Operational Considerations for Crew Fatality on the International Space Station.

BACKGROUND: While catastrophic spaceflight events resulting in crew loss have occurred, human spaceflight has never suffered an on-orbit fatality with survival of other crewmembers on board. Historical plans for management of an on-orbit fatality have included some consideration for forensic documentation and sample collection, human remains containment, and disposition of remains; however, such plans have not included granular detailing of crew or ground controller actions. The NASA Johnson Space Center Contingency Medical Operations Group, under authority from the Space and Occupational Medicine Branch, the Space Medicine Operations Division, and the Human Health and Performance Directorate, undertook the development of a comprehensive plan, including an integrated Mission Control Center response for flight control teams and Flight Surgeons for a single on-orbit crew fatality on the International Space Station (ISS) and subsequent events. Here we detail the operational considerations for a crew fatality should it occur during spaceflight onboard the ISS, including forensic and timeline constraints, behavioral health factors, and considerations for final disposition of decedent remains. Future considerations for differential survival and crewmember fatality outside of low-Earth orbit operations will additionally be discussed, including consideration of factors unique to planetary and surface operations and disposition limitations in exploration spaceflight. While the efforts detailed herein were developed within the constraints of the ISS concept of operations, future platforms may benefit from the procedural validation and product verifications steps described. Ultimately, any response to spaceflight fatality must preserve the goal of handling decedent remains and disposition with dignity, honor, and respect.Stepaniak PC, Blue RS, Gilmore S, Beven GE, Chough NG, Tsung A, McMonigal KA, Mazuchowski EL II, Bytheway JA, Lindgren KN, Barratt MR. Operational considerations for crew fatality on the International Space Station. Aerosp Med Hum Perform. 2023; 94(9):705-714.

Thyroid status of Space Shuttle crewmembers: effects of iodine removal.

INTRODUCTION: Iodine is often used for water purification and has been used throughout the U.S. space program. Because of concern about potential effects on crewmembers' thyroid function, in 1997 a system was implemented on board the Space Shuttles to remove iodine from water before it was consumed. We report here thyroid hormone data from crews flying before and after this system was implemented. METHODS: Blood samples were collected and analyzed for thyroid hormone content during routine medical exams before and after Space Shuttle missions. Data are reported for 224 male and 49 female astronauts (about two-thirds of them before implementation of iodine removal). RESULTS: Serum concentrations of total thyroxine (T4) and the free T4 index were elevated in men after flight and triiodothyronine (T3) was lower after flight, regardless of iodine removal status. T4 was higher, even before flight, in the group of men who flew after iodine removal was implemented. Conversely, T3 was lower in men who flew during that period. Before iodine removal was implemented, thyroid stimulating hormone (TSH) was elevated in male and tended to be elevated in female astronauts, with average increases of 27% and 19% after flight, respectively. After iodine removal was implemented, postflight TSH was not significantly different from preflight values. DISCUSSION: These data provide evidence that crewmembers' increase in serum TSH on landing day after early Shuttle flights resulted from their consumption of iodinated water during spaceflight, because the same increase was not observed after implementation of the iodine removal system.

Spaceflight validation of technology for point-of-care monitoring of peripheral blood WBC and differential in astronauts during space missions.

During long duration orbital space missions, astronauts experience immune system dysregulation, the persistent reactivation of latent herpesviruses, and some degree of clinical incidence. During planned NASA 'Artemis' deep space missions the stressors that cause this phenomenon will increase, while clinical care capability will likely be reduced. There is currently minimal clinical laboratory capability aboard the International Space Station (ISS). The ability to monitor the white blood cell count (WBC) and differential during spaceflight has been an unmet NASA medical requirement, primarily due to a lack of capable hardware. We performed ground and flight validation of a device designed to monitor WBC and differential within minutes from a fingerstick blood sample. This device is miniaturized, robust, and generally compatible with microgravity operations. Ground testing for spaceflight consisted of vibration tolerance, power/battery and interface requirements, electromagnetic interference (EMI), and basic evaluation of sample preparation and operations in the context of spaceflight constraints. The in-flight validation performed aboard the ISS by two astronauts included assessment of three levels of control solution (blood) samples as well as a real time analysis of a fingerstick blood sample by one of the crewmembers. Flight and ground testing of the same lot of control solutions yielded similar total WBC values. There was some select discrepancy between flight and ground data for the differential analysis. However, the data suggest that this issue is due to compromise of the control solutions as a result of storage length before flight operations, and not due to a microgravity-associated issue with instrument performance. This evaluation also yielded lessons learned regarding crewmember training for technique-sensitive small-volume biosample collection and handling in microgravity. The fingerstick analysis was successful and was the first real-time hematology assessment performed during spaceflight. This device may provide an in-mission monitoring capability for astronauts thereby assisting Flight Surgeons and the crew medical officer during both orbital and deep space missions.

Alterations in hematologic indices during long-duration spaceflight.

BACKGROUND: Although a state of anemia is perceived to be associated with spaceflight, to date a peripheral blood hematologic assessment of red blood cell (RBC) indices has not been performed during long-duration space missions. METHODS: This investigation collected whole blood samples from astronauts participating in up to 6-months orbital spaceflight, and returned those samples (ambient storage) to Earth for analysis. As samples were always collected near undock of a returning vehicle, the delay from collection to analysis never exceeded 48 h. As a subset of a larger immunologic investigation, a complete blood count was performed. A parallel stability study of the effect of a 48 h delay on these parameters assisted interpretation of the in-flight data. RESULTS: We report that the RBC and hemoglobin were significantly elevated during flight, both parameters deemed stable through the delay of sample return. Although the stability data showed hematocrit to be mildly elevated at +48 h, there was an in-flight increase in hematocrit that was ~3-fold higher in magnitude than the anticipated increase due to the delay in processing. CONCLUSIONS: While susceptible to the possible influence of dehydration or plasma volume alterations, these results suggest astronauts do not develop persistent anemia during spaceflight.