Source: BBC
By Richard Hollingham
The International World Extreme Medicine Conference in London is not for the faint-hearted.
As I sneak into the back of the main lecture hall, record-breaking polar explorer Sir Ranulph Fiennes is in full flow – vividly describing the state of his companion’s frostbitten foot during an Arctic expedition. Fiennes details how a plate of rotten skin peeled away in his friend’s boot exposing the nerve ends. There are pictures. Even some of the hardened medics in the audience have to look away.
Sir Ranulph has travelled to the ends of the Earth to tackle the coldest, highest and most dangerous environments. Several times he has barely lived to tell the tale – suffering starvation, sickness and the loss of fingers to frostbite, some of which he amputated himself.
On the ISS, astronauts are a short ride away from life-saving attention – but what if they were halfway to Mars? (Credit: Nasa/SPL)
This ability to improvise, treat injuries, illness and even perform surgery in extreme and isolated conditions has been a mainstay of explorers for centuries. And, as space agencies contemplate missions to the Moon and Mars, the next conference speaker is concerned with emergency medicine at the final frontier of exploration.
“I guess I’ve been compared to Dr McCoy from Star Trek – it’s quite flattering,” confesses Michael Barratt, medical doctor and Nasa astronaut, when I talk to him after his lecture. “But we’re not yet at that point where we have a large enough crew or are far enough away to have a dedicated medical officer.”
‘We can stabilise someone who has a dramatic injury but we can’t sustain a patient for long’ – Michael Barratt
In fact you can forget any images you might have of pristine space sick bays with comfy couches, flashing lights or medical probes that make futuristic squiggly noises. The medical facilities on the International Space Station (ISS) are positively primitive – with about the same level of equipment as a typical public swimming baths.
“It’s very much what a downgraded paramedic might have in his kit,” says Barratt. “We have a defibrillator, a small ventilator and some emergency drugs so we can stabilise someone who has a dramatic injury, but we can’t sustain a patient for long.”
Space sickness
Fortunately, the medical problems experienced by successive ISS crews have not been life-threatening. Only one astronaut, Italian Luca Parmitano, has come close to serious injury after nearly drowning after water leaked into his helmet during a spacewalk. There are, however, plenty of routine issues unique to the space environment. As well as longer-term challenges, such as muscle and bone wastage, astronauts living on the ISS report a number of medical complaints.
Will future Moon bases need their own hospitals? (Credit: David A Hardy/Science Photo Library)
“We see our own brand of motion sickness, back pain, vision changes – actual changes in the optic nerve and retina of the eye,” says Barratt. “The immune system changes, fluid regulation changes…and all these changes have a set of medical issues that might happen to you.”
Because the ISS is only around 400 kilometres (250 miles) above the Earth, the policy is to pack seriously sick or injured astronauts into a Soyuz spacecraft and get them home as quickly as possible. “Within hours we can have someone in a care centre back on Earth,” says Barratt. “It becomes a more dicey question if you want to go further, if you’re in a spaceship on your way to the Moon or Mars.”
‘If you have a vein that’s leaking, surface tension will cause the blood to adhere to the surface you’re operating on’ – Michael Barratt
To investigate the challenge of emergency surgery in deep space, there have been several zero-g surgery experiments. As far back as 1991, when engineers were planning to fit the space station with a fully equipped sick bay, surgeons carried out operations on anaesthetised rabbits during zero-g parabolic aircraft flights.
The results were not pretty
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