Evidence to Practice
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1 Evidence to Practice
2 Images courtesy of NASA. Materials are derived from previous editions as well as this edition of Space Physiology and Medicine - Evidence and Practice, 4th Edition. Reproduction for purposes other than personal use or teaching will require the Editors' and the Publisher's approval. The Editors reserve the right to change this materials as new information arises.
3 Learning Objectives 1. Review the current academic and professional academic and skill training offered to space medicine practitioners. 2. Understand the unique tools used in the practice of space medicine such as consultations, remote monitoring, and risk mitigation to maintain crew health and safety.
4 Outline Learning Objectives Introduction Evolution of Training Development of the Specialty of Aerospace Medicine Training in Aerospace Medicine in the Space Age Civilian Training Transition from Aerospace Medicine to Space Medicine Non Physician Training Space Shuttle Training International Space Station Training International Aerospace Medicine Training Programs Russia Canada United Kingdom China Crew surgeons (space medicine specialists) at the Mission Control Center, NASA Johnson Space Center, Houston TX. (courtesy NASA) Additional Non Degree Granting Programs Future Challenges
5 Introduction 1. Influence of other specialties 2. Scope of space medicine training why is it necessary? 3. The basic premise of space medicine practice is to address hazards and health risks, and protect crew health through monitoring of systems and individual s responses to space flight. 4. Providing personalized preventive care pre-flight and rehabilitation after each mission are part of the practice. Not only do ground-based physicians require specific training, individuals who serve as a crew medical officer (CMO) during flight also require training regardless of whether they are a physician or not.
6 Evolution of Training Development of the Specialty of Aerospace Medicine World Wars and the integration of aviation U.S. Air Commerce Act May 1926 o Specialized aeromedical training of professionals in the civilian sector American Board of Preventive Medicine (ABPM) and Public Health incorporated late 1940s ABPM approved the specialty of aviation medicine early 1950s ABPM began offering specialty certification for physicians 1955 ABPM updated aviation medicine to aerospace medicine Doarn CR, Mohler S. Physician training in Aerospace Medicine An Historical Review. Aviat Space Environ Med 2013; 84(2):
7 Evolution of Training Training in Aerospace Medicine in the Space Age Academic training core courses Practicum year hands on experience o Specialized aeromedical training of professionals in the civilian sector U.S. Military Program o o o Naval Operational Medicine Institute Pensacola, FL U.S. Air Force School of Aerospace Medicine Dayton, OH U.S. Army School of Aviation Medicine Ft. Rucker, AL U.S. Civilian Programs o o o College of Medicine, Mayo Clinic Rochester, MN University of Texas Medical Branch Galveston, TX Wright State University Dayton, OH
8 Evolution of Training Training in Aerospace Medicine in the Space Age o Naval Operational Medicine Institute Pensacola, FL Naval aviators o U.S. Air Force School of Aerospace Medicine Dayton, OH Aviation for pilots and crew members Wide array of aircraft o U.S. Army School of Aviation Medicine Ft. Rucker, AL Fixed wing/rotary aircraft Atmospheric flight
9 Development of Academic Training Philanthropy and the Great Depression Daniel Guggenheim Foundation promotion of aeronautics 1926 Donation of $750,000 to Harvard University Ross McFarland Chair of Aerospace Health and Safety* Academic training in Aviation Medicine at Harvard Curriculum development for MPH degree Collaborations with industry, academia and government Space Task Group Lovelace Committee Interactions with NASA (Generals Charles Roadman and Jack Bollerud, Robert Gilruth, and others) *Ross McFarland Collection at Wright State University.
10 Development of Academic Training The Ohio State University Drs. Ashe and Billings* Civil Aviation Medical Laboratory Occupational health and aviation medicine Notable graduates leadership within NASA Program tied to national efforts and needs of NASA Robust curriculum Masters degree Board Certification *Billing C. Aviation medicine graduate training at Ohio State University. Aviat Space Environ Med 2010; 81:
11 Development of Academic Training Wright State University NASA s needs Shuttle Program Wright State University Wright Patterson Air Force Base Drs. Stanley Mohler and Charles Billings California or Ohio Robust curriculum Clinical rotations at select NASA field centers Masters degree Board Certification Significant number of graduates (national and international) Astronaut, NASA, FAA, etc Present Residency 1. Billing C. Aviation medicine graduate training at Ohio State University. Aviat Space Environ Med 2010; 81: Doarn CR, Mohler S. Physician training in Aerospace Medicine An Historical Review. Aviat Space Environ Med 2013; 84(2):
12 Development of Academic Training University of Texas Medical Branch NASA s needs Space Medicine University of Texas Medicine Branch Robust curriculum Clinical rotations at select NASA field centers Masters degree Board Certification Significant number of graduates (national and international) Astronauts, NASA, FAA, etc Fellowship 1997 Present - Residency
13 Development of Academic Training Mayo Clinic Two year fellowship 2008 Present
14 Civilian Training Program Name Location Dates Yearly Enrollees Website (Approx) United States Army School of Aviation Medicine Ft Rucker, AL Present Ft Sam Houston, TX United States Air Force School of Aerospace Medicine San Antonio, TX Dayton, OH Present 12 United States Navy Naval Aerospace and Operational Medical Institute Pensacola, FL 1953 Present 5 mi/pages/default.aspx Harvard University Cambridge, MA NA NA Ohio State University Aerospace Columbus, OH NA Medicine Residency FAA/University of Oklahoma Oklahoma City, OK NA Mayo Clinic Fellowship in Space Medicine Rochester, MN 2008 Present 1 Stanford University Palo Alto, CA NA Wright State University Aerospace Dayton, OH Present 4 Medicine Residency University of Texas Medical Branch Fellowship University of Texas Medical Branch Aerospace Medicine Residency Galveston, TX NA NA Galveston, TX 1996 Present 4 overview_copy1.aspx Notes: 1. School of Aerospace Medicine moved from Brooks AFB to WPAFB in Dayton as part of Base Realignment and Closure in 2005.
15 Curriculum for Civilian Training Residency Requirements Wright State University 1 University of Texas Medical Branch 2 Mayo Clinic 3,5 Outcome MS MPH or MS Fellowship / MPH Residency Hrs 42 Credit Hours 42 Credit Hours 42 Credit Hours Course (Credit Hrs) Course (Credit Hrs) Biostatistics (4) Principles of Aviation and Space Medicine (4) Public Health as a Team Sport: the Power of Collaboration (1.5) Epidemiology (4) Aerospace Toxicology (3) Fundamentals of Social and Behavioral Science (3) Environmental Medicine (3) Biostatistics (4) Issues in Environmental and Occupational Health (2 Aerospace Skills for Healthcare Providers I (2) Introduction to Epidemiology (3) Fundamentals of Epidemiology (3) Fundamentals of Aerospace Medicine I (2) Environmental Health & Toxicology (3) Biostatistical Methods I (3) Space Medicine I (2) Health Policy and Management (3) Ethics in Public Health: Professional Practice and Policy (1) Introduction to Aerospace Medicine Research I (1) Health Promotion: Social & Behavioral Approaches Public Health Management (3) (3) Fundamentals of Social & Behavioral Science (3) Ethics of Scientific Research (1) Master's Project: Public Health Practice (4) Aerospace Skills for Healthcare Providers II (2) Tropical and Travel Medicine (4) Field Experience: Public Health Practice (4) Fundamentals of Aerospace Medicine II (2) Accident Investigation/Risk Management and Mitigation (2) Space Medicine II (2) Public Health Practice (4) Introduction to Aerospace Medicine Research II (1) Practicum, Capstone, Thesis (8) 4 Health Services Administration (3) Aerospace Toxicology (2) Aerospace Skills for Healthcare Providers III (2) Fundamentals of Aerospace Medicine III (2) Space Medicine III (2) Aerospace Medical Research Project (3) (Cited Apr 23, 2014) (Cited Jan 15, 2014) (Cited Jan 15, 2014) Practicum opportunities include spending time at various sites, including the NASA Johnson Space Center Time is spent at the University of North Dakota School of Aerospace Sciences to learn the basic principles of flight.
16 Transition from Aerospace Medicine to Space Medicine Non Physician Training - Nursing - Biomedical engineers - Flight controllers - Crew members (non MD CMO s) - Didactic wide array of materials covered regarding health and space flight - Simulation - Computer-based - KC-135/DC-9/ Testbeds (See Chapter 17)
17 International Space Station International Aerospace Medicine Training Programs Mir/Shuttle Program ISS Program Article 11.4 of the MOUs between partners (International Partners [IPs] USA/NASA Canada/CSA Japan/JAXA Russia/Roscosmos European Union/ESA
18 International Space Station Medical Structure Governs all medical operations activities for the ISS MMOP working level MSMB certification of flight crew MMPB senior level medical leadership policy driven MMPB MSMB MMOP MMPB = Multilateral Medical Policy Board; MSMB = Multilateral Space Medicine Board; MMOP = Multilateral Medical Operations Panel Grigoriev AI, Williams RS, et al. Space Medicine Policy Development for the International Space Station. Acta Astronautica. 2009; 65(5-6):
19 International Space Station MMOP Working level panel with subgroups Training for crew members, flight surgeons, and other support personnel NASA KSC, Florida NASA JSC, Texas Gagarin Cosmonaut Training Center, Russia Institute for Medical and Biological Problems, Russia JAXA, Japan ESA, Germany
20 International Programs International Aerospace Medicine Training Programs Russia (beginning in 1939) Naval Medical Academy in Leningrad (St. Petersburg) Military Medical Academy in Kuybyshev, Samara Region Military Medical Faculty, Saratov University First Kharkov Institute, Ukraine (now Vasyl Karazin Kharkiv National University Second Moscow Institute (now Russian National Research Medical University named after N. I. Pirogov)* Yuri Gagarin Cosmonaut Training Center Institute of Medical and Biological Problems Lomonosov Moscow State University Space Biomedical Center** *Significant role in post WWII Soviet Union **Funded in part by NASA 1. Dorogobed VS, Vlasov W. The 40th anniversary of the start of aviation physician training in the Military Medical Department of Saratov Medical Institute/ Aviaksom Ekolog Med 1992; 26:88-90 (In Russian). 2. Ponomarenko VA. Specialized training of the aviation physician. Voen Med Zh 1976; 9:25-8. (In Russian) 3. Grigoriev AI, Burakova B, et al. Educational programme on aerospace and environmental medicine for medical faculty of Lomonosov Moscow State University. Adv Space Res 1997; 20:
21 International Programs International Aerospace Medicine Training Programs Canada Royal College of Physicians and Surgeons Basic training in aviation medicine International Space University United Kingdom During WWII RAF Physiological Laboratory (1945 Institute of Aviation Medicine) Kings College London School of Medicine and Dentistry MS degree program in Aviation Medicine China Chinese Department of Clinical Aerospace Medicine, School of Aerospace Medicine, Fourth Military Medical University in Xi an Duan H, Yao B, Liu X. The development of aviation medicine appraisal and training center under new situation. Clinical Medicine & Engineering 2011 (In Chinese).
22 Future Challenges Cultural sensitivity training Language and customs New methods of teaching Physicians on long distance exploration missions Commercial programs Shortages of trained individuals (Courtesy of NASA) 1. Lane DS A threat to the public health workforce: evidence from trends in preventive medicine certification and training. Am J Prev Med 2000; 18: Bamidis PD, Konstantinidis S, Papadelis CL, Perantoni E, Styliadis C, Kourtidou-Papadeli C, Kourtidou-Papadeli C, Pappas C. An e-learning platform for aerospace medicine. Hippokratia 2008; 12(Suppl 1):15 22
23 Key Points to Remember 1. Space medicine training encompasses general knowledge of the clinical, aviation, and preventive medicine. 2. There are military and academic training programs with a rich history of preparing the next generation of flight surgeons ready to support humans in space regardless of duration or mission. 3. Individuals who take care of individuals who fly in space are not all physicians and may include a variety of other disciplines. 4. Generic academic training prepares physicians to practice aerospace medicine and flight (aviation) training. 5. Space medicine training is often designed based on the type of spacecraft and mission duration. This training supports physicians, on orbit CMO, and other personnel.
24 Self-study Topics 1. Explain how academic training evolved and why? 2. What value has the training provided to human space exploration? 3. How are non-physicians trained to support the various phases of human space flight? 4. How does training prepare the ISS flight surgeons and other essential support staff for ISS operations? 5. How does the training of personnel in space medicine help in mitigating risk associated with human space flight.
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