Biomaterial Database

Clinical risk management approach for long-duration space missions. 2010

Gary W Gray, and Ashot E Sargsyan, and Jeffrey R Davis

International Space Station Multilateral Space Medicine Board. gary.gray@drdc-rddc.gc.ca

BACKGROUND In the process of crewmember evaluation and certification for long-duration orbital missions, the International Space Station (ISS) Multilateral Space Medicine Board (MSMB) encounters a surprisingly wide spectrum of clinical problems. Some of these conditions are identified within the ISS Medical Standards as requiring special consideration, or as falling outside the consensus Medical Standards promulgated for the ISS program. METHODS To assess the suitability for long-duration missions on ISS for individuals with medical problems that fall outside of standards or are otherwise of significant concern, the MSMB has developed a risk matrix approach to assess the risks to the individual, the mission, and the program. The goal of this risk assessment is to provide a more objective, evidence- and risk-based approach for aeromedical disposition. Using a 4 x 4 risk matrix, the probability of an event is plotted against the potential impact. Event probability is derived from a detailed review of clinical and aerospace literature, and based on the best available evidence. The event impact (consequences) is assessed and assigned within the matrix. RESULTS The result has been a refinement of MSMB case assessment based on evidence-based data incorporated into a risk stratification process. This has encouraged an objective assessment of risk and, in some cases, has resulted in recertification of crewmembers with medical conditions which hitherto would likely have been disqualifying. CONCLUSIONS This paper describes a risk matrix approach developed for MSMB disposition decisions. Such an approach promotes objective, evidence-based decision-making and is broadly applicable within the aerospace medicine community.

UI	MeSH Term	Description	Entries
D007037	Hypothyroidism	A syndrome that results from abnormally low secretion of THYROID HORMONES from the THYROID GLAND, leading to a decrease in BASAL METABOLIC RATE. In its most severe form, there is accumulation of MUCOPOLYSACCHARIDES in the SKIN and EDEMA, known as MYXEDEMA. It may be primary or secondary due to other pituitary disease, or hypothalamic dysfunction.	Central Hypothyroidism,Primary Hypothyroidism,Secondary Hypothyroidism,TSH Deficiency,Thyroid-Stimulating Hormone Deficiency,Central Hypothyroidisms,Deficiency, TSH,Deficiency, Thyroid-Stimulating Hormone,Hormone Deficiency, Thyroid-Stimulating,Hypothyroidism, Central,Hypothyroidism, Primary,Hypothyroidism, Secondary,Hypothyroidisms,Primary Hypothyroidisms,Secondary Hypothyroidisms,TSH Deficiencies,Thyroid Stimulating Hormone Deficiency,Thyroid-Stimulating Hormone Deficiencies
D007391	International Cooperation	The interaction of persons or groups of persons representing various nations in the pursuit of a common goal or interest.	Foreign Aid,Treaties,Aid, Foreign,Cooperation, International,Treaty
D010560	Personnel Selection	The process of choosing employees for specific types of employment. The concept includes recruitment.	Employee Recruitment,Employee Selection,Personnel Recruitment,Recruitment Activities,Activity, Recruitment,Employee Recruitments,Personnel Recruitments,Recruitment Activity,Recruitment, Employee,Recruitment, Personnel,Selection, Employee,Selection, Personnel
D010808	Physical Examination	Systematic and thorough inspection of the patient for physical signs of disease or abnormality.	Physical Exam,Examination, Physical,Physical Examinations and Diagnoses,Exam, Physical,Examinations, Physical,Exams, Physical,Physical Examinations,Physical Exams
D002568	Certification	Compliance with a set of standards defined by non-governmental organizations. Certification is applied for by individuals on a voluntary basis and represents a professional status when achieved, e.g., certification for a medical specialty.	Certification Level,Certification Levels,Certifications,Level, Certification,Levels, Certification
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000337	Aerospace Medicine	That branch of medicine dealing with the studies and effects of flight through the atmosphere or in space upon the human body and with the prevention or cure of physiological or psychological malfunctions arising from these effects. (from NASA Thesaurus)	Aviation Medicine,Space Medicine,Medicine, Aerospace,Medicine, Aviation,Medicine, Space
D012308	Risk Management	The process of minimizing risk to an organization by developing systems to identify and analyze potential hazards to prevent accidents, injuries, and other adverse occurrences, and by attempting to handle events and incidents which do occur in such a manner that their effect and cost are minimized. Effective risk management has its greatest benefits in application to insurance in order to avert or minimize financial liability. (From Slee & Slee: Health care terms, 2d ed)	Hospital Incident Reporting,Incident Reporting, Hospital,Hospital Incident Reportings,Incident Reporting,Incident Reportings, Hospital,Management, Risks,Reporting, Hospital Incident,Reportings, Hospital Risk,Voluntary Patient Safety Event Reporting,Hospital Risk Reporting,Hospital Risk Reportings,Incident Reportings,Management, Risk,Reporting, Hospital Risk,Reporting, Incident,Reportings, Hospital Incident,Reportings, Incident,Risk Reporting, Hospital,Risk Reportings, Hospital,Risks Management
D013026	Space Flight	Travel beyond the earth's atmosphere.	Space Exploration,Space Travel,Spaceflight,Exploration, Space,Explorations, Space,Flight, Space,Flights, Space,Space Explorations,Space Flights,Space Travels,Spaceflights,Travel, Space,Travels, Space
D013617	Tachycardia, Supraventricular	A generic expression for any tachycardia that originates above the BUNDLE OF HIS.	Supraventricular Tachycardia,Supraventricular Tachycardias,Tachycardias, Supraventricular