This study had the following specific aims:
1. Identify objective measures of non-technical skills that enhance crew management of in-flight medical emergencies.
2. Develop a simulated spacecraft medical bay, and run a series of simulation scenarios to measure crew behavior during high acuity, low frequency medical emergencies.
The key finding in specific aim 1 was development of a non-technical skills taxonomy and objective measurement tool called ASTRONOTSS that identifies the essential astronaut crew behaviors for effective medical emergency management. This includes a set of objective measures for onboard training of the specific skills that enhance crew cohesion, performance, and safety when faced with an unanticipated medical emergency in flight. The expert panel recommended developing separate skills taxonomies for each medical event. This allowed investigators to identify common behavioral skills across medical events which were: (i) Situation Assessment; (ii) Crew-Ground Communication; (iii) Stress Management; (iv) Team Coordination; (v) Calling for Help; (vi) Conflict Management; and (vii) Leadership Transition. Investigators were also able to gain consensus on other LDEM specific features relevant to in-flight medical care such as training of Crew Medical Officer (CMO), the duration of training, crew composition, inflight versus ground training, just-in-time training, measurement scale for behavioral skills, and retention/ decay of skills training.
The key finding in specific aim 2 was development of a simulation-based training platform to replicate the spacecraft environment and provide crews with valid medical emergency scenarios on which to gain experience. The investigators built the simulation platform at the STRATUS Center for Medical Simulator at Brigham and Women's Hospital in Boston. They also set up a simulated Mission Control desk to include interactions of the in-flight crew with Capcom and the flight surgeon, which allows them to focus on the key behavioral skills required for effective communication between crew and the ground. During this process investigators identified the main technological requirements to set up a spacecraft medical simulator with sufficient fidelity for training drills in medical event management. To demonstrate the capabilities of the simulator and for the purpose of reliability testing, investigators storyboarded, scripted, and filmed four diverse potential medical events: Cardiac Arrest, Toxic Exposure, Eye injury and Pneumothorax. The investigators incorporated input on space and medical contexts from expert panelists to ensure the scenarios were clinically relevant and authentic.
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