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What's It Like To Practice Medicine On Mars?

Podcast: Live from the Hab, hear from the 2Mars crew

minute read.

Written by Chris Casey on June 20, 2019

INSIDE ‘THE HAB,’ MARS UTAH – When it comes to medicine on Mars, or even on a spaceflight to the Red Planet, “definitive care” means something very different than it does on Earth. Quite simply, it means that nobody is coming to help the crew tend to an injured or ill astronaut.

Ben Easter, larger portrait

Ben Easter is an Assistant Professor of Emergency Medicine at CU Anschutz and works at NASA.

This was one of the more profound lessons students learned as part of a new Maymester course co-created and co-led by medical and engineering experts at CU Anschutz Medical Campus and CU Boulder. “Medicine in Space and Surface Environments” unfolded over three weeks in early May, with the last week taking place in the desolate surroundings of the Mars Desert Research Station near Hanksville, Utah.

The course is chock-full of simulation exercises that forced students to work as a unit and solve problems during fast-developing medical emergencies that could occur on Mars. The class is the brainchild of Ben Easter, MD, Assistant Professor of Emergency Medicine in the CU School of Medicine, and Allie Anderson, Assistant Professor of Aerospace Engineering at CU Boulder, in collaboration with other colleagues.

Arika Armstrong, an aerospace graduate student as well as an engineer for Lockheed Martin Corp., was among the 21 CU Boulder engineering students enrolled in the program. Taking a rare break from the rigorous slate of simulation drills – or extra-vehicular activities (EVAs) – Armstrong joined instructors Anderson and Easter for a candid chat about the class and space exploration.

The trio from the 2Mars crew sat down with CU Anschutz Today inside the Hab to record a podcast about this unique and innovative collaboration, one that positions CU Anschutz and CU Boulder as leaders in training some of the first of a new breed – first responders for deep space.

 

The ‘serious business’ of sims

Allie Anderson, larger portrait

Allie Anderson, co-teacher of the new Maymester class, is an Assistant Professor of Aerospace Engineering at CU Boulder.

Because so much of the “Medicine in Space” class is focused on real-world training, CU Anschutz Today asked Arika Armstrong, an aerospace engineering graduate student, to elaborate on the simulations and their impact on her. Here are her thoughts:

Was there a moment during your week in the field where it dawned on you: “Wow, these simulations really are serious business.” If so, what triggered that moment?

The search-and-rescue EVA was the event where I realized these simulations were serious business. I was part of the group that found most of the patients during that EVA. We were down in the bottom of a canyon with a patient who was mostly unresponsive and another patient who was lunging herself at other crewmembers because she was worried. This ended up with an incredibly realistic scenario regarding patient management. What really triggered it for me though was when I realized we were going to have to carry this guy out of the canyon on a makeshift stretcher, and we had no idea how far it was to the road where the rovers would be able to pick him up.

What was your role during the search-and-rescue EVA and how did your learnings help you grow into the rest of the week’s simulations?

Personally, I primarily helped to calm a panicking and asthmatic patient and helped carry out another patient on a stretcher. I learned a lot in that simulation. For example, communication is incredibly difficult with 20 to 30 people, and it's really important to keep track of every member of your team. More than anything, that simulation gave me a glimpse of how hectic a similar “real-life” situation might be, and it helped prepare me, mentally, for the simulations to come. I realized I needed to refine my communication methods, speak up when I noticed a hazard or issue, and stay calm despite any chaos around me. I continued working on those skills through the remaining EVAs.

What, in general, was the strangest or most profound thing that happened during the class and why? 

I think one of the most profound experiences of the week was an EVA where two unresponsive patients required significant resuscitation once they were returned to the Hab. What made this stick out in my mind so much was the need for us to consider stopping. All prior training told us to “keep going until the patient is under definitive care.” Unfortunately, “the Hab” is your definitive care on Mars – there's nobody else coming to help you. The discussions about whether or not to continue were really insightful and provided a very important lesson.

 

Fun in Mars class

 

Not every moment of the "Medicine in Space" class was serious business and intense simulations. Students enjoyed many light moments during meals and in the classroom, as seen here in the Science Lab.

 

Photos by Matt Kaskavitch, director of digital engagement, Office of Communications at CU Anschutz.

 

Episode Transcript

Chris Casey Welcome to CU Anschutz 360, a podcast about the CU Anschutz Medical Campus. We feature faculty, staff and students on our campus and their interesting and innovative work. Today, we're in the desert of Southern Utah meeting with members of a Martian crew during a rare break from their rigorous training exercises. They're participating in a new Medicine in Space Maymester course, which is a collaboration between the School of Medicine at CU Anschutz and the Department of Aerospace Engineering Sciences at CU Boulder. So, let's go around the habitat building and introduce you to a few of the members of the ‘To Mars’ crew.

Erika Armstrong I'm Erika Armstrong. I am a distance graduate student at the University of Colorado Boulder in the aerospace engineering sciences program.

Allie Anderson My name is Allie Anderson, and I'm an assistant professor of aerospace engineering and an adjunct professor in physiology at the University of Colorado Boulder.

Ben Easter My name is Ben Easter. I'm an assistant professor of emergency medicine at the University of Colorado School of Medicine.

Chris Casey Ben and Allie, you're co-teaching a class here. It's called Medicine in Space and Surface Environments, and this is on a very different kind of campus compared to what you're accustomed to, say at CU Boulder, CU Anschutz. Describe why this structure we're sitting in here as well as the landscape around this structure here in Southern Utah are perhaps an ideal environment for teaching a class on this subject.

Ben Easter So we are currently sitting in the Hab at the Mars Desert Research Station on campus outside Hanksville, Utah. This is a Mars simulation research facility that's used by crews to study any aspect of a possible mission to Mars. There's a habitat, a science lab, multiple observatories, and then opportunities to perform extravehicular activities, or EVAs, to go out and explore the Martian environment.

What we were really looking for with our course was an opportunity to get outside of the classroom and really put students into a simulated environment to gain some experience of what these lessons will be like in the real world.

Allie Anderson And especially for these engineering students, we're trying to use these simulation-based mechanisms, which are not typical in our curriculum, but it's sort of a technique drawn from medicine. And that's really the emphasis of the class, so it's kind of the perfect environment to really study that.

Chris Casey How does the offering of this class tie into the much larger goal of making space exploration safe and feasible for humanity in general? You know, that seems to be the overarching long-term goal.

Allie Anderson The students that we have here are all engineering students, but who are dedicated to moving human space flight forward. In whatever capacity that they can. And so, the emphasis is really on trying to be interdisciplinary and having them learn - what operations is really like, what biomedical engineering is really like, and what medicine is really like, so that way they can take that and turn that into a better engineering practice for them later to help contribute to human space flight.

Ben Easter Just to add to that, though I work at Anschutz as an emergency physician, the other portion of my job is actually working at NASA as a physician. And unlike a hospital, NASA is an engineering organization, and as someone with medical or health care training - you are certainly in the minority when it comes to your expertise. So, this course was really about bringing those two disciplines together to improve what we can accomplish in human space flight.

Chris Casey Speaking of the inevitable time it seems that humans will venture to Mars: what are some of the key challenges of aerospace medicine as they apply specifically to Mars?

Ben Easter The most significant is the distance from Earth that Mars is. It sounds simple to say, but it really is the challenge. Though we think of the International Space Station as being really far away from Earth, it's really only a few hundred miles above the surface of the earth.

And in a really bad situation, from a medical standpoint: we could have the crew back home on Earth and potentially within a hospital within a matter of hours to days, depending on the situation. When we talk about going to Mars, we're talking about transit time of maybe six to nine months in a multi-year mission. And whatever resources we take with us when we leave Earth are what we're gonna have with us for the entire time period of that mission. We're not gonna have any ability to evacuate, and probably minimal to no ability to resupply.

So when we think about how we need to design and scope a medical system for that mission, it really needs to be much more comprehensive than what we have in our current paradigm with the International Space Station.

Chris Casey I understand that as the class has unfolded this week, Allie - I understand you taught a lecture on the biomechanics of space suits?

Allie Anderson Yeah (laughs). In fact, I taught it twice (laughs).

Erika Armstrong (Laughs)

Chris Casey (Laughs) And how they perhaps cause astronauts to possibly tire more easily than necessary, or just perhaps are more clumsy to them than are necessary. So I'm curious: what are some other examples of how aerospace engineers can help advance and improve aerospace medicine?

Allie Anderson So just as an aside, I was laughing about the EVA lecture because I used that lecture to trick the students twice...

Erika Armstrong (Laughs)

Allie Anderson ...To surprise them with some EVA simulations that we did. So that's what that comment is derived from (laughs). A lot of the medical issues that are going to happen in long-duration missions, say to Mars, are really because we are putting healthy humans into an extreme environment that is an engineered environment. We need to design technologies that can measure and mitigate some of those medical issues. I think that that's something that a lot of these students hadn't really thought about before, because it's not part of traditional aerospace curriculum. 

At CU Boulder we have a bioastronautics emphasis and all of these students are kind of interested in that aspect of it, so we kind of really opened their eyes to what some of those challenges are. But really - looking at medical device development, looking at designing a spacecraft environment that is healthy for humans, and designing countermeasures such as exercise devices, that can help us mitigate physical issues that astronauts might have.

Chris Casey Now I understand another course that you folks teach out here are courses for healthcare professionals, and they come out and do simulations as well. So for both of those, health care professionals and students, the goal seems to be to teach them the challenges of an operational environment - put them through practical simulations and situations and emergencies that could happen in space. I'm just curious, why are these exercises so important to the program?

Ben Easter Much of the training that physicians - and I think many engineers have - certainly the initial part of it is in the classroom, and then on the medical side maybe in a hospital, on the engineering side maybe in a lab. And it can be very difficult to envision some of the challenges of a real-world operational environment when you are working in that type of situation. 

When patients come into the ER to me - paramedics have already seen them, they started an initial work-up, they have an IV line that's already in place, they already have a set of vital signs that paramedics have already started to identify the problem. And so, I get a patient who's already very nicely packaged and someone has already started to think about and diagnose and treat that patient. 

What I've missed is the entire situation that the paramedic has learned in the field of seeing the scene of the car accident or what the weather was like, or seeing what a patient's home might look like and what the dynamics were with their family.

By way of analogy, we're trying to do a very similar thing here, which is to take that learning so it's not just happening in the classroom, or working on a project is not just theoretical or testing that happens in a lab. But to actually bring folks out and show them what the challenges are of having 10 people on an EVA working on a single radio or communications frequency. Or how difficult it is to navigate in unknown terrain, even if you have something like a GPS unit. How do you prioritize multiple different issues or challenges within the scope of an EVA, and how do you work on a team? 

Those are all challenges and lessons that you can get from an operational environment that I think are very difficult to get from a classroom.

Chris Casey Great. And so Erika, as one of the students who's gone through many of these EVAs (laughs) this week, I'm curious: just what have you thought of these? And what's been your big takeaway from going through these multiple simulations?

Erika Armstrong Honestly, the biggest thing is it's just been a ton of fun. This is really an opportunity that you don't get anywhere else. I haven't seen any other classes like this at any other schools. A neat thing to see has been watching the students in the class, myself included just grow and change over the course of the week. The best example that we talked about on it today was the first EVA that we did as a full class, we had 21 people-plus on comms, and it was a disaster (laughs), everyone trying...

Chris Casey (Laughs)

Erika Armstrong ... to talk to each other, and we couldn't get anything through because the comms were cluttered with a bunch of extra information. 

And today we did two of them almost flawlessly as far as comms go, at least. Just picking up on small things that we've learned from our classmates and from the instructors and being able to have the chance to incorporate those over multiple EVAs over a week has been a really awesome opportunity.

Chris Casey Have you ever been through a course of this nature where you notice things just building in a very hands-on way like that?

Erika Armstrong Not at all, especially not in the hands-on nature. You know, you dive into the first one kind of head first and at the deep end, and you think: "There's no way I can figure out how to do this. It's gonna be like this the whole week." Then by the end of the week you've learned a lot, you've figured out quite a bit. And I think by the means of that hands-on nature it gives you the opportunity to really put those new skills to the test. That's really what helps reinforce what you've learned in this class I think, is the hands-on EVA. Just that ratcheting up of the simulations.

Chris Casey And you guys have also dealt with a fair amount of...

Erika Armstrong (Laughs)

Chris Casey ... weather adversity this week.

Allie Anderson (Laughs)

Chris Casey We can't let that go...

Erika Armstrong Only a little bit, yeah (crosstalk).

Chris Casey ...by the wayside. How has that been, and has that done anything to the experience for you?

Erika Armstrong It's added to it for sure. We keep talking about these isolated extreme environments, and what better than to throw a group of 21 college students out in the rain and the wind and the cold and have them figure out how to deal with it (laughs)?

Chris Casey Yeah (laughs).

Erika Armstrong We came out to Utah in the middle of May expecting 90 degree weather. Instead we have rain and forties, and we had to figure out how to make that work. And we did. We absolutely did. I think the second night here we had multiple tents blow down, and so one by one we put them all back up and we survived the week (laughs).

Allie Anderson It's one of the most awesome team-building experiences...

Erika Armstrong (Laughs)

Allie Anderson ... we didn't even plan for it.

Multiple people (Laughter)

Chris Casey Yeah, it's impressive how all of you seem to have really come together, because we've been here several days with you and it's really been very impressive to see how the teamwork dynamic has evolved a bit. 

Ben, you're part of the Human Research Program through NASA, which is responsible as I understand for looking at the risks of putting humans into space and doing research to minimize those risks. Can you put into words - how do you do that? Buy down those risks?

Ben Easter Yes. So within the Human Research Program I actually work for a group called Exploration Medical Capability. Which handles a number of those different risks, but probably most predominant among those is: the risk of developing acute medical conditions during flight. 

I think one of the really interesting things about this course is that - our approach to handling that risk is actually not an approach that comes from medicine, despite our training and the clinical bent of that group at NASA. It's an approach that comes from engineering called probabilistic risk analysis.

The way we use that is we take medical subject matter expertise and then use this mode of analysis that's really common in engineering so that we can translate that expertise coming from clinicians to the language of space flight and the language of NASA. Which is predominantly an engineering language. 

So, it's been very important for me personally and for our group to learn how engineers think and talk about risk and buy down risk to be able to do that - that translation from medical expertise to the language that the rest of NASA is using.

Chris Casey And I heard that somebody commented this week that a large part of this course is, by nature, blending medical speak with engineering speak.

Allie Anderson Absolutely.

Chris Casey Just finding a balance. Would you agree with that?

Allie Anderson Absolutely. I mean, Ben and I and the other instructors have known each other for a couple years, and this has been sort of stewing for a while, building from some classes like you mentioned that they had already done with medical doctors. 

And I think that we all see very, very much the need for that interdisciplinary crosstalk, cross-training between the different groups, and I think that that was really the motivation for us to go ahead and kind of commit to doing this. Because we weren't sure if it was gonna work (laughs). I think that it's actually been very successful, and I can really just see just how much the students have learned. I've had students come up and be like, "Well, now I'm thinking about medical school or biomedical engineering," you know?

Multiple people (Laughter)

Allie Anderson And it's sort of opening their eyes to things that they didn't realize they could work on as aerospace engineers. Everyone who's here is really passionate about human space flight and interested in solving those problems, and kind of realizing that actually you can bring in a lot of different disciplines to work on the same challenges.

Chris Casey As I understand it with the courses that you've done exclusively for the healthcare professionals, the doctors who've come here to the Mars Research Station for training - they've come from all over the world. So what does that tell you about the level of interest in this kind of training?

Allie Anderson Mm-hmm (affirmative).

Ben Easter Yeah, we have had folks come from all over the world. My favorite story is of an Australian ICU physician who his wife bought him a continuing medical education course here as an anniversary gift.

Multiple people (Laughter)

Ben Easter So that was a real compliment to me and the other instructors that set it up (laughs). That a normally very dry thing, continuing medical education, was actually something that was worthy of being an anniversary gift.

Multiple people (Laughter)

Ben Easter So, we got a pretty good chuckle out of that.

Allie Anderson What do you think, Erika? Do you think it's gone over well for the students?

Erika Armstrong I think so, yeah (laughs). It's been a lot of fun for everyone here.

Chris Casey And do you think there will be no problem gaining interest for students to continue to enroll in this course going forward?

Erika Armstrong No problem at all. I had people asking me already before the class even started if Allie was gonna do it again next year (laughs).

Ben Easter We're just gonna have to somehow keep all the students quiet about what exactly the scenarios were that we threw at them, 'cause we don't want the secret sauce getting out.

Multiple people (Laughter)

Allie Anderson No one's gonna trust me anytime I give an EVA lecture. They're just gonna be like, "Yeah, right."

Erika Armstrong Allie's lying to us. There's no way.

Multiple people (Laughter)

Ben Easter Even in Boulder they'll just be like, "Uh, something's coming."

Erika Armstrong Yep.

Allie Anderson Right. Yeah, even when we go back.

Chris Casey I'm curious: I thought I heard some banter back and forth about the names of these EVAs. Do you guys sit around and come up with creative names for these EVAs as well?

Multiple people (Laughter)

Ben Easter So Rick Cole, who has been a mentor of mine, is an emergency physician and flight surgeon at NASA and has been involved with our physician course, and was here earlier this week. Rick is a pretty prolific namer of things.

Multiple people (Laughter)

Ben Easter

There's a lot of clever names around. 'Tim's Peak' is actually a little bit of a pun, because one of the first times we were out here, Tim Peake, who is a British astronaut, was actually flying on the International Space Station.

Chris Casey Okay, okay.

Ben Easter So we climbed to the top of this outcropping and Rick had the great idea of naming it Tim's Peak.

Chris Casey Okay. Yeah, that's one of the ones I thought I heard, an EVA called Tim's Peak. Which one was that, by the way? Or did you do the Tim's Peak EVA?

Ben Easter We got it done with one group early in the morning, and then unfortunately we had some weather and lightning roll in, so we were not able to accomplish it with the second group, unfortunately.

Chris Casey Okay (laughs).Well, so Ben, with the work with NASA and the human exploration medical capability where you're the deputy element scientist, there's a lot on your plate - and the problems you're looking at are pretty enormous. I'm just wondering, any of these keep you up at night?

Ben Easter

The answer is certainly yes. So I think by far the largest one we work on is the one I was referring to earlier, which is the acute medical conditions that occur in flight.

Chris Casey Oh, okay.

Ben Easter But fortunately, the Human Research Program has this very broad, set of folks who are working on these problems for us. These are folks working at NASA, and then external or extramural, funded researchers, like Allie is, who are actually doing a lot of the work, and then at the Human Research Program level we're kind of coordinating a lot of this external work and providing scientific direction. But fortunately, there's fantastic teams and CU Boulder is certainly one of the leaders in the world in this field of doing the actual research and work that's helping NASA to buy down those risks.

Chris Casey And these are just a couple observations just about space flight in general that I thought all of you might have a thought or two on. So, I was reading that Richard Branson of Virgin Galactic has said that he thinks one of the beauties of space exploration is how it brings humanity together. And I'm curious if you all agree or disagree with that and why.

Allie Anderson I absolutely agree with that, and I think that if you speak to any astronaut about their experience viewing the world from that position, I think you'll unequivocally hear the same. We've seen time and time again (laughs) how international cooperation is facilitated by building these large engineering structures that are complex systems in space, and they have to be maintained because lives are on the line - despite whatever international tensions that we might have. And I think that the more we sort of use it as a mechanism to bring us closer together, the more successful that we'll be in doing amazing feats for human space flight.

Erika Armstrong Space is...it's one of those things that's far off, far off in the distance, but it's still cool. And everyone, pretty much everyone, agrees on that point. Watching the first Falcon Heavy rocket land on the pad with the two boosters come down - my entire office was cheering. It's just stuff like that brings all these groups together no matter what their background is or what they do. Everyone agrees that this is something that's worth looking into. It's definitely interesting in that sense.

Ben Easter I obviously agree as well. I think that as humans we have an innate sense of exploration and desire to climb the next hill and see what the view looks like from the top of that mountain or across an ocean. And now that frontier has become space, become the moon, and eventually on to Mars. And I think something about working together to accomplish those goals just satisfies something within us as explorers.

Chris Casey And that dovetails right into the next thing. Branson had said, and I think it's very applicable to this group, is that when you set off on important adventures, exceptional people come forward to join in the journey. And here at the Mars Desert Research Station it seems as though that's what's taking place to me - from an outside observer just stepping in and looking around what's happened here. Would you guys agree with that?

Allie Anderson I think in addition to the idea that there's an exceptionalism, what I also see and what I think we've definitely seen this week is that it helps people find what it - this is gonna sound so cheesy, but it's true-

Multiple people (Laughter)

Allie Anderson ... that it helps them find what is exceptional about themselves. You see some students who were almost fearful of a leadership position - over the course of the week say, "Yeah, I want to do that. I want to take charge, because I know that I'm needed right now." And I think that that's another reason why the experiential learning is so important.

Erika Armstrong I know I've seen that as well. And just being able to share that learning and those experiences, and learning over the course of the week how to apply that to these new situations. And the skill that you gain doing that is definitely something that can be said for a situation like this as well. So, not only that exceptionalism, but also the ability to take what you've learned and apply that in these new ways and it's cool to see how that's evolved over the week.

Chris Casey What's the first thing all of you are gonna do once you're out of here at the end of the week?

Ben Easter (Laughs)

Erika Armstrong Shower.

Allie Anderson Shower.

Multiple people (Laughter)

Ben Easter I'm gonna hug my dog. (Laughter) She'll appreciate not showering.

Chris Casey Thank you all so much. It's been a real pleasure for us to be here. Thanks for letting us come in.

Ben Easter Yeah, thank you guys for coming.

Allie Anderson Yeah.

Chris Casey Well, we've really enjoyed it and look forward to seeing you guys shooting off in a rocket to space someday.

Multiple people (Laughter)

Allie Anderson Great, thank you.

Erika Armstrong Thanks.

Ben Easter Thank you.

Disclaimer: Transcripts are generated using a combination of speech recognition software and human transcribers. It may contain minor differences from the audio, including some edits for clarity in print. Please check the recording and with the Communications team before quoting in print.