Astronaut Crew Non-Technical Skills for Medical Event Management on Deep Space Exploration Missions

Introduction: In the unique context of deep space, long duration exploration spaceflight, an unforeseen inflight medical emergency could compromise crew health and jeopardize mission success. Returning prematurely to Earth or consulting with a flight surgeon via long distance communications may be challenging or impossible. In the operating room, non-technical skills (NTS) such as situation awareness, leadership, and team coordination have been shown to reduce performance errors and the risks associated with high acuity low frequency events. The aim of this study was to develop a NTS taxonomy and behavior markers to support astronaut crew training in preparation for the management of medical emergencies during long duration space missions. Methods: A Delphi method with an expert panel comprising physicians, astronauts, health service researchers, human factors scientists and space medicine practitioners (n=28) was used to reach consensus on critical non-technical skills required for an astronaut crew. Panelists ranked the potential impact of NTS on management of 30 medical events defined in NASA’s Space Medicine Exploration Medical Condition List. In a subsequent consensus meeting, panel members were assigned to four parallel groups and identified specific non-technical skills that may assist management of medical events in space. Results: Panelists ranked the management of obstructed airway, cardiac arrest, shock, decompression sickness, anaphylaxis, and events requiring surgical treatment as most likely to be enhanced by effective NTS of the spaceflight crew. After several rounds of panel discussion, iterative development, and refinement, a taxonomy of the essential 20 behaviors for medical event management were identified and mapped to NASA’s existing team training framework (Figure 1). Conclusion: We developed the first medically-focused NTS taxonomy for spaceflight, reflecting an innovative translation of non-technical skills research in surgery. Future studies will test the reliability of the taxonomy using video scenarios filmed in a medical care capable spacecraft simulator. As in surgery, deliberate practice on non-technical skills can improve outcomes in spaceflight medical emergencies, reducing the risk of unanticipated medical events on long duration exploration missions such as a future mission to Mars.