The past year has shown that medicine and medical treatments aren't necessarily confined to the doctor's office. Even as a pandemic shook the world, telemedicine and AI technology helped to ensure people got the care they needed.

In the future, medicine might be even smarter. We could check our blood for infection from the comfort of home. Rather than racing a dehydrated patient to the hospital, we could find a tap and turn plain water into sterile IV fluid. Whenever and wherever we are, medical imaging tools could scan our bodies and send automated read-outs to human and AI medical experts anywhere in the world (or worlds).

That's the dream for someday on Earth. But it's already starting right now in space, where aerospace medicine is laying the groundwork for the healthcare of tomorrow — hundreds of miles above ground.

Generation Space Health

Healthcare innovation has been trickling down from orbit for as long as humans have been rocketing up toward it. As part of NASA's mandate, the organization both funds research and shares its discoveries with the public. A very large number of discoveries have made it possible to safely go to space and back. In the 63 years since NASA's inception, thousands of patents have launched into successful and life-sustaining patient-facing products.

In order to land on the Moon in 1969, NASA invented digital image processing. That technology was later shared and integrated into a number of devices, including MRI machines and CT scanners. A generation or so later, the Hubble space telescope's ability to see fine detail at high resolution spun off into a company that made breast biopsy imaging devices. Rather than just looking out, NASA's technology now looks in to pinpoint possible tumor locations. It also lays at the heart of a series of programmable pacemakers, robotic surgery tools, suture material that can hold an organ together — and currently runs through cables on the International Space Station (ISS).

This high-end healthcare innovation is life-saving but requires something hard to come by on Earth and even harder to find off it: hospitals. In the United States, hospital transit times by ambulance can be measured, from some rural communities, in hours. In bad weather, transport can become impossible. In developing countries and isolated communities, hospital care isn't an option. In low-Earth orbit, where humans have been living continuously for twenty years, there has never been a hospital. Astronauts in medical distress are evacuated back to Earth.

The concept of "stabilize and transport" works well in space and on Earth only when the patient can survive the trip and the trip is short. Beyond the moon, transport times to a hospital back on Earth stretch out to more than four days. In the high mountains of Peru and Nepal, and in the Antarctic winter, no amount of time may be enough to bring a patient to safety. This is why bringing healthcare to humans, wherever they are, is the goal of aerospace medicine.

Here or There: Definitive Care Everywhere

In places in the solar system where a hospital is available, the question becomes — is it needed? In December 2020, a device flew to the ISS to test how well we could diagnose diseases from a distance. The HomeCue system, made by a Swedish company, is designed to help identify illness by counting all kinds of white blood cells — from neutrophils and lymphocytes, which increase in size and number with acute infections, to eosinophils and basophils, which respond to allergens and parasites. But would such a system work in space, where every drop of blood drawn tries to float away?

As of March 2021, HomeCue remained in orbit. Anchored to the workstation by footholds, astronauts worked with the system in a small expandable plastic tent, keeping blood from leaking into other parts of the station while keeping the station — which houses an interesting and somewhat unique collection of microflora — from coming near the collection area.

If it proves successful, similar systems could be deployed all over the Earth — at farms, cliffside villages or even home countertops. But if a problem were detected in these austere and remote environments, what would the next step be?

In space — and many other hard-to-reach locations — it might be easiest to reach for autonomous support. In fact, autonomous medical operations (AMO) have been taking place in space and on Earth for decades. For example, in 1999, under the guidance of a specialist in Indianapolis, Dr. Jerri FitzGerald diagnosed and began treating herself for cancer while deployed in Antarctica.

The autonomous medical system under development is meant to supplement crew training. Before launch, all members of space crews are trained in basic and even some advanced medical skills, such as taking temperatures, giving anesthetics, pulling teeth and stitching wounds. Given their constant connections to the ground, astronauts on the ISS call mission control to seek guidance in handling trickier medical problems. But the time it takes to send a message one way increases over ten minutes each way. In the future, when crews one day travel to Mars, astronauts will need a more close-at-hand consult.

The idea behind AMO is that it can guide local users down a path of actions that need to be taken sooner rather than later: checking blood pressure, putting a blood sample into the HomeCue, using an ultrasound to look at an appendix, etc. The hope is that by the time the images are ready for review, information from a specialist somewhere on Earth will have reached the patient's remote area, whether that's in the middle of the ocean or in the middle of deep space.

For half a century, aerospace medicine has been deeply involved in developing ways for non-specialists to use tools such as an ultrasound to aid in remote diagnosis. At the end of last year, remote use of a commercial, off-the-shelf ultrasound scanner was used in conjunction with AMO and telemedicine from the ground. The goal was to build a medical advisor, also known as a Medical Decision Support System. Such a tool would allow astronauts and doctors on Earth to bypass delays brought by distance or time, diagnosing and treating emergent conditions in place.

Reuse, Recycle, Re-Infuse

The good news is that medical decision support systems might one day soon be suggesting treatments. The less-good news is that treatments often require a lot of stuff. Even big hospitals run out of basic supplies, such as saline, after hurricanes knock out parts of the supply chain or pandemics slow down delivery. But healthcare innovations from the last half century have lead to huge gains in recycling and reclaiming water from food, urine and even sweat. Now, aerospace medicine is taking this reclaim-and-recycle process one step further: turning what came out of the blood into something capable of going right back into it.

Enter IVGEN, an intravenous fluid generation device. This is a portable water purification system that's small and light enough to easily fly to the ISS. Not only has IVGEN made medical-grade water from reclaimed fluids, but it can also add salt in the right proportions so that what comes out could be infused back into a patient needing fluid resuscitation. In the decade since that technology first flew into space, IVGEN sat stored on a shelf for two years. Then, they turned it back on — just to see if it would work in the middle of a Mars mission or after gathering dust in a remote health clinic. It did. Now, the technology is now being further automated to see if we can use the system, its collector, purifier, mixer and bags to directly infuse a patient, freeing up caregiver time and further healthcare resources.

Looking Ahead: Far, Far Ahead

Sixty-three years of human spaceflight makes for a lot of trickle-down technology. Much of it was designed to keep explorers alive in a near vacuum, among microgravity and high radiation. All of it was built to take up minimal mass and volume.

The one thing astronauts lack in space is, well, space. A shockingly small amount is available for equipment of any kind — much less equipment that might be used once in a blue moon, if ever. By design or cosmic coincidence, Earth's healthcare needs have also trended that way: lighter and smaller. Personal and portable is where we're headed, wherever we're headed. In some ways, healthcare on Earth is just catching up to where aerospace medicine was going all along. Together, we're getting better, faster, and traveling further, safer.

Interested in all things in outer space and exploration? We are, too. Take a look at open positions at Northrop Grumman and consider joining our team.

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Future Aerospace Medicine: Coming to a Planet Near You

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