In orbit, the human body changes in unexpected ways
All astronauts must go through rigorous medical training to prepare for space. They need to know that, say, if a fellow astronaut experiences chest pains on a spaceship en route to Mars, a crew member must ultrasound their heart — which will look oddly spherical compared to a heart on Earth. NASA’s medical training, however, is complicated by the very limited data on astronaut health. Only a few hundred people have ever been to space, and even fewer have been on long-duration flights. To prepare astronauts for completely new medical scenarios they might encounter while in orbit, NASA is turning to video games.
The space agency’s Human Research Program, together with an academic consortium called the Translational Research Institute for Space Health, or TRISH, partnered with the medical video game company Level Ex in August 2019 to provide simulated training for the human spaceflight program. The initial grant, which will provide an undisclosed amount of funding for 12 months, will help Level Ex develop a training framework for all active astronauts. Level Ex’s existing phone-based games for doctors and nurses, like Pulm Ex (for pulmonologists) and Airway Ex (for anesthesiologists), are first-person shooter-style games that realistically simulate the interior of the human body and are based on real case studies. Players enter parts of the body, such as intestines and blood vessels, to perform tasks like eliminating growths, suctioning mucus, and managing bleeding.
Level Ex’s high-fidelity simulations will depict how it feels to operate on a real person in space, where bodies function differently because of microgravity: Hearts change shape, organs shift around, bladders act strangely, and some medical risks increase. Simulating the communication delay between Earth and space — one second between Mission Control in Houston and the ISS, or up to 40 minutes between Earth and Mars — adds an element of time pressure to the game meant to mimic the urgency of real-life space medicine. While these simulations aren’t meant to replace current medical training, they can act as a supplement and refresher for crewmembers who are already in space or for future astronauts.
“We’re looking for research innovations in personnel and a process that would enable astronauts in space to have countermeasures to the risks that we know they’re going to face to their health. And also to rapidly respond to medical scenarios should that come up,” says Dr. Aenor Sawyer, a University of California, San Francisco orthopedist and TRISH’s chief medical officer.
TRISH is made up of a group of scientists from Baylor College of Medicine, California Institute of Technology, and the Massachusetts Institute of Technology whose primary job is to translate terrestrial medical training and technology into innovations that can be used in space. “We get to landscape a lot of the cutting-edge research and innovation going on in managing health and medical scenarios,” says Sawyer.
“You don’t want to deal with an appendix infection on Mars.”
NASA astronaut Terry Virts, who spent over 200 days in space on the Space Shuttle Endeavor and the International Space Station, says of Level Ex, “I do think that would be very helpful both for training and actual execution because even if you’ve trained it’s likely been a long time, so everybody is going to be a bit rusty.” Virts was the medical crew chief on all three of his flights to space and was trained before such simulations were available. “I went to a hospital in Houston for a week and I worked in the OR and in the ER. People would come in presenting basic ER type of problems. One guy had a giant chunk taken out of his arm and I was able to stitch him up, and there were other burn victims from local oil and gas facilities.” Current astronauts still do hands-on training in hospitals and at Johnson Space Center in Houston, where NASA staff volunteer to be guinea pigs for the crew.
But one of the outstanding challenges for Level Ex and NASA is understanding how bodies change in space over long periods of time and in different conditions. “Our terrestrial game levels are based on real patient cases submitted by doctors around the country,” says Level Ex founder and CEO Sam Glassenberg. “When we’re talking about space, we don’t necessarily have real cases for all of the scenarios that we’ll be addressing — some of them haven’t happened yet on the ISS.” Until that data is collected in real-life missions, his team relies on NASA’s modeling of how crew member health can go awry while in microgravity or zero gravity.
Sawyer is also using her research expertise to advise Level Ex on training players to perform remote medical intervention. To develop these training techniques, Sawyer has worked as a medic for athletes like Roz Savage, a record-setting rower who crossed three major oceans alone. Like astronauts on Mars, long-distance rowers experience a similar time delay when communicating with medical staff while in the middle of the ocean. Sawyer has worked with these athletes on emergency medical training in instances when it could be many days before anyone can reach them; in those situations, the ability to self diagnose is vital.
One of Level Ex’s goals is to create a training system that involves minimal equipment to avoid overburdening spacecraft with extra weight. “We need to be able to train them using the hardware they already have on the spacecraft, be that tablets or future AR/VR hardware,” says Glassenberg.
Looking toward Mars, Virts suggests that astronauts also start training for preventative medicine, like removing wisdom teeth. If humans are headed into deep space for the long term, they’ll have to be prepared for medical emergencies of all kinds. “These are the types of random incidents that are not likely to happen, but are not impossible either,” says Virts. “Especially the appendix. You’ve just gotta get that out. You don’t want to deal with an appendix infection on Mars.”
