•'<al Medicine 



Development of countermeasures to the known deleterious physiological effects of 

 space flight requires continued effort from Operational Medicine. Exercise has 

 been shown to prevent some of the cardiovascular and muscle deconditioning 

 known to occur in space-flight. However, it remains to be determined whether the 

 negative calcium balance associated with exposure to microgravity can be 

 effectively reversed by some form of exercise; this issue deserves a high priority 

 effort. Success criteria for a given countermeasure to a space-flight adaptation 

 should be carefully specified. Issues requiring careful analysis are the extent to 

 which physiological adaptations induced by microgravity require countermeasures 

 and the timing of such interventions during the mission. 



In general, it is desirable to develop countermeasures that are as simple as 

 possible. Consideration of pharmacological interventions, a human-rated variable- 

 gravity facility, electromagnetic musculoskeletal system stimulation, active 

 electromagnetic radiation shielding, and other possibilities are all less desirable 

 solutions. They should, however, be pursued at least theoretically until the other, 

 more conservative countermeasures have been fully evaluated. 



Diagnosis. The development of design considerations for the Space Station HMF, 

 under way at JSC, represents a significant diagnostic effort. An additional chal- 

 lenge will be the diagnosis of disease during space flight for individuals who have 

 developed altered physiological parameters as a consequence of exposure to the 

 unique environment of space. 



Treatment. Considerable work has been accomplished in planning for treatment 

 of crew members using the HMF. Future decisions rest upon the results of 

 epidemiological studies of inflight experience and biomedical research. Particularly 

 important areas include the study of incidence figures for specific medical prob- 

 lems that may occur and the evaluation of any potential effects of space flight 

 upon, for example, pharmacodynamics, drug interactions, and wound healing, as 

 in soft tissue versus bone. Decisions concerning the need for specialized 

 hardware, such as a hyperbaric treatment facility, a miniature lithotriptor, or a 

 human-rated variable-gravity facility, must be made by Operational Medicine using 

 accumulated inflight biomedical data. The treatment capabilities that Operational 

 Medicine defines as requirements are anticipated to evolve as the application 

 changes from the Space Station with a CERV, for example, to a manned Mars 

 mission, which will require more autonomy. 



Recommendations 



Previous sections of this summary detailed areas in which Operational Medicine 

 must make continued progress to ensure the success of long-duration missions 

 with humans in space. Strategies for several high priority areas are outlined 

 below. 



Inflight Health Maintenance Facility 



• The Space Station HMF should be designed for flexibility and the capability 

 to change as new experience dictates. The effects of a Space Station CERV 



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