Figure 1. In-flight medical-operations setup
* Space Consultant
The longest manned mission previously supported by ESA was Euromir 94, which lasted just 30 days. The quantum leap to the originally planned 135 days of the Euromir 95 mission meant that a number of concepts needed to be rethought and adapted. One of the more obvious consequences was that the astronaut would be separated for a much longer period from his home environment, which meant that some of the ground-related support also had to be re-evaluated. Additional support associated with the 'psychological climate' onboard the station as a result of the longer mission duration was also necessary. Post-flight analysis has shown that all support elements functioned satisfactorily, but a number of potential improvements have also been identified.
The Euromir 95 flight represented an important increment in ESA's experience with long-term manned spaceflights. Whereas the 30 days of the earlier Euromir 94 flight were not considered critical in terms of the isolation involved, a number of lessons were learnt which were important enough to be carefully considered for Euromir 95. Debriefings and feedback from other long-duration flights involving the presence of foreign astronauts on-board Mir also received attention.
The ground support provided during the Euromir 95 flight fell into two distinct categories:
The ESA/EAC Medical Operations team is responsible for the health and well- being of the ESA astronauts during all phases of a space mission. The length of the Euromir 95 mission provided a unique opportunity to accumulate new experience, but also called for modifications to the medical support programme devised for earlier much shorter missions such as the Euromir 94 mission and Shuttle trips.
The decentralised mission support scenario for Euromir 95 required the setting up of reliable communications links and reporting chains. In addition, the European crew surgeons working at the Russian Control Centre at Kaliningrad (TsUP) had to be trained to operate within the Russian flight operations team, on the basis of bilateral agreements between the Russian and the ESA Medical Operations teams.
Two flight surgeons, Dr. A. Putzka and Dr. K. Lohn, were provided by the contractor, DLR Medical Operations, and one, Dr. B. Comet, by the subcontractor MEDES. Their shift schedule was such that each surgeon was on duty at TsUP for a 2-3 week period, covering all onboard activities from the first morning space-to-ground contact until the last communication in the evening.
During Euromir 94, it was found to be important to establish a link between the TsUP flight surgeons and the flight control team at the Payload Operations Centre (SCOPE). A dedicated crew- surgeon console was there-fore installed at SCOPE in Oberpfaffenhofen (D) to enable the medical team to communicate via the digital intercom system (DICE). There was one public DICE line and one secure line, which was used to communicate confidential medical information, between the two centres.
The TsUP-based flight surgeons interfaced directly with their Russian counterparts and were responsible for all medical issues arising during the mission. All routine inflight medical checks and the countermeasure program were monitored and, in concurrence with the Russian crew surgeons, the appropriate recommendations were uplinked to the crew. In addition, the surgeons provided support to the timeline planners for all crew-schedule-related activities.
There was a private medical conference between the ESA astronaut and the ESA surgeon(s) approximately two to three times per week, on the understanding with the Russians that any information gathered that could have an impact on the mission's execution would be passed on to them. Information from these conferences was used to brief the Payload Operations Manager (EPOM) and the Mission Management on the ESA astronaut's health and workload, so that the daily activity plan for onboard tasks could be fine-tuned or adapted as necessary.
In addition, the Russian medical team issued an extensive daily medical report, which was translated and sent to the chief crew surgeon at SCOPE.
The SCOPE crew surgeon's role was to collect all medical information from the TsUP surgeons and to provide the SCOPE team and ESA Mission Management with a thorough understanding of the medical situation. A secondary task was to provide the link with the ESA Medical Board for decisions relating to the execution of the human life-sciences experiments. The Russian and the ESA Medical Boards had approved all of the life-sciences experiments, including the operational procedures to be followed, before the flight. Any changes to those agreed protocols had to be re- approved by the ESA Medical Board. The SCOPE surgeon was responsible for informing the Medical Board about any such changes, in addition to filing the nominal reports on the mission's progress. Thirdly, the SCOPE surgeon had to interface with the responsible safety officer in the event of apparently hazardous operations or equipment malfunctions that might affect the crew's health.
Figure 1 shows the links and interactions between the various teams, but does not reflect the hierarchical structures.
Figure 1. In-flight medical-operations setup
In order to define clearly the roles and responsibilities of the medical- operations personnel and to make those roles more transparent to the Euromir 95 mission management, several documents were created.
The first document to be finalised and approved was the 'Euromir 95 Medical Flight Rules'. This document describes in detail all rules governing the daily tasks of the medical team, the rationales behind those rules, and the structure of the decision-making processes during nominal inflight operations and in contingency situations.
The second document, on 'Medical Data Protection Policy', defines the rules for protecting the astronaut's private medical data from public release, and the underlying criteria for medical data exchange with, for example, the scientific community. Further documents, such as the 'Medical Checklist', were published to give other non-medical flight controllers a more detailed insight into possible medical situations that might be encountered during a long-duration mission like Euromir 95.
A 'Medical Console Handbook' was used by all flight surgeons as the main reference for their work at the medical consoles, either in TsUP or SCOPE. It covers the operation of all equipment, contains basic space-medicine chapters, and lists all contact personnel needed to cope with contingency or emergency situations.
A 'Handbook on the Russian Medical Programme' compiles all available information about the routine inflight medical examinations and the countermeasures programme. This handbook was also made available to the life-sciences team, for whom detailed knowledge of these medical routines was especially important in the setting up of their experiment programme.
As the TsUP-based ESA surgeons were to be integrated into the Russian medical system, a 'Joint Medical Support Requirements' agreement was established with their Russian counterparts. This document describes the training needed by a foreign flight surgeon in order to be certified to work in the Control Centre. Fortunately, the ESA flight surgeons selected for EuroMir 95 had previously provided mission support in Russia and therefore required no further training. More importantly, it spells out the interactions and responsibilities of both medical teams, includes western-European medical data-protection guidelines, and formalises the Russian agreement to the routinely scheduled private medical conferences.
Figure 2. Medical counter-measures taken onboard before landing -
the LBNP suit
The Euromir 95 mission as a whole was a great success from the medical and ground-support points of view especially, in that it served to prove that the current medical-operations structure is well able to support long-duration missions. It also demonstrated that an open and transparent mode of working, whilst still protecting the astronaut's medical privacy to the greatest degree possible, enhances the relationship between the medical operations, the mission management and the other ground personnel to the benefit of all concerned.
Nevertheless, there are still some elements that can be improved for future missions, particularly in the context of the broadening of multinational cooperation in the International Space Station era:
For such long- duration missions, one can only expect an astronaut to concentrate fully on his/her tasks if he/she knows that their family is being well taken care of, and that they can have regular contact. Such support should not be over- institutionalised, but needs to be sufficient to instil a feeling of mutual confidence between the astronaut and his/her family and the crew surgeon and EAC support staff.
As far as the contact aspect is concerned, one really needs more location-independent communication possibilities. The Russian system provides a videolink from TsUP once every two weeks, as well as allowing regular short phone calls from private locations (via the installation of a specific system). This, however, requires that the astronaut's family be present in Russia. A video link provided via the DICE system proved to be a valuable addition, especially when the families were on the move or further afield. Audio contact could also be made by linking the space-to-ground loop to the public telephone network, which not only provided a good backup system but also provided contact with other more remote family members from time to time.
As a result of conflicting feedback from earlier flights, various aspects of the Euromir 94 flight were analysed with the help of a psychologist trainee at EAC. As a result, a number of recommendations for improvement were implemented for Euromir 95. A typical example was the news summaries, which were collected and condensed at EAC, and then transmitted in the astronaut's mother tongue to the station at regular intervals.
In fact, the cultural isolation problems cited after earlier Russian cooperative missions were not reported at all during Euromir 95. The well-balanced composition of the crew certainly played a very important role in this respect, but a number of small support activities undoubtly contributed also (e.g. presents and video tapes sent up at Christmas).
The two Euromir 95 Crew Interface Coordinators (CICs) were based, together with the two Experiment Coordinators, at the main Control Centre (TsUP) in Kaliningrad, near Moscow. They worked in two shifts, from one afternoon to the next, with a one-hour overlap for handover purposes. From the fourth week of the mission onwards, one of the four persons was always free for relaxation.
There were several systems available for communications between TsUP and SCOPE, serving complementary as well as back-up functions. These included the DICE system and a dedicated audiosystem, called VIS, in addition to the classical communication tools of telephone, fax and e-mail. An Internet link that became available near the end of the flight also proved to be very useful.
When communicating with the Mir station, there are typically 10 passes per day/night, each affording only between 10 and 20 mins of link time (because only ground stations on Russian territory are used). Given the predominant system-related communications needs, this strongly limits the ground contact time available for the ESA astronaut. A good understanding prior to the flight of the activities to be performed onboard is therefore a must, as well as a good command of Russian as the station's working language.
The amount of written information that could be sent up was also rather limited, relying on so-called 'radiograms'. In practice, sending small 'electronic packages' to the onboard laptop computer proved more effective.
The use of Russian as the principal language of communication allowed the Russian crew members to feel more involved in the ESA scientific programme, and it also allowed the ground controllers to give advice as they were able to listen in. This was a 'lesson learnt' from Euromir 94, where the ESA astronaut communicated with the ground mainly in English.
Figure 3. A rare social event visitors in space
The Euromir 95 support concept proved to be a viable setup that worked very satisfactorily. The more harmonious cooperation with the Russian medical infrastructure was clearly beneficial and merits further development and follow up.
A major conclusion, however, is that in the International Space Station scenario ESA needs to provide its astronauts, and their families, with carefully structured support before, during and after their flights. This support needs to address not only the technical demands of the particular mission, but also the cultural factors that begin to play an ever-increasing role as the durations of our astronauts' stays in space become ever longer.
Regular communication with the crew is considered a must for long-duration missions, not least for psychological reasons. Internet connections to TsUP and electronic-mail possibilities need to be further investigated and improved.
ESA Bulletin Nr. 88.