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Health of space explorers is a requisite for success of human exploration missions and, potentially, for return of explorers to Earth. Continuous, long term existence and complex, potentially hazardous tasks in space environments will challenge health of explorers. Immediate return to Earth will not be possible. Health care systems are being designed to address these concerns, starting from the requirement to maintain health of crew members throughout all mission phases, and the assumption that clinical (medical), preventive, and occupational health care will be necessary in space as on Earth. Systems for medical care, health monitoring and countermeasures, and environmental monitoring and countermeasures are being designed. Basic system definition concepts include an individual crew member, a crew surgeon, remote consultation, equipment, and work area or volume within space habitats that is dedicated for health care.

Exploration of the solar system has captured the imagination of scientists and artists for centuries. The U.S. and other space-faring nations now plan to take the first step by examining the requirements for a human mission to Mars. A three-year journey to Mars will test the limits of our technical and human experience. Maintenance of crew mental and physical health is of utmost importance to mission success. Several critical technologies must be developed to enable healthy and productive crews during Mars missions. The technology development process must begin now, by identifying technology and research requirements, so that the necessary systems are ready when the decision is made to leave Earth and travel to Mars.

Human missions to Mars will represent not only a departure from the relative protection and proximity of low Earth orbit but also the way space missions are currently conducted. Traveling at 180,000 miles per second, radiofrequency communication will require up to 20 minutes to reach Mars from Earth. Extended periods of communication blackout may leave the Mars-nauts without Earth contact for weeks. Crews will be on their own to recover from mission complications, including serious crew member illness or injury. These conditions dictate unique applications of telemedicine.

As a more permanent human presence in space is established during future missions, crew health issues will require additional attention. Since a physician will not be a part of most crews, the flight surgeons will require more clinical information than can currently be provided to regularly assess crew health status and direct medical treatment. The Telemedicine Instrumentation Pack (TIP) is being designed to enable the Crew Medical Officers (CMO) in space to acquire the necessary medical information for telemedical consultation with the flight surgeons in the Mission Control Center (MCC). To date, two prototypes of the TIP have been developed, with the first being clinically evaluated in a local telemedicine testbed in the Fall of 1994 and the second prototype being recently completed. The current system concept, progress in the development of the system, plans for future development, and the evolution of the system are described.

NASA flight surgeons have routinely relied on telemedicine to augment inflight medical care since the Gemini program. The current telemedicine capability aboard the Space Shuttle is limited to two-way voice communication, one-way video, and telemetry of ECG and spacecraft parameters. This capability has been sufficient to manage the routine minor medical problems that have occurred in-flight, but long-duration Space Shuttle and International Space Station missions are likely to be accompanied by more serious medical contingencies. In the event of emergent crew health problems, NASA flight surgeons will require an improved capability to provide a rapid, accurate assessment of an ill or injured crewmember. Onboard systems will supply flight surgeons and medical specialty consultants with real-time voice communication, medical video, and data.

During Space Shuttle missions, telemedicine is used daily to ensure the health and productivity of the crew. NASA has incorporated telemedicine into routine space operations since the beginning of the space program, utilizing its experience in advanced satellite communications to assist in providing terrestrial health care during several telemedicine projects. Telemedicine is a technology with promise for improving access to health care on Earth, and numerous terrestrial telemedicine programs are currently underway. NASA and the terrestrial health care community have important roles to play in telemedicine technology development, and each stand to benefit greatly from the other's telemedicine experiences.

The practice of space medicine is fraught by several unique challenges, including limitations in spacecraft resources and limited medical training opportunities. The great distance separating the astronauts from their doctors on Earth further confounds managing their health. NASA uses computer and telecommunication technology to bridge this distance and practice telemedicine. Since the beginning of the U.S. space program, NASA flight surgeons have relied on two-way radio communication and limited biomedical telemetry to remotely assist the crew in managing crew health matters. More recently, the capability for bi-directional video transmission was added, to enable the crew to speak virtually face-to-face with their doctors. However, for the International Space Station (ISS), additional capabilities must be provided. This paper presents a vision for delivering telemedicine in the ISS era.