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Imagine you’re on the moon, digging up lunar regolith. You’re focused on the task at hand when you suddenly slip and fall, right into your pickaxe. Even in the moon’s weaker gravitational field, accidents are a real possibility. A sharp pain flares up on your right side, and you call for your nearby crewmate. Is the pain due to a contusion, or is it a sign of something more serious?
To find out, you’ll need to be assessed and treated by the mission’s medical officer, stationed at the lunar habitat. They in turn may want to consult the flight surgeons at mission control back on Earth. For the best possible care, your medical officer should have immediate access to your full medical history, along with a suite of diagnostic tools and physiological monitoring devices to assess the situation and guide treatment.
Are we prepared for this level of medical care on the lunar surface or a future Gateway station? Not quite yet. Medical situations in low Earth orbit (LEO) on the International Space Station (ISS) currently depend on just-in-time guidance from medical experts on Earth. If we are to use the lunar environment to prepare ourselves for longer missions away from Earth’s vicinity, we have to learn to be Earth-independent. And this requires us to rethink how to provide healthcare anywhere.
Developing the medical tools and healthcare approaches of the future is one of our priorities at the Translational Research Institute of Space Health (TRISH) with support from NASA. We need to prepare for trauma and medical incidents during exploration missions to the moon or Mars.
NASA’s Artemis 2 mission will be a lunar flyby and lay the groundwork for Artemis 3, which will see astronauts land on the lunar surface. These crew members will operate across multiple environments: the spacecraft that takes them to orbit, the Gateway station circling the moon, a lunar habitat and exploration rovers. It is very likely, based on NASA’s procurement plans to support private companies in building these, each of these habitats and vehicles will be owned and operated by different entities. If a medical emergency arises, preparedness must extend across all these vehicles and systems, ensuring that no matter where an astronaut is, they have access to the care they need seamlessly.
Astronauts also face risks from illnesses that stem from prolonged exposure to space conditions, such as radiation exposure from a solar particle event. In a medical emergency on or around the moon, returning to Earth isn’t a quick or safe option, especially if the astronaut’s condition is unstable. That’s why crews must be equipped to provide in-field treatment and continuously monitor everyone’s health. We must remain vigilant in tracking physiological changes and refining our ability to predict and detect health issues before they escalate.
In 2024, we launched a call for research proposals to address this need. Our vision is to develop a program named HERMES (after the protector of travelers and a messenger of the gods) that would deliver a medical architecture ready to continuously monitor astronauts’ health, detect early signs of potential illness or physiological changes and guide medical interventions to best support the crew. Today, HERMES has been demonstrated, but needs testing in spaceflight and space analog operational environments like Antarctica.
Deep-space exploration will demand real-time access to astronauts’ in-flight medical data and medical histories. While this information currently resides at mission control back on Earth, future missions will require localized support within the spacecraft itself to enable dynamic, on-the-spot decision-making. The system must also be interoperable with various health monitoring tools and adaptable across different spaceflight vehicles (potentially from different, competitor companies). Furthermore, beyond serving as baseline, crew health information should be continuously updated during the mission. With the integration of artificial intelligence, such a healthcare system might not only provide real-time treatment guidance but also proactively flag early signs of illness or performance decline, enhancing crew health and mission success.
Beyond protecting future space explorers, military personnel and workers, investment in health and performance capabilities by the companies building the habitats, vehicles, and platforms safeguard safeguard the longevity of the space industry. In the absence of appropriate systems and medical architectures, a serious medical event would shake public confidence and potentially tilt the risk-benefit analysis away from crewed missions.
A good outcome to a health event depends on numerous critical moments where informed decisions must be made. To better understand the implications of having an informed just-in-time healthcare system during missions like Artemis, let’s return to your hypothetical fall on the moon, and how it might be managed by an all-encompassing healthcare platform, like what we are developing with HERMES, that will prove essential for treating medical emergencies far from Earth.
Post-fall, your geological activities are no longer possible and you begin planning your return to the lunar habitat. Your crewmate assists you into a pressurized lunar rover, and, much like the start of any Earth-based medical appointment, the first priority is to record your vitals into a platform like what we’re building with HERMES. You remove your spacesuit and don a wearable sensor to measure your ECG, heart rate and other vital signs. As the rover bumps across the lunar terrain, you experience sharp, cramping pain in waves. Capturing these variations is critical to the diagnostic process, so it is essential that the vital readings are continuous and comprehensive.
Once back at the habitat, you cycle through the airlock before being examined. The chief medical officer (CMO) notices a minor laceration caused by landing on the pickaxe and takes a photo of it. They take notes as they ask you to describe your pain, and see that your heart rate is elevated. This is important information that will be stored locally for future reference but also be sent back to mission control for their consultation. During normal doctor visits on Earth, medical professionals also chart as they go, as it ensures accuracy, improved decision-making, efficiency in emergencies and visibility for all involved. On the moon — or in any remote setting — real-time charting becomes even more essential, as medical care might be delivered in shifts, and Earth-based teams may need up-to-date information to assist with treatment from afar.
Looking at the data, the lunar CMO also sees an important piece of medical history — you once had a non-obstructing kidney stone. Because of this and the nature of the pain you report, our lunar team must leave no “stone” unturned!
Using a handheld ultrasound, the CMO, guided in real-time by training videos and imaging (which we hope to provide within HERMES itself), confirms with mission control a partially obstructing stone near your uretero-pelvic junction. The CMO prescribes pain management with on-board drugs and continues monitoring. Your mission can’t continue at full capacity, so once feasible, you are transported to the Gateway station for a procedure called burst wave lithotripsy, which uses image guided ultrasound and HERMES-enabled artificial intelligence assistance to help identify and recommend a setting to help dissolve the stone. Post-treatment ultrasound images are sent to Earth once bandwidth allows, and after three days of observation, you’re cleared to resume your mission.
Upon return to Earth, post-mission care continues with seamless data capture and transmission. Your Earth physician will have access to your medical records from your time in space. This level of thorough, coordinated care is what HERMES aims to enable in the near future to ensure astronaut health both during and after their missions.
Obstructive kidney stones can become life-threatening. By having these capabilities in the lunar vicinity, you have averted the costly requirement to evacuate and prematurely end the mission.
While space is one of the most extreme environments humans can occupy, medical solutions designed for space exploration can also benefit healthcare in more familiar, Earth-bound settings. These innovations can be applied to other high-risk environments, such as remote polar expeditions, deep-sea exploration and military missions in isolated locations, where access to immediate medical care is limited.
Additionally, this level of synchronization and monitoring could improve early illness detection and response in various fields, from disaster response teams to everyday healthcare.
The lessons learned and technologies developed for space missions like Artemis are not only advancing human exploration beyond our planet but are also paving the way for a new era in healthcare here on Earth. By integrating real-time data monitoring, AI-guided interventions and seamless communication across vast distances, HERMES is laying the foundation for a more responsive, efficient and accessible healthcare system for high-risk environments. From remote expeditions to everyday medical care, the advancements we make in space will have far-reaching implications for the future of healthcare on Earth.
Dorit Donoviel is the executive director of the Translational Research Institute for Space Health (TRISH), a NASA-funded consortium based at Baylor College of Medicine (BCM), with partners Caltech and MIT. Dr. Donoviel is also an associate professor of space medicine and Associate Director of the Center for Space Medicine at BCM.
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