DRAFT NASA Whitepaper XXXXXXX ________________________________________________________________ The Apollo Medical Operations Project: Recommendations to Improve Crew Health and Performance for Future Exploration Missions and Lunar Surface Operations Richard A. Scheuring, DO, MS, UTMB/NASA-Johnson Space Center, Houston, Texas Jeffrey A. Jones, MD, MS- NASA-Johnson Space Center, Houston, Texas Joseph D. Novak, MEng- University of Chicago Pritzker School of Medicine, Chicago, Illinois James. D. Polk, DO, MS-NASA-Johnson Space Center, Houston, Texas David B. Gillis, MD, PhD- UTMB/NASA-Johnson Space Center, Houston, Texas Josef Schmid, MD, MPH, NASA-Johnson Space Center, Houston, Texas James M. Duncan, MD NASA-Johnson Space Center, Houston, Texas Jeffrey R. Davis, MD, NASA-Johnson Space Center, Houston, Texas March 2007 DRAFT Acknowledgments The Apollo Medical Operations Project was a team effort. Members of this team included the core Summit group at Wyle Labs: Kae Parker, Phyllis McCulley, Mary McFarther, Luisa Rivera, Christopher Stokes, Marilyn Sylvester, Karen Mathis and Sandy Ballesteros. The facility hosting the Summit, Space Center Houston, provided excellent accommodations and service led by Sheri Armstrong. The JSC Center director, Mr. Michael Coats, provided opening remarks to the group and set the tone for the meeting’s agenda. A tremendous thank you is offered to Dr. Joe Kerwin who provided insight and encouragement throughout the development process and into the face-to-face meeting. Of course, all the NASA-JSC flight surgeons and astronaut physicians: Ellen Baker, Lee Morin, Scott Parazynski, Michael Barratt, Thomas Marshburn, Bob Satcher, David Wolfe and Anna Fischer offered their time in preparing for the meeting and could not have been done without them. Other individuals contributed to the writing of the manuscript and deserve heartfelt thanks: Joseph Novak, Nancy House and Malinda Moller. Lastly, the future generation of lunar explorers will benefit greatly from the servant spirit offered during the few days in June 2006 by the Apollo astronauts and flight surgeons to make the new vehicles better and improve crew health and performance. DRAFT Table of Contents Abstract.................................................................................................................1 Introduction...........................................................................................................2 Methods................................................................................................................3 Background Research.......................................................................................4 Data Collection..................................................................................................5 Panel Questions................................................................................................6 Face-to-Face Summit........................................................................................6 Post-Summit Review and Validation.................................................................7 Results..................................................................................................................7 Data...................................................................................................................7 Operational and Research Recommendations by Category.................................8 EMU/EVA Suit...................................................................................................8 Lunar Surface Operations...............................................................................11 Inflight Illnesses...............................................................................................15 Medication/Medical Kits (Appendix D).............................................................17 Environmental Impacts....................................................................................18 Radiation.........................................................................................................21 Performance/Human Factors..........................................................................22 Crew Schedule................................................................................................25 Exercise ..........................................................................................................25 Food/ Nutrition.................................................................................................27 Launch, Landing and Recovery Ops...............................................................28 Flight Surgeon-Crew Interaction......................................................................29 Discussion ..........................................................................................................30 Conclusion………...……………………………………………………………………50 References .........................................................................................................58 Appendices.........................................................................................................60 DRAFT The Apollo Medical Operations Project: Recommendations to Improve Crew Health and Performance for Future Exploration Missions and Lunar Surface Operations 1Richard A. Scheuring, 2Jeffrey A. Jones, 3Joseph D. Novak, 2James D. Polk, 1David B. Gillis, 2 Josef Schmid, 2James M. Duncan, and 2Jeffrey R. Davis 1 2 UTMB/NASA-Johnson Space Center, Houston, Texas; NASA-Johnson Space Center, Houston, Texas, 3University of Chicago Pritzker School of Medicine, Chicago, Illinois Johnson Space Center Abstract Introduction. Medical requirements for the future Crew Exploration Vehicle (CEV), Lunar Surface Access Module (LSAM), advanced Extravehicular Activity (EVA) suits and Lunar habitat are currently being developed. Crews returning to the lunar surface will construct the lunar habitat and conduct scientific research. Inherent in aggressive surface activities is the potential risk of injury to crewmembers. Physiological responses and the operational environment for short forays during the Apollo lunar missions were studied and documented. Little is known about the operational environment in which crews will live and work and the hardware will be used for long-duration lunar surface operations.Additional informantion is needed regarding productivity and the events that affect crew function such as a compressed timeline. The Space Medicine Division at the NASA Johnson Space Center (JSC) requested a study in December 2005 to identify Apollo mission issues relevant to medical operations that had impact to crew health and/or performance. The operationally oriented goals of this project were to develop or modify medical requirements for new exploration vehicles and habitats, create a centralized database for future access, and share relevant Apollo information with the multiple entities at NASA and abroad participating in the exploration effort. Methods. A review of medical operations during Apollo missions 7 through 17 was conducted. Ten categories of hardware, systems, or crew factors were identified during preliminary data review generating 655 data records which were captured in an Access® database. The preliminary review resulted in 280 questions which were posed to surviving Apollo crewmembers using mail, face- to-face meetings, phone communications, or online interactions. Crew member responses to these questions formed the basis for recommendations to items in each of the categories. Results. 14 of 22 surviving Apollo astronauts (64%) participated in the project. Approximately 236 pages of responses to the questions were generated based on the Apollo experiences, with 107 recommendations offered for future vehicles, habitats, EVA suits, and lunar surface operations. 1 of 63 DRAFT Discussion. The Apollo medical operations recommendations are being incorporated into the exploration mission architecture at various levels: 49 recommendations either validated, revised or created new requirements, 4 are currently in practice, 15 are being evaluated, and 44 are being considered. A centralized database has been developed, and the recommendations have been presented to the different organizations involved with building the new vehicles, habitats, suits, or systems that may impact crew health and performance. Conclusions. The Apollo crewmembers’ input has proved to be an invaluable resource to a multitude of departments beyond space medicine. We will continue soliciting input from this group as we evolve and refine requirements for future exploration missions. Introduction The Apollo program, which began in January of 1966, was comprised of 18 missions: 12 crewed missions (including the Apollo 204 mission with Virgil “Gus” Grissom, Ed White, and Roger Chaffee) and six uncrewed missions which tested the capabilities of the Saturn rocket components6. The Apollo 7 mission heralded the first successful crewed mission, and in July of 1969, Apollo 11 fulfilled John F. Kennedy’s mandate to send a man to the Moon and return him safely home7. Twenty-six men flew Apollo missions, including four repeat flyers. Of the manned missions, six flights conducted between July 1969 and December 1972 successfully landed 12 humans on the lunar surface and returned them to the Earth. In January 2004, President George W. Bush committed the United States to the further exploration of space8. This new vision for space exploration has the benefit of the cumulative knowledge and experience gained from the Apollo program. The exploration effort will require the development of new vehicles to transport crews from Earth to the lunar surface and for transportation while on the moon. In addition, crew will need extravehicular activity (EVA) suits and extended duration habitation elements for the lunar surface operations10. The Crew Exploration Vehicle (CEV) and Lunar Surface Access Module (LSAM) though slightly larger, will bear many similarities to the Apollo Command Module (CM) and Lunar Module (LM). The EVA suits may serve the dual function of a launch and entry suit as well as the lunar surface suit. Lunar habitation is a new frontier, enabling humans to live on the Moon for extended periods in order to conduct science experiments and use the lunar environment for in-situ resource utilization (ISRU). During previous studies, Apollo astronauts provided input into the engineering and mechanical aspects of EVA suit system designs 2. However, no study has 2 of 63 DRAFT specifically addressed the impact of the Apollo vehicles, hardware, and systems on crew health or performance throughout all mission phases, including lunar surface operations and the influence of that impact on the new exploration vehicles and mission architectures. To identify Apollo mission issues that had impact to crew health and/or performance and were relevant to medical operations, the Space Medicine Division requested a study in December of 2005. The goals of this project were to develop or modify medical requirements for new vehicles and habitats, create a centralized medical operations database for future access, and provide this knowledge to the multiple directorates at NASA-JSC participating in the exploration effort. Secondary objectives included using this information to validate current requirements and refresh knowledge regarding lunar operations in an effort to reduce both programmatic risk and risk to crew health, productivity, and safety. The Space Medicine Division study and this paper are not intended to be a review of information contained in previous publications, such as Biomedical Results of Apollo. Due to the multidisciplinary operational focus of this study, the primary audience targeted is diverse. The audience includes flight surgeons, engineers, and scientists developing the medical requirements for exploration vehicles, habitats, and suits, the mission planners developing crew timelines, and experts supporting behavioral health and performance. Various aspects of this report will be of interest to a broader readership outside the medical operations community. Therefore, the report is written in a medically non-attributable format accessible to anyone with an interest in the Apollo program. The Apollo Medical Operations Project was headed by Rick Scheuring, DO, MS, UTMB/Wyle Labs flight surgeon, James D. Polk, DO, MS, Manager of Medical Operations at JSC and Josef Schmid, MD, also with Medical Operations at JSC. The team included other flight surgeons from the Medical Operations office at JSC and University of Texas Medical Branch, Galveston, as well as project scientists and engineers within the Space Life Sciences Directorate (SLSD) and the Mission Operations Directorate (MOD) at JSC. Participation of the Apollo astronauts was solicited through the Medical Operations Division.The team would like to express an acknowledgement of the enormity of the task and an appreciation to the Apollo crews for discussing their missions which occurred at a time when most of the team members were still children. Methods This section addresses the spectrum of approaches taken to assimilate, categorize, and assess the data. 3 of 63 DRAFT Background Research Background research was undertaken by the Apollo Medical Operations Project team to maximize the benefits from the study. The approach taken in this study consisted of the following: • Identify specific medical-related problems, if any, in each area associated with the operational environment during all mission phases • Define the impact on crew health and/or performance • Identify problems that recurred or were fixed on subsequent missions • Develop an integrated, comprehensive set of questions that could be used in a face-to-face meetings with the Apollo astronauts The impetus to take these steps to “do our homework” before meeting with the astronauts came from the Apollo crewmembers themselves11. The crews voiced annoyance at discussing subjects or responding to questions that previously had been published. Therefore, it was incumbent upon the team to research areas and develop questions not previously documented. Review of Apollo resources pertaining to Medical Operations and the sources of data included: Apollo 7-17 medical mission debriefs; Apollo 7-17 flight surgeon logs; Apollo 7-17 biomedical engineer logs; Apollo 7-17 mission commentaries; Apollo mission reports (11-17)13; Apollo lunar surface journals (11-17)3; preliminary science reports (11-17)12; the Apollo lecture series11; Apollo videos; NASA technical memorandums, related papers2,14,15,16,17,18; and personal communications with the crewmembers through email, phone or direct contact. These materials were reviewed by the team to understand the Apollo astronauts’ experiences and the issues impacting their health and/or performance as previously reported. It is important to note that the medical debriefs and flight surgeon/BME logs are considered medically confidential material and subject to the Medical Privacy Act of 1974. All other resources are available to the public. It is equally important to note that some issues identified in the debriefs were detailed in the crew logs, crew questionnaires, or air-to-ground communications but were unavailable. Every attempt was made to fill in the missing information from available resources for this study. After reviewing historical data, the team identified eleven categories within the operational environment occurring during Apollo 7-17 that had impacts to crew health and/or performance. The data assembled into these categories formed the basis of the questions used to interview the Apollo astronauts. The categories included EVA mobility unit (EMU) and EVA suit issues; lunar surface operations; inflight illnesses, medical kit, medications, or bioinstrumentation; environmental (vehicle); radiation; exercise; food and nutrition; performance, human factors, crew schedule; launch, re-entry, and recovery; and flight surgeon-crew interactions. Certain well-documented areas relating to crew health or performance, such as lunar dust, were identified but not covered in detail during 4 of 63 DRAFT this study. Likewise, areas that affected the Apollo crews but were not relevant to the new vehicle design, such as the Apollo water chlorination system, were identified in the data collection but were not addressed during the face-to-face meetings. Data Collection The historical data collected was organized and compiled into an Access® database (Appendix A). This database facilitated the search capabilities of the team in identifying areas that had health and/or performance impacts. The data was organized by mission, source of information, topic (category), medical/hardware issue, crewmember involved (if applicable), description of the problem, general comments about the issue, and resolution/reoccurrence. From this body of data questions related to the issue were generated. The team used this method, to create 655 data records. An example of one record is provided in figure 1. Note that any attributable astronaut medical information contained in Appendix A has been removed for the purpose of this paper and exists as a separate document. Figure 1. Sample Access® data record from the Apollo Medical Operations Project. 5 of 63 DRAFT Panel Questions Questions were generated within the 11 categories from the historical data search effort and input from operational and research disciplines associated with each category (Appendix B). These questions were augmented with others impacting crew health or performance solicited from discipline leads in each category. The categorized questions were reviewed by flight surgeons and current astronaut physicians at JSC for relevance and operational applicability to the exploration effort. This resulted in a final list of 280 questions used during the face-to-face meeting with the Apollo astronauts. Face-to-Face Summit The face-to-face summit with the Apollo astronauts was held June 2006 in Houston, Texas. Per the crewmembers’ request, days 1 & 2 were closed sessions limited to Apollo crew, the current flight surgeon cadre, and astronaut physicians. Day 3 was limited to invited guests and the Apollo flight surgeons. Of the original 29 Apollo astronauts, 22 survive today and were invited to participate in the face-to-face summit (Appendix E). Dr. Joseph Kerwin, who served as CAPCOM for Apollo 13 and astronaut physician on Skylab I, was a project team member and invited to participate as an astronaut. The invited guests for Day 3 submitted questions to the Apollo Medical Operations Project team prior to the meeting to insure the appropriateness of the question and to facilitate interaction with the crewmembers during the session. Prior to the panel question discussion on days 1 and 2, the project team presented informational briefings to achieve the intended outcome of the meeting. The two-fold purpose of the meetings was to capture the experiences of the Apollo astronauts to validate findings from the historical data search and to project applicable aspects of Apollo operational experience to the exploration initiative. The project team presented the issues that faced the crews during their missions from the historical data research to increase their awareness of the current knowledge base. It also served to stimulate memories garnered three and a half decades ago. The presentation concluded with a discussion of the exploration architecture to familiarize the participants with the new strategies and mission plans. The panel discussions were held with the astronauts and project team members meeting in one room. A professional transcriptionist recorded all comments from the astronauts and later organized the responses with the corresponding questions. The day-3 session was conducted in a similar manner by the team and transcriptionist. This document was then reviewed by the project team for accuracy and clarification. Notes taken by the panel team during the question sessions were added to the document as necessary. 6 of 63 DRAFT Post-Summit Review and Validation The purpose of the post-summit phase was to compile the accumulated responses to the panel questions and organize into a comprehensive report (Appendix B). Apollo astronauts who participated in the face-to-face summit reviewed and validated the report. They also submitted additional input and points of clarification. After review by the project team, the updated version including recommendations was then submitted to all the Apollo astronauts providing an opportunity for an additional six crewmembers not attending the face-to-face meetings to participate. Responses can be found in Appendix G. Results Data Sixty-four percent (14 of 22) of the surviving Apollo astronauts participated in the project. The combined crewmember responses to the 280 questions generated from the background research resulted in 236 pages of data. A comprehensive review of all the responses from the astronaut sources revealed 107 recommendations from statements in all 11 categories that the group made to the questions as shown in Appendix C. The input shown in table 1 formed the basis of the Apollo Medical Operations Project recommendations. Number of attendees 8 Post-summit full responses 7 Total number of Apollo astronauts 14 input Number of Apollo astronauts 22 available Table 1. Astronaut attendance and participation at Apollo Summit. The panel discussion questions and answers document is broken down into the number of questions per category and the responses from the post-summit participants in Table 2. Note that this section is only post-summit responses and does not include the eight summit attendees’ responses, which could not be individualized. 7 of 63