propulsion engineer, David Saucier who had a heart transplant by Michael DeBakey.
At the same time Michael DeBakey was trying to develop a pump that can help heart patients while they were waiting for a transplant. It was called the left ventricular assist device. He was talking to his patient. This is Michael DeBakey here on the far right, and David Saucier had develop the high-speed turbine or at work on with the high-speed space shuttle propulsion main engines using the super high-speed fans. So instead of a traditional type pump they used in a power system.
This is the complex of computational fluid dynamics modeling that they came up with the right rotation speed not to shear the red blood cells. Here's another example of something from space coming back and helping us on Earth. Well, future healthcare systems are going to continue to advance because of the long distance and the ability that we don't have to immediately return somebody back to Earth, we're going to have to come up with a mission control. In fact, we've often discussed that the concept of Mission Control Center needs to be switched to Mission Support Center, and that they will no longer have the ability to do real time consultation and control of systems. They're going to have to push forward the capabilities. That requires using decision support tools, using various machine learning or artificial intelligence.
Something that you take the ultrasound machine and you put it on an object, and it has a repository or library of images and it says, "This is what it is or this is what you need to do to get a better image." We also need to have enhanced diagnostic and therapeutic capabilities, such as using the ultrasound that can both image and also coagulate blood vessels. Then another big thing is using an analysis of the human's omic system which includes the genetic and protein and also the microbiome which is in our intestines.
All of those things to individualized healthcare. This right now is the hot topic in medicine. Cancer patients now get chemotherapy that is much less likely to cause adverse side effects and much more likely to be effective because of analysis of these omic parameters. Then finally, the capabilities of 3D printing, which can also print metals and other things, you can even print the medication.
This might be a way of getting around the shelf life of medications. Technology development is great until it isn't. One thing that we always have to remember is how do you anticipate the failures like you see here in this little cartoon of the shuttle toilet or this Apollo toilet not working? For those of us that are old enough to remember the Arthur C. Clarke 2001, a Space Odyssey.
This will always get to the heart of white people are worried about computers. My closing thoughts are from my mentor and colleague, Craig Fischer. He was a Gemini and Apollo and Shuttle Flight Surgeon, but he also did the 14-day Gemini test in the spacesuit on the ground. He's quite a hero of mine. But he said, the design and content of any space healthcare system has always an unfinished work in progress, continuously updating based on the science research objectives of the mission, the vehicle constraints, crew training and levels of desired care.
With that, I'll end with my contact info. I have a huge repository of reference material, including many of the textbooks that cost a lot of money that I make available for educational purposes and I also wrote a huge reference files. Connect with me please, if you have any further.
Thanks. [MUSIC]
2021-05-16