Scott Parazynski, MD, is performing a surgical repair. He is using the same motor skills and muscle memory as any other repair that he has performed in the emergency department, but this time the patient is a torn solar panel, and he is orbiting the Earth at 17,500 miles per hour. Ed Powers, MD, another emergency physician, mans the “Surgeon” console in Mission Control, monitoring Dr. Parazynski’s spacewalk.
It should come as no surprise that at NASA, the medical specialty most represented in the cadre of astronauts and flight surgeons is emergency medicine. Currently at NASA, Drs. Tom Marshburn, Kjell Lindgren and Serena Aunon are all training in earnest for the International Space Station missions, and all are emergency physicians. Including myself there are nine flight surgeons who support the space program and are boarded emergency physicians. In addition to being EPs, all have additional training in aerospace medicine, human factors engineering, or hyperbarics. Some were trained via a second residency in aerospace medicine, while others trained via the military’s aerospace medicine training courses.
As the Chief of Space Medicine, I am often asked by some of my colleagues if I “miss emergency medicine.” I guess it would depend on your definition of emergency medicine. On a typical day last week, I met with several flight surgeons and astronauts as we discussed revising the medical kits on board the space station. We weighed the evidence and debated whether an obturator airway or intubating LMA would be best. Simultaneously in another building, one of the surgeons was teaching suture techniques and intraveous techniques to several astronauts. Also simultaneously, a flight surgeon was fully engaged in a simulation in mission control that involved a decompression sickness and bends emergency treatment protocol on-board the space station. Still another physician was seeing a patient with chest pain in the clinic. Later that same day I worked on the EMS landing plan for Kazakhstan, when the astronauts return to Earth in a Russian Soyuz. I ended the day with a meeting on disaster preparedness plans for the upcoming hurricane season, where we planned how we would convert an occupational health clinic to a thriving emergency department, something we have done twice before. Do I miss emergency medicine? I still practice emergency medicine. I just don’t practice it the same way I used to – some of my patients happen to be 260 nautical miles above the planet.
For the most part, emergency medicine in space is similar to emergency medicine on the ground. Flight surgeons handle foreign bodies in the eye, tooth pain, rashes, cuts and scrapes in space much the same as they would in the fast track of any urban ED. We have ultrasound capability and make frequent use of telemedicine to guide the non-physician astronauts on routine urgent care issues. That said, there is one small yet critical element to space medicine that complicates even the simplest procedure: that lack of gravity.
On the ground, we still have shortness of breath and chest pain patients in the NASA clinic. We still sew up lacerations and perform FAST ultrasounds on trauma. But admittedly, our volume is not very high thanks to an aggressive and robust preventive medicine program.
Emergency medicine plays a large and significant role in the planning, training and execution of all space missions. From support of launch and landings, to the on-orbit care, emergency medicine is sewn into the very fabric of what we do. Planning for future missions beyond Low Earth Orbit will involve training astronauts to handle emergencies without the aid of mission control, and may include trained emergency physicians on exploration missions.
I often have to remind residents that emergency medicine is a profession, not a room. The definition of an emergency physician is not limited to that individual who is being bludgeoned with 65 critical patients on a night shift and hoping those step-down beds will open up. Emergency medicine takes place on mountain tops, under the sea, in the air and in space. I used to have a mentor who would tell residents that “the sky’s the limit” for their career in emergency medicine. But now I know even he was thinking too narrowly. The sky has already been breached and EPs will have to set their gaze even higher.