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You have been selected as the ship doctor on the first manned mission to Mars. What do you pack?

Theoretical questions like this are all in a day’s work for Dr. Erik Antonsen, MD, PhD, FAAEM (@eantonse). He is the Element Scientist for Exploration Medical Capabilities at NASA, a Professor of Space Medicine at Baylor College, and an Emergency Physician in Houston — and in these roles, he evaluates and reduces health risk when it comes to sending humans into space.

Dr. Antonsen recently took questions from our community of over 1 million healthcare professionals. You can read the entire Q&A on Figure 1. When asked what he would pack, he responded:

We break medical operations in a Mars missions into two categories — planned operations and unplanned operations. For unplanned we worry about 100 conditions currently. So far 47 of them have happened in human spaceflight and 53 have not. They range from things like fingernail delamination to decompression sickness to appendicitis. Lots of things to worry about, not much room to pack.

Learning from the Dark Side

With the topic of space exploration on the table, it shouldn’t be a surprise that Star Wars came up in conversation. One advanced practice registered nurse asked jokingly if a patient’s hand were severed in a lightsaber duel, could it be replaced with a bionic hand?

“Believe it or not, I actually use pictures of those very scenes to get the concept of medical risk management across in presentations,” said Dr. Antonsen. “We look at risk as the cross section of the likelihood of an event happening vs. the consequence of that event. So for dueling Lord Vader, the likelihood is low, but the consequence is high. Bionic hands would let us mitigate those ‘medical events’.”

The health concerns of space travel

With the Mars mission in mind, the Q&A strongly focused on the physiological and psychological stressors that come from living in space long-term. Our community shared their concern with Dr. Antonsen about what efforts, if any, were in place to properly address the health risk to the crew.  

“Some level of shielding would still be intact from the spacecraft hull, but I see where you’re headed. Cancer risk would be increased like that of a smoker. There are also cardiovascular risks (coronary artery disease, etc.) and cognitive effects,” says Dr. Antonsen. “We are still working to characterize these, but it is not considered an absolute roadblock to a Mars mission at this point.”

Bone loss is a common medical problem for astronauts as a result of long-term weightlessness. “Bone loss occurs because of unloading of the skeletal system. Muscle atrophy as well for same reasons.”

So how do they treat bone loss in space? “Exercise regimes that include resistance and cardiovascular regimes have shown some good promise in offsetting these… Interestingly the bone loss also seems to lead to urinary changes that look like renal stone-formers’ urines. It makes sense as calcium is absorbed that this might happen. Medications like Forteo and potassium citrate have been investigated as countermeasures for bone loss and kidney stone formation and shown promise.”

So, who gets to go to space?

“Is the expectation to include medical personnel in the crew should the Mars expedition get the green light?” a nursing student asked. “If so, what specialties have been identified as most significant?”

Dr. Antonsen replied:

Yes, NASA has a requirement for physician level crew member for a Mars mission. Lots of people have written about who is the best doctor for that mission. Strangely it seems like the best doctor matches the person writing the paper. Seems like lots of people want to go. For my opinion, I think Emergency Medicine (surprise) or Family Medicine are the most apt specialties.

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