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Yule S, Robertson JM, Mormann B, Smink DS, Lipsitz S, Abahuje E, Kennedy-Metz L, Park S, Miccile C, Pozner CN, Doyle T, Musson D, Dias RD. Crew Autonomy During Simulated Medical Event Management on Long Duration Space Exploration Missions. HUMAN FACTORS 2023; 65:1221-1234. [PMID: 35430922 PMCID: PMC10466940 DOI: 10.1177/00187208211067575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Our primary aim was to investigate crew performance during medical emergencies with and without ground-support from a flight surgeon located at mission control. BACKGROUND There are gaps in knowledge regarding the potential for unanticipated in-flight medical events to affect crew health and capacity, and potentially compromise mission success. Additionally, ground support may be impaired or periodically absent during long duration missions. METHOD We reviewed video recordings of 16 three-person flight crews each managing four unique medical events in a fully immersive spacecraft simulator. Crews were randomized to two conditions: with and without telemedical flight surgeon (FS) support. We assessed differences in technical performance, behavioral skills, and cognitive load between groups. RESULTS Crews with FS support performed better clinically, were rated higher on technical skills, and completed more clinical tasks from the medical checklists than crews without FS support. Crews with FS support also had better behavioral/non-technical skills (information exchange) and reported significantly lower cognitive demand during the medical event scenarios on the NASA-TLX scale, particularly in mental demand and temporal demand. There was no significant difference between groups in time to treat or in objective measures of cognitive demand derived from heart rate variability and electroencephalography. CONCLUSION Medical checklists are necessary but not sufficient to support high levels of autonomous crew performance in the absence of real-time flight surgeon support. APPLICATION Potential applications of this research include developing ground-based and in-flight training countermeasures; informing policy regarding autonomous spaceflight, and design of autonomous clinical decision support systems.
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Affiliation(s)
- Steven Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA; Center for Surgery & Public Health, Brigham & Women's Hospital, Boston, MA, USA; Department of Surgery, Brigham & Women's Hospital/ Harvard Medical School, Boston, MA, USA; Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Jamie M Robertson
- Department of Surgery, Brigham & Women's Hospital/ Harvard Medical School, Boston, MA, USA
| | - Benjamin Mormann
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Douglas S Smink
- Center for Surgery & Public Health, Brigham & Women's Hospital, Boston, MA, USA; Department of Surgery, Brigham & Women's Hospital/ Harvard Medical School, Boston, MA, USA
| | - Stuart Lipsitz
- Center for Surgery & Public Health, Brigham & Women's Hospital, Boston, MA, USA
| | - Egide Abahuje
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Kennedy-Metz
- Department of Surgery, Brigham & Women's Hospital/ Harvard Medical School, Boston, MA, USA; Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, U.S. Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Sandra Park
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian Miccile
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles N Pozner
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Thomas Doyle
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - David Musson
- Faculty of Health Science, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
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