University of Southern California Dissertations and Theses

Extravehicular activity (EVA) emergency aid for extended planetary surface missions: through-the-spacesuit intravenous (IV) administration

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Extravehicular activity (EVA) emergency aid for extended planetary surface missions: through-the-spacesuit intravenous (IV) administration

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Content i

EXTRAVEHICULAR ACTIVITY (EVA) EMERGENCY AID FOR EXTENDED
PLANETARY SURFACE MISSIONS:
THROUGH-THE-SPACESUIT INTRAVENOUS (IV) ADMINISTRATION

by

Alejandro R. Diaz

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(ASTRONAUTICAL ENGINEERING)

May 2012

Copyright 2012 Alejandro R. Diaz
ii
DEDICATION

To my wife Jennifer and our three wonderful children Skye, Isabella and Sophia;
thank you for your love and support and for allowing me the time to develop the research
associated with this dissertation. I am forever indebted to you for your understanding and
endless patience when it was most needed.
To my parents Mary and Alejandro; to my brother Alberto and sister Alessandra;
and to all of my family in the United States and Peru; thank you for your unconditional
love, motivation and guidance. Without your encouragement and support it would have
been impossible for me to perform this research.

iii
ACKNOWLEDGEMENTS

I would like to express my deep and sincere gratitude to the Department of
Astronautical Engineering at the University of Southern California. I would like to thank
my Dissertation Committee (Dr. Joseph Kunc, Dr. Daniel Erwin, Dr. Michael Gruntman,
Dr. Vadim Rygalov, and Dr. Tzung Hsiai) for their encouragement and enthusiastic
supervision during this research, and Mrs. Dell Cuason and Mrs. Marrietta Penoliar for
their logistical and administrative support.
During this work, I collaborated with many colleagues and received mentorship
from numerous outstanding individuals from academia, industry and government
agencies for whom I have great regard. I wish to extend my warmest thanks to all those
who helped me with this research. Most notably, I would like to thank Dr. Michael Katz,
Mr. Pablo de Leon, Mr. Gary Harris, Dr. Tam Czarnik, Mr. Bill Ayrey, and Mr. Fernando
Calderon. It is to these individuals, that my heartfelt gratitude and thanks go out to, for
without their help, this dissertation would not have been possible. The support from
USC’s Information Sciences Institute (ISI), INFICON, Inc., Scapa North America, Value
Plastics, Inc., Bard Access Systems, and Antibody, Inc., is also greatly appreciated.
Completing this research, while working full-time at The Boeing Company, was a
truly challenging endeavor. Without the support and, most importantly, flexibility from
my management, this research would not have been possible. I would like to thank my
work colleagues, most notably, Mr. John McKinney, Mr. John R. McCann, Mrs. Kathryn
F. Osaka, and Mr. Abundio F. Adriano. I would also like to thank The Boeing Company
for funding my doctorate studies through the Learning Together Program (LTP).
iv
TABLE OF CONTENTS

DEDICATION .................................................................................................................... ii

ACKNOWLEDGEMENTS ............................................................................................... iii

LIST OF TABLES ............................................................................................................. xi

LIST OF FIGURES ......................................................................................................... xiv

ABBREVIATIONS ...................................................................................................... xxvii

ABSTRACT ................................................................................................................. xxxiv

INTRODUCTION .............................................................................................................. 1

CHAPTER 1: ASSUMPTIONS ......................................................................................... 9
1.1 EVA Emergency Scenario Assumptions .............................................. 12
1.1.1 EVA Emergencies Inside Habitat ..................................................... 12
1.1.2 EVA Emergencies Outside Habitat .................................................. 14

CHAPTER 2: NASA RELEVANT RESEARCH AND POSITION ............................... 16
2.1 NASA Relevant Research ..................................................................... 16
2.1.1 NASA Request for Proposals (RFPs) ............................................... 16
2.1.2 NASA Human Research Program .................................................... 17
2.1.2.1 HRP ExMC 4.10 Project ................................................... 18
2.1.2.2 HRP ExMC 4.12 Project ................................................... 18
2.1.2.3 HRP ExMC 4.25 Project ................................................... 20
2.1.2.4 HRP IMM Project ............................................................. 20
2.1.3 National Space Biomedical Research Institute ................................. 22
2.1.4 NASA Space Technology Roadmap ................................................ 23
2.2 NASA Position on Through-the-Suit IV Administration ..................... 24
2.3 Conclusion ............................................................................................ 29

CHAPTER 3: PLANETARY SURFACE EVA ............................................................... 30
3.1 EVA Considerations for Exploration Tasks ......................................... 30
3.2 Exploration Mission Phases .................................................................. 31
3.3 EVA Tasks in Extended Planetary Surface Missions (Phase 3) ........... 33
3.4 Conclusion ............................................................................................ 39

CHAPTER 4: EMERGENCY FIRST-AID RESPONSE OPERATIONS ....................... 40
4.1 Urban First-Aid Response..................................................................... 42
4.2 Construction Injuries First-Aid Response ............................................. 44
4.3 Military Combat First-Aid Response .................................................... 45
v
4.4 Bio-chemical Warfare Research First-Aid Response ........................... 49
4.5 Conclusion ............................................................................................ 51

CHAPTER 5: MEDICAL INCIDENCE RATES ............................................................. 52
5.1 Medical Incidence Rates during Space Missions .................................. 52
5.1.1   Ground-Based Analog Population ..................................................... 53
5.1.2   U.S. Navy Submarines ....................................................................... 55
5.1.3   Astronaut Population ......................................................................... 56
5.1.4   Spaceflight Medical Events ............................................................... 59
5.1.5   NASA Medical Risk Study ................................................................ 59
5.1.6   Incidence Rate Applicability to Space Missions ............................... 60
5.2 Medical Incidence Rates in Earth General Population ......................... 61
5.3 Medical Incidence Rates in Earth Construction Sites ........................... 63
5.4 Medical Incidences vs. Mission Impact ................................................ 64
5.5 Conclusion ............................................................................................ 65

CHAPTER 6: MEDICAL ISSUES IN SPACE ................................................................ 66
6.1 Salient Medical Ailments in Spaceflight .............................................. 66
6.2 EVA Health Problems / Injuries Requiring IV Administration ............ 70
6.3 Space Medicine Exploration Medical Condition List ........................... 77
6.4 Conclusion ............................................................................................ 84

CHAPTER 7: MEDICAL PROPHYLACTICS, TRAINING, AND EQUIPMENT ....... 86
7.1 Injury and Medical Problems Mitigation (Prophylactics) .................... 86
7.2 Training for Medical Procedures Application ...................................... 89
7.3 Medical Equipment ............................................................................... 95
7.4 Conclusion ............................................................................................ 98

CHAPTER 8: MEDICAL ADMINISTRATION ROUTE ............................................... 99
8.1 Oral Administration .............................................................................. 99
8.2 Intramuscular (IM) Administration ..................................................... 100
8.3 Intravenous (IV) Administration ......................................................... 101
8.4 Intraosseous (IO) Administration ....................................................... 102
8.5 Conclusion .......................................................................................... 103

CHAPTER 9: VASCULAR ACCESS DEVICES (VADs) ............................................ 106
9.1 Peripheral IV Access ........................................................................... 106
9.2 Central IV Access ............................................................................... 107
9.2.1   Central Venous Lines ...................................................................... 108
9.2.1.1 Non-Tunneled CVC ......................................................... 108
9.2.1.2 Tunneled CVC ................................................................. 109
9.2.2   Peripherally Inserted Central Catheter (PICC) ................................ 110
9.2.3   Implanted Venous Ports ................................................................... 111
9.3 Conclusion .......................................................................................... 114
vi
CHAPTER 10: VAD TRADE STUDY AND ANALYSIS ........................................... 115
10.1 VAD Trade Study ............................................................................... 115
10.2 VAD Analysis ..................................................................................... 119
10.3 Conclusion .......................................................................................... 121

CHAPTER 11: INTRAVENOUS FLUID RESEARCH IN SPACE ............................. 122
11.1 Precedence .......................................................................................... 122
11.2 Drug Absorption in Reduced Gravity ................................................. 127
11.3 IV Fluids Administration Procedures ................................................. 128
11.4 IV Fluids Packaging ............................................................................ 128
11.5 Conclusion .......................................................................................... 129

CHAPTER 12: ETHICS AND AMENABILITY ........................................................... 130
12.1 Ethics of Implanted Venous Ports....................................................... 130
12.2 Amenability to Implanted Venous Ports ............................................. 132
12.3 Conclusion .......................................................................................... 133

CHAPTER 13: SPACESUITS ........................................................................................ 134
13.1 Spacesuits Overview ........................................................................... 134
13.2 Spacesuit Layers ................................................................................. 136
13.2.1 Layers 1 to 3 – Liquid Cooling and Ventilation Garment .......... 137
13.2.2 Layer 4 – Pressure Garment ........................................................ 137
13.2.3 Layer 5 – Pressure Garment Restraint Layer .............................. 138
13.2.4 Layer 6 – TMG Liner .................................................................. 138
13.2.5 Layers 7 to 13 – TMG Insulating Layers .................................... 138
13.2.6 Layers 14 – Micrometeoroid/Tear Protection Layer ................... 138
13.3 Spacesuit Manufacturing .................................................................... 139
13.3.1 Helmet and Visor Assembly ....................................................... 139
13.3.2 Portable Life-Support System (PLSS) ........................................ 140
13.3.3 Control Module ........................................................................... 140
13.3.4 Liquid Cooling Ventilation Garment .......................................... 141
13.3.5 Upper and Lower Torso .............................................................. 141
13.3.6 Final Assembly ........................................................................... 142
13.4 Past and Present Spacesuit Injection Implementation ........................ 142
13.5 Spacesuit IV Port Location ................................................................. 144
13.5.1 Freedom of Movement ................................................................ 145
13.5.2 Stability ....................................................................................... 145
13.6 Conclusion .......................................................................................... 146

CHAPTER 14: SURFACE ENVIRONMENTAL FACTORS....................................... 147
14.1 Partial Gravity and Terrain ................................................................. 147
14.2 Thermal Gradients and Atmospheric Pressure ................................... 148
14.3 Dust ..................................................................................................... 150
14.4 Conclusion .......................................................................................... 154
vii
CHAPTER 15: SYSTEMS ENGINEERING APPROACH ........................................... 156
15.1 State the Problem ................................................................................ 157
15.1.1 Functional Requirements ............................................................ 158
15.1.2 Component Requirements ........................................................... 158
15.1.2.1 EVA Connector ............................................................. 158
15.1.2.1.1 EVA Connectors Design Considerations ..... 159
15.1.2.1.2 EVA Connectors Design Requirements ....... 159
15.1.2.2 IV Pump Design Requirements ....................................... 164
15.1.3 Environmental Requirements ...................................................... 166
15.2 Investigate Alternatives ...................................................................... 166
15.2.1 Planetary vs. In-Flight Operations Trade Study .......................... 171
15.2.2 IV Capability Coverage Trade Study .......................................... 171
15.2.3 EVA Coverage Trade Study ....................................................... 172
15.2.4 Additional Trade Studies ............................................................ 173
15.3 Model the System ............................................................................... 173
15.4 Integrate System Components ............................................................ 176
15.5 Launch the System, Assess Performance, Re-Evaluation .................. 178
15.6 Conclusion .......................................................................................... 178

CHAPTER 16: DEVELOPMENT PROCESS ............................................................... 179
16.1 Medical Device Development ............................................................. 179
16.2 Conclusion .......................................................................................... 181

CHAPTER 17: DESIGN CYCLE #1 ............................................................................. 182
17.1 Vein Finder ......................................................................................... 184
17.2 Spacesuit Mechanical Interface Port ................................................... 185
17.3 Inflatable Cuff ..................................................................................... 186
17.4 Conclusion .......................................................................................... 186

CHAPTER 18: DESIGN CYCLE #2 ............................................................................. 187
18.1 Implanted Venous Port ....................................................................... 189
18.2 Needle Push-Button Device ................................................................ 190
18.3 IV Infusion Pump and Fluids .............................................................. 191
18.4 Portable Life Support System (PLSS) ................................................ 195
18.5 Contamination Resistant Connector ................................................... 200
18.6 Conclusion .......................................................................................... 203

CHAPTER 19: DESIGN CYCLE #3 ............................................................................. 204
19.1 Through-the-Suit Connector and Cap ................................................. 204
19.2 Conclusion .......................................................................................... 211

CHAPTER 20: DESIGN CYCLE #4 ............................................................................. 212
20.1 Vacuum Feedthrough Connector ........................................................ 212
20.1.1 Background ................................................................................. 213
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20.1.2 Vendor Vacuum Feedthrough Recommendations ...................... 216
20.1.2.1 FCH016-H Rotary/Linear Motion Feedthrough ............ 216
20.1.2.1.1 Seals .............................................................. 217
20.1.2.1.2 Pressure Direction ........................................ 219
20.1.2.1.3 Vacuum Grease ............................................ 220
20.1.2.1.4 Assessment ................................................... 221
20.1.2.2 FPU016-H Linear Motion Feedthrough (CF) ................ 221
20.1.2.2.1 Bellow Welded Seal ..................................... 223
20.1.2.2.2 Conflat Flanges (CF) .................................... 223
20.1.2.2.3 Copper Gaskets ............................................. 225
20.1.2.2.4 Assessments .................................................. 226
20.1.2.3 Magnetic Linear Motion Feedthrough (CF) .................. 228
20.1.2.3.1 Assessment ................................................... 230
20.1.3 Temperature Considerations ....................................................... 231
20.1.3.1 Indium Seals .................................................................. 234
20.1.3.2 Heaters ........................................................................... 236
20.1.3.3 Assessment .................................................................... 236
20.2 Connector Cap .................................................................................... 238
20.3 IV Needle Size and Attachment Considerations ................................. 240
20.4 Alignment Provisions.......................................................................... 244
20.4.1 XY Plane Vacuum Feedthrough ................................................. 246
20.4.2 Alignment Supports .................................................................... 246
20.4.3 Padding for Alignment ................................................................ 248
20.4.4 LCVG to Skin Alignment ........................................................... 250
20.4.5 LCVG Adhesive .......................................................................... 251
20.5 Internal Contamination Provisions ..................................................... 254
20.5.1 Luer-Type Connectors ................................................................ 255
20.6 Conclusion .......................................................................................... 258

CHAPTER 21: DESIGN CYCLE #5 ............................................................................. 262
21.1 Prototype Connector Design ............................................................... 262
21.2 Conclusion .......................................................................................... 263

CHAPTER 22: DESIGN CYCLE #6 ............................................................................. 266
22.1 Proposed Flight-Like Design .............................................................. 266
22.1.1 Connector Cap ............................................................................. 268
22.1.2 CF Flanges .................................................................................. 271
22.1.3 Dynamic and Contamination Seals ............................................. 273
22.1.4 Linear Lock ................................................................................. 277
22.1.5 Shaft Grapple Fixtures ................................................................ 278
22.1.6 Alignment Support Attachments ................................................. 279
22.1.7 Luer-Type Female Adaptor ......................................................... 283
22.2 Conclusion .......................................................................................... 284

ix
CHAPTER 23: DEMONSTRATION TEST #1 ............................................................. 286
23.1 Test Description .................................................................................. 286
23.2 Test Pictures ........................................................................................ 287
23.3 Conclusion .......................................................................................... 289

CHAPTER 24: DEMONSTRATION TEST #2 ............................................................. 290
24.1 Test Description .................................................................................. 290
24.2 Test Pictures ........................................................................................ 292
24.3 Conclusion .......................................................................................... 294

CHAPTER 25: DEMONSTRATION TEST #3 ............................................................. 296
25.1 Test Description .................................................................................. 296
25.2 Test Pictures ........................................................................................ 296
25.3 Conclusion .......................................................................................... 298

CHAPTER 26: DEMONSTRATION TEST #4 ............................................................. 299
26.1 Test Description .................................................................................. 299
26.2 Test Pictures ........................................................................................ 300
26.3 Conclusion .......................................................................................... 302

CHAPTER 27: DEMONSTRATION TEST #5 ............................................................. 303
27.1 Objectives ........................................................................................... 303
27.2 Test Pictures ........................................................................................ 305
27.3 Conclusion .......................................................................................... 307

CHAPTER 28: MATERIALS ENGINEERING ............................................................ 311
28.1 Materials for Use in Vacuum .............................................................. 311
28.2 Dust Considerations in Material Selection ......................................... 314
28.3 Conclusion .......................................................................................... 315

CHAPTER 29: HABITAT MEDICAL CAPABILITY AND PROCEDURES ............. 316
29.1 Planetary Surface Habitat Medical Capability .................................... 316
29.2 IVP Maintenance Procedures .............................................................. 319
29.3 Spacesuit Preparation and Donning Operations ................................. 322
29.4 Conclusion .......................................................................................... 323

CHAPTER 30: POST-DOCTORAL RESEARCH ........................................................ 325
30.1 Research Topics .................................................................................. 325
30.2 Conclusion .......................................................................................... 333

CONCLUSION ............................................................................................................... 334

BIBLIOGRAPHY ........................................................................................................... 339

x
APPENDICES
APPENDIX A: DEPRESSURIZED MISSION PROFILE ............................. 362
APPENDIX B: MODIFIED EVA STRETCHER ........................................... 363
APPENDIX C: REMOTE MEDICAL ACCESS SUIT .................................. 366
APPENDIX D: AMBULANCE RIDE-ALONG PETITION .......................... 371
APPENDIX E: INTRAVENOUS (IV) TRAINING COURSE ....................... 372
APPENDIX F: PICC PRACTICAL EXPERIENCE ....................................... 375
APPENDIX G: HISTORICAL SPACESUIT REVIEW ................................. 377
APPENDIX H: PRE-FLIGHT IV INFUSION DEVICE TESTING ............... 392
APPENDIX I: VACUUM FEEDTHROUGH TECHNOLOGY ..................... 395
APPENDIX J: SEALS ..................................................................................... 402
APPENDIX K: LCVG ADHESIVE DESCRIPTIONS ................................... 405
APPENDIX L: DESIGN CYCLE 4 ENGINEERING DRAWINGS .............. 408
APPENDIX M: DESIGN CYCLE 5 ENGINEERING DRAWINGS ............. 412
APPENDIX N: DESIGN CYCLE 6 ENGINEERING DRAWINGS ............. 414
APPENDIX O: HUMAN SUBJECT - USC IRB ............................................ 418
APPENDIX P: OUTGASSING ....................................................................... 467
APPENDIX Q: IV INFUSION USING AN IVP ............................................ 468
xi
LIST OF TABLES

Table 1.1.1-1: EVA Emergencies Inside Habitat .............................................................. 12
Table 1.1.2-1: EVA Emergencies Outside Habitat ........................................................... 14
Table 2.2-1: EVA Tasks in Extended Planetary Surface Missions .................................. 24
Table 3.3-1: EVA Tasks in Extended Planetary Surface Missions .................................. 36
Table 4-1: Golden Principles of Pre-Hospital Trauma Care ............................................. 40
Table 4.3-1: Basic Management Plan for Tactical Care ................................................... 46
Table 5.1.1-1: Incidence of Medical Evacuation Events from McMurdo Station ............ 54
Table 5.1.2-1: Reasons for 332 Medical Evacuations from All Submarines .................... 56
Table 5.1.3-1: ISS Medical Event Classification .............................................................. 57
Table 5.1.3-2: Class IIc (n=15) and Class III (n=15) ........................................................ 58
Table 5.1.5-1: ISS Evac Estimates - Ground Analog and Inflight Populations ................ 60
Table 6-1: Salient Space Medical Ailments...................................................................... 66
Table 6.2-1: EVA Medical Issues Requiring IV Administration ..................................... 72
Table 6.3-1: Lunar Sortie/Outpost Medical Conditions Requiring IV Treatment ............ 81
Table 7.1-1: Mission Levels of Care ................................................................................. 87
Table 10.1-1: Type of Catheter Device Trade Matrix .................................................... 118
Table 14-1: Comparison of Environments ...................................................................... 147
Table 14.2-1: Pressure Levels ......................................................................................... 149
Table 14.3-1: Dust Effects on Connectors ...................................................................... 152
Table 14.3-2: Apollo Crew Dust Recommendations ...................................................... 153
Table 14.3-3: Dust Effects on Connectors ...................................................................... 154
xii
Table 15.1-1: Deficiencies vs. Benefits .......................................................................... 158
Table 15.1.2.1.2-1: EVA Connector Design Requirements ............................................ 159
Table 15.1.2.2-1: IV Pump Design Requirements .......................................................... 164
Table 15.1.3-1: Environmental Requirements ................................................................ 166
Table 15.2-1: Planetary vs. In-Flight Operations Trade Matrix ..................................... 168
Table 15.2-2: Through-the-Suit IV Availability Trade Matrix ....................................... 168
Table 15.2-3: EVA Coverage Trade Matrix ................................................................... 169
Table 15.2-4: IV Access Trade Matrix ........................................................................... 169
Table 15.2-5: Central IV Access Trade Matrix .............................................................. 170
Table 15.2.6: Implanted Port Location Trade Matrix ..................................................... 170
Table 18.3-1: IV Infusion Device Hardware Specific Parameters ................................. 193
Table 18.3-2: IV Infusion Device Battery Specifications ............................................... 194
Table 18.3-3: Approximate Weights and Dimensions .................................................... 194
Table 20.1.1-1: Vacuum Feedthrough Requirements Sent to Manufacturers ................ 214
Table 20.1.1-2: INFICON Responses ............................................................................. 215
Table 20.4.5-1: Double-Sided Tape Requirements Sent to Manufacturers .................... 252
Table 24.3-1: Demonstration Test #1 - Results and Recommendations ......................... 295
Table 28.1-1: Material Property Requirements .............................................................. 311
Table 28.1-2: Materials for Vacuum Use Assessment .................................................... 312
Table 29.2-1: IVP Maintenance Procedures ................................................................... 320
Table 30-1: Dust Contamination Notional Requirements .............................................. 331
Table Con-1: Salient Research Steps .............................................................................. 334
xiii
Table Con-2: TRL Definitions ........................................................................................ 335
Table Con-3: Through-the-Suit IV Major Components – TRL Assessment .................. 336
Table A-1: Depress Scenario - Medical Conditions Requiring IV Administration ........ 362
Table E-1: Paramount Nurse Education ......................................................................... 372
Table Q-1: IVP Chemotherapy Treatment Procedure .................................................... 468
xiv
LIST OF FIGURES

Figure I-1: Multifunctional Mars Base ............................................................................... 2
Figure I-2: Geology EVAs .................................................................................................. 3
Figure I-3: Maintenance EVA ............................................................................................ 4
Figure I-4: EVA Emergency Rescue .................................................................................. 5
Figure I-5: MDRS Crew 11 EVA Emergency Simulation ................................................. 7
Figure 2.2-1: NASA IV Pump Loan Agreement to USC (Page 1) ................................... 27
Figure 3.3-1: Canyon Geology/Weather EVA .................................................................. 34
Figure 4.1-1: Glendale Fire Department – EMT K. Krikov and Ambulance #25 ............ 43
Figure 4.4-1: Intraosseous Administration ....................................................................... 50
Figure 5.4-1: Emergency Impact vs. Probability .............................................................. 64
Figure 7.2-1: Medical Training ......................................................................................... 93
Figure 7.2-2: Subject Performing NASA-STD-3000 Mobility Test ................................ 94
Figure 7.3-1: Mercury Medical Equipment ...................................................................... 95
Figure 7.3-2: Apollo Medical Equipment ......................................................................... 96
Figure 7.3-3: Apollo Medical Equipment ......................................................................... 96
Figure 7.3-4: Shuttle Medical Equipment ......................................................................... 96
Figure 7.3-5: ISS Medical Equipment .............................................................................. 97
Figure 9.1-1: Peripheral IV in Hand ............................................................................... 107
Figure 9.2.1.1-1: Non-Tunneled CVC (SICC) ................................................................ 109
Figure 9.2.1.2-1: Tunneled CVC .................................................................................... 110
Figure 9.2.2-1: Peripherally Inserted Central Catheter (PICC) Description ................... 111
xv
Figure 9.2.3-1: Implanted Venous Port ........................................................................... 113
Figure 11.1-1: Arm Veins - Cephalic Vein ..................................................................... 123
Figure 11.1-2: Dr. Thagard working in IML-1 Module .................................................. 124
Figure 11.1-3: Catheter removal from Payload Specialist Gaffney's arm ...................... 126
Figure 13.1-1: EVA Spacesuit Schematic ...................................................................... 135
Figure 13.4-1: Apollo 11 Medical Injection Patch ......................................................... 143
Figure 13.5.2-1: NASA MK-III HUT ............................................................................. 146
Figure 15-1: Systems Engineering Process ..................................................................... 157
Figure 15.1.2.1.2-1: EVA Gloved Hand Clearances for Wing Tab Connectors ............ 162
Figure 15.1.2.1.2-2: EVA Wing Tab Connector (Large Size) ........................................ 163
Figure 15.1.2.1.2-3: Minimum Clearance Between Wing Tab Connectors ................... 163
Figure 15.1.2.1.2-4: Actuation Force Test – Mechanical Force Meter ........................... 164
Figure 15.2-1: Trade Study Tree ..................................................................................... 167
Figure 15.3-1: Sample Concept Hand Drawing .............................................................. 174
Figure 15.3-2: Sample MS PowerPoint Drawing ........................................................... 174
Figure 15.3-3a: Sample SolidWorks CAD 3D Drawing ................................................ 175
Figure 15.3-3b: Sample SolidWorks CAD Detailed Measurements .............................. 175
Figure 15.3-4: Sample 3D Printed Components ............................................................. 176
Figure 15.4-1: Alignment Support Adhesive Installation - Bottom View ...................... 177
Figure 15.4-2: Integration Complete - Side View .......................................................... 177
Figure 17-1: Georgia Tech University - Vein Finder ..................................................... 182
Figure 17-2a: Pre-Loaded Syringe .................................................................................. 182
xvi
Figure 17-2b: Initial Through-the-Spacesuit IV Concept ............................................... 183
Figure 18-1a: Proposed Components .............................................................................. 187
Figure 18-1c: PLSS to Spacesuit Interface ..................................................................... 188
Figure 18.1-1: Bard Access System IVP ........................................................................ 189
Figure 18.1-2: IVP Component Description ................................................................... 189
Figure 18.1-3: IVP Dimensions ...................................................................................... 190
Figure 18.2-1: Push-Button Spring Mechanism ............................................................. 191
Figure 18.3-1: NASA ISS IV Infusion Device ............................................................... 193
Figure 18.4-1: Apollo PLSS and Shuttle EMU PLSS .................................................... 196
Figure 18.4-2: Advanced Developmental PLSSs for EVA ............................................ 197
Figure 18.4-3: Astronaut Clayton Anderson enters Orlan Suit through Rear Hatch ...... 198
Figure 18.4-4: Astronaut Entering Suit / Disconnecting from Suitport .......................... 199
Figure 18.5-1: Contamination Resistant Connector (Disconnected) .............................. 201
Figure 18.5-2: Contamination Resistant Connector (Connected) ................................... 201
Figure 18.5-3: Surface Rover with Umbilical ................................................................. 202
Figure 19.1-1: Through-the-Suit Connector Components .............................................. 204
Figure 19.1-2: Through-the-Suit Connector Components Layout .................................. 205
Figure 19.1-3: Needle Holder and Fluid Inflow ............................................................. 205
Figure 19.1-4: Through-the-Suit Connector Assy Preliminary Dimensions .................. 206
Figure 19.1-5: Through-the-Suit Connector Casing Dimensions with Thread Detail .... 206
Figure 19.1-6: Dust Retardant Cover Approaches .......................................................... 207
Figure 19.1-7: Approach A – Dust Retardant Cover ...................................................... 208
xvii
Figure 19.1-8: Through-the-Suit Connector Cover, Cover Lock, and Casing ................ 209
Figure 19.1-9: Through-the-Suit Connector Cover Lock ............................................... 209
Figure 19.1-10: Through-the-Suit Connector Cover Removal ....................................... 210
Figure 19.1-11: Through-the-Suit Connector Cover Lock Detail Layout ...................... 210
Figure 20.1.2.1-1a: INFICON FCH016-H ...................................................................... 216
Figure 20.1.2.1-1b: INFICON FCH016-H Callouts ....................................................... 216
Figure 20.1.2.1-1c: INFICON FCH016-H Dimensions and Technical Data ................. 217
Figure 20.1.2.1.1-1: ISO-KF Flange ............................................................................... 218
Figure 20.1.2.1.1-2: Spring Energized Seal (Garter Spring) .......................................... 219
Figure 20.1.2.1.3-1: Vacuum Grease .............................................................................. 220
Figure 20.1.2.2-1a: INFICON FPU016-H ...................................................................... 221
Figure 20.1.2.2-1b: INFICON FPU016-H Callouts ........................................................ 222
Figure 20.1.2.2-1c: INFICON FPU016-H Dimensions and Technical Data .................. 222
Figure 20.1.2.2.2-1a: Conflat Flange (CF) – Figure A ................................................... 224
Figure 20.1.2.2.2-1b: Conflat Flange (CF) – Figure B ................................................... 225
Figure 20.1.2.2.3-1: Copper Gasket ................................................................................ 226
Figure 20.1.2.2.4-1: Standard

and Spacesuit Application ............................................... 227
Figure 20.1.2.2.4-2: Spacesuit Bellow Feedthrough Concept ........................................ 228
Figure 20.1.2.3-1: Magnetic Rotary Feedthrough .......................................................... 229
Figure 20.1.2.3-2: Magnetic Lineary Feedthrough ......................................................... 230
Figure 20.1.2-1: Apollo A7L Connectors ....................................................................... 232
Figure 20.1.2-2: NDX-2 Spacesuit ................................................................................. 233
xviii
Figure 20.1.2.1-1: Indium O-Ring - Flange Application ................................................ 235
Figure 20.1.2.1-2: Indium Wire ...................................................................................... 235
Figure 20.2-1: Connector Cap and Cap Base.................................................................. 239
Figure 20.2-2: Connector Cap and Cap Base Dimensions ............................................. 239
Figure 20.2-3: Cap Base and Feedthrough Attachment to HUT .................................... 240
Figure 20.3-1: Needle Gauge Chart ................................................................................ 241
Figure 20.3-2: SafeStep Huber Needle ........................................................................... 243
Figure 20.3-3: Vacuum Feedthrough to Needle Holder Attachment .............................. 244
Figure 20.4.2-1: Alignment Supports ............................................................................. 247
Figure 20.4.2-2: Alignment Support Dimensions ........................................................... 247
Figure 20.4.3-1: Padding Use During NBL Training ..................................................... 249
Figure 20.4.4-1: NDX-2 LCVG ...................................................................................... 251
Figure 20.4.5-1: Double-Sided Adhesive – Layers Callouts .......................................... 253
Figure 20.4.5-2: Double-Sided Adhesive Samples Provided ......................................... 254
Figure 20.5.1-1: Luer-Type Adaptors ............................................................................. 256
Figure 20.5.1-2: Luer-Type Adaptor Dimensions .......................................................... 257
Figure 20.5.1-3: Luer Coupler – LC34-9 ........................................................................ 258
Figure 20.6-1: Design Cycle 4 Overview ....................................................................... 259
Figure 20.6-2: Design Cycle 4 Callouts .......................................................................... 259
Figure 20.6-3: Design Cycle 4 Length Dimensions ....................................................... 260
Figure 20.6-4: Feedthrough Locked and Inserted Positions ........................................... 260
Figure 21.2-1: Prototype Connector Components .......................................................... 263
xix
Figure 21.2-2: Prototype Connector Integration with HUT ............................................ 264
Figure 21.2-3: Prototype Connector Integration with Needle Holder Adaptor .............. 264
Figure 21.2-4: Prototype Connector Push-Pin ................................................................ 265
Figure 22.1-1: Design Cycle Overview .......................................................................... 267
Figure 22.1-2: Design Cycle Callouts ............................................................................. 267
Figure 22.1.1-1: Cap and Feedthrough Dimensions ....................................................... 268
Figure 22.1.1-2: Cap and Cap Base Dimensions ............................................................ 269
Figure 22.1.1-3: Cap Lock to Cap Base Connection ...................................................... 270
Figure 22.1.1-4: Cap/Lock Alignment ............................................................................ 270
Figure 22.1.1-5: Cap/Lock Rotation ............................................................................... 271
Figure 22.1.2-1: Conflat Flange Attaches to HUT with Bolts (blue) ............................. 272
Figure 22.1.2-2: CF Flanges and Needle Holder Adaptor .............................................. 273
Figure 22.1.3-1: Vacuum Seal Approach ....................................................................... 275
Figure 22.1.3-2: DMR™ Metric Series - 409012 ........................................................... 275
Figure 22.1.3-3: Modified Dynamic Seal ....................................................................... 276
Figure 22.1.3-4: Contamination Seal .............................................................................. 276
Figure 22.1.3-5: Dynamic and Contamination Seal ........................................................ 276
Figure 22.1.4-1: Linear Lock .......................................................................................... 277
Figure 22.1.4-2: Linear Lock .......................................................................................... 278
Figure 22.1.5-1: Shaft Grapple Fixture ........................................................................... 279
Figure 22.1.6-1: Alignment Supports ............................................................................. 280
Figure 22.1.6-2:Alignment Support-to-LCVG Connection Mechanism ........................ 280
xx
Figure 22.1.6-3: Button Deactivated ............................................................................... 281
Figure 22.1.6-4: Button Activated .................................................................................. 281
Figure 22.1.6-5: LCVG Alignment Lock inserted into Button ....................................... 282
Figure 22.1.6-6: Button Released – LCVG Alignment Lock Secured ........................... 282
Figure 22.1.7-1: Luer-Type Adaptors ............................................................................. 283
Figure 22.1.7-2: Luer-Type Female Adaptor - Base Hole .............................................. 284
Figure 22.2-1: Side Section View - Dimensions ............................................................ 285
Figure 22.2-2: Linear Displacement ............................................................................... 285
Figure 23.1-1: BodyGuard™ Compression Shoulder Brace .......................................... 287
Figure 24.1-1: Chester Chest Components ..................................................................... 291
Figure 24.1-2: Chester Chest Port ................................................................................... 291
Figure 24.2-1: Manikin – Port Exposed/Unexposed....................................................... 292
Figure 24.2-2: Double Sided Adhesive Installation ........................................................ 292
Figure 24.2-3: Feedthrough Connector Installation ........................................................ 292
Figure 24.2-4: Syringe Tubing Installation ..................................................................... 293
Figure 24.2-5: IV Administration Test with Chester Chest Skin.................................... 293
Figure 24.2-6: IV Administration Test without Chester Chest Skin .............................. 293
Figure 24.2-7: Simulated Blood Extracted into Syringe ................................................. 294
Figure 25.2-1: Alignment Supports Located on Manikin ............................................... 296
Figure 25.2-2: Connector to Needle Holder Assembly .................................................. 297
Figure 25.2-3: Test Setup Assembly Complete .............................................................. 297
Figure 25.2-4: Connector Inserted Into Chest Port ......................................................... 297
xxi
Figure 26.2-1: HUT to LCVG Indicator (Pen) ............................................................... 300
Figure 26.2-2: Indicator (Marker) Installation ................................................................ 300
Figure 26.2-3: HUT to LCVG Relative Movement Test ................................................ 301
Figure 26.2-4: LCVG Marking Results .......................................................................... 301
Figure 27.2-1: Pre-Procedure Assembly ......................................................................... 305
Figure 27.2-2: Alignment Support Marking ................................................................... 305
Figure 27.2-3: IV Administration – Test Run #1 ............................................................ 305
Figure 27.2-4: IV Administration – Test Run #1 ............................................................ 306
Figure 27.2-5: IV Administration – Test Run #2 ............................................................ 306
Figure 27.2-6: IV Administration – Test Run #2 ............................................................ 306
Figure 27.2-7: IV Administration – Test Run #3 ............................................................ 307
Figure 27.2-8: IV Administration – Test Run #3 ............................................................ 307
Figure 27.3-1: Test Insertion Locations .......................................................................... 308
Figure 27.3-2: Dr. Katz Demonstration Assessment ...................................................... 310
Figure 29.1-1: Representative Habitat Medical Module ................................................. 318
Figure 30-1: Inflatable Plug ............................................................................................ 327
Figure 30-2: Silicone Disk Installed ............................................................................... 328
Figure 30-3a: NDX-1 Dust Test in Vacuum Chamber ................................................... 332
Figure 30-3b: NDX-1 Dust Test in Vacuum Chamber ................................................... 332
Figure Con-1: Planetary Surface EVA Emergency ........................................................ 338
Figure B-1: EVA Emergency Stretcher Transportation (face-down) ............................. 364
Figure B-2: EVA Emergency Stretcher Modification .................................................... 364
xxii
Figure B-3: EVA Emergency Stretcher Transportation (supine position) ...................... 364
Figure B-4: EVA Emergency Stretcher Transportation .................................................. 365
Figure C.1-1: Straight Blade Placement ......................................................................... 366
Figure C.1-2: Modified Jaw Thrust ................................................................................ 367
Figure C.1-3: Modified Snoopy Cap .............................................................................. 368
Figure C.2-1: Suit Ventilator .......................................................................................... 369
Figure C.3-1: Military Anti-Shock Trousers (MAST)

................................................... 370
Figure E-1: Author, Hands-On IV Training ................................................................... 373
Figure E-2: IV and Blood Withdrawal Program Certificate ........................................... 374
Figure F-1: PICC Line .................................................................................................... 376
Figure G-1: Flowchart of EVA Suit Evolution ............................................................... 377
Figure G.1-1: Test Pilots of the H-10 Series Lifting Body Aircraft ............................... 379
Figure G.2-1: Original Mercury Astronauts in their Spacesuits ..................................... 381
Figure G.3-1: Gemini 4 Astronaut Ed White During America's First Spacewalk .......... 382
Figure G.4-1: The Apollo Spacesuit As Used For Moonwalking .................................. 384
Figure G.5-1: Skylab 3 - Astronaut Jack Lousma ........................................................... 385
Figure G.6-1: Shuttle Astronaut Donning EVA Spacesuit ............................................. 386
Figure G.7-1: ISS Extravehicular Mobility Unit ............................................................ 387
Figure G.8-1: NASA Mark III and UND NDX-1 ........................................................... 388
Figure G.8-2: NASA Ames AX-5 Experimental Hard Spacesuit ................................... 390
Figure G.8-3: MIT BioSuit™ Spacesuit ......................................................................... 391
Figure H.1-1: IV Infusion Device Tests (Sheet 1 of 3) ................................................... 392
xxiii
Figure H.1-2: IV Infusion Device Tests (Sheet 2 of 3) ................................................... 393
Figure H.1-3: IV Infusion Device Tests (Sheet 3 of 3) ................................................... 394
Figure I.1-1: Magnetically Coupled Rotary Drives ........................................................ 396
Figure I.1-2: O-Ring Seal ............................................................................................... 396
Figure I.1-3: Ferrofluid Seal ........................................................................................... 397
Figure I.2-1: Push-Pull Positioner................................................................................... 398
Figure I.2-2: Manual Linear Shift ................................................................................... 399
Figure I.3-1: Multi-Stage XYZ ....................................................................................... 401
Figure I.3-2: XY Stage .................................................................................................... 401
Figure J.1-1: V-Seals ...................................................................................................... 402
Figure K-1: BIOFLEX® RX 1400P ............................................................................... 405
Figure K-2: UNIFILM® U880 ....................................................................................... 406
Figure K-3: UNIFILM® UP5040 ................................................................................... 407
Figure L-1: DC4 Engineering Drawing (Sheet 1 of 8) ................................................... 408
Figure L-2: DC4 Engineering Drawing (Sheet 2 of 8) ................................................... 408
Figure L-3: DC4 Engineering Drawing (Sheet 3 of 8) ................................................... 409
Figure L-4: DC4 Engineering Drawing (Sheet 4 of 8) ................................................... 409
Figure L-5: DC4 Engineering Drawing (Sheet 5 of 8) ................................................... 410
Figure L-6: DC4 Engineering Drawing (Sheet 6 of 8) ................................................... 410
Figure L-7: DC4 Engineering Drawing (Sheet 7 of 8) ................................................... 411
Figure L-8: DC4 Engineering Drawing (Sheet 8 of 8) ................................................... 411
Figure M-1: DC5 Engineering Drawing (Sheet 1 of 4) .................................................. 412
xxiv
Figure M-2: DC5 Engineering Drawing (Sheet 2 of 4) .................................................. 412
Figure M-3: DC5 Engineering Drawing (Sheet 3 of 4) .................................................. 413
Figure M-4: DC5 Engineering Drawing (Sheet 4 of 4) .................................................. 413
Figure N-1: DC6 Engineering Drawing (Sheet 1 of 8) ................................................... 414
Figure N-2: DC6 Engineering Drawing (Sheet 2 of 8) ................................................... 414
Figure N-3: DC6 Engineering Drawing (Sheet 3 of 8) ................................................... 415
Figure N-4: DC6 Engineering Drawing (Sheet 4 of 8) ................................................... 415
Figure N-5: DC6 Engineering Drawing (Sheet 5 of 8) ................................................... 416
Figure N-6: DC6 Engineering Drawing (Sheet 6 of 8) ................................................... 416
Figure N-7: DC6 Engineering Drawing (Sheet 7 of 8) ................................................... 417
Figure N-8: DC6 Engineering Drawing (Sheet 8 of 8) ................................................... 417
Figure O-1: Collaborative Institutional Training Certification ....................................... 421
Figure O-2: HIPAA Privacy Education Program Certification (Sheet 1 of 2) ............... 422
Figure O-3: HIPAA Privacy Education Program Certification (Sheet 2 of 2) ............... 423
Figure O-4: IRB Human Subject Application (Sheet 1 of 26) ........................................ 424
Figure O-5: IRB Human Subject Application (Sheet 2 of 26) ........................................ 425
Figure O-6: IRB Human Subject Application (Sheet 3 of 26) ........................................ 426
Figure O-7: IRB Human Subject Application (Sheet 4 of 26) ........................................ 427
Figure O-8: IRB Human Subject Application (Sheet 5 of 26) ........................................ 428
Figure O-9: IRB Human Subject Application (Sheet 6 of 26) ........................................ 429
Figure O-10: IRB Human Subject Application (Sheet 7 of 26) ...................................... 430
Figure O-11: IRB Human Subject Application (Sheet 8 of 26) ...................................... 431
xxv
Figure O-12: IRB Human Subject Application (Sheet 9 of 26) ...................................... 432
Figure O-13: IRB Human Subject Application (Sheet 10 of 26) .................................... 433
Figure O-14: IRB Human Subject Application (Sheet 11 of 26) .................................... 434
Figure O-15: IRB Human Subject Application (Sheet 12 of 26) .................................... 435
Figure O-16: IRB Human Subject Application (Sheet 13 of 26) .................................... 436
Figure O-17: IRB Human Subject Application (Sheet 14 of 26) .................................... 437
Figure O-18: IRB Human Subject Application (Sheet 15 of 26) .................................... 438
Figure O-19: IRB Human Subject Application (Sheet 16 of 26) .................................... 439
Figure O-20: IRB Human Subject Application (Sheet 17 of 26) .................................... 440
Figure O-21: IRB Human Subject Application (Sheet 18 of 26) .................................... 441
Figure O-22: IRB Human Subject Application (Sheet 19 of 26) .................................... 442
Figure O-23: IRB Human Subject Application (Sheet 20 of 26) .................................... 443
Figure O-24: IRB Human Subject Application (Sheet 21 of 26) .................................... 444
Figure O-25: IRB Human Subject Application (Sheet 22 of 26) .................................... 445
Figure O-26: IRB Human Subject Application (Sheet 23 of 26) .................................... 446
Figure O-27: IRB Human Subject Application (Sheet 24 of 26) .................................... 447
Figure O-28: IRB Human Subject Application (Sheet 25 of 26) .................................... 448
Figure O-29: IRB Human Subject Application (Sheet 26 of 26) .................................... 449
Figure O-30: Informed Consent - Human Subject Bill of Rights (Sheet 1 of 5) ............ 450
Figure O-31: Informed Consent (Sheet 2 of 5) ............................................................... 451
Figure O-32: Informed Consent (Sheet 3 of 5) ............................................................... 452
Figure O-33: Informed Consent (Sheet 4 of 5) ............................................................... 453
xxvi
Figure O-34: Informed Consent (Sheet 5 of 5) ............................................................... 454
Figure O-35: Sponsor-Investigator Agreement Form ..................................................... 455
Figure O-36: HIPAA Authorization Form (Sheet 1 of 5) ............................................... 456
Figure O-37: HIPAA Authorization Form (Sheet 2 of 5) ............................................... 457
Figure O-38: HIPAA Authorization Form (Sheet 3 of 5) ............................................... 458
Figure O-39: HIPAA Authorization Form (Sheet 4 of 5) ............................................... 459
Figure O-40: HIPAA Authorization Form (Sheet 5 of 5) ............................................... 460
Figure O-41: Human Subject Compensation Agreement ............................................... 461
Figure O-42: Human Subject Compensation Acknowledgement ................................... 462
Figure O-43: USC Department of Radiology IRB Application Approval ..................... 463
Figure O-44: IRB Application Approval (Sheet 1 of 3) ................................................. 464
Figure O-45: IRB Application Approval (Sheet 2 of 3) ................................................. 465
Figure O-46: IRB Application Approval (Sheet 3 of 3) ................................................. 466
Figure Q-1: IVP Chemotherapy Use, Part I .................................................................... 470
Figure Q-2: IVP Chemotherapy Use, Part II .................................................................. 470

xxvii
ABBREVIATIONS

ABC – Airway, Breathing, Circulation

ABCDE – Airway, Breathing, Circulation, Disability, Expose/Environment

ABS – Acrylonitrile Butadiene Styrene

ADL – Activities of Daily Life

ALS – Advanced Life Support

ALS – Amyotrophic Lateral Sclerosis

ALSA – Astronaut Life Support Assembly

ASTP – Apollo-Soyuz Test Project

ATV – All-Terrain Vehicle

A7LB – Apollo Spacesuit

BA – Bioavailability

BLS – Bureau of Labor Statistics

BSLSS – Buddy Secondary Life Support System

BMD – Bone Mineral Density

CAD – Computer-Aided Design

CASEVAC – Casualty Evacuation

CEV – Crew Exploration Vehicle

CF – Conflat Flange

CITI - Collaborative IRB Training Initiative

CliFF – Clinical Findings Forms

CMO – Crew Medical Officer
xxviii
CO – Carbon Monoxide

CPR – Cardiopulmonary Resuscitation

CSSS – Constellation Space Suit Systems

CSA – Canadian Space Agency

CVC – Central Venous Catheter

DCM – Display and Control Module

DCS – Decompression Sickness

DMCF – Definitive Medical Care Facility

DRM – Design Reference Mission

DVT – Development and Verification Testing

ECLSS – Environmental, Control and Life Support System

EKG – Electrocardiography

EMI – Electromagnetic interference

EMT – Emergency Medical Technician

EMU – Extravehicular Mobility Unit

ER – Emergency Response

EVA – Extravehicular Activity

ExPC – Exercise Physiology and Countermeasures

ExMC – Exploration Medical Capability

FDA – Food and Drug Administration

FMARS – Flashline Mars Arctic Research Station

FPM – Fluorinated Propylene Monomer

xxix
G – Gravity

GT – Georgia Tech

GTVF – Georgia Tech Vein Finder

HEOMD – Human Exploration and Operations Missions Directorate

HIPAA – Health Insurance Portability and Accountability Act

HMS – Health Maintenance System

HRP – Human Research Program

HSIRB – Health Sciences IRB

HUT – Hard Upper Torso

IC – Inflatable Cuff

IM – Intramuscular

IMG – Integrated Medical Group

IMM – Integrated Medical Capability

IO – Intraosseous

IRB – Institutional Review Board

ISI – Information Sciences Institute

ISO-KF – International Standard Organization – Klein Flange

ISRU – In-Situ Resource Utilization

ISS – International Space Station

iStar – IRB Submission Tracking And Review

ISU – International Space University

IV – Intravenous

xxx
IVA – Intravehicular Activity

IVP – Implanted Venous Port

JICC – Jugular Inserted Central Catheter

JSC – Johnson Space Center

KVO – Keep Vein Open

LASIK – Laser-Assisted In Situ Keratomileusis

LCVG – Liquid Cooling and Ventilation Garment

LEA – Launch, Entry and Abort

LEO – Low Earth Orbit

LES – Launch Entry Suit

LOC – Level of Care

LOCL – Loss of Crew Life

LSAH – Longitudinal Study of Astronaut Health

LSS – Life Support System

MAST – Military Anti-Shock Trousers

MCP – Mechanical Counter Pressure

MDRS – Mars Desert Research Station

MG – Myasthenia Gravis

MIT – Massachusetts Institute of Technology

MR – Mission Report

MS – Mission Specialist

M-HUT – Malleable Hard Upper Torso

xxxi
NASA – National Aeronautics and Space Administration

NDX-1 – North Dakota Space Suit-1

NDX-2 – North Dakota Space Suit-2

NSBRI – National Space Biomedical Research Institute

NSF – National Science Foundation

N.D. – No Date

N/A – Not Applicable

N/V – Nausea and Vomiting

OCHMO – Office of the Chief Health and Medical Officer

OFHC – Oxygen Free High Conductivity

OPRS – Office for the Protection of Research Subjects

OTFC – Oral Transmucosal Fentanyl Citrate

PGA – Pressurized Garment Assembly

PhD – Doctor of Philosophy

PHTLS – Pre-Hospital Treatment Life Support

PICC – Peripherally Inserted Central Catheter

PLSS – Portable Life Support System

PO – Per Os (Oral Administration)

PSI – Pound per Square Inch

PTFE – Polytetrafluoroethylene

PVC – Premature Ventricular Contractions

PVC – Polyvinyl chloride (Plastic)

xxxii
QD – Quick Disconnect

QFD – Quality Function Deployment

RBC – Red Blood Cell

RCU – Remote Control Unit

RFP – Request for Proposal

RTG – Radioisotope Thermoelectric Generator

SAFER – Simplified Aid for EVA Rescue

SBIR – Small Business Innovation Research

SICC – Subclavian Inserted Central Catheter

SLS – Spacelab Life Sciences

SMEMCL – Space Medical Exploration Medical Conditions List

SMS – Space Motion Sickness

SMART – Simple Multi-Attribute Rating Technique

STD - Standard

STS – Space Transportation System

SVC – Superior Vena Cava

SVT – Supraventricular tachycardia

TA – Technology Area

TBI – Traumatic Brain Injury

TMG – Thermal-Micrometeoroid Garment

UND – University of North Dakota

US – United Sates

xxxiii
USC – University of Southern California

VAD – Vascular Access Device

VTAC – Ventricular tachycardia
xxxiv
ABSTRACT

Future NASA space exploration strategic plans will call for extended human
presence in space, with long term missions to the Moon and/or Mars. This human
presence in extra-terrestrial locations will require use of Extra-Vehicular Activities
(EVAs). Planetary surface EVAs will be an essential part of human space exploration,
but involve inherently dangerous procedures which can put crew safety at risk. To help
mitigate these risks, astronaut training programs will spend substantial attention on
preparing for planetary surface EVA emergencies. And though EVA emergency
protocols will be to transport an ill/injured EVA crewmember to a pressurized safe haven
for medical intervention, there may be situations where this will not be expeditiously
possible. Furthermore, even though most serious health risks will be diagnosed before
flight, there will be unforeseeable EVA illnesses and/or injuries which may require the
use of intravenous (IV) fluid administration.
The purpose of this research is to propose a through-the-spacesuit IV
administration concept approach for future spacesuits. This capability would allow for
enhanced patient accessibility during EVA emergencies. In the case of serious injury
and/or illness during an EVA, IV fluid administration might be necessary until the patient
is transported back to a pressurized safe haven. To date, only Apollo spacesuits have
incorporated a through-the-spacesuit injection provision, which allowed for intramuscular
(IM) injections. However, no spacesuit has incorporated an IV capability.
The methodology to conduct this research was to identify key researchers in the
spacesuit design and aerospace medicine fields and engage them in this study. An
xxxv
extensive literature review was also performed, which concluded that no prior spacesuit
had an IV capability incorporated into its design; a through-the-spacesuit concept
approach was developed and tested; and topics were identified to be performed as part of
future research.
The reason for this research arose from the author’s participation (as EVA
Director) at the Mars Desert Research Station (MDRS), NASA Spaceward Bound
Program, Crew 61, 2007. During this crew rotation, EVA medical simulations were
performed, which concluded that the time to transport an injured EVA crewmember back
to a pressurized habitat was significant. It was determined that during this first-aid
response period, it might be necessary to administer IV fluids to the patient. However,
such a provision is not presently available for a spacesuit.
Emergency conditions that NASA has determined would need IV infusions of
some type were identified and grouped. Out of these conditions, only the ones that would
be feasible to occur in an EVA were extracted (in doing so, conditions that would not
occur during an EVA were eliminated, e.g., food poisoning. Once a set of possible
conditions needing IV during an EVA was established, it was necessary to understand the
best way of delivering the IV medication. Various types of IV infusion methods were
researched, namely, peripheral IV lines, central IVs, and chest ports. After completing a
certified IV Training Course and consulting with medical doctors, including
interventional radiologists, it was determined that for long-term use, chest ports had the
lowest rate of infection and could be used for the longest duration.
xxxvi
This study concludes that emergencies in space will happen, both inside and
outside living habitats. For those EVA emergencies requiring IV administration, a
through-the-spacesuit IV provision is feasible with the use of an implanted chest port, and
spacesuit IV chest port connector interfaces.
1
INTRODUCTION

The past four decades have amply demonstrated that humans can tolerate space
flight well for long periods of time (Barratt and Pool, 2008). We have demonstrated the
ability to maintain adequate health and to work productively in new environments.
However, space exploration successes to date have not come without accidents. The
losses of the shuttles Challenger (1986) and Columbia (2003) have been tragic
experiences in the human spaceflight era. NASA has attempted to learn from these
failures and affirms that safety is its highest priority, above cost, manpower, reusability,
adherence to schedule, and all other considerations. However, the risk of injury and, in
the worst of cases, human life loss will continue to be accepted to a certain degree as part
of human space exploration missions (Acevedo, et al., 2008).
Future manned space exploration missions will involve a high degree of human-
machine interactions. The human factor will become more important as the duration of
missions into deep space and the complexity of crew operations increases, and as the
crew functions more autonomously, adapts to unexpected situations and makes real-time
decisions (Ball and Evans, 2001).
Space is a dangerous place to get sick, mentally or physically. There is no
question that with an increased presence in space, serious illnesses/injuries will occur and
their impact on health and mission will potentially be more serious if these medical
emergencies take place during EVAs
1
. One need only peruse proposed EVA operations

1
EVAs refer to any manned space operation performed in a pressurized spacesuit outside the confines of a
pressurized planetary habitat or spacecraft. EVAs are essential to conducting complex work outside the
pressurized habitat. EVA equipment consists of the spacesuit and tools that enable the EVA crewmember
to accomplish the necessary tasks (EVA, 1997).
2
for future planetary surface missions to understand the risks astronauts will be exposed
to. These EVAs will include activities such as base construction, base operation and
maintenance, emergency and safety procedures, planetary surface exploration, planetary
surface science, robotic operation and maintenance, and in-situ resource utilization
(ISRU) operations (Figure I-1).

Figure I-1: Multifunctional Mars Base
2

The advantages and disadvantages of EVAs must also be weighed. Advantages of
EVAs include task flexibility at worksite; dexterous manipulations; high visual
resolution; and human perceptual, cognitive, and effectors skills on site (Figure I-2 and I-
3). Disadvantages of EVAs include limitations to human perception, strength, dexterity

2
Source: NASA Images (2011) – In this artist’s concept of future Mars Base, on their way to perform
surface experiments, two residents of a Martian outpost pause to look at their home.
3
and endurance; time requirements (pre-breath); resources requirements (life support);
working volume and access limitations; and hazards to crew (LSS failure, radiation,
debris) (Rygalov, de Leon, McLaughlin, 2006). As a result, it is clear that the most
effective construction and operations will synergistically employ human-robot buddy
systems. While robots work best under highly predictable conditions, humans in EVAs
are able to adapt better to an unpredictable or constantly changing environment. By using
a human-robot buddy system, it will be possible to exploit the best attributes of both
robots and humans; increasing safety and retaining resources and human skills (Schrunk,
et al., 1999).

Figure I-2: Geology EVAs
3

3
Source: NASA Images (2011) – In this artist’s concept, crew gathers samples on the surface of Mars,
while robotic rovers stand by. Crew operating from a field camp will allow interesting sites to be explored
in more detail than would be possible if the EVA were staged from the landing site.
4

Figure I-3: Maintenance EVA
4

According to David J. Shayler (2000), there have been more than a dozen EVA
incidents cited from 1965 to 2000, which have included: excessive workload (nearly all
early EVAs); fatigue, visor fogging, and thermal control problems; insufficient flexibility
and mobility (spacesuit pressure prevented entering hatches); surface hazards; inadequate
handholds and footholds; hatch closure failures; and airlock pressurization failures. As
more extensive EVAs are conducted, EVA Medical Emergencies will become part of
future EVA incidents.
Unfortunately, unlike the ISS, for which there are well-established ISS protocols
for emergency and routine medical procedures (including IV provisions) (JSC-48522-E4,
International Space Station Integrated Medical Group (IMG) Medical Checklist), current
medical treatment options are very limited for emergencies in extended planetary surface
missions, e.g., Mars missions. These treatment options would be further complicated by
extended evacuation times; estimated to be 24 hours from Low Earth Orbit (LEO), 3 days
from the Moon, and as long as 2 years from a Mars colony (Czarnik, 1998).

4
Source: NASA Images (2011) – In this artist’s concept of future EVA operations, an astronaut is shown
setting up, monitoring, and adjusting a test bed system.
5
The major issue with administering medical treatment to a suited astronaut is the
spacesuit itself. The EVA spacesuit is essentially a spacecraft, i.e., provides similar
protection to an astronaut, which means that a crewmember cannot be administered
immediate medical administration. Current procedures would require the crewmember to
walk, or be transported, to a pressurized habitat (possibly requiring the aid of a fellow
crewmember) (Figure I-4), undergo the repressurization cycle to enter the habitat, and
finally have the spacesuit removed to initiate emergency treatment (Churchill, 1997).

Figure I-4: EVA Emergency Rescue
5

In the late 1960s, Dr. Cowley, conceived the idea of a crucial time period during
which it was important to begin definitive casualty care for a critically injured trauma
casualty. Dr. Cowley referred to this period as the “Golden Hour;” stating that if you are
critically injured, you have less than 60 minutes to survive. You might not die right then
(it may take days or weeks), but something has happened in your body that is irreparable.

5
Source: Rawlings (1992) – In this artist’s concept, an injured crewmember injured is cared for by other
members of the EVA crew. Sufficient equipment will be carried on EVAs to allow an initial assessment to
be made of such injuries and to stabilize the crewmember for transport back to the pressurized habitat.
6
An important realization is that a casualty does not always have the luxury of a “Golden
Hour.” A penetrating wound of the heart may only have a few minutes to reach definitive
care. On the other hand, an isolated femur fracture may lead to a prolonged, slow,
ongoing internal hemorrhage. Due to the fact that the “Golden Hour” is not a strict 60
minutes time frame and varies from incident to incident, the more appropriate term is the
“Golden Period” (PHTLS, 2007). Trauma doctors say that if a critically injured casualty
is able to obtain definitive care, within the casualty’s “Golden Period,” the chance of
survival is greatly improved (Lerner and Moscati, 2001). The longer it takes to get care,
the lower survival rates drop (Czarnik, 2005).
According to Tsybuliak and Pavlenko (1975), a study from Russia of more than
700 trauma deaths found that most casualties who rapidly succumbed to their injuries fall
into one of three categories: 1) massive acute blood loss (36%), 2) severe injury to vital
organs such as the brain (30%), and 3) airway obstruction and acute ventilator failure
(25%). This emphasizes the importance of treating casualties promptly and transporting
them to a facility where expert trauma care is immediately available. For these trauma
casualties to have the best chance of survival, interventions should start in the field with
pre-hospital care providers and then continue in the emergency department, operating
room, and intensive care unit (PHTLS, 2007).
Simulations at the Mars Desert Research Station in 2005 showed it took
approximately ninety-minutes to immobilize an injured crewmember, transport him/her
to the Habitat (1000 meters away), pressurize in airlock, and remove the spacesuit to
initiate treatment. This timeframe goes beyond the “Golden Period,” which would put the
7
injured astronaut at increased risk. To mitigate this risk, this research aims to propose a
concept which would allow for expedient accessibility to a pressure suited crewmember
in case of an emergency.

Figure I-5: MDRS Crew 11 EVA Emergency Simulation
6

It is not an issue of if, but rather of when, an EVA emergency will occur which
will require the need for IV administration. Of course, the first line of defense should
always be to transport the injured EVA crewmember to a pressurized habitat. However, if
this is not immediately possible, especially within the “golden period,” then an IV
through the spacesuit may need to be administered. The issue is that allowing for IV
access, while maintaining the spacesuits' ability to protect against depressurization and
dust contamination, is a difficult problem, further complicated by the ability to identify

6
Source: Groemer, G.E., et al. (2005).
8
the vein to be injected, and other medical complications, e.g., infection. Nonetheless, the
need for through-the-spacesuit IV access in extended planetary surface missions is a
problem that has not yet been sufficiently addressed and merits further research.

9
CHAPTER 1: ASSUMPTIONS

As a practical matter, planetary surface design and operational mission
assumptions will continue to evolve as planetary surface EVA tasks are identified. The
following list indicates the currently understood salient assumptions for a ‘through-the-
suit’ IV capability:
a. Research only aims to provide an IV provision in the time period from an onset of
a planetary surface EVA emergency to the time it takes to transport the injured
astronaut back to the habitat, i.e., 'golden period'. From the clinical stand point,
the main reason for IV route, as opposed to others, is the expedient
pharmacokinetics to an astronaut in a health crisis. The purpose of this life-saving
regiment is to sustain the vital signs of the astronaut before medical attention is
available inside the pressurized habitat.
b. In an EVA emergency, the primary objective is to transport the injured/ill EVA
crewmember back to a pressurized habitat where the spacesuit can be taken off
and medical treatment administered.
c. Research is proposing a solution approach for one piece of the puzzle, i.e., IV
administration. It does not aim to provide solutions to all the medical provisions
that may be necessary for treatment of a spacesuited astronaut.
d. IV administration during EVAs will only be reserved for emergencies where, (1)
an astronaut cannot expeditiously remove his/her spacesuit, and (2) medical
treatment cannot be administered via any other route, e.g., orally, intramuscularly.
10
e. It is assumed that there will be EVA emergencies which will require a through-
the-spacesuit IV provision.
f. One member of the crew will be a trained physician and this person will be
responsible for the basic medical care of the crew. However, all crewmembers
will carry a responsibility for assisting the physician as the situation warrants. All
of the members of the crew will need to be trained in emergency first-aid response
(Duke, et. al., 2003).
g. For Implanted Venous Port (IVP) in chest area, it is assumed that an area would
be allocated into the spacesuit HUT to allow access to the IVP, and that any
equipment or connector on the HUT, e.g., DCMs, gas/fluid connectors, will either
be smaller and/or be located in a place which allows access to the IVP.
h. The Liquid Cooling Ventilation Garment (LCVG) will have a circular slot on top
of chest port, which is free of LCVG clothing or tubing; this will allow the needle
to be injected into the port without having to penetrate any other material.
i. If an astronaut consents to have an IVP procedure, he/she also consents to IV
treatment. In case of an EVA emergency, there would be limited time for
discussion with the injured astronaut, the astronaut may be unconscious, or the
astronaut may be mentally unstable, i.e., requiring restraint from other
crewmembers to inject IV treatment.
j. It is assumed that an astronaut’s willingness to have an IVP procedure would not
be a restraint to astronauts wishing to undergo preparation for long-duration
planetary surface missions.
11
k. Research does not address current NASA Design Reference Missions (DRMs),
such as missions to ISS. For these, there are well established protocols to address
EVA emergencies, e.g., re-enter habitat, doff suit, and administer treatment.
Instead, it addresses EVA emergencies for advanced EVA planetary surface
operations (Phase 3, see Section 1.1.2). These are not early phase explorations
that operate in a highly constrained environment. These are truly 'exploratory'
missions, i.e., rover excursions, geology missions, etc., where accidents would be
more likely to occur, i.e., rover flips over, rock falls on astronaut, astronaut falls
on a ditch, etc. The assumption is that during 'advanced' planetary missions, the
probability of EVA emergencies requiring IVs would increase.
l. NASA has performed analysis on the likelihood of medical conditions that might
require an IV during an EVA. However, it has only done so for its current DRMs,
i.e., ISS or Lunar Outpost missions. NASA has not conducted this type of injury
probability analysis for 'advanced' planetary EVAs.
m. NASA has not yet considered a through-the-suit port for surface operations
(Moon or Mars). In those cases, the operational concept is to return the crew to a
pressurized environment, doff the suit, and then proceed with medical care.
n. Focus should be on preventive medicine (screening, countermeasures);
diagnostic/treatment capabilities should only be provided for medical events that
cannot be screened, or medical emergencies that cannot be foreseen.

12
1.1 EVA Emergency Scenario Assumptions
There are two main scenarios that encompass an EVA emergency:
1. EVA Emergencies inside the habitat (depressurization, contamination, etc)
2. EVA Emergencies outside the habitat (surface accidents, medical issues, etc).
1.1.1 EVA Emergencies Inside Habitat
The first scenario entails contingencies in which the crew dons their spacesuit as a
result of a pressurized structural or life support systems failure that leads to cabin
depressurization and/or contamination (Table 1.1.1-1).
Table 1.1.1-1: EVA Emergencies Inside Habitat

Scenario Title Example Scenario Description
1A Habitat Structural
Failure (explosion,
micrometeoroid impact).
Structural failure scenarios could mean, for example, that the
air pressure inside the structure is lost, or that temperatures
can no longer be maintained as intended. If there is no other
safe pressurized module available, spacesuit donning would
be necessary. The source of the structural failure could in
fact have injured the astronaut, meaning he/she would need
medical treatment immediately after donning spacesuit.

1B Habitat Life Support
Failure (gas pressure, gas
composition, gas
contamination).
This failure would mean that the internal atmosphere has
been altered, e.g., partial gas pressure, gas composition, or
gas contamination. Life support systems failure could lead to
reduced levels of oxygen, increased levels of carbon dioxide,
or any type of gas contamination, e.g., carbon monoxide. As
an example, in the Space Shuttle and ISS, lack of gravity
prevents formation of currents in the air; thus, gases such as
carbon dioxide and carbon monoxide can, and do, build up in
floating “pockets” or “bubbles.” An astronaut sitting in one
of these “bubbles” would be, and have been, exposed to high
concentrations of toxic gas. Carbon monoxide poisoning,
while primarily treated with supplemental oxygen and
hyperbaric therapy, can also necessitate anticonvulsants (for
seizures), antiarrhythmics (for tachycardia), and furosemide
(for pulmonary edema) (Czarnik, 2009). If there is no other
safe pressurized module available, spacesuit donning would
be necessary.

13
In 2010, NASA concluded a study which defined the set of medical conditions –
Space Medical Exploration Medical Conditions List (SMEMCL) - that are most likely to
occur in any of seven mission profiles. These medical conditions are detailed in the Space
Medical Exploration Medical Conditions List (SMEMCL), and are discussed in Section
6.3. Out of this list, the mission profile which is of relevance to Scenario #1
(Emergencies within the habitat (depressurization) is the “144 Hour Depressurization
Return” mission profile, which was intended for the Orion
7
capsule. The NASA study
concluded that there are nine medical conditions that could arise during a
depressurization scenario that may require IV administration. These are diarrhea,
infection – cellulitis, infection – sepsis, medication overdose/misuse, nausea/vomiting,
seizure, space motion sickness, sprain/strain overuse syndromes, and toxic exposure
(Appendix A – Depressurized Mission Profile) (Watkins, 2010). The probabilities of
these medical conditions occurring during this mission profile are low, therefore, NASA
decided to not incorporate a ‘through-the-suit’ IV capability in its Orion spacesuit, and
accept the risk of not being able to provide IV administration during this scenario. This
position is also based on the fact that the Orion medical kit is very small (size of a lunch
box), and would probably not have an IV kit available (Baumann, 2011). Given the low
probability and volume restrictions, it may be acceptable to accept this risk for this
mission profile. However, this would not be acceptable for a planetary surface EVA

7
The Orion spacecraft (Crew Exploration Vehicle) was projected to transport crew and cargo to ISS. On 11
October 2010, with the cancellation of the Constellation Program, the development of the Orion vehicle
was retooled into the similarly-named Orion Multi-Purpose Crew Vehicle.

14
emergency requiring IV administration, which might involve life threatening trauma
conditions.
1.1.2 EVA Emergencies Outside Habitat
The second scenario entails contingencies where a crewmember experiences a
medical emergency while performing a surface EVA (Table 1.1.2-1). Note, this is not
intended to be inferred as the only scenario.
Table 1.1.2-1: EVA Emergencies Outside Habitat

Scenario Title Example Scenario Description
2 Medical incident outside of
Habitat
Astronaut “A,” perhaps having grown a little
negligent on his fourteenth EVA, steps through a
seemingly solid crust on Mars’ volcanic regolith,
plunging three meters through the shell before striking
bottom. A bad landing on an underground rock twists
his left leg violently outward. Regulations call for
minimum three person EVAs, but mired in sheer
volume of data to be processed, the commander had
approved two-person EVAs. Astronaut “B” hears his
EVA teammate shout on his headset. Minutes later he
finds the hole in the regolith crust, with Astronaut “A”
dimly visible at the bottom; he is not moving.
Astronaut “B” ties a rope to the team’s rover and
rappels down into the chasm. By acting quickly, he
has reached his teammate only ten minutes after
finding him. Astronaut “A” is unconscious with a
broken femur. Astronaut “A” might not live the ten
minutes it would take Astronaut “B” to immobilize
him, much less the thirty minutes to extricate him, the
twenty to race back to the Habitat, the five minutes to
reenter the airlock, and the time to remove him from
his spacesuit (Czarnik, 2005).

Unlike scenarios 1A and 1B, NASA’s SMEMCL study did not include an
Extended Surface Operations mission profile. It did include Lunar Sortie (Phase 1)
8
and
Lunar Outpost (Phase 2) mission profiles; however, the intent of this research focuses on

8
Exploration Mission Phases are discussed in Section 4.1.
15
EVA emergencies during Phase 3 mission profiles, i.e., Full Outpost Capability.
Nonetheless, the SMEMCL is still applicable to this research in that it identifies medical
conditions that might require IV administration during Lunar Sortie and Lunar Outpost
EVA operations. The assumption here is that if these conditions are likely to occur during
Phase 1 and/or Phase 2 mission profiles, then they would also occur during a Phase 3
mission. Section 6.3 describes the NASA SMEMCL medical conditions during Phase 1
and 2, which require an IV.
It needs to be re-emphasized that IV administration during surface EVAs will
only be reserved for emergencies where (1) an astronaut cannot expeditiously remove
his/her spacesuit, i.e., on surface EVA, and (2) medical treatment cannot be administered
via any other route, e.g., orally, intramuscularly. The main objective still remains to
transport the injured/ill crewmember back to a pressurized habitat where the spacesuit
can be taken off and medical treatment administered.
It is worth noting that in scenarios where an EVA astronaut has been injured and
cannot walk back, a modified stretcher is needed to get him/her to the Habitat. The main
challenge of transporting an injured EVA suited crewmember in a standard stretcher lies
in the spacesuit PLSSs, which for walking EVA spacesuits have to be carried as
backpacks. This hampers the ability to place the injured suited crewmember on a
stretcher in the supine position. During field testing at the Mars Desert Research Station
(MDRS), a modified stretcher was designed and built to transport EVA suited
crewmembers in the supine position (Appendix B – Modified EVA Stretcher).

16
CHAPTER 2: NASA RELEVANT RESEARCH AND POSITION

2.1 NASA Relevant Research

The following sections demonstrate that medical issues for extended space
exploration missions, especially for emergency provisions for EVA suited crewmembers
and IV research, are areas of great concern to NASA; further validating the need for this
research.
2.1.1 NASA Request for Proposals (RFPs)
This dissertation has significant relevance to research being proposed by NASA.
For example, NASA’s 2008 Small Business Innovation Research (SBIR) & Technology
Transfer Program Solicitations listed a section on “Through-Spacesuit Medication
Delivery,” which called for through-the-spacesuit proposals for use in case of cabin
depressurization:
NASA operations concepts envision contingencies where astronauts may
be required to wear Extra Vehicular Activity (EVA) suits for up to 120
hours. If a crewmember requires medication while in a suit, a method of
administration must be developed that does not compromise the integrity
of the suit, nor the environment it provides. Current concepts for the EVA
suit include a self-sealing diaphragm through which injections could be
given. However, fluid management in microgravity presents problems
with filling a syringe and delivering medication in such an environment.
The three main concerns are preventing bubbles from being injected,
appropriate fluid management, and excessive volume requirements for
pre-loaded syringes. Due to uncertainties about when such an event might
occur, the system would have to function in the range of gravity levels
between 0 to 1G, as well as pressure levels from vacuum to 1 atmosphere,
and require very little volume and no power. Accordingly, NASA seeks
proposals detailing concepts for such a system.
9

9
Source: NASA SBIR&T (2008)
17
Additionally, in 2008, NASA’s Microgravity University, Systems Engineering
Educational Discovery Program had a project proposal open titled “Medical Injections
for Emergency Extended EVA Suit.” Below is a synopsis of the project:
In anticipation of the development and design for the next generation
ExtraVehicular Activity (EVA) suits for Constellation missions to the
moon, the Human Research Program is conducting preliminary studies to
examine feasibility issues associated with extended continuous use of
EVA suits of up to 144 hours. Such a requirement is imposed to tackle the
emergency situation that would occur if the spacecraft cabin atmosphere
becomes unsuitable to sustain life. A partial or complete loss of cabin
pressure or spacecraft fire could render the cabin atmosphere
incompatible. The time requirement is being driven by the total transit
time to and from the moon and addresses the theoretical maximum time
required if the cabin pressure were lost shortly after the trans-Lunar
injection burn
10
.

2.1.2 NASA Human Research Program
The Human Research Program (HRP) conducts research and technology
development that: 1) enables the development or modification of Agency-level human
health and performance standards by the Office of the Chief Health and Medical Officer
(OCHMO), and 2) provides the Human Exploration and Operations Mission Directorate
(HEOMD) with methods of meeting those standards in the design, development, and
operation of mission systems (NASA Human Research Roadmap, 2011). HRP plays a
vital role in providing solutions to critical problems that place human exploration
missions and their crews at risk. Its objective is to ensure the health, safety, and effective
performance of astronauts. Currently, HRP’s focus is on three projects: 1) Exercise
Physiology and Countermeasures Project (ExPC), 2) Digital Astronaut to Simulate
Human Body in Space Project, and 3) Exploration Medical Capability Gaps Project

10
Source: NASA Microgravity University (n.d.)
18
(NASA HRP, 2009). The latter project is the most relevant to this dissertation, as it
involves the following salient gaps: 1) Lack of rapid vascular access capability for space
flight, 2) Lack of In Situ Intravenous (IV) Fluid Generation and Resource Optimization
Capability, 3) Lack of capability to deliver medication to crewmember in pressurized
suits, and 4) Lack of medical event modeling - Integrated Medical Model (NASA HRP,
2009).
2.1.2.1 HRP ExMC 4.10 Project

The ExMC (Exploration Medical Capability) 4.10 Project (Lack of Rapid
Vascular Access Capability for Space Flight) addresses the lack of rapid vascular
accessibility during space missions. In a medical contingency, the ability to gain access to
the patient's vascular system to provide medications or fluid can be critical. This task is
difficult to accomplish even for skilled medical care providers. This gap is focused on
finding technologies or techniques that can allow a medical care provider to safely and
rapidly establish vascular access in a patient that is easy for a layperson to operate,
minimizes trauma, and minimizes the infection rate. This assessment will consider
conventional Intravenous (IV) and Intraosseous (IO) vascular access methods as potential
treatment modalities. The medical conditions that are relevant to this gap are
Anaphylaxis; De Novo Cardiac Arrhythmia; Decompression Sickness; Infection - Sepsis;
Seizure; and Sudden Cardiac Arrest (NASA Human Research Roadmap, 2011).
2.1.2.2 HRP ExMC 4.12 Project
The ExMC 4.12 Project (Lack of In Situ Intravenous Fluid Generation and
Resource Optimization Capability) addresses the lack of IV fluid generation during space
19
missions. Medical operations concepts for both ISS missions and exploration missions
include pharmaceuticals that can only be given intravenously. Additionally, several
conditions may require intravenous fluid to maintain hydration and electrolyte balance.
Because of the volume and mass that would be required to treat all conditions specified,
NASA prefers to generate sterile water for injection in situ on an ad hoc basis. Currently,
no proven technology exists that can do this in a spaceflight environment (NASA Human
Research Roadmap, 2011).
According to Dr. Griffin (2009), Exploration Medical Capability Project
Manager, the IV fluid research being conducted is intended for unsuited use, meaning
either in a vehicle or in a habitable environment. Nonetheless, it has direct applicability to
this research, because even though it is intended for unsuited scenarios, IV fluid
management and preparation would still be needed.
Water must be appropriately sterilized and mixed with the required drugs or
electrolytes. Glenn has extensive expertise in microgravity fluid physics and it has
partnered with ZIN Technologies to identify water purification and mixing technologies
that will function in microgravity environments and will be easy to operate in emergency
situations. Testing and analysis has revealed that commercial distillation systems,
normally used to generate water for injection, do not function well in microgravity. If a
new system could properly filter and purify water in space, little or no medical grade
water would have to be launched at the start of the mission, reducing the overall mass of
the cargo. If astronauts require IV therapy during a mission, an appropriate drug will have
to be mixed with the water. However, due to the absence of buoyancy, most stirring
20
techniques do not work in reduced gravity. Glenn recently conducted an analytic trade
study examining microgravity mixing techniques and concluded that simple magnetic stir
bars were the best option (NASA HRP, 2009).
2.1.2.3 HRP ExMC 4.25 Project
The ExMC 4.25 Project (Lack of Capability to Deliver Medication to
Crewmember in Pressurized Suits) addresses the lack of capability for a through-the-suit
medical delivery capability. Given the possibility that vehicle failures could result in
crew needing to remain in pressurized suits for up to 144 hours, and given that medical
operations may need to provide medications via injection during that time, NASA must
develop reliable methods for delivering such medications through the suit. Key
assumptions as part of this effort are that if the crew is in their suits, the cabin atmosphere
is likely to be absent, or at a greatly reduced pressure. Such a condition could lead to
bubbles in the medication and pharmaceutical freezing. The research aim is to 1) Assess
current medical concept of operations for a 144 hour suited contingency, and 2) Identify
technology shortfalls and complete a development roadmap (based on the physical
properties of fluids in microgravity, combined with the properties of fluids in an
environment with reduced pressure and temperature, fluid physics experts will complete
an analysis of design and testing required to provide an IM or IO injection capability
during a 144 hour suited EVA contingency) (NASA Human Research Roadmap, 2011).
2.1.2.4 HRP IMM Project
The Integrated Medical Model (IMM) Project addresses the lack of medical event
modeling for space missions. The objective of the Integrated Medical Model (IMM) is to
21
quantify risks to astronauts, guide mission planners in improving safety, and help
improve fitness for duty standards (NASA HRP, 2009). The Integrated Medical Model
(IMM) is designed to identify and quantify crew health risks during flight and to evaluate
the effectiveness of in-flight mitigation strategies. To derive a quantitative measure of
relative medical condition risks, IMM integrates terrestrial and space flight evidence
bases to quantify probability and consequences of in-flight medical risks using Monte
Carlo simulations. Utilizing well accepted scenario driven techniques such as
probabilistic risk analysis as a guide, IMM generates a set of quantitative measures, such
as mission time lost or changes in fitness for duty, and their underlying uncertainty to
enable decision makers to make objective assessment of crew health and mission
outcomes with respect to our current level of knowledge (Myers, et. al., n.d.).
Bone fracture risk assessment is one component of NASA’s IMM. The possibility
of a traumatic bone fracture in space is a concern due to the observed 1-2% per month
localized decrease in astronaut bone mineral density (BMD) during spaceflight and
because of the physical demands that will be placed on astronauts as they construct a
Lunar or Martian base. This leads to the risk statement: “Given that astronauts could
experience significant skeletal loading during planetary surface activities, particularly in
areas where bone is compromised due to BMD reduction from low-g exposure, there is
the possibility of bone fracture leading to astronaut impairment or significant mission
impact.” Their preliminary results indicate that there is a small, but non-negligible risk of
bone fracture during a Mars mission. However, the model shows a wide uncertainty in
the fracture probability and indicates several areas where additional information can
22
improve the model predictions. Since the consequences of a fracture to the mission and
crew are severe, the thrust of ongoing work will be to “buy down” this uncertainty by
improving the data and simulations and identifying approaches to mitigate the risk of
fracture (Myers, et. al., n.d.)
In the near future, NASA HRP will be implementing their simulation approach to
medical events in the areas of renal stone formation, muscular performance and
behavioral health and performance (Myers, et. al., n.d.). The IMM will help validate
exploration medicine requirements, crew risks, and associated Levels of Care (LOC)
needed for missions with different durations, crew profiles, and operational objectives
(Fitts, et. al., n.d.).
2.1.3 National Space Biomedical Research Institute
NASA and the National Space Biomedical Research Institute (NSBRI) are
working together to help investigate questions related to astronaut health and
performance on future space exploration missions. NSBRI is a unique, non-profit science
institute established in 1997 by NASA. The Institute is working on countermeasures to
the health-related problems and physical and psychological challenges men and women
will face on long-duration missions. The research consortium's primary objective is to
ensure safe and productive human spaceflight. Research addresses key technologies
required to enable and enhance exploration. In particular, NSBRI scientists and
physicians are developing technologies to provide medical monitoring, diagnosis and
treatment in the extreme environments that will be faced during exploration missions.
23
NSBRI's integrated and coordinated activities engage academic, government and industry
sectors (NSBRI, 2009).
The Smart Medical Systems and Technology is a team of the NSBRI. Since
astronauts on long-duration missions will not be able to return quickly to Earth, new
methods of remote medical diagnosis, monitoring and treatment are necessary. On
exploration missions, it is possible that medical procedures may have to be performed by
a non-physician astronaut. To this end, the goal for the Smart Medical Systems and
Technology Team is the development of intelligent, integrated medical systems to assist
in delivering quality health care during spaceflight and exploration. Possible technologies
needed include ultrasound diagnostics and therapeutics, lab-on-a-chip systems, patient
and health physiologic monitors, and automated systems and devices to aid in decision-
making, training and diagnosis (NSBRI, 2009).
2.1.4 NASA Space Technology Roadmap
The NASA Space Technology Roadmap is an integrated technology roadmap that
considers a wide range of pathways to advance the nation’s current capabilities; meeting
both the near term space technology needs of the NASA mission directorates, as well as
the longer term Space Technology Grand Challenges. This roadmap is an integrated set
of fourteen technology area (TA) roadmaps, recommending the overall technology
investment strategy and prioritization of NASA’s space technology activities. The 14
chosen TAs focus upon capabilities where substantial enhancements in NASA mission
capabilities are needed, and where significant technology investments are anticipated
(Technology Roadmap, 2011). Of most relevance to this research is Technology Area 06
24
(Human Health, Life Support and Habitation Systems). Within TA06, one of the
objectives of Section 2.2 (Extra-Vehicular Activity Systems) is to address technology
solutions to enable long-duration suited operations (as in the case of a cabin
depressurization event), which could resolve technical challenges associated with long-
duration waste management, provision of food and water, and administering medication;
and the objective of Section 2.3 (Human Health and Performance) is to maintain the
health of the crew and support optimal and sustained performance throughout the
duration of a mission (Hurlbert, et. al, 2010).
2.2 NASA Position on Through-the-Suit IV Administration

As of the date of this dissertation publication, this author was not able to obtain an
official NASA position on a through-the-spacesuit IV provision with the use of a chest
port. However, independent opinions were obtained from notable NASA personnel. It is
important to emphasize that these are independent opinions and should not be
interpreted to be NASA positions on this subject.
Table 2.2-1: EVA Tasks in Extended Planetary Surface Missions

NASA Personnel Comments
Dr. James Polk
(Deputy Chief Medical
Officer, Space Medicine
Division Chief, NASA
JSC)

a. NASA is trying to decide how much risk to buy for the risk of
trauma…it’s an on-going process that NASA is going through (Polk,
2011).
b. Appendectomy and gall bladder removal are being considered as
possible procedures having to be performed on otherwise healthy
individuals. This gives rise to ethical issues! NASA has not come yet
to any conclusions on this (Polk, 2011).
c. As the risks involved with medical procedures get safer (the quality of
it gets safer) the more amenable NASA may become towards
incorporating such procedures. The issue is the risk of the actual
procedure. The risk of the medical implant procedure will decrease
with years, as it becomes safer NASA’s position may change over time
on this (Polk, 2011).
d. The probability of EVA incidence needing IV may also change in the
future as DRMs evolve. Probability assessments were only performed
25
NASA Personnel Comments
for current NASA architectures. These probabilities may increase in
the future. If the risk of the medical procedure is low, and probability
of EVA incidence needing IV increases, then it would be a worthwhile
risk to implant chest-port. In conclusion, the overall risk assessment
could change if the risk in the procedure goes down (Polk, 2011).

Dr. Sharmila Watkins
(Element Scientist,
Human Research
Program, Exploration
Medical Capability,
NASA JSC)
a. Medical incidence probabilities study performed by NASA HRP has
been based on 8-10 hour EVAs for NASA’s current DRMs, which
include missions to ISS or Lunar Outposts (6 months duration). Used
83 sets of conditions to perform study. When available, used conditions
that have occurred during EVAs; when not available, used incidence of
conditions on Earth, but targeted group of people similar to astronaut
population, i.e., age, health, etc. (Watkins, 2011).
b. Concurred that there may be a use for a through-the-suit IV concept for
eventual long-term duration missions, i.e., settlement mission phases,
as opposed to Lunar sortie/outpost beginning missions (Watkins,
2011).
c. Recommended that this dissertation focus on scenarios that may lead to
IV use, i.e., rover exploration, geology missions, rock falls on you, etc.,
but only in advanced planetary surface missions (Watkins, 2011).

Dr. David Baumann
(Manager, Human
Research Program,
Exploration Medical
Capability, NASA JSC)
a. NASA has not considered a suit port for surface operations (Moon or
Mars). In those cases, the operational concept is to return the crew to a
pressurized environment, doff the suit and then proceed with medical
care (Baumann, 2011).
b. Because NASA operates in a highly constrained environment (mass,
volume, power, budget), it focuses on preventive medicine (screening,
countermeasures) and then only provides diagnostic/treatment
capabilities for the most likely medical events that cannot be screened
(Baumann, 2011).
c. For current NASA DRMs where the crew might be in their suits for
over 5 days, NASA has identified a very short list of medical
conditions and they can all be treated by IM injection (Baumann,
2011).
d. Concurred that a through-the-suit IV concept might be necessary 30-50
years from now when there are hundreds of people on Mars, etc.
(Baumann, 2011).
e. Given that NASA has limited resources and budget, at this time,
through-the-suit IV is not something it is researching (Baumann,
2011).

Dr. Babs Soller
(NSIRB; Professor of
Anesthesiology,
University of
Massachusetts Medical
School)
a. NASA anticipates a need for technologies to provide rapid vascular
access. It is not known whether this will be through the spacesuit, or
under reduced gravity conditions; the specific requirements for this
have not yet been defined (Soller, 2008).
b. Not aware of any current NASA or NSBRI funded research in this
area, however there may be previous work done (Soller, 2008).

Table 2.2-1: Continued
26
NASA Personnel Comments

Gwyn Smith (Special
Assistant for Integration,
NASA Space Medicine
Division)
a. NASA had considered pursuing through-the-suit IV research, but only
work they are still investigating is the IM injection (Smith, 2009).
b. Interested to keep up to date with this dissertation research, as it could
come in handy in the future (Smith, 2009).
c. NASA loaned the IV Pump (same as one manifested in ISS Medical
Checklist) to the USC Department of Astronautical Engineering for
academic research purposes. IV Pump Loan Agreement (Figure 2.2-
1): “The intravenous (IV) administration kit, saline, and an IV pump
will be loaned to USC for research purposes. USC will research
methods of IV injections through an extravehicular activity (EVA) suit
to support planetary surface exploration.” (Smith, 2009).

Dr. Devon Griffin
(Program Manager,
NASA Human Research
Program, NASA GRC)

a. NASA has investigated the possibility of providing IV capability
through the EVA suit and has decided to delete that requirement
(Griffin, 2009).
b. This contingency is likely only in case of a vehicle or habitat accident,
which means the presence of co-morbidities is highly likely (Griffin,
2009).
c. If you look at the conditions for which IV in the suit would be needed,
you realize that there are probably a bunch of other required treatments
that cannot be delivered through the suit. As a result, we could spend a
lot of money developing a system that would not save a patient anyway
(Griffin, 2009).

Table 2.2-1: Continued
27

Figure 2.2-1: NASA IV Pump Loan Agreement to USC (Page 1)

28
Dr. Griffin is quite right: through-the-spacesuit IV capacity will not resolve all
possible medical concerns. However, to not pursue research for that reason alone would
be unacceptable. For example, the use of Military Anti-Shock Trousers (MAST)
11
in the
field could not address airway problems, but research continued and their use was
instituted (Czarnik, 2009). In other words, just because a portion of a solution does not
solve the whole problem, it does not mean that work on that portion should stop. This
research is proposing a solution approach for one piece of the puzzle, i.e., IV
administration. It does not aim to provide solutions to all medical provisions that may be
necessary for treatment of a spacesuited astronaut. It is assumed that further research will
be conducted to provide solutions to other necessary through-the-spacesuit medical
provisions.
In fact, preliminary research which addresses other aspects of medical treatment
of an EVA crewmember has already been proposed. Namely, Dr. Czarnik has proposed a
Remote Access Medical Suit (Appendix C – Remote Medical Access Suit), which
addresses many (but not all) of the medical contingencies facing an astronaut isolated in
their pressure suit (Czarnik, 2005). The Remote Access Medical Suit proposes
modifications to current spacesuit designs which incorporate medical provisions to
address the ABC’s of medical emergency treatment: Airway, Breathing and Circulation.
Airway maintains a patent (open) path for air to enter and leave the lungs. Breathing
provides a force driving air into and out of the lungs. Circulation ensures adequate

11
Military anti-shock trousers (MAST) are medical devices used to treat severe blood loss in the lower
extremities (they look like a pair of pants). The pressure decreases blood flow to the legs and actually
squeezes blood out of the lower body.
29
circulating fluid and ‘pumping action’ to maintain tissue perfusion which could improve
the survival of injured crewmembers (Czarnik, 2005).
Furthermore, in almost all medical emergencies, doctors are taught to treat
everyone with the "IV, O2, Monitor” procedure. Oxygen will not save everyone, but it
will help most patients. An EKG monitor may not be necessary for all patients, but it
almost always helps to see how the heart is doing. Likewise, not all patients may need an
IV, but establishing it early covers a multitude of necessities, from rehydration to
emergency volume expansion to rapid administration of medications. Any medical
doctor, one who works in an ER, will see the necessity of IV (Czarnik, 2009).
2.3 Conclusion
Sections 2.1 (NASA Relevant Research) and 2.2 (NASA Position on Through-
the-Suit IV Administration) demonstrate that even though there is justifiable rationale to
pursue a through-the-suit IV provision, it may not be currently taking place due to
constraining factors. Most notably, funding issues may have influenced NASA’s decision
to not pursue this requirement, especially in this environment of continued reduction in
NASA’s budget. There are cost-benefit analyses that take place in all of NASA’s
decisions, which may have put through-the-spacesuit IV research in the bottom of
priority lists, especially when only current NASA DRMs are being considered. On the
other hand, a PhD is not hindered by these factors, and as such, finds that there is
sufficient evidence to proceed with this research.

30
CHAPTER 3: PLANETARY SURFACE EVA

In all, 29 astronauts flew in the Apollo program, with 12 landing to spend a total
of 4 man-weeks on the Lunar surface (Barratt and Pool, 2008). The Apollo missions
provided a wealth of data; however, we are still in the infancy phase of planetary surface
EVA experience and knowledge of crew performance on planetary surfaces. As the
objective of human exploration of the Moon and Mars will be to spend time on their
surfaces, extensive EVA will be required as part of these missions.

3.1 EVA Considerations for Exploration Tasks
Surface exploration EVA Systems will entail a different design approach than
zero-g EVAs. The items below capture salient considerations for surface operations,
development of surface EVA suits, and the equipment used by the crews while in these
suits (Hoffman, 2001):
a. Field of View – Spacesuits must provide the ability for screw members to observe
the environment around them. For example, geologic field work is an exercise in
seeing rocks and structures. The accommodations that allow observation must
allow as wide a field of view as possible. Further, the visibility provided must be
as free of optical distortion and preferably without degradation of color vision. In
particular, seeing colors allows discrimination between otherwise similar rock
units. (Hoffman, 2001).
b. Mobility – EVA suits and other exploration accommodations must allow as much
mobility as possible, both in terms of suit mobility and the ability to explore as
much terrain as possible. Where suit mobility is difficult or disallowed by the
31
mechanics of inflated suits, e.g., bending and squatting down, an easily used suite
of tools should compensate for the lack of mobility, so rock samples and dropped
tools can be picked up with as little effort as possible (Hoffman, 2001).
c. Maintenance – Tools and equipment must be maintainable in the field and the
EVA suit/tool interface must accommodate the environmental conditions under
which this maintenance will take place. The level of maintenance that must be
accomplished in the field versus maintenance at the outpost will need to be
determined (Hoffman, 2001).
d. Communication – Reliable and redundant communication between the EVA team
in the field and the outpost must be provided, as well as navigational aids for the
EVA team while in the field (Hoffman, 2001).
3.2 Exploration Mission Phases
Through the analysis of current space agency plans, three specific exploration
mission phases were identified, which reflect the objectives of leading space agencies.
These phases are Phase 1 (Sorties), Phase 2 (Outpost Growth), and Phase 3 (Full Outpost
Capability).
a. Phase 1 (Sorties) entails multiple missions that each go to a different location to
explore the vicinity; no infrastructure is left for a follow-on mission (Bienhoff,
2011). A solid structure similar to a Lunar lander will be established to house 3 to
4 astronauts for mission durations of less than one week. This will be a temporary
outpost that will be used for reconnaissance to locate an appropriate site for a
base, as well as for conducting some scientific experiments. The limited number
32
of tasks being performed will only require basic and proven robotic architectures
to be used. Additionally, only open loop life support systems will be necessary.
This phase is expected to last approximately 3 to 5 years (Acevedo, et al., 2008).
b. Phase 2 (Outpost Growth) entails multiple missions to a single site with each one
delivering additional infrastructure capability and supporting increasing surface
durations (Bienhoff, 2011). Once the base location has been identified, structures,
possibly inflatable, will be deployed to the surface of to establish a base capable
of housing a maximum of 15 astronauts for durations of up to 180 days. This
phase's main focus will be to carry out more complex experiments and test
advanced technologies in life-support and ISRU such as bio-regenerative closed
loop Environmental Control and Life Support System (ECLSS). In addition,
robotic architectures extending from terrestrial based applications will begin to be
implemented to facilitate maintenance, construction and ISRU operations. Phase 2
is expected to last an additional 10 to 15 years (Acevedo, et al., 2008).
c. Phase 3 (Full Outpost Capability) entails a site being continuously occupied with
regular crew exchange and logistics missions. Phase 3 is not the end state, but the
first point when continuous permanent occupancy can occur (Bienhoff, 2011). It
is a continuation of Phase 2 with the addition of a hybrid closed loop ECLSS, e.g.,
physico-chemical and bio-regenerative, with a minimum closure of 75% of the
water, oxygen and food loops. ISRU will commence to enhance the self
sustainability of the base. Advanced robotic systems that incorporate changes to
33
previously tested systems will be implemented. Extensive EVAs are expected to
support surface habitation and exploration (Acevedo, et al., 2008).
The Full Base Capability phase is of most relevance to this research. It is assumed
that this phase will encompass the highest risk of injury to EVA crews based on the
complexity, difficulty, and duration of EVA tasks. Habitat medical facilities during this
phase will require expanded/advanced medical capabilities, due to the probability of
encountering a medical problem, and the time and expense required to return a
crewmember to Earth (Duke, et. al., 2003). Similarly, EVA systems will require
provisions that will allow the EVA crew to initiate emergency first-aid response on the
field; one such provision is a “through-the-suit” IV capability.
3.3 EVA Tasks in Extended Planetary Surface Missions (Phase 3)
Future extended planetary surface missions will include extensive EVA surface
exploration, which will take place in the vicinity and many kilometers from the base.
These EVAs are inherently dangerous and can put crew safety at risk; however, they will
be an essential part of human activities on a planetary surface. According to Harris
(2001), unlike Apollo, where the suit’s mobility limitations dictated the EVA mission
objective and range, future planetary surface explorers will utilize EVA spacesuits with
enough mobility to go “anywhere” (Figure 3.3-1).

34

Figure 3.3-1: Canyon Geology/Weather EVA
12

According to Barratt and Pool (2008), crews can be expected to undertake heavy
exertions and load manipulations during surface activities, donning heavy suits and life
support systems while manipulating surface material and equipment. The optimal balance
among effect of partial gravity, surface EVAs, and deliberate countermeasures during
long-duration stays remains to be delineated.
Present strategies suggest substantial manned EVAs for assembly and exploratory
operations. These are difficult and risky activities in extended planetary surface missions
due to the paucity of redundant systems. It is expected that future planetary surface
missions will entail exploratory (geosciences) expeditions, infrastructure construction and
assembly, as well as mining of in-situ materials. Using advanced in-situ resource

12
Source: NASA Images (2011) – This is an artist's concept depicting an EVA on a canyon. The area
depicted is Noctis Labyrinthus in the Valles Marineris system of enormous canyons. The scene is just after
sunrise, and on the canyon floor four miles below, early morning clouds can be seen. The astronaut
depicted on the left might be a planetary geologist seeking to get a closer look at the stratigraphic details of
the canyon walls. On the right, the geologist's companion is setting up a weather station to monitor Martian
climatology. In the far right frame is a six wheeled articulated rover, which transported the pair of
astronauts here from their habitat.
35
utilization (ISRU) technologies, humans at the base, along with tele-operated robots, will
build habitable facilities and large agricultural enclosures, as well as pressurized and
unpressurized structures for manufacturing, storage and maintenance facilities. While it is
true that these operations will mainly entail the use of special tools and machinery, onsite
human supervision and support (EVA) will be required (Schrunk, et al., 1999).
In 2008, professionals from all over the world from various disciplines (including
this author), were contacted by the International Space University (ISU) to obtain a good
statistical account for the different tasks astronauts will perform during Lunar
explorations. Whereas the ISU list includes tasks performed inside and outside a habitat,
and tasks performed by robots and/or humans, for purposes of this research, this list was
adapted to filter only tasks requiring astronaut operations outside a pressurized habitat
(EVA tasks) (Table 3.3-1). The intent of presenting this adapted list is not to imply that
all these tasks are hazardous, instead, to illustrate the many tasks astronauts will be
exposed to, which “may” lead them to get injured. Proper EVA planning/training and
adequate support systems will be helpful, but unfortunately EVAs will always remain a
dangerous activity. Whether on the bottom of a subsurface lava tube, at the base of a
steep hillside, or under a large disturbed rock, planetary surface explorers will face
scenarios which will have the potential of getting them seriously injured (Czarnik, 2005).
Astronaut will be trained to deal with a laundry list of potential emergencies that can
come up, and everything they learn can be rendered moot by events nobody could
predict.
36
Test
Table 3.3-1: EVA Tasks in Extended Planetary Surface Missions
13

Classification Surface Planetary
EVA Task
Description
Base Construction Excavation/Mining Includes scooping, scraping, dozing, and ripping using
heavy machinery similar to terrestrial designs. Use of
explosives may also be considered.
Hauling Includes loading, transport, and unloading of large
quantities of construction material and Lunar soil using
heavy machinery.
Placing Includes spreading, piling, compacting, and shaping of
Lunar soil using heavy machinery, e.g., habitat
shielding, terrain clearing.
Transportation Transportation of cargo, equipment, and personnel using
Lunar vehicles for the purpose of base construction.
Lifting/stabilizing Lifting, placing, and stabilizing of structural
members/modules.
Connecting/disconne
cting service lines
Service connections for hydraulic, pneumatic, water,
and electrical lines.
Joining Welding, riveting, or other fastening methods of
structural members.
Handtool tasks Use of handtools for tasks that are complex or require
substantial dexterity, or in support of other tasks.
Surveying Initial surveying for semi-permanent or permanent
structures.
Connecting modules Connecting of individual habitat modules in multi-
module designs.
Power system
installation
Installation of solar arrays, RTGs, fuel cells or
combustion generators, and all associated components.
Laying of electrical
cables
Any tasks related to unrolling and laying of electric
cable between habitat modules and power sources.
Base Operation &
Maintenance
External
Housekeeping
Cleaning of habitat external surfaces and scientific
payloads; replacement of tanks, filters, bulbs, etc.
Fueling Operations Fuelling, defueling, and changing of fuel tanks.
Unloading/stowage
of resupply cargo
Removing cargo from resupply craft and transporting.
Climbing structures Climbing in and out of habitat for EVA; climbing of
base structures for maintenance purposes.
Crew rover
maintenance
Changing of batteries, repair to damaged components,
cleaning away dust, etc.
ECLSS/Life support
maintenance
Monitoring and maintenance of ECLSS.

13
Table Source (from References):
- Acevedo, et al., (2008)
- NASA SBIR&T (2008)
- NASA Microgravity University (n.d.)
37
Classification Surface Planetary
EVA Task
Description
Power system
maintenance
Periodic cleaning, adjustment, or replacement/repair of
power system components.
Emergency and
Safety Procedures
Transporting injured Transportation of injured crew members on EVA back
to Lunar habitat.
First Aid/CPR/trauma
treatment
Response to situations or conditions having a high
probability of disabling or immediately life-threatening
consequences or requiring first aid or other immediate
intervention (including surgical and non surgical
procedures like CPR).
Dust Mitigation
Egress/Ingress
Removal of dust from spacesuits prior to ingress.
Retrieval of stranded Search and recovery of lost or stranded crewmembers
during Lunar excursions.
Death management Care, removal, and/or stowage of body(ies).
Treatment of
psychiatric
emergencies
Dealing with crew who suffer from acute psychiatric
conditions; post-traumatic disorder.
Evacuation Removal of crewmembers from Lunar base to
evacuation spacecraft.
Emergency donning
of EVA spacesuit
Emergency situation that would occur if the habitat
atmosphere becomes unsuitable to sustain life, leading
to extended continuous use of EVA spacesuits. A partial
or complete loss of habitat pressure or habitat fire could
render the cabin atmosphere incompatible.
Planetary Surface
Exploration
Traveling Traveling to Lunar sites of interest for exploratory,
geological, surveying or ISRU purposes.
Sample collection Physical sampling of Lunar geology, e.g., asteroid
impact recovery.
Navigating Navigating between Lunar base and points of interest.
Repelling/Climbing Descent/ascent of high inclination slopes requiring
special equipment.
Transporting
scientific instruments
Transportation of any instrumentation necessary for
exploration activities.
Communication Communication between crewmembers during
excursions.
Planetary Surface
Science
Measurement taking Taking of various scientific measurements exterior to
the Lunar habitat.
Experiment setup Setup of various scientific experiments.
Maintenance Maintenance of software/hardware, calibration of
instruments.
Table 3.3-1: Continued
38
Classification Surface Planetary
EVA Task
Description
Control of
experiments
Monitoring and control of experiment conditions and
procedures.
Robotic Support
Operations
Maintenance of
robots
Maintenance of robotic systems
Integration of robots Integration of individual robotic components as
transported to the Lunar base
ISRU Procedures Mining Location and extraction of Lunar resources.
Processing Processing of Lunar resources into refined or more
usable products.
Transportation Transportation of raw Lunar resources from extraction
site to processing site.
Refined material
production
Production of any refined product using Lunar
resources, e.g., concrete, fuel, etc.
Table 3.3-1: Continued
39
3.4 Conclusion
As Table 3.3-1 depicts, EVA tasks in extended planetary surface missions (Phase 3)
will involve vigorous and highly complex activities. Planetary surface crews will be
actively involved with a an array of EVA tasks (Duke, et. al., 2003), which will increase
the probability of EVA emergency incidences. EVA tasks that will most likely lead to
injury are: base construction, base operation & maintenance, planetary surface
exploration, and ISRU procedures. These tasks are highlighted in Table 3.3-1. The
unusual environmental characteristics of planetary surface EVAs, with their
commensurate occupational hazards, predicate the development of a robust medical
capability inside the pressurized habitat and the EVA system. Keeping the crew healthy
and productive during planetary surface EVAs will undoubtedly involve routine EVA
medical capabilities such as health monitoring, e.g., biosensors, but also the capability to
handle more serious situations, e.g., through-the-suit IV administration.

40
CHAPTER 4: EMERGENCY FIRST-AID RESPONSE OPERATIONS

For purposes of this research, emergency first-aid response operations refer to the
pre-hospital operations that are taken by EMTs prior to arrival to a definitive care unit,
i.e., during the “Golden Hour”. Table 4-1 depicts the Golden Principles of Pre-Hospital
Trauma Care.
Test

Table 4-1: Golden Principles of Pre-Hospital Trauma Care
14

Principle Definition
1 Ensure the safety of the pre-
hospital care providers and the
casualty.
This includes not only the safety of the casualty, but the EMTs
safety as well.
2 Assess the scene situation to
determine the need for
additional resources.
During the response to the scene and immediately on arrival, a
quick assessment is performed to determine the need for additional
or specialized resources.
3 Recognize the kinematics that
produced the injuries.
As the scene and the casualty are approached, the kinematics of
the situation can be noted. Understanding the principles of
kinematics leads to better casualty assessment.
4 Use the primary survey
approach to identify life-
threatening conditions.
This brief survey allows vital functions to be rapidly assessed and
life-threatening conditions to be identified through systematic
evaluation of the ABCDEs: airway, breathing, circulation,
disability, and expose/environment.
5 Provide appropriate airway
management while
maintaining cervical spine
stabilization.
The essential skills of airway management should be performed
with ease: manual clearing of the airway, manual maneuvers to
open the airway (trauma jaw thrust and trauma chin lift),
suctioning, and the use of oropharyngeal and nasopharyngeal
airways.
6 Support ventilation and deliver
oxygen to maintain an Sp02
greater than 95%.
Assessment and management of ventilation is another key aspect
in the management of the critically injured casualty.
7 Control any significant
external hemorrhage.
In the trauma casualty, significant external hemorrhage is a
finding that requires immediate attention. Because blood is not
amenable to administration in the pre-hospital setting, hemorrhage
control becomes a paramount concern for pre-hospital care
providers in order to maintain a sufficient number of circulating
RBCs.
8 Provide basic shock therapy,
including restoring and
maintaining normal body
temperature and appropriately
splinting musculoskeletal
injuries.
At the end of the primary survey, the casualty’s body is exposed
so that the pre-hospital care provider can quickly scan for
additional life-threatening injuries.

14
Data obtained from PHTLS Chapter 18 (Golden Principles of Pre-Hospital Trauma Care)
41
Principle Definition
9 Consider use of pneumatic
antishock garment for
casualties with decompensated
shock (SBP < 90 mm Hg) and
suspected pelvic,
intraperitoneal, or
retroperitoneal hemorrhage,
and in casualties with
profound hypotension (SBP <
60 mm Hg).
When a trauma casualty in decompensated shock has suspected
pelvic, intraperitoneal, or retroperitoneal hemorrhage, application
and inflation of the pneumatic antishock garment (PASG) may
decrease and even tamponade serious internal bleeding.
10 Maintain manual spinal
stabilization until the casualty
is immobilized on a long
backboard.
When contact with a trauma casualty is made, manual stabilization
of the cervical spine should be provided and maintained until the
casualty is either a) immobilized on a long backboard, or b)
deemed not to meet indications for spinal immobilization.
11 For critically injured trauma.
casualties, initiate transport to
the closest appropriate facility
within 10 minutes of arrival on
scene.
Numerous studies have demonstrated that delays in transporting
trauma casualties to appropriate receiving facilities lead to
increases in mortality rates. Although pre-hospital care providers
have become proficient at endotracheal intubation, ventilator
support, and administration of intravenous (IV) fluid therapy, most
critically injured trauma casualties are in hemorrhagic shock and
are in need of two things that cannot be provided in the pre-
hospital setting: blood and control of internal hemorrhage.
12 Initiate warmed intravenous
fluid replacement en route to
the receiving facility.
While en route to the receiving facility, the pre-hospital care
provider can insert two large-bore IV catheters and start an
infusion of warmed (102 deg. F) crystalloid solution.
13 Ascertain the casualty’s
medical history and perform a
secondary survey when life-
threatening conditions have
been satisfactorily managed or
have been ruled out.
If life-threatening conditions are found in the primary survey, key
interventions should be performed and the casualty prepared for
transport within the Platinum 10 minutes. Conversely, if life-
threatening conditions are not identified, a secondary survey is
performed.
14 Above all, do no further harm. When caring for a critically injured casualty, pre-hospital care
providers need to ask themselves if their actions at the scene and
during transport will reasonably benefit the casualty. Interventions
should be limited to those that prevent or treat physiologic
deterioration.

As can be seen from Table 4-1, the establishment of an IV line is one of the
Golden Principles of Pre-Hospital Trauma Care (Step #12). This emphasizes the
importance of incorporating a through-the-suit IV administration, which would allow
Table 4-1: Continued
42
injured EVA crewmembers to be administered intravenous fluids during an emergency
response.
4.1 Urban First-Aid Response
As part of this research, this author petitioned for, and was approved, an
ambulance Ride-Along to obtain a better appreciation for first-aid response procedures in
an urban setting (Appendix D – Ambulance Ride-Along Petition). This was relevant for
this research because it allowed the author to understand the intricacies of establishing an
IV in a very dynamic environment, such as occur during 911 calls in urban settings. The
Ride-Along was performed with the Glendale Fire Department (Ambulance #25) on July
1
st
, 2011, during an 8 hour shift with EMTs Karlow Krikov and Wayne Runcie (Figure
4.1-1). These EMTs are trained in advanced life support (ALS) and can provide a level
of care provided by pre-hospital emergency medical services. Advanced life support
consists of invasive life-saving procedures including the placement of advanced airway
adjuncts, intravenous infusions, manual defibrillation, electrocardiogram interpretation,
and much more (ALS, 2011).
43

Figure 4.1-1: Glendale Fire Department – EMT K. Krikov and Ambulance #25

According to Krikov (2011), 60% of EMT calls are advanced life support (ALS) related,
and all ALS calls require the establishment of an IV. This could be due to an array of
issues, including the following:
a. Fluid replacement – As a result of blood loss, vomiting.
b. Pain – To mitigate severe pain (broken bone)
c. Cardiovascular Medicine – Issues with SVT, VTAC.
d. Pre-hospital trauma life support (PHTLS) – IV established during transporting of
patient to hospital to allow expedient access for blood/fluid infusion upon arrival
at the hospital.
15

For example, if someone was involved in a vehicle accident and lost a leg, two IVs would
be started to give the injured patient fluids to try to keep his/her blood pressure up.

15
PHTLS – During an emergency, every second counts. The purpose of establishing an IV line during
transport to a hospital is to save precious minutes upon arrival.
44
4.2 Construction Injuries First-Aid Response
Construction site accidents kill hundreds and injure hundreds of thousands of
workers each year (BLS-1, 2002; BLS-2, 2002). Indeed, working at a construction site is
one of the most dangerous occupations in the United States. That said, the majority of
injuries are minor, i.e., finger cuts, crushed finger, sprained ankle, etc., and injured
patients are usually transported to hospitals by co-workers or drive themselves (Krikov,
2011). According to Krikov, (2011), construction sites do not like to call 911 for minor
injuries; once construction site employees make a 911 call, they have to report the call to
OSHA, which leads to an OSHA investigation of the accident and is reported to the
Bureau of Labor Statistics (BLS)
16
. As a result, ambulances are only called for major
construction trauma cases, such as blunt trauma injuries, e.g., I-beam impacts. For such
calls, for example, two large bore IVs might need to be established upon EMT arrival to
maintain an adequate blood pressure. In essence, when an ambulance is called to a
construction site, it implies a major injury requiring ALS; therefore, EMTs will be
required to establish an IV on 100% of such calls. It is envisioned that planetary surface
exploration will entail many construction-type operations performed with machinery,
robots, and EVA crews, which may lead to trauma injuries similar to Earth, even taken
into account the reduced gravities of other surfaces, i.e., Moon and Mars.

16
During an 8-year study from 1998-2005, there were an estimated 3,216,800 construction industry-related
injuries seen in U.S. emergency departments; however, a significant lower number of these were reported
to BLS.
45
4.3 Military Combat First-Aid Response
Historically, 90% of combat wound fatalities die on the battlefield before reaching
a medical treatment facility (Bellany, 1984). This fact emphasizes the need for continued
improvement in tactical pre-hospital care (which includes IV administration). Casualty
management during combat missions can be divided into three distinct phases: 1) Care
Under Fire, 2) Tactical Field Care
17
, and 3) CASEVAC Care
18
(Butler and Hagmann,
1996). Phases 2 and 3 are of relevance to this research, as it is not envisioned that
astronauts will be under fire.
Regarding IV access during PHTLS, two 18-gauge catheters are preferred in the
field setting because of the ease of cannulation (Butler and Hargmann, 1996). Crystalloid
and colloid solutions can be administered rapidly through an 18-gauge catheter, and
blood products requiring the larger cannulae are not given in the field. Blood products
may be administered in the CASEVAC phase or later at a military treatment facility, but
field-placed IV cannulae will normally be replaced there anyway because of the risk of
contamination (Lawrence and Lauro, 1988). For combat casualties who need IV access,
rapid line placement is anticipated and 5 mg morphine sulfate is administered
intravenously repeated at 10-minute intervals until adequate analgesia is achieved
(PHTLS, 2007).

17
Tactical Field Care – Care rendered once the casualty and his or her unit are no longer under effective
hostile fire. Medical equipment is limited to that carried into the field by mission personnel. Time to
extraction may range from a few minutes to many hours.
18
CASEVAC – Casualty Evacuation Care is the care rendered while the casualty is being evacuated to a
higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be
available during this phase.
46
In essence, the basic treatment procedures for treating a casualty are: make sure
the casualty is breathing adequately, control serious bleeding, and control shock. If a
casualty has lost a good deal of blood, the most important procedure other than promptly
controlling the bleeding is to initiate an IV to control hypovolemic shock. The quicker the
casualty receives intravenous fluids, the better his chances for surviving. An IV can be
maintained while the casualty is being evacuated. If a medic arrives before the casualty
is evacuated, he/she can maintain the IV and administer additional fluids using the same
catheter and tubing. Initiating an IV is probably the most challenging task in Combat
Lifesaver training (Intravenous Infusion, 2011).
Military combat first-aid response is a good analog to EVA planetary surface
emergencies because of the extreme environment in which these emergencies take place.
Table 4.3-1 illustrates the steps that need to be taken for tactical field care.
Table 4.3-1: Basic Management Plan for Tactical Care
19

Principle Definition
1 Casualties with an altered
mental status should be
disarmed
N/A
2 Airway management a. Unconscious casualty without airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Place casualty in recovery position
b. Casualty with airway obstruction or impending airway obstruction.
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
o Allow conscious casualty to assume any position that best
protects the airway, to include sitting up.
o Place unconscious casualty in recovery position.
- If previous measures unsuccessful: Surgical
cricothyroidotomy (with lidocaine if conscious)
3 Breathing a. Consider tension pneumothorax, and decompress with needle
thoracostomy if casualty has torso trauma and respiratory distress.
b. Sucking chest wounds should be treated by applying a three-sided

19
Data obtained from PHTLS Chapter 21 (Tactical Field Care)
47
Principle Definition
dressing during expiration, then monitoring for development of a
tension pneumothorax.
4 Bleeding a. Assess for unrecognized hemorrhage, and control all sources of
bleeding.
b. Assess for discontinuation of tourniquets once bleeding is
definitively controlled by other means. Before releasing any
tourniquet on a casualty who has been resuscitated for
hemorrhagic shock, ensure a positive response to resuscitation
efforts, i.e., a peripheral pulse normal in character and normal
mentation if there is no traumatic brain injury (TBI).
5 Intravenous (IV) Access Start an 18-gauge IV or saline lock, if indicated. If resuscitation is
required and IV access is not obtainable, use the intraosseous (IO)
route.
6 Fluid Resuscitation

Assess for hemorrhagic shock; altered mental status in the absence of
head injury and weak or absent peripheral pulses are the best field
indicators of shock.
a. If not in shock: No IV fluids necessary; PO
20
fluids permissible if
conscious.
b. If in shock: Hextend, 500mL IV bolus; Repeat once after 30
minutes if still in shock; No more than 1000mL of Hextend.
c. Continued efforts to resuscitate must be weighed against logistical
and tactical considerations and the risk of incurring further
casualties.
d. If a casualty with traumatic brain injury (TBI) is unconscious and
has no peripheral pulse, resuscitate to restore the radial pulse.
7 Prevention of
Hypothermia
a. Minimize casualty’s exposure to the elements. Keep protective
gear on or with the casualty if feasible.
b. Replace wet clothing with dry if possible.
c. Apply Ready-Heat blanket to torso.
d. Wrap in Blizzard Rescue Blanket.
e. Put Thermo-Lite Hypothermia Prevention System Cap on the
casualty’s head, under the helmet.
f. Apply additional interventions as needed and available.
g. If mentioned gear is not available, use dry blankets, poncho liners,
sleeping bags, body bags, or anything that will retrain heat and
keep the casualty dry.
8 Monitoring Pulse oximetry should be available as an adjunct to clinical
monitoring. Readings may be misleading in the settings of shock or
marked hypothermia.
9 Inspect and dress known
wounds
N/A
10 Check for additional
wounds
N/A
11 Provide analgesia as
necessary
a. Able to fight. These medications should be carried by the
combatant and self-administered as soon as possible after the

20
PO - ‘Per os’ is an adverbial phrase meaning literally from Latin “by mouth” or “by way of mouth.” The
expression is used in medicine to describe a treatment that is orally administered.
Table 4.3-1: Continued
48
Principle Definition
wound is sustained – Mobic (15 mg PO qd); Tylenol (650 mg
bilayer caplet, 2 PO q8h)
b. Unable to fight. Note, have naloxone readily available whenever
administering opiates.
- Does not otherwise require IV/IO access:
- Oral transmucosal fentanyl citrate (OTFC), 800ug
transbucally
o Recommend taping lozenge-on-a-stick to casualty’s finer
as an added safety measure.
o Reassess in 15 minutes.
o Add second lozenge, in other cheek, as necessary to
control severe pain.
o Monitor for respiratory depression.
- IV or IO access obtained:
- Morphine sulfate, 5 mg IV/IO
o Reassess in 10 minutes
o Repeat dose every 10 minutes as necessary to control
severe pain.
o Monitor for respiratory depression.
- Promethazine, 25 mg IV/IO/IM nausea, for synergistic
analgesic effect.
12 Splint fractures and
recheck pulse

13 Antibiotics:
recommended for all open
combat wounds
a. If able to take PO:
- Moxifloxacin, 400 mg PO qd.
b. If unable to take PO (shock, unconsciousness)
- Cefotetan, 2 g IV (slow push over 3-5 minutes) or IM q12h, or
- Ertapenem, 1 g IV/IM q24h.
14 Communicate with the
casualty if possible
a. Encourage; reassure.
b. Explain care.
15 Cardiopulmonary
resuscitation (CPR)
Resuscitation on the battlefield for victims of blast of penetrating
trauma who have no pulse, no ventilations, and no other signs of life
will not be successful and should not be attempted.
16 Document clinical
assessments, treatments
rendered, and changes in
casualty’s status
Forward this information with the casualty to the next level of care.

As can be seen from Table 4.3-1, the establishment of an IV line is also part of
Military Combat First-Aid Response procedures (Step #5, 6, 11, 13).
Table 4.3-1: Continued
49
4.4 Bio-chemical Warfare Research First-Aid Response
Protective gear is mandatory for combat personnel, as well as for medical
personnel treating casualties in a contaminated environment, i.e., biological warfare
21

and/or chemical warfare
22
. In the case of an emergency, one of the medical procedures
that needs to be performed by a rescue medic is the insertion of an IV line in a patient
that is probably in shock. This is a very difficult task that must be performed with the
rescue medic wearing thick protective rubber gloves, sweating in a biochemical suit with
a mask and filters, and exposed to a dangerous and dynamic environment, i.e., sounds of
sirens, gunshots and bombings, flashing lights, smoke, etc. In fact, simulated multi
casualty demonstrations suggest that IV establishment on the battle field is very difficult,
even for experienced IV technicians and anesthesiologists, who failed repeated attempts
at IV access, leading to the death of the simulators (Vardi, 2011).
In 1999, the Israeli Defense Forces Medical Corps, performed a study to assess
the ability of emergency medical technicians to insert an intravenous line while wearing
chemical protective ensembles. Sixty emergency medical technicians took part wearing
full protective gear. Even though the overall success rate was 58.6%, the findings
suggested that introduction of an intravenous line is possible, but time consuming. The
study recommended alternative methods for antidotal treatment, such as the use of
automatic auto-injectors for intramuscular administration (Berkenstadt, et al., 1999).

21
Biological Warfare – Involves the use of bacteria, viruses, fungi, or biological toxins, for the purpose of
killing or incapacitating humans, animals or plants as an act of war.
22
Chemical Warfare – Involves using the toxic properties of chemical substances as weapons.
50
Similar research has been conducted by other military services around the world.
This demonstrates that the need to expeditiously establish an IV line in emergency
situations is well established. That said, even though bio-chemical suit research is
relevant, it is not necessarily comparable to EVA emergencies where the integrity of the
suit cannot be compromised. For example, during the bio-chemical simulations
aforementioned, the simulated patient (manikin) was undressed for medical treatment;
only the rescue medic had protective gear. Secondly, even though the simulated patient
had protective gear, this was removed prior to treatment, exposing the patient to the bio-
chemical agent (Berkenstadt, et al., 1999). As part of similar tests conducted by the
Israeli Center for Medical Simulation, Figure 4.4-1 shows a physician in full protective
gear, placing the IO needle into a manikin simulating a severe combined chemical and
conventional warfare casualty.

Figure 4.4-1: Intraosseous Administration
23

23
Source: Vardi, et. al., (2004)
51
4.5 Conclusion
The review of emergency first-aid response for relevant scenarios (urban,
construction, military combat, and biochemical warfare) demonstrates the need to
establish an IV in emergency trauma cases, during the time prior to reaching a definitive
care unit. Establishing an IV line during an urban-type emergency is difficult, but more
so during a battlefield, and even more so while wearing protective gear. This will also be
the case for EVA emergencies on a planetary surface. To facilitate this, utilizing a
through-the-suit IV concept and an implanted chest port would make this task easier. Just
as on Earth, having an IV established prior to reaching a definitive care unit, i.e.,
pressurized habitat, will increase the survival probabilities of the injured astronaut.

52
CHAPTER 5: MEDICAL INCIDENCE RATES
As humans continue to explore other planets and survive in environments that are
beyond standard physiologic limits, an understanding of human reactions to these new
environments and development of protective systems and processes will become more
critical. Addressing these medical issues in space will entail the application of standard
medical practice in this unique and challenging environment, and it will pull doctors in
the world of engineers and vice versa (Barratt and Pool, 2008).
5.1 Medical Incidence Rates during Space Missions
In four decades of human space flight and exploration, our knowledge, activities,
and capabilities have grown significantly. Between 1971 and 2005, several medical
events have occurred during space flight. From this experience and that of analogous
environments, it is possible to estimate the likelihood of a serious medical event,
defined as one that would require emergency room care
24
in a terrestrial setting, for
future space missions (Barratt and Pool, 2008). These estimates are known as incidence
rates and are expressed as events per person-year.
To determine incidence rates, three unique populations were considered: 1)
Ground-based analog population representing medical evacuations from the U.S.
National Science Foundation’s (NSF) Polar Medicine Program at McMurdo
25
Antarctic
Station; 2) Hospitalizations among U.S. astronauts from 1959 to present; and 3) Actual

24
Terrestrial emergency room care is defined as a facility that, among others, can handle medical issues
such as chest pain, difficulty breathing, severe bleeding or head trauma, loss of consciousness, sudden loss
of vision or blurred vision (Emergency Room, 2011).
25
McMurdo Station is the largest community in Antarctica, capable of supporting up to 1,258 residents,
and serves as USA's Antarctic science facility (Source: McMurdo Station, 2009).

53
Russian cosmonaut in-flight events and evacuation data from 1971 to 1999. In addition,
NASA also performed a Medical Operations Risk Study to determine medical evacuation
rates from ISS (Barratt and Pool, 2008).
5.1.1 Ground-Based Analog Population
Antarctica and outer space are considered two of the most extreme environments
with which human beings have to contend. Because of their similarities, Antarctica is
treated as a research environment studied to find solutions to potential problems in space
habitats (Noonan, 2006). Antarctic stations are useful study analogs for planetary surface
space exploration missions, because the Antarctic environment is one of the most
extreme on earth, with temperature and humidity at the South Pole more similar to that on
Mars than to the rest of earth (Amos, J., et al., n.d.). Akin to long-term duration planetary
surface missions, Antarctic missions are 1) remote and require their stand-alone medical
care capabilities (similar to ISS); 2) evacuation capabilities are limited and may not be
available for up to eight months because of weather, seasonal lightning, and sea-ice
conditions; and 3) their populations are medically screened and have epidemiological
characteristics similar to those of spaceflight populations (Barratt and Pool, 2008). The
Antarctic environment also mimics many of the physiological conditions that will be
experienced during long-duration missions to Mars, particularly with regard to the
unusual light environment, the potential for circadian rhythm and sleep disorders, the
isolation and close quartering of crews and the risk of developing psychological
disorders.
54
Medical evacuation rates were studied at McMurdo Station from 1992 through
1996. During five summer deployments (each of four months duration), 71 total medical
evacuations took place (Table 5.1.1-1), yielding an evacuation rate of 0.036 evacuations
per person-year (Barratt and Pool, 2008).
Table 5.1.1-1: Incidence of Medical Evacuation Events from McMurdo Station
Antarctica 1992-1996 (Total = 71)
26

Category Number (%)
Trauma 34 (48%)
Orthopedic 23
Surgical 5
Dental 3
Ophthalmology 2
Neurology 1
Cardiopulmonary 8 (11%)
Arrhythmia 2
Angina 3
Pneumonia 1
Pulmonary embolism 1
Lung carcinoma 1
Dental Conditions 7 (10%)
Internal Medicine 6 (8%)
Insulin dependent diabetes mellitus 2
Deep vein thrombosis 1
Other 3
Ob-Gyn 5 (7%)
Breast disorders 4
Gynecology 1
Genito-Urological 4 (6%)
Kidney stone 1
Testicular carcinoma 1
Prostatitis 1
Urinary tract infection 1
Psychiatric 3 (4%)

26
Source: Billica, et al. (1996), Barratt (2008)
55
Category Number (%)
Surgical 2 (3%)
Neurology 2 (3%)

5.1.2 U.S. Navy Submarines
Medical events during submarine missions are instructive for space missions as
they occur in similar confined, remote environments where there is limited diagnostic and
therapeutic support. The occurrence of severe medical illnesses or injuries can end a
mission by requiring the submarine to interrupt or even abort a mission (Ball and Evans,
2001). Epidemiologic studies of U.S. Navy submarine expeditions have looked into the
incidence of illnesses and injuries on submarine patrols. A range of 1.9 to 2.3 medical
evacuations per 1,000 person-months, i.e., 0.0228 events per person-year to 0.0276
events per person-year, respectively, was reported for all submarines in the U.S. Atlantic
Fleet from 1993 to 1996 (Sack, 1998). The medical reasons for submarine evacuations
are detailed in Table 5.1.2-1. The largest number of conditions requiring medical
evacuation are trauma and ‘other’. The ‘other’ category most likely includes unrelated or
uncommon medical conditions. This reinforces the diversity of clinical conditions that
can be expected to occur during a space mission, even after thorough pre-screening
processes are performed (Ball and Evans, 2001). It is noteworthy to mention that even
though ground-based data, i.e., Antarctic and U.S. Submarines, is helpful, space flight
poses unique operational and occupational risks that area not duplicated on the ground.
Table 5.1.1-1: Continued
56
As a result, ground-based data can only provide approximate estimates of frequency and
type of medical events (Barratt and Pool, 2008).
Table 5.1.2-1: Reasons for 332 Medical Evacuations from All Submarines
U.S. Atlantic Fleet, 1993-199627

Reason for Evacuation Number of Cases
Trauma 71
Psychiatric Illness 41
Chest Pain 34
Infection 40
Kidney Stones 23
Appendicitis 21
Dental Problem 31
Other 71
Total 332

5.1.3 Astronaut Population
A study conducted in 1999 to estimate the occurrence, type, and severity of injury
and illness onboard the ISS used retrospective data review of records from the NASA
JSC Longitudinal Study of Astronaut Health (LSAH) to characterize astronaut
hospitalizations from 1959 to the present (Johnston, S.L., et al., 2000). NASA and
Canadian Space Agency (CSA) flight surgeons evaluated non-flight injuries and illnesses
sustained by active astronauts during normal activities. Classification criteria were
developed according to the likelihood, mission impact, and medical management required
if the disorder occurred during space flight (Table 5.1.3-1) and whether it could have
satisfactorily been treated utilizing the Health Maintenance System (HMS) currently
deployed on ISS. Hospitalizations that are either unlikely to occur in microgravity or that

27
Source: Sack (1998)
57
would be detected and effectively screened out in a pre-mission evaluation were removed
from the assessment. Out of the 88 hospitalizations between 1959 and 1999 (40-year
period represents 2,715 person-years), the study concluded that only 30 would require
evacuations (Table 5.1.3-2), yielding an anticipated evacuation incidence of 0.011 events
per person-year (Barratt and Pool, 2008).
Table 5.1.3-1: ISS Medical Event Classification
28

Class Description
Class I medical event No mission impact, e.g., minor muscle strain

Class II medical event Significant medical event requiring use of the ISS HMS

Class IIa Manageable with the HMS and not likely to require
evacuation or affect mission duration, e.g., prostatitis.

Class IIb Manageable with the HMS but may require the astronaut
to return at next available opportunity for further
evaluation and treatment, e.g., breast mass.

Class IIc Manageable with the HMS but may necessitate emergent
evacuation if condition does not improve or worsens, e.g.,
cardiac dysrhythmia.

Class IIx An event unlikely to occur in a microgravity environment
or one that would be detected in a pre-mission evaluation,
e.g., herniated nucleus pulpois.

Class III medical event An event requiring emergent evacuation from the ISS,
e.g., acute appendicitis, cerebral hemorrhage.

28
Source: Barratt (2008)
58
Table 5.1.3-2: Class IIc (n=15) and Class III (n=15)
LSAH Astronaut Hospitalizations 1959-199929

LSAH Astronaut Hospitalizations (Class IIc and III)
Class IIc
a
(n = 15)
Traumatic pneumothorax
Pneumonia
Viral pneumonitis and pleuritis
Cardiac arrhythmia
Abdonminal pain with bloody diarrehea
Active duodenal ulcer
Cholelithiasis/chronic cholecystitis
Acute diverticulitis
Left flank pain
Hemorrhagic corpus luteum
Dysmenorrhea
Corneal ulcer
Shoulder dislocation
Septic arthritis of knee
Infectious mononucleosis
Class III
b
(n = 15)
50% total body surface area burn/30% third degree burn
Diffuse chemical pneumonitis from toxic inhalation (of nitrogen
tetroxide) (3)
Anaphylactoid reaction to intravenous tracer
Acute appendicitis
Ruptured retroperitoneal appendix
Pancreatitis/choledocholithiasis
Nephrolithiasis
Cholecystitis
Cholelithiasis
Retinal detachment
Cervical spinal stenosis with central cord syndrome
Cervical spondylosis with brown-sequard syndrome
Metastatic malignant melanoma
a
Class II – Ground-based significant medical events requiring ISS HMS
intervention if occurring on-orbit.
b
Class III – Ground-based significant medical events requiring evacuation if
occurring on-orbit.

29
Source: Barratt (2008)
59
5.1.4 Spaceflight Medical Events
Russian spaceflight experience has also been helpful in demonstrating that
medical issues will affect the mission in terms of lost crew work time, diminished crew
performance, and even early crew return. Although most Russian medical care issues
have been minor, several medical evacuations resulting from specific medical events, but
also by psychological stress, have also been necessary (Wade, 2006). In all, Russian
spaceflight experience has yielded 3 medical evacuations over 42 person-years in space,
which yields an incidence of 0.071 events per person-year (Barratt and Pool, 2008).
5.1.5 NASA Medical Risk Study
According to Barratt and Pool (2008), NASA has also performed a Medical Risk
Study that analyzed various medical events that would require evacuation from ISS.
Their results yielded a 0.059 medical evacuation rate from ISS for a Class II event, and a
0.010 medical evacuation rate from ISS for a Class III event. It is noteworthy that the
aforementioned estimates are based solely upon primary medical events and did not
consider possible failures of onboard life support systems or non-medical emergencies
such as vehicle system failures as the cause for the evacuations. The combined risk data
results of the Antarctic station evacuations, U.S. Submarine evacuations, LSAH astronaut
hospitalizations, spaceflight medical events, and the NASA Medical Operations Risk
Study are summarized in Table 5.1.5-1.

60
Table 5.1.5-1: ISS Evac Estimates - Ground Analog and Inflight Populations
30

Population Estimated Incidence
(Events per Person-Year)
Analog
Antarctic (McMurdo Station) 0.035

U.S. Submarines 0.023 – 0.028
LSAH Astronaut Hospitalizations 0.011
In-Flight
Cosmonaut evacuations 0.071
Astronaut evacuations 0.000
NASA Medical Risk Study
Likely mission impact/possible evacuation, Class IIc 0.059
Critical medical events requiring evacuation, Class III 0.010

5.1.6 Incidence Rate Applicability to Space Missions
Utilizing the most conservative rate of 0.059, i.e., NASA Medical Risk Study, a
Class IIc event (significant medical event requiring the HMS, with potential for mission
impact and or evacuation) can be expected to occur once every 5.6 years for a crew of
three and every 2.4 years for a crew of seven at the ISS. This latent possibility is what
drove the development of a medical evacuation capability, as well as a requirement for an
unsuited configuration for crew return to allow for airway access, physiological
monitoring, and intervention (Barratt and Pool, 2008).
Similarly, applying the 0.059 incident rate for a Mission to Mars, a ten member
crew on a 2.4 year (~9 months travel to, ~11 months stay, ~9 months travel from) mission
would have approximately 1.4 medical emergencies (10 people x 2.4 years x 0.059
incidence per person-year = 1.4 emergency medical events) during that time span.

30
Source: Table modified from Table 7.8 in Barrat (2008), Billica, et al. (1996)
61
However, a Mars mission would not have the ability to evacuate back to Earth, and
would have to provide all medical response within the confines of the space vehicle. This
presents serious challenges for future space mission planning with regards to medical
capabilities. Factors such as volume, power, and mass will limit the size of an on-board
health system. However, advanced treatment equipment and facilities will have to be
addressed to treat ill and injured crewmembers.
5.2 Medical Incidence Rates in Earth General Population
In the general population, the incidence of medical emergencies is 0.06 events per
person year; meaning that for every 100 people, there would be 6 medical emergencies in
a given year (Wade, 2006). It could be expected that the incidence of medical
emergencies in extreme environment, i.e., Antarctica and Russian spaceflight, would be
higher than the rate observed in the general population. However, this research
hypothesizes there are some extreme environment attributes which may explain why this
is not the case. Among others, these include age, health, education, organizational
culture, organizational structure, and organizational process (Casler, 2009).
a. Age - The age of the population who undertake activities in extreme environments
is an important point to consider. On the whole they are younger, and people who
have co-morbidities are not selected to participate. In addition they do not have
the age extremes with the greatest risk for medical emergencies, the aged and the
young male population 18-22. On the other hand, the general population would
contain accidents resulting from youthful carelessness and recklessnes, as well as
from inattention or elderly falls.
62
b. Health - The extreme environment population is assumed be of better overall
health, and lower variance, than the general population. That suggests that this
population is likely to be generally stronger, more agile, and more alert to better
avoid and/or withstand an adverse event than large portions of the general
population.
c. Education - The extreme environment population, in general, is more likely to
have received training on specific equipment and systems being operated and to
be better educated and more aware of potential accident situations. Through
alertness and training, the extreme environment population is likely to avoid or
see reduced incidence of medical emergencies.
d. Organizational Culture - Submarines and Antarctic camps typically have
substantially more developed safety cultures than does the general population.
e. Organizational Structure - The discipline and structure of these organizations is
likewise substantially more developed such that unsafe situations may be
generally avoided.
f. Organizational Process - The extreme environment populations typically are
process-oriented, in that checklists and standard operating procedures are used to
make tasks well-defined and routine. There typically is little opportunity for ‘free-
lancing’; not so in the general population.
A mention of aviation accident rates is also relevant. Airliners are more complex aircraft
to fly, and generally take on more difficult weather conditions, but accident rates are
lower due to established procedures and safety culture (Jensen, 2009).
63
5.3 Medical Incidence Rates in Earth Construction Sites
Planetary surface EVAs will involve similar tasks as on construction sites, and
will be gravity-based events, albeit reduced gravity, which bring about an array of
possibilities for astronauts to get injured from among others, falls, moving objects, motor
vehicle accidents, etc. In the United States there were 1,225 fatal occupational injuries in
the construction sector in 2001 with an incidence rate of 13.3 per 100,000 employed
workers (BLS-1, 2002). For the same year, the construction industry experienced 481,400
nonfatal injuries and illnesses at a rate of 7.9 per 100 full-time workers in the industry
(0.079 incidence rate) (BLS-2, 2002). Construction has about 6% of U.S. workers, but
20% of the fatalities - the largest number of fatalities reported for any industry sector
(NIOSH Construction, 2007).
The problem is not that the hazards and risks are unknown, it is that they are very
difficult to control in a constantly changing work environment. The causes of most
injuries are falls from height, scaffold collapse, electrocution, repetitive motion injuries,
motor vehicle crashes, excavation accidents, machines, and being struck by falling
objects. Out of these, falls are the leading safety hazard on construction sites. More than
360 deaths each year occur as a result falls: 30 percent are as a result of falls from a roof;
18 percent were falls from scaffolding; and 16 percent were falls from ladders (Harvey,
2011). These are all hazards that will be encountered by EVA crews on a planetary
surface. EVA personnel will have to be trained to understand the proper way to use
robotic and EVA systems and to identify hazards.
64
5.4 Medical Incidences vs. Mission Impact
Utilizing data from analogue populations, e.g., military pilots, submarine crews,
and members of Antarctic expeditions, as well as actual flight data, most notably ISS
missions, researchers have applied risk-management approaches to predict the probable
incidence of significant illnesses/injuries during space flight missions vs. their probable
effect (impact) on mission success (Figure 5.4-1) (Nicogosssian, et al., 1994)
31
.

Figure 5.4-1: Emergency Impact vs. Probability
32

This analysis did not discuss the impact on health and mission if these
injuries/illnesses occurred while on a planetary surface EVA. It only addressed
emergency scenarios where crewmembers would have immediate access to ambulatory
care, first aid, and basic life support (as in a pressurized habitat). Assuming a

31
The objective of this research was to provide a foundation from which resources could be allocated,
selection standards revised, and medical investigations assigned priority (Nicogossian, et al., 1994).
32
Source: Nicogossian, et al. (1994)
65
crewmember is on an EVA and medical intervention cannot be initiated expeditiously
(during the “golden period”), the impact on the health of the EVA crewmember and
impact on mission success would be significantly high. Future research utilizing
statistical modeling would need to determine exactly how high the impact on health and
mission would be for these injuries/illnesses occurring during an EVA.
5.5 Conclusion
The intent is not to imply that every medical evacuation will require IV
administration, instead that there will be medical incidents that will occur in space
mission that will be serious enough to require evacuation. As release of this study, the
probabilities of what medical evacuations would require an IV for these evacuations were
not available, but one need only peruse the various lists of medical reasons for
evacuations (depicted in this chapter), to understand that IV treatment will be necessary
during evacuations. Additionally, as was depicted in Chapter 4, a common practice
during first-aid response is to administer an IV, which could be assumed would also be
implemented during an evacuation.
Furthermore, it is not the intent of this chapter to imply that a through-the-suit IV
provision would somehow have an effect on the number of emergency evacuations.
Instead, the purpose of such a provision would be to change the outcome of a critical
event. Critical is not meant in terms of seriousness of the injury, but in terms of how the
injury could compromise the mission or outcome. The number of evacuations may not be
as significant as the risk of overall failure with the inability to treat an individual injured
in a remote site.
66
CHAPTER 6: MEDICAL ISSUES IN SPACE
6.1 Salient Medical Ailments in Spaceflight
According to Czarnik (1998), several salient medical ailments have been noted in
both the American and Soviet/Russian space programs; however, they were reported
selectively. Among others, these include (1) space motion sickness; (2) headache and
back pain; (3) infections; (4) rashes; (5) cardiac dysrhythmias; (6) decompression; (7)
toxic exposure; and (8) psychological problems. Of course, not all these ailments have
occurred during EVAs, however, they are listed in Table 6-1 to illustrate that space
medical ailments have occurred and will continue to occur.

Table 6-1: Salient Space Medical Ailments
33

Medical Ailment Incident / Comments
Space Motion
Sickness
By far the most common of ailments on entering space is Space Motion Sickness, or
SMS. This syndrome of sweating, dizziness, nausea and vomiting affects 2/3rds to
3/4s of all astronauts and can be disabling. EVAs are not scheduled for the first 3
days of a Shuttle/ISS mission for just this reason.

Headache and
Back Pain
Headache in space seems to be a function of fluid accumulation in the head and
sinuses. While Mercury crews carried nothing for pain, Gemini missions carried
Aspirin and injectable Demerol, and Apollo added Tylenol and Darvon.

Back pain, on the other hand, seems to result from the body’s “antigravity” (slow
twitch) muscles having nothing better to do. Because there is no gravity to
counteract, astronauts naturally assume a curled, fetal position when relaxed. Since
the back is designed with a lumbar curve to help counteract gravity, muscles in the
lower back begin to ache.

Infections Why are infections common in spaceflight? Without gravity, particles larger than a
micron in size (which normally settle to the floor) remain in the cabin atmosphere,
irritating eyes and lungs. Some potentially harmful bacteria grow faster and yield
higher numbers in spaceflight. Lymphocytes, a kind of white blood cell that fights
infection, show decreased activation in space, and Immunoglobulins (“antibodies”)
are decreased after long-duration spaceflight as well. Furthermore, there is even
evidence that some antibiotics work less well in microgravity, presumably because

33
Table adapted from Medical Emergencies in Space (Czarnik, 1998).
67
Medical Ailment Incident / Comments
of gravity-sensitive mechanisms of action.

Minor infections of the skin, eyes and respiratory tract were reported 13 times in
Apollo (including stomatitis, pharyngitis, recurrent inguinal and axillary infections),
and 8 times in Skylab, despite carrying Tetracycline, Ampicillin and Neosporin
antibiotics.

Viral upper respiratory infections have occurred on Apollo (not counting nasal
stuffiness and rhinitis of undetermined origins); 15 of 29 astronauts had in/flight or
post/flight respiratory infections (~ 15/29*100% = 52 %) (Jensen and Rygalov,
2005). A “cold” in space isn’t just a nuisance; in microgravity, the nose won’t drain,
so the sinuses become more packed with fluid and uncomfortable, aggravating the
natural headward movement of fluid and congestion. During Apollo 7, a cold by
Wally Schirra quickly spread to shipmates Donn Eisele and Walter Cunningham.
Sinus pressure and pain caused some strained relations with Mission Control,
worsened by the astronauts’ decision not to wear helmets on re-entry (to allow
pressure on the ear drums to equalize as cabin pressure changed on descent). None
of the three ever flew in space again.
After Apollo 13’s oxygen tank exploded, the Command Module lost all power and
the three astronauts had to use the attached Lunar Module as a lifeboat. In addition
to enduring freezing temperatures and dehydration (water was rationed to six ounces
per person per day), all three had to wear their condom-style urinary catheters
constantly. Fred Haise became feverish and lethargic; medical examination after
their successful recovery indicated a Pseudomonas aeruginosa urinary tract infection
brought on by dehydration. Had their 87-hour ordeal gone on much longer, all three
would likely have had the infection.

In September 1985, Vladimir Vasyutin rode a Soyuz-14 to Salyut-7 with fellow
cosmonauts G Grechko and A Volkov for another record-breaking stay in space. In
late October, however, Vasyutin had lost his appetite and was obviously sick,
staying in bed all day. Mission Control told him to wait for his condition to change
and continue working. But by November his condition had not improved, and on
November 21 the crew returned to Earth. The Soviets released to the press that he
had a fever of 104 F and inflammation for three weeks.

Rashes Skin infections usually require a break in the skin to set in, and these too are
frequent in space. Since humans cannot live in zero pressure, spacesuits are
“inflated” in space, like balloons. This makes joints hard to move, especially the
fingers (which are moved most frequently), and working in space gloves can rub
fingers raw and cause subungual hematomas (blood under the fingernails). These
contributed to two skin infections on Skylab and five subungual hematomas on
Apollo.

Astronauts frequently wear biosensors, giving us data on their condition. But skin
irritation from these biosensors is common, being reported 11 times during the
Apollo program. As Apollo also had no toilet facilities, astronauts got excoriations
from constantly wearing urine collection devices.

Table 6.1: Continued
68
Medical Ailment Incident / Comments
Cardiac
Dysrhythmias
(irregularities of
heart rhythm)
During Skylab, one crewmember had a 5-beat run of ventricular tachycardia (a
rhythm that can progress easily into ventricular fibrillation and death) during a
lower-body negative pressure protocol, while another had episodes of "wandering
supraventricular pacemaker."
During reentry, one Shuttle crewmember showed up to 16 PVCs (premature
ventricular contractions) per minute, and another had sustained ventricular bigeminy
during EVA (all rhythms which can lead to death).
Cosmonaut Alexander Laveikin, had to be returned to Earth prematurely for
abnormal heart rhythms. Having spent 6 months on Mir with Yuri Romanenko (who
went on to spend 430 consecutive days on Mir), had to cut short his mission and
return due to dysrhythmias

Vasily Tsibliyev was bumped from an “internal EVA” in 1997 due to developing an
arrhythmia.
Decompression Because humans cannot long survive at low pressures, spacesuits, spacecraft, and
habitats must be pressurized; on several occasions, a breach of pressurization has
endangered astronauts’ lives
Vladimir Lyakhov & Aleksandr Aleksandrov, aboard Soyuz T-9 in 1983, prepared
to evacuate after hearing a loud crack; investigation revealed a 0.15 in. (3.8 mm)
impact crater on a window; they escaped decompression.
On STS-37, the palm restraint in one of the astronaut’s gloves came loose and
migrated until it punched a hole in the pressure bladder between his thumb and
forefinger. The astronaut bled out into space, but the skin of the astronaut’s hand
partially sealed the opening. His coagulating blood sealed the opening enough that
the bar was retained inside the hole.
On 25 June 97 resupply ship Progress struck the Mir space station, causing a 20-30
centimeter hole in the Spektr module and decompressing the station rapidly enough
to make Michael Foale’s ears pop.
On Soyuz 11’s return from Salyut-1 in 1971, a pressure equalization valve was
jerked loose at the jettison of the Soyuz Orbital Module, depressurizing the cabin.
Viktor Patsayev tried to close the pressure equalization valve, but only got it half
closed before he died. As the cosmonauts were not wearing pressure spacesuits,
Dobrovolskiy, Volkov, and Patsayev were found dead in their cabin.

Toxic Exposure Following the 1997 fire aboard Mir, Jerry Linenger and 2 cosmonauts don gas
masks to avoid smoke inhalation, benzene and carbon monoxide. Linenger prepares
to intubate victims, but they emerge safely.

Ethylene glycol (a frequent problem from 1995-97) leaking from the Kvant-1
coolant loop hits cosmonaut Tsibliyev head-on, causing eye irritation, lethargy and
nausea. Carbon monoxide buildups cause Shannon Lucid to complain of difficulty
thinking.

In 1977, during reentry of the Apollo capsule from the Apollo-Soyuz Test Project,
inadvertent firing of the reaction control system during descent exposed the 3
American astronauts to toxic gases (mostly nitrogen tetroxide). After a very hard
Table 6.1: Continued
69
Medical Ailment Incident / Comments
landing, the crew was able to escape the gas by donning oxygen masks, but not
before Vance Brand lost consciousness. All crewmembers developed a chemical
pneumonitis, and all required intensive therapy and hospitalization.

In 1999, astronauts aboard STS-96 to en-route to ISS complained of headaches,
burning and itching eyes, flushed faces and nausea, suspected to be due to carbon
dioxide buildup.
Psychological
Problems
John Blaha, aboard Mir for 4 months in 1996-7, began experiencing fits of anger,
insomnia and withdrawal, exacerbated by an over demanding workload. "He was
hurting," Linenger recalls. "He was, in essence, depressed." Blaha confirms the
depression; with a reduced workload and improved support, he completes his
mission.

Soyuz-21 (Volynov and Zholobov) was terminated early due to "interpersonal
issues", Soyuz T-14 (Vasyutin) due to "mood and performance issues", and Soyuz
TM-2 in 1987 (Laveikin) due to "interpersonal issues and cardiac irregularity.”

Stress from the fire aboard Mir led Jerry Linenger himself to become more
withdrawn and isolated; eventually he even refused to participate in voice
communications. Burrough observes, "Linenger’s voice is high-pitched and shrill;
he sounds as if he is on the verge of some kind of breakdown."

Table 6.1: Continued
70
6.2 EVA Health Problems / Injuries Requiring IV Administration
If astronauts find themselves in any of the EVA Emergency Scenarios listed in
Chapter 2, there are several medical issues that may require IV administration. Table 6.2-
1 depicts a list of health problems and/or injuries which could require IV administration
to a pressure-suited crewmember (EVA). Note that treatment for the listed medical issues
may not be limited to IV Administration and may in fact be preceded by IM or Oral
Administration.
There are also health problems that even though are common in space missions,
they are not likely to occur during an EVA. Some of these problems include burns,
toothaches, or poisoning. With regards to burns, the spacesuit’s thermal-micrometeoroid
garment (TMG) provides thermal protection to the astronaut. JSC28918-1 (2003), EVA
Design Requirements, defines thermal requirements for hardware an astronaut may have
incidental or extended contact with. These requirements include glove palm external
touch-temperature compliance, glove back external touch-temperature compliance, and
EMU TMG compliance (rest of spacesuit). If any touchable surfaces exceed thermal
requirements, they are considered keep-out zones for EVA, and are clearly marked.
Therefore, the risk of burns to an EVA crewmember is low, mitigated by strict hardware
EVA requirements.
Tooth problems are a surprisingly frequent cause of early withdrawals from
simulations at the Mars Desert Research Station (MDRS), and at least one near-
withdrawal from the Flashline Mars Arctic Research Station (FMARS). These might
include: cracked, chipped, broken, missing or loose tooth due to trauma; dental pain due
71
to an abscess; dental cavities; periodontal disease; or “dry socket” (Czarnik, 2009).
Though astronauts would be screened for the absence of dental problems prior to launch,
it is possible that on a multi-year mission to Mars, dental problems might develop.
However, if dental problems do arise, the astronaut would start having pain for a while,
and the astronaut would not be allowed to go on an EVA, i.e., identification of tooth
problems would not be sudden.
With regards to poisoning, a malfunction in the lithium hydroxide canister in the
PLSS (Portable Life Support System) could result in carbon dioxide poisoning (Czarnik,
2009). However, if a malfunction of the PLSS results in poisoning in the spacesuit, no
amount of IV medication is likely to help in the confined, concentrated environment of
the spacesuit until the astronaut is removed from the spacesuit (or at least until the helmet
is able to be removed) (Czarnik, 2009).
It should be noted that advances in terrestrial screening and preventive medicine
do allow potential health problems to be identified early and screened out of the astronaut
population (Hamilton, et al., 2007). Well established standards are expected to ensure
selection of spaceflight candidates who are healthy and likely to remain so throughout
their careers, and who will meet defined medical requirements of their mission. Medical
testing is geared to three objectives: 1) identify those individuals with over symptomatic
disease, 2) identify asymptomatic disease in individuals with no apparent manifestations,
and 3) identify individuals with a high probability of developing a flight-limiting disorder
during their careers. Regarding the third objective, estimating the probability of future
disease is the most difficult, and is based on risk factors (typically related to biochemical,
72
genetic, or lifestyle factors) that apply to entire populations, but for which extrapolation
from population data to individual risk is imprecise (Barratt and Pool, 2008).
However, in spite of all medical risk mitigations taken, health problems and/or
injuries occurring during planetary surface EVAs are a real possibility. Furthermore, if
these EVA health problems and/or injuries require immediate medical attention, but they
cannot be expeditiously addressed, i.e., spacesuit accessibility, they can be life and/or
mission-threatening.

Table 6.2-1: EVA Medical Issues Requiring IV Administration
34

Medical Issue
Rationale for IV
Administration
Comments
Chest Pain – Acute To gain access to a vein to
give medication. Multiple IV
medications are typically
given, including morphine, a
beta blocker, nitroglycerine
and heparin or a thrombolytic
(“clot-buster”) (Czarnik,
2009).
Must obtain description of pain, location (mid-
sternal, left side, right side), radiating vs.
localized, severity (scale of 1-10, 10 being
worse), constant vs. intermittent, duration of
pain, sharp vs. burning vs. pressure sensation
(JSC-48522-E4, 2001).
Seizures To gain access to a vein to
give medication. If Diazepam
(Valium) IV does not control
seizure, give Phenytoin
(Dilantin) IV ((JSC-48522-
E4, 2001).
Generalized seizure, or total body convulsions,
may result from severe illness, head injury,
stroke, prolonged hypoxia, or other disorders. It
is most important to prevent injury during the
seizure by guiding the patient away from hard
structures; do not tightly restrain. There is a
good chance the seizure will resolve on its own,
but as soon as seizures are recognized,
Diazepam (Valium) injection should be
prepared. This is a sedative, anticonvulsant/anti-
seizure drug, which is most effective if injected

34
Table Source (from References):
- JSC-48522-E4 (2001)
- Churchill (1997)
- Harris, G. (2008)
- Shock (Physiology) (n.d.)
- Brown University (2002)
- Shrunk (2007)
- Rygalov (2009)
- Thomson (2008)
73
Medical Issue
Rationale for IV
Administration
Comments
intravenously. Note, Diazepam is poorly
absorbed intramuscularly (IM) and should
preferably be given IV. However, if IV access is
not possible, it may be given IM (JSC-48522-
E4, 2001).
Shock - Circulatory
Collapse
To gain access to vein and
administer Saline (JSC-
48522-E4, 2001).
The most critical step is identifying and treating
the underlying cause. Basic causes of shock are:
Anaphylaxis/Severe allergic reaction, heart
attack, loss of circulating blood volume
(bleeding, burn, dehydration), decompression
sickness, venous dilation (allergy, pain, drugs,
heat stroke, infection), or high or low body
temperature ( (JSC-48522-E4, 2001). Shock -
Circulatory Collapse would be nearly fatal to an
EVA astronaut. The astronaut would need to be
removed from the spacesuit as soon as possible.
Nonetheless, if this is not possible, this is
another emergency for which an IV injection
might be necessary. For this case, if the patient
is unconscious, the patient would have to be
administered saline. IV fluids are the usual
treatment for shock caused by loss of blood, but
adding extra fluid to the circulation can overload
a damaged heart that already has a reduced
output, so that the shock deepens. When the
cause of shock is unclear, physicians may make
a trial using IV fluids. If the central venous
pressure rises, indicating diminished cardiac
capacity, the fluids are stopped before the heart
can be further compromised (Shock, Physiology,
n.d.).
Decompression
Sickness (DCS)
* To gain access to vein and
administer Saline. If possible,
hydrate orally - 1 L/hour for
2 hours or as tolerated. If
unable to drink, administer
1L/hour Normal Saline via
IV (JSC-48522-E4, 2001).
* Drugs which might be used
include Pentoxifylline,
NMDA Antagonists, calcium
channel blockers and
prostaglandins (Czarnik,
2009).
1. Symptoms of DCS may be the result of
inadequate pre-breathe time, inadequate nitrogen
purge from EMU, strenuous and/or prolonged
EVA, severe dehydration during EVA, loss of
spacesuit pressure, or no apparent cause; 2.
Primary treatment principles consist of
repressurization and 100% 02 over time (JSC-
48522-E4, 2001).

For Type 1 DCS, pain medication is rarely
administered because it masks the symptoms of
DCS. For Type 2 DCS, it may be possible for
the astronaut to lose large fluid volume, e.g.,
urine, bowels. Saline could help in preventing
veins from collapsing, i.e., need adequate
pressure in veins (Harris, 2009).
Table 6.2-1: Continued
74
Medical Issue
Rationale for IV
Administration
Comments

Depressurization in preparation for EVA also
exposes crewmembers to an increased risk of
cardiopulmonary DCS, which may require
advanced life cardiac life support (ACLS)
capability (Barratt and Pool, 2008).
Kidney Stones * To gain access to a vein to
give pain medication. If able
to take oral fluids, drink as
much water as possible, e.g.,
4 L/hour. If unable to take
oral fluids, start IV
immediately; deliver Normal
Saline at a rate of 1 L/hour
((JSC-48522-E4, 2001).
This condition can occur due to an increase of
calcium in the blood, which is a result of bone
loss during space flight. As an additional
complication, astronauts become dehydrated in
microgravity, which may also increase the risk
for kidney stone formation (NASA HRP, 2009).
Symptoms include painful urination, spasms,
feeling of heaviness in groin, fever (may or may
not be present), lower abdomen pain, back/flank
pain, nausea, vomiting, contracting pain (pain
coming and going) (JSC-48522-E4, 2001).
Researcher, and now astronaut, Peggy Whitson
has done extensive research showing why the
incidence of kidney stones may be much higher
in long-duration spaceflight (Czarnik, 2009).
Nausea/Vomiting To gain access to vein and
administer IV fluids (JSC-
48522-E4, 2001).
Nausea and vomiting (N/V) are always
secondary to an underlying cause. The main
principles followed include identification and
treatment of the underlying cause and
maintaining adequate fluid hydration.
Maintaining adequate hydration is critical if
vomiting continues. Drinking frequently in small
volumes may suffice. If unable to keep even
small sips of drink down, do not give oral
medications. Consideration should be given to
administering IV fluids, which are simple and
highly effective in treatment of dehydration
associated with vomiting (JSC-48522-E4, 2001).
Dehydration To gain access to vein and
administer IV fluids, e.g., IV
potassium, or other
medicines (Czarnik, 2009).
Though this can be caused by nausea and
vomiting (as noted above), simply working hard
(as all astronauts encased in a pressure spacesuit
must do) in a relatively low-pressure
environment (4.3 psi on Shuttle or Station) will
cause increased evaporative fluid loss, leading to
insidious dehydration. Astronauts could (and
likely have) become sub-clinically dehydrated
by this mechanism. In addition, dehydration can
lead to dangerous electrolyte imbalances,
necessitating the use of IV potassium or other
medicines (Czarnik, 2009).
Table 6.2-1: Continued
75
Medical Issue
Rationale for IV
Administration
Comments
Fibrillation If atrial fibrillation, cardizem
(Diltiazem), a beta-blocker or
digoxin is given IV; if
ventricular fibrillation,
epinephrine, amiodarone or
lidocaine may be given as
adjuncts to electrical
cardioconversion (“shocks”)
(Czarnik, 2009)
Fibrillation (unorganized contractions) of the
ventricles (powerful pumping chambers of the
lower heart) or atria (upper heart chambers,
which contribute 30% of the heart’s pumping
power) can result from trauma, dehydration, or
unknown mechanism (Czarnik, 2009).
Arrhythmias Arrhythmias may require the
use of lidocaine, amiodarone
or other IV drugs (Czarnik,
2009).
Irregularities of the heart’s electrical activity,
such as bigeminy, trigeminy, supraventricular
tachycardia and ventricular tachycardia, can
occur during EVA. There is some evidence that
microgravity may induce cardiac arrhythmias
(Czarnik, 2009). Particular attention has been
paid to the incidence of arrhythmias arising from
space flight such as those involving ventricular
bigeminy and profound bradycardia during an
Apollo mission, and paroxysmal
supraventricular tachycardia arising during and
persisting after EVA. Although the astronaut
and cosmonaut populations are extensively
screened for cardiovascular disease before flight,
episodes of arrhythmia and symptoms
suggestive of cardiac ischemia have nevertheless
occurred during flight. During the Apollo
Program, a crewmember experienced a 14-s run
of bigeminy during flight. The Russian medical
community terminated one mission early
because of an episode of paroxysmal
supraventricular tachycardia. In at least one
other incidence, a cosmonaut was placed on
cardiac medications for symptoms suggestive of
ischemic heart disease. Moreover, long-duration
space flight may predispose crewmembers to
arrhythmias. Review of electro-cardiographic
tracings during EVA and the results of in-flight
Holter monitoring during Space Shuttle missions
do not show a predisposition to arrhythmias
during short-durations space flight, but limited
data suggests this may not be true for long-
duration space flight (Barratt and Pool, 2008).
Mental Disturbance Only recourse for immediate
and effective restraint might
be IV injection of Haldol,
which is used in ERs to
obtain instant chemical
On rare occasions crewmembers in space
simulations (at MDRS) have had to be
physically restrained. An astronaut on EVA
could potentially do tremendous damage to a
spacecraft, or even an eventual Mars outpost,
Table 6.2-1: Continued
76
Medical Issue
Rationale for IV
Administration
Comments
restraint (Czarnik, 2009). under the influence of a psychotic break
(Czarnik, 2009).
Pain Relief, e.g.,
Fracture/Dislocation,
etc.
Injectable Narcotics: (1)
Demerol (Narcotic pain
reliever for severe pain); (2)
Morphine Sulfate (Narcotic
pain reliever for severe pain).
Moderate to severe pain
might result from a
musculoskeletal injury,
kidney stone, etc. However,
whatever is necessary to
relieve pain should be used
(JSC-48522-E4, 2001). Even
though these narcotics can be
injected intramuscularly,
compared with other routes
of administration, the IV
route is the fastest way to
deliver medications
throughout the body.
Fracture/Dislocation (Broken Bone) - Fractures
of pelvis or upper leg can result in large blood
loss and shock. Fractures and local tissue
injuries might be sustained by having a limb
caught between a structural surface and a
sufficiently massive moving object (Churchill,
1997). Wearing a pressurized EVA spacesuit is
akin to wearing an inflatable splint, so it might
be difficult to break a bone in a pressure
spacesuit (Harris, 2008). On the other hand, after
losing bone calcium over a long flight to Mars,
an astronaut's bones might be brittle enough to
increase the risk of fracture. A significant effect
of microgravity is the reduction of an astronaut’s
bone mineral density and bone strength, which
can make his/her bones more susceptible to
fracture. Though gravity is reduced in space, an
astronaut could still fall and injure him/her self
during a space walk on the moon or Mars. Space
suits used for EVAs are very heavy and
dramatically increase the overall mass of the
astronaut (NASA HRP, 2009). Though unlikely,
breaking a bone while wearing a pressurized
spacesuit is possible.
Strains/Sprains - Soft tissue injuries, e.g., muscle
and tendon strains, might be incurred while
exerting large forces such as to dislodge a
sample from the surface, or pushing/pulling of
equipment during construction. Unexpected
lateral forces against a crewmember might
induce debilitating injuries to ankle or knee
ligaments (Churchill, 1997). Muscle or tendon
deep over-extension during EVA can also lead
to soft tissue injuries. In severe cases, may
require anesthetics, such as novocaine, to
mitigate the pain.
Head/Neck Injury - With trauma to neck,
possibility of fracture and/or spinal cord damage
must be considered. Never move victim's head
or neck until assessment complete.
Table 6.2-1: Continued
77
Medical Issue
Rationale for IV
Administration
Comments
Solar flares and
galactic radiation
effects
IV is needed to inject saline
& protective substances
solutions (Rygalov, 2009)
According to Thomson (2008), space travel can
be dangerous for humans because of the large
amounts of radiation, particularly during EVAs,
when an astronaut is outside the shielded walls
of his or her habitat and protected only by a
spacesuit. Planetary surface exploration will
require hundreds of hours of EVAs. Very high
doses of radiation can kill cells and damage
tissue, leading to cancer, cataracts, and even
cause injury to the central nervous system.
Comatose Astronaut When a person is comatose,
IV administration is needed
to maintain proper fluid
levels (Shrunk, 2007).
If astronaut is comatose for more than an hour,
then dealing with a serious medical problem.
The EVA astronaut would need to be removed
from the spacesuit as soon as possible, to
perform a competent diagnosis and significant
intervention. Nonetheless, if this is not
immediately possible, when in doubt about any
medical question where a person loses
consciousness, it is far better to err on the side of
having an IV line in place (Shrunk, 2007).
Electrocution Traditionally, one of the first
steps taken when someone
has been electrocuted is fluid
loading through use of an IV
(Brown University, 2002).
According to NASA, electrocution is one of the
primary safety concerns for astronauts (Brown
University, 2002). For example, electrocution is
a potential cause of cardiac arrhythmia during a
mission. The electrical power systems (28 Vdc
on the Space Shuttle and 120 Vdc on the ISS)
represent a potential electrical injury hazard
(Barratt and Pool, 2008)

6.3 Space Medicine Exploration Medical Condition List
In 2010, NASA’s HRP assigned the Exploration Medical Capabilities (ExMC)
Element the responsibility of addressing the overarching risk of “the inability to
adequately treat an ill or injured crewmember.” As the first step in addressing this risk,
the Space Medicine Exploration Medical Condition List (SMEMCL) was created in order
to define the set of medical conditions that are most likely to occur during any one of
seven distinct mission profiles:
Table 6.2-1: Continued
78
1. Orion to ISS Transfer Mission: 4 crewmembers (3 males, 1 female), 3 days, No
EVAs.
2. Lunar Sortie: 4 crewmembers (3 males, 1 female), 24 days, 4 EVAs per
crewmember.
3. Lunar Outpost: 6 crewmembers (5 males, 1 female), 6 months, 60 EVAs per
crewmember.
4. ISS Contingency Return: Illness or injury occurring on the ISS which
necessitates a contingency return from the ISS back to Earth, and requires on-
route medical care.
5. Lunar Sortie Contingency Return: Illness or injury occurring during a Lunar
Sortie mission which will necessitate a contingency return from the Lunar surface
back to Earth, and require on-route medical care.
6. Lunar Outpost Contingency Return: Illness or injury occurring during a Lunar
Outpost mission which will necessitate a contingency return from the Lunar
surface back to Earth, and require on-route medical care.
7. 144 Hour Depressurization Return: Illness or injury occurring during a
contingency return from a Lunar mission, assuming a depressurized cabin and
crewmembers in full pressurized suits, for up to 144 hours.
The SMEMCL was derived from the International Space Station (ISS) medical checklist,
the Space Shuttle (STS) medical checklist, Longitudinal Study of Astronaut Health
(LSAH) in-flight occurrence data, and the Delphi study, and assumes use of the new
Crew Exploration Vehicle (CEV)
7
. The list of conditions was further prioritized for the
79
seven specific missions with the assistance of the ExMC Advisory Group, which
included flight surgeons and representatives from the astronaut office, Space Medicine
Division management, and the National Space Biomedical Research Institute. The
SMEMCL serves as an evidence-based foundation in determining which medical
conditions could affect a crewmember during a given mission profile, which of those
conditions would be of concern and require treatment, and for which conditions a gap in
knowledge or technology development exists. This information is being used to focus
research efforts and technology development. The SMEMCL provides a clinical priority
scale describing which medical conditions will be given adequate resources to treat. The
clinical priority scale is defined as (Watkins, 2010):
a. Shall: The condition must be addressed by the medical system.
b. Should: If resources are available, it is desirable for the condition to be addressed
by the medical system.
c. Not Concerned: The condition will not be addressed by the medical system.
It should be noted that while the SMEMCL encompasses numerous medical conditions, it
is an evolving document. As new evidence comes forth from spaceflight and analogue
environments it is anticipated that additional conditions will be suggested for addition to
the list. Those new conditions will be evaluated by the Advisory Group and brought to
the SMCCB for review prior to incorporation into the SMEMCL (Watkins, 2010).
For this research, mission profile #2 and #3 (Lunar Sortie and Lunar Outpost,
respectively) are the most relevant as it is understood that they involve surface EVA
80
operations. Table 6.3-1 summarizes the medical conditions for these two mission profiles,
but it only includes cases with the following:
1. Medical conditions with a critical scale of ‘Shall’, i.e., the condition must be
addressed by the medical system.
2. Medical conditions which require IV treatment, i.e., IV Start Kit (skin antiseptic,
tourniquet, needles, etc); IV Administration Kit (tubing, connectors, lever lock,
etc); IV Fluids; IV Pump.
Additionally, even though mission profiles #2 and #3 are the most relevant to this
research, they do not encompass the complete set of medical conditions that are
envisioned in extended planetary surface missions (Phase 3). NASA has not conducted
studies for Phase 3 type medical conditions, which would potentially also include
accidents during EVAs, as a result of falling, mechanical failures, etc.
Furthermore, not all conditions requiring an IV are listed; only ones that are likely
to occur during an EVA are presented in Table 6.3-1. For example, smoke inhalation, eye
foreign body penetration, and toxic exposure would be prevented during the EVA by the
spacesuit barrier. Other conditions such as infections, skin abrasions/lacerations, space
motion sickness, and sprains/strains, would eliminate the astronaut from consideration to
perform an EVA.

81
Table 6.3-1: Lunar Sortie/Outpost Medical Conditions Requiring IV Treatment
35

Condition Incidence (Lunar Sortie) Incidence (Lunar Outpost)
Anaphylaxis Based on terrestrial data, the incidence
of anaphylaxis is 0.00021 events/person-
year.

(0.00021 events/person-year)*(4
people)*(24/365 years)= 0.000055
events

Therefore, the likelihood is very low.
Based on terrestrial data, the incidence of
anaphylaxis is 0.00021 events/person-
year.

(0.00021 events/person-year)*(6
people)*(0.5 years)=0.00063 events

Therefore, the likelihood is very low.
Appendicitis Based on terrestrial data, the incidence
of appendicitis in an adult population
(age 40-44) is 0.00102 events/person-
year, and decreases with age [1]. In US
and British Navy submariners, rates
range from 0.00156 to 0.00931
events/person-year. Polar Explorers have
had rates ranging from 0 to 0.0157
events/person-year. Finally, in NASA
astronauts on the ground, incidence rates
are 0.000361 events/person-year
compared to an incidence of 0.000752
events/person-year in a control cohort of
NASA employees [2].

US General Population (Age 40-44):
(0.00102 events/person-
year)*(4crew)*(24/365)=0.000268
events

Submariners:
(0.00156 events/person-
year)*(4crew)*(24/365)=0.00041 events

(0.00931 events/person-
year)*(4crew)*(24/365)=0.00245 events

Polar Explorers (max):
(0.0157 events/person-
year)*(4crew)*(24/365)=0.00413 events

NASA Astronauts (on ground):
(0.000361 events/person-
year)*(4crew)*(24/365)=0.000095
Based on terrestrial data, the incidence of
appendicitis in an adult population (age
40-44) is 0.00102 events/person-year, and
decreases with age [1]. In US and British
Navy submariners, rates range from
0.00156 to 0.00931 events/person-year.
Polar Explorers have had rates ranging
from 0 to 0.0157 events/person-year.
Finally, in NASA astronauts on the
ground, incidence rates are 0.000361
events/person-year compared to an
incidence of 0.000752 events/person-year
in a control cohort of NASA employees
[2].

US General Population (Age 40-44):
(0.00102 events/person-
year)*(6crew)*(0.5)=0.00306 events

Submariners:
(0.00156 events/person-
year)*(6crew)*(0.5)=0.00468 events

(0.00931 events/person-
year)*(6crew)*(0.5)=0.0279 events

Polar Explorers (max):
(0.0157 events/person-
year)*(6crew)*(0.5)=0.0471 events

NASA Astronauts (on ground):
(0.000361 events/person-
year)*(6crew)*(0.5)=0.00108 events.

35
Modified from Watkins (2010).

82
Condition Incidence (Lunar Sortie) Incidence (Lunar Outpost)
events.

Therefore, the likelihood is most likely
very low.

Some specific studies have higher
likelihood rates, but given the low rate
of appendicitis in the astronauts at
baseline and the potentially younger
population of these studies
(Submarines/Polar Explorers), these
higher rates are probably outliers.

[1] Addiss D, et al. The epidemiology of
appendicitis and appendectomy in the
United States. Am J Epidemiol. 1990;
132:910-925.
[2] Campbell MR, et al. Nonoperative
Treatment of Suspected Appendicitis in
Remote Medical Care Environments:
Implications for Future Spaceflight
Medical Care. J Am Coll Surg. 2004;
198:822-830.
Therefore, the likelihood is relatively low.

Some specific studies have higher
likelihood rates, but given the low rate of
appendicitis in the astronauts at baseline
and the potentially younger population of
these studies (Submarines/Polar
Explorers), these higher rates are
probably outliers.

[1] Addiss D, et al. The epidemiology of
appendicitis and appendectomy in the
United States. Am J Epidemiol. 1990;
132:910-925.
[2] Campbell MR, et al. Nonoperative
Treatment of Suspected Appendicitis in
Remote Medical Care Environments:
Implications for Future Spaceflight
Medical Care. J Am Coll Surg. 2004;
198:822-830.
Decompression
Sickness
Based on NASA models, the incidence
of DCS is 0.011 events/EVA [1].
Additional models using Shuttle/ISS
atmosphere and prebreathing
characteristics estimate the risk of
serious DCS (type II) between 0.00016-
0.00196 events/exposure [2]. There has
been no evidence of DCS in 100 EMU
or over 200 Orlan suit EVAs [3]. There
are two reported incidences of possible
mild DCS in the same Gemini and
Apollo pilot, although neither was
associated with EVA [1]. There are
terrestrial studies from the HDSD that
have documented 918 cases of serious
DCS in over 79,366 exposures (0.011
events / exposure). Of course the risk of
DCS is a function of N2 tissue ratio (a
function of baseline FiN2 and
atmospheric pressure), time spent
depressurized, and performance of
exercise at altitude [2].

Based on NASA models, the incidence of
DCS is 0.011 events/EVA [1]. Additional
models using Shuttle/ISS atmosphere and
prebreathing characteristics estimate the
risk of serious DCS (type II) between
0.00016-0.00196 events/exposure [2].
There has been no evidence of DCS in
100 EMU or over 200 Orlan suit EVAs
[3]. There are two reported incidences of
possible mild DCS in the same Gemini
and Apollo pilot, although neither were
associated with EVA [1]. There are
terrestrial studies from the HDSD that
have documented 918 cases of serious
DCS in over 79,366 exposures (0.011
events / exposure). Of course the risk of
DCS is a function of N2 tissue ratio (a
function of baseline FiN2 and
atmospheric pressure), time spent
depressurized, and performance of
exercise at altitude [2].

NASA Model (CliFF):
Table 6.3-1: Continued
83
Condition Incidence (Lunar Sortie) Incidence (Lunar Outpost)
NASA Model (CliFF):
(0.011 events/EVA)*(4
EVAs/person)*(4 people) =0.176 events

Conkin Model:
(0.00016 events/EVA)*(4
EVAs/person)*(4people)=0.00256
events

(0.00196 events/EVA)*(4
EVAs/person)*(4people)=0.0314 events

The likelihood is high according to the
CliFF based risk-assessment. However,
the model by Conkin using ISS/Shuttle
prebreathing and atmospheric conditions
predicts the frequency of DCS events to
be one to two orders of magnitude lower
and consequently, the magnitude is
moderate to low. Given the history of
300 successful EVAs without DCS, the
CliFF model incidence seems elevated.

Given that pre-breathe protocols have
been shown to be extremely safe, and no
DCS events have been experienced on-
orbit to date, the likelihood is weighted
towards a score of Low.

[1] IMM CliFF - Decompression
Sickness (DCS Associated with EVA)
[2] Conkin J. Evidence-Base Approach
to the Analysis of Serious
Decompression Sickness with
Application to EVA Astronauts. NASA
TP 210196. 2001.
[3] John-Baptiste A, et al. Decision
Analysis in Aerospace Medicine: Costs
and Benefits of a Hyperbaric Facility in
Space. Aviation, Space, and Env Med.
2006; 77(4):434-443.
(0.011 events/EVA)*(60
EVAs/person)*(6 people) = 3.96 events
Conkin Model:
(0.00016 events/EVA)*(60
EVAs/person)*(6people)=0.0576 events

(0.00196 events/EVA)*(60
EVAs/person)*(6people)=0.706 events

The likelihood is high according to the
CliFF based risk-assessment. However,
the model by Conkin using ISS/Shuttle
prebreathing and atmospheric conditions
predicts the frequency of DCS events to
be one to two orders of magnitude lower
and consequently, the magnitude is
moderate to very high. Given the history
of 300 successful EVAs without DCS, the
CliFF model incidence seems elevated.

Given that pre-breathe protocols have
been shown to be extremely safe, and no
DCS events have been experienced on-
orbit to date, the likelihood is weighted
towards a score of Low.

[1] IMM CliFF - Decompression Sickness
(DCS Associated with EVA)
[2] Conkin J. Evidence-Base Approach to
the Analysis of Serious Decompression
Sickness with Application to EVA
Astronauts. NASA TP 210196. 2001.
[3] John-Baptiste A, et al. Decision
Analysis in Aerospace Medicine: Costs
and Benefits of a Hyperbaric Facility in
Space. Aviation, Space, and Env Med.
2006; 77(4):434-443.
Diarrhea Based on spaceflight data, the incidence
of diarrhea is 1.21 events/person-year.

(1.21 events/person-year)*(4
people)*(24/365 years) = 0.3182 events
Based on spaceflight data, the incidence
of diarrhea is 1.21 events/person-year.

(1.21 events/person-year)*(6 people)*(0.5
years) = 3.63 events
Table 6.3-1: Continued
84
Condition Incidence (Lunar Sortie) Incidence (Lunar Outpost)

Therefore, the likelihood is relatively
high.

Therefore, the likelihood is very high.
Kidney Stone Based on the IMM CliFF for kidney
stone, the estimated mean incidence rate
is 0.002555 events per person-year.

(0.00255 events/person-year) x (4
persons) x (24/365 years) = 0.0006
events.

Therefore the likelihood of kidney stone
is Very Low.

[1] IMM CliFF - Kidney Stone
(Nephrolithiasis)
Based on the IMM CliFF for kidney
stone, the estimated mean incidence rate
is 0.002555 events per person-year.

The incidence stratified by renal calculus
size should be determined.

(0.00255 events/person-year) x (6
persons) x (0.5 years) = 0.00765 events.

Therefore the likelihood of kidney stone
is low.

[1] IMM CliFF - Kidney Stone
(Nephrolithiasis)
Nausea /
Vomiting
Based on spaceflight data the incidence
of gastroenteritis-related nausea and
vomiting is 0.146 events per person-
year.

(0.146 events/person-year) x (4 persons)
x (24/365 years) = 0.0384 events.

Therefore the likelihood of
gastroenteritis related nausea and
vomiting is moderate.
Based on spaceflight data the incidence of
gastroenteritis is 0.146 events per person-
year.

(0.146 events/person-year) x (6 persons)
x (0.5 years) = 0.438 events.
Therefore the likelihood of
gastroenteritis-related nausea and
vomiting is high.
Radiation
Sickness
Per IMM Acute Radiation Sickness
CliFF estimations, the incidence of acute
radiation sickness is 0.003125
events/person-year.

(0.003125 events/person-year) x (4
crew) x (24/365) = 0.0008 events.

Therefore, the likelihood is very low.
Per IMM Acute Radiation Sickness CliFF
estimations, the incidence of acute
radiation sickness is 0.003125
events/person-year.

(0.003125 events/person-year) x (6 crew)
x (0.5 year) = 0.009 events.

Therefore, the likelihood is low.

6.4 Conclusion
This chapter discusses the incidence of medical problems on space missions, and
lists salient medical ailments noted in spaceflight. This demonstrates that medical
Table 6.3-1: Continued
85
emergencies have occurred in past space missions, and will occur in future planetary
surface missions. Furthermore, it lists health problems/injuries that are likely to occur
during EVAs, which may require an IV. Tables 6.2-1 and 6.3-1 depict medical conditions
that would require IV treatment during a surface EVAs.

86
CHAPTER 7: MEDICAL PROPHYLACTICS, TRAINING, AND EQUIPMENT
Crew safety preparations will continue to be a first priority for future manned
space missions; however, emergencies during EVAs due to a variety of reasons will
occur. As a result, emergency provisions must be in place to deal with such crisis.
7.1 Injury and Medical Problems Mitigation (Prophylactics)
In order to implement effective training to mitigate injury and medical problems
in planetary surface exploration missions, the use of a preventive strategy is the single
most important method to reduce risk. The present approach of preventing illness and
injury is focused on reducing the likelihood and/or severity of medical events occurring,
i.e., controlling a “medical hazard.” This is usually accomplished by applying mitigation
strategies to risk factors. Humans are protected medically in extreme environments by
taking a preventative approach to illness and injury and using progressive addition of
levels of care (Primary, Secondary and Tertiary) until the risk is considered adequately
mitigated (Table 7.1-1) (Hamilton, et. al., 2007).

87
Table 7.1-1: Mission Levels of Care
36

Level of Care Rationale Methods
Primary
(Prevention)
Eliminate the hazard, i.e., by
selecting in crew members
without disease, and who have
no symptoms of disease
This is achieved by estimating the incidence
and prevalence of pathology in the astronaut
cohort. The astronaut cohort is small, and
therefore risk data must be derived from
observations, likelihoods, and severity of
illness or injury in similar cohorts such as
the military.
Secondary
(Countermeasures)
Protect against a hazard that
could not be controlled by
primary prevention alone such
as the effects of reduced gravity
on bone or chronic low dose
radiation on increased cancer
likelihood.
During space travel there are root-causes to
environmental and operational hazards
which are not adequately controlled by
mission design or other primary prevention
strategies. These root-causes need to be
mitigated using secondary prevention such
as load bearing exercise to reduce bone loss
in reduced gravity environments.
Tertiary
(Clinical Treatment)
Tertiary prevention is invoked
in most medical systems when
primary and secondary
prevention has failed.
Illness or injury may be due to an
uncontrolled hazard harming the crew, an
ineffective countermeasure (decompression
sickness), or previously undetected disease
causing an acute illness requiring treatment.

Primary (Prevention) level of care is the most effective and least expensive method
of delivering medical care; thus, medical care of the crew on planetary surfaces will
begin prior to the mission. This is achieved by applying previous epidemiological
knowledge about space travel, and potential known and predicted risks of the proposed
mission to select the crew. The prevention of illness/injury is the most important aspect
of medical care of any crew. However, there are risks associated with surface exploration
that may not be mitigated through preventative measures. Those risks must be mitigated
through the use of countermeasures (Duke, et. al, 2003).

36
Table adapted from Autonomous Medical Care for Exploration Class Space Missions (Hamilton, et al.,
2007).
88
Secondary (Countermeasures) level of care mitigates a particular risk by changing
the crew environment or prescribing a medical intervention on a crewmember.
Illness/injury that cannot be prevented or mitigated by countermeasures will require
clinical treatment (Duke, et. al, 2003).
Tertiary (Clinical Treatment) is a medical endpoint where intervention is required
to mitigate illness/injury. Resources required to treat unexpected illness and injury are
dependent on the mission profile and the success of the previous levels of care, namely,
Prevention and Countermeasures (Duke, et. al., 2003). According to Table 7.1-1, this
through-the-spacesuit IV research would be a mitigation strategy falling under Tertiary
level of care, i.e., illnesses or injuries which may occur as a result of uncontrolled
hazards, ineffective countermeasures, or previously undetected diseases.
Prophylactics can also be extended to prevention in design. A relevant example is
the design of EVA spacesuits. To mitigate the risk of ankle injury, the University of
North Dakota’s (UND) Lunar EVA prototype spacesuit, the NDX-2, is being designed to
limit ankle mobility and motion range for just such a contingency. UND’s predecessor
spacesuit, the NDX-1, had too much mobility range in the ankle, which might have
contributed to an ankle fracture in a fall or high jump (Harris, 2008). Similarly,
incorporating a “through-the-suit” IV provision is a prophylactic in design, in that it
mitigates the risk of not being able to provide IV treatment during the “Golden Hour”
after an EVA emergency.
89
7.2 Training for Medical Procedures Application
According to Hamilton, et al. (2007), for ISS Operations two crewmembers are
selected as Crew Medical Officers (CMOs) to receive 40 hours
37
of dedicated training in
the use of the on-orbit medical hardware and hands-on training in an emergency and
surgical operating room. For Shuttle (STS), two crewmembers are selected as CMOs to
receive 18 hours of dedicated training in the use of the Shuttle medical equipment for the
treatment of many types of illness and injury. The objective for both ISS and STS is
stabilization, medical transport, and initial advanced life support capability of the ill or
injured crewmember to a definitive medical care facility (DMCF) on Earth, rather than
being treated in space (Hamilton, et al., 2007). Such a return to Earth from LEO because
of a medical event or an emergency is an expensive proposition that would seriously
affect mission objectives. Nevertheless, such a return is possible, and, in fact, has been
done on at least three occasions from Russian space stations. Contingency plans for the
ISS include the possibility of emergency evacuation and return to Earth within 24 hours
using a Soyuz or crew return vehicle (Barratt and Pool, 2008).
On the contrary, for extended planetary surface missions, immediate return to a
DMCF in case of an emergency will not be possible. Step-by-step help, i.e., as in
“telepresence,” from Mission Control might also not be efficient in a mission to Mars due
to a 22-minute communication delay, i.e., 44 min round-trip communication delay,
especially when trying to perform treatment within the “golden hour.” Evan a Mars ‘fly-
past’ with direct return to Earth may represent a 9-month round-trip, and most Mars

37
According to Barratt (2008), current ISS procedures require that the CMO receive 80 hours of medical
training.
90
mission scenarios involve mission durations of 18-36 months (Barratt and Pool, 2008).
As a result, crews on extended space crews will have to be well trained on how to deal
with emergency scenarios autonomously and have the best resources available to them to
increase their probability of survival. This is certainly the case for emergencies within a
pressurized habitat, and it can be concluded that it would be even more so for
emergencies during an EVA.
EVA emergency “skills” required for successful treatment of EVA medical
emergencies can be successfully obtained with high-fidelity trauma simulation within the
extreme environment. Medical simulation allows effective training and development of
trauma capabilities for spaceflight. As a result, eventual training for a through-the-
spacesuit IV concept could be integrated into NASA’s Space Medicine Workgroup which
studies medical risk, capabilities, and training for spaceflight using Human Patient
Simulators in parabolic flights in NASA’s KC-135 (Figure 8.2-1). With the use of this
human manikin, NASA has been able to perform the following procedures in
microgravity: laceration closure, assessment of pupils using an eye chart, listening to
breath sounds, insertion of an IV catheter, assembling of an IV line for use in
microgravity, needle chest decompression, application of an automatic external
defibrillator, and cardiopulmonary resuscitation (Doerr, 2006). The U.S. parabolic flight
program has demonstrated that surgical procedures (including standard techniques for
cardiac and trauma life support) in weightlessness can be performed with no more
difficulty than in the 1-G environment if the principle of restraining the patient, the
operation personnel, and the surgical hardware is adhered to (Barratt and Pool, 2008).
91
As part of the Space Shuttle training program, CMOs are given the opportunity to
train with the IV virtual-reality simulator and with human test subject volunteers (Barratt
and Pool, 2008). For purposes of this research, the IV procedures that the NASA Space
Medicine Workgroup has performed have the most applicability. Obviously, adding a
spacesuit to the equation increases the complexity of establishing an IV line in
microgravity. However, the Space Medicine Workgroup has demonstrated that it has the
capability to help in the development of a through-the-spacesuit IV concept, and
eventually train astronauts for its use.
Another method of training astronauts for EVA emergencies is by utilizing Moon
or Mars analogs here on Earth. In these analogs, new technologies and exploration
strategies can be formulated and tested. For accomplishing this in a proper fashion, places
on Earth that have several resemblances with Mars and the Moon in regard with
geological and environmental conditions are required. A leading Mars analog site is
located in the desert near Hanksville, Utah, which is known for its similarity with several
distinct Martian landscapes

(Zea and Diaz, 2008). The Mars Society has its Mars Desert
Research Station (MDRS) in this site. Selected engineers, geologists, astrobiologists,
astronomers and other scientists and professionals from NASA and other institutions are
permitted to conduct their science investigations and exploration research at the MDRS.
Several studies have been conducted at the MDRS, such as Design of Wastewater
Treatment and Recycling, Airlock Design, Optical Dust Characterization, In-Situ Martian
Construction, Human Factors, and EVA Emergency Procedures (Figure 7.2-1). The
habitat is an 8-meter diameter, two-story cylinder mounted on landing struts. MDRS is a
92
mostly self-sustainable base. Crews of up to 6 people inhabit the MDRS at a given time.
During Mars surface exploration mission simulation, crew members are required to
spacesuit up in unpressurized spacesuit replicas (surface spacesuits) before leaving the
habitat. In the same manner, they must stay in a decompression area before being able to
either enter or exit the habitat. During these EVAs, previous missions have conducted
studies on the feasibility of using magnetometer and soil conductivity equipment with the
surface spacesuits, prototype planetary surface spacesuits, EVA rescue procedures, tested
EVA sample collection tools, and performed surface spacesuit analyses

(Zea and Diaz,
2008). It is worth noting that the University of North Dakota tested its NDX-1 Planetary
Spacesuit at MDRS in 2007 (Figure 7.2-2). NDX-1 was a NASA-funded spacesuit
designed and built with the main objective of improving mobility and walking
capabilities.

93

NASA K-135 Medical Research

MDRS External View / MDRS Crew 11 Simulated Transportation of Injured
Crewmember (Broken Leg)

Figure 7.2-1: Medical Training
38

38
Source: Doerr (2006), Diaz (2007) and Groemer (2005).
94

Figure 7.2-2: Subject Performing NASA-STD-3000 Mobility Test
39

Figure 7.2-3: Subject Performing Core Sample Drilling
40

39
Source: Picture credit Alejandro R. Diaz (MDRS 2007)
40
Source: Picture credit Pablo de Leon (MDRS 2012)
95
Although we have, and will continue, to learn a great deal from human behavior
in analogue environments, e.g., polar expeditions and nuclear submarines, as well as from
isolation experiments, there clearly is a great deal left to learn about medical procedures
for long-term expeditionary space missions (Barratt and Pool, 2008).
7.3 Medical Equipment
Medical equipment has evolved throughout the more than 40 years of space
activities. They have gone from basic medical kits to advanced life support hardware.
Figures 7.3-1 to 7.3-5 illustrate the evolution of medical kits from Mercury to ISS.

Figure 7.3-1: Mercury Medical Equipment
41

41
Source: Barratt (2008)
96

Figure 7.3-2: Apollo Medical Equipment
17

Figure 7.3-3: Apollo Medical Equipment
17

Figure 7.3-4: Shuttle Medical Equipment
17

97

Figure 7.3-5: ISS Medical Equipment
17

Medical provisions for long term space expeditions are likely to be more
comprehensive than they are for Shuttle/ISS missions. However, volume, weight, and
electrical power constraints will continue to impose significant limits on the ability to
provide medical care (Barratt and Pool, 2008). Nonetheless, as spaceflight missions
increase in duration, complexity of payloads, and number of high-risk activities, e.g.,
EVAs, the need for advanced on-site medical equipment will have to increase as well.
Medical and surgical equipment must be accurate, reliable simple, and have very
long lifetimes. Commercially available equipment with only minor modifications to
withstand vibration and to function in microgravity will be used. Nonflammable materials
that are not subject to prolonged off-gassing will have to be used; this will exclude many
plastics (Barratt and Pool, 2008).
For current missions, NASA has carefully analyzed what medical problems are
most likely to be encountered and will constitute the most serious danger to the crew and
mission (Billica, et al., 1996). This same approach will be utilized for future missions and
will help in designing medical care systems that will be able to handle those medical
98
events that are more commonly encountered, have a substantial effect on crewmember
health, or could affect the mission (Barratt and Pool, 2008). Many rare but nonetheless
serious surgical events will not be provided for, and such events could exceed the
system’s medical capacity and overwhelm its ability to respond adequately (Barratt and
Pool, 2008)
7.4 Conclusion
This chapter discusses medical prevention approaches utilized by NASA in order
to mitigate injury and medical problems in planetary surface exploration missions. It also
discusses the medical training NASA performs at NASA’s Space Medicine Workgroup;
and it recommends the use of MDRS for future medical training and procedure
development.

99
CHAPTER 8: MEDICAL ADMINISTRATION ROUTE

There are several types of medical administration. Among the most salient used
are oral medications, intramuscular (IM) injections and intravenous (IV) injections.
Intraosseous (IO) infusion (injection directly into the bone marrow) is also used in
emergency situations when intravenous access is not available or not feasible.
To date, only an IM provision has been incorporated into a spacesuit design
(Apollo). Additionally, during the early phases of the Apollo program, there was a
through-helmet port capability which allowed astronauts to drink water or eat food from a
tube. This was designed in case the cabin pressure failed and they had to wear spacesuits
for several days to make it home (Harris, 2008). It is reasonable to speculate that oral
medication could have been administered as well via this through-helmet port during the
Apollo program.
8.1 Oral Administration
Oral administration is the most common method of drug administration.
According to Hamilton and Timmons (1990), “this route of administration has the
advantage of quickly and easily placing the drug in contact with the relatively large
surface membrane of the stomach, which has a rich supply of capillaries for entry into the
plasma compartment. The stomach wall is relatively resistant to the irritating properties
of most drugs, and the churning action of the stomach will improve the physical
distribution of the compound. Finally, the presence or absence of food in the stomach can
be manipulated to increase or decrease the rate of absorption, to minimize irritating
effects, or to change the chemical environment of the stomach.” Hamilton and Timmons
100
(1990) add that there are, however, some special characteristics of the gastric
environment that may cause difficulties for the administration of certain drugs. The high
acidity of the stomach may alter the structure of the drug, causing it to precipitate and be
less easily absorbed into the bloodstream. These factors contribute to the first-pass
effect
42
, which reduces the bioavailability
43
of oral medications. For example, the oral
bioavailability of morphine is 20-40% (Morphine, n.d.), as compared to 100%
intravenous bioavailability.
8.2 Intramuscular (IM) Administration
IM injections involve the injection of a substance directly into a muscle. It is used
for particular forms of medication that are administered in small amounts, e.g.,
analgesics, antibiotics, antidotes, and vaccines, which the muscles are good for.
Absorption speed depends on the chemical property of the drug. IM injections are often
given in the deltoid, vastus lateralis, and gluteal muscles. Generally, IM injections are not
self-administered, but rather injected by a trained medical professional. However,
prescribed self-administered IM injections are becoming more common for patients that
require these injections routinely (Intramuscular Injection, 2009).
For IM administration, bioavailability decreases due to the water solubility of the
drug, dispersion of the injected solution, and blood flow at the muscle site. Clinical

42
First-pass effect is a phenomenon of drug metabolism whereby the concentration of a drug is greatly
reduced before it reaches the systemic circulation. It is the fraction of lost drug during the process of
absorption which is generally related to the liver and gut wall. Notable drugs that experience a significant
first-pass effect are imipramine, morphine, propranolol, buprenorphine, diazepam, midazolam, demerol,
cimetidine, and lidocaine.
43
In pharmacology, bioavailability (BA) is a subcategory of absorption and is used to describe the fraction
of an administered dose of unchanged drug that reaches the systemic circulation; it is one of the principal
pharmacokinetic properties of drugs.
101
experience with diazepam, chlordiazepoxide, phenytoin, digoxin and lidocaine has shown
that IM absorption may be slow, erratic or incomplete. For many drugs, oral
administration may even be more efficacious than IM injection (Tuttle, 1977).
8.3 Intravenous (IV) Administration
IV injections refer to the giving of liquid substances directly into a vein. IV
injections are used when rapid absorption is called for, when fluid cannot be taken by
mouth, or when the substance to be administered is too irritating to be injected into the
skin or muscles. Compared with other routes of administration, the intravenous route is
the fastest way to deliver fluids and medications throughout the body (Intravenous
Injection, 2009).
Using an IV needle as the method of drug administration has some significant
advantages over oral ingestion. First, the drugs are protected from the digestive system.
This prevents them from being chemically altered or broken down before they can be
effective. Second, since the active compounds are quickly absorbed into the bloodstream,
they begin working faster (Syringe, 2007).
According to Hamilton and Timmons (1990), an IV injection is the most direct
route for a medical drug, because it is placed directly into the circulatory system without
having to cross any membranes. The most common usage of the IV injections is the
administration of anesthetics, since the level of anesthesia can be carefully titrated by
monitoring vital signs. Additionally, drugs that would otherwise be severe irritants to
local tissue can sometimes be administered via this route, owing to the resistant nature of
102
the walls of the bloodstream and the rapid dilution of the drug in the moving fluid
environment.
8.4 Intraosseous (IO) Administration
Intraosseous infusion is the process of injection directly into the marrow of the
bone. The needle is injected right through the bone and into the soft marrow interior.
Intraosseous infusion is one of the quickest ways to establish access for rapid infusion of
fluids, drugs and blood products in emergency situations, as well as resuscitation.
Unfortunately many doctors do not know this technique or do not employ it. In situations
when peripheral or central venous access can be difficult to obtain and/or dangerous, IO
infusion is usually the next approach. It can be maintained for 24–48 hours, after which
another route of access should be obtained. The best site to use is the flat anteromedial
aspect of the tibia. The anterior aspect of the femur and the superior iliac crest can also be
used. The tibia is preferred since the anteromedial aspect of the bone lies just under the
skin and can easily be identified (Vreede, et. al., 2000). Clavicular IO may be an
alternative infusion technique as numerous studies have demonstrated the efficacy of IO
administration of emergency medication (Iwama, et. al., 1994; Intraosseous Cannulation,
2011). IO access requires less skill and practice than peripheral or central lines, has fewer
serious complications than central lines, and can be performed much faster than central or
peripheral lines when vascular collapse is present (Intraosseous Cannulation, 2011).
Because of this, IO systems (most of which use a mechanical or powered adjunct to place
the catheter into the bone marrow) have become more common across the United States
in the pre-hospital setting.
103
8.5 Conclusion
Compared to other methods of drugs administration, namely oral or IM, IV
administration is the most efficient method of drug/fluid delivery, as the bioavailability of
medication administered intravenously is 100% (Griffin, 2009), i.e., it goes directly into
the blood circulatory system without having to cross any membranes. Similarly, IO
infusion is, in effect, an indirect intravenous access because the bone marrow drains
directly into the venous system.
In comparing IV and IO infusion for a through-the-suit provision capability, it
became evident that IO had several drawbacks and that IV infusion would be the
preferred solution. Salient IO drawbacks (when compared to IV) for a through-the-suit
provision:
1. Brittle Bones - When an astronaut experiences zero gravity, the weight-bearing
bones of the body such as those in the spine and leg, are relieved of their burden,
a condition known as skeletal unloading. When skeletal unloading persists for
several weeks, bones start to deteriorate: the number of bone cells decreases,
movement into the bone of such minerals as calcium and phosphorous slows, and
production of bone-cell precursors called osteoprogenitor cells diminishes. All
these changes result in weakened, brittle bones prone to fracture (Bone Loss,
2011). It is not known whether the bones of an astronaut, having been in a
weightless environment for around 8 months (travel time to Mars), would
withstand the pressure involved with inserting an IO catheter.
104
2. Invasive Procedure – Establishment of IO access is a very invasive procedure
performed on the emergency site (or en route to the medical facility); this is even
more of a challenge when the spacesuit barrier is considered. On the other hand,
even though a chest port is an invasive procedure (implant) as well, it is
performed prior to launch (on Earth) and in a medical facility.
3. Duration – Whereas a chest port can be implanted and stay implanted for years,
the IO route needs to be replaced as soon as IV access is possible. This should be
no more than a few hours. The longer the period of use the greater the risk of
complications.
4. Bone Fracture – IO access is most commonly administered in leg bones (tibia);
however, a broken leg is one of the scenarios that are envisioned to occur during
planetary surface exploration. If this occurs, a tourniquet incorporated into the
spacesuit might be ‘deployed’ to stop the hemorrhaging. Doing this, would lend
IO access futile. In fact, it is common medical practice to not use the tibia if the
femur is fractured on the same side.
5. Spacesuit Mobility – An IO access provision on the leg of an astronaut would
include a through-the-suit IO ‘push button’ device. This would significantly
hinder leg mobility, as the astronaut would not be able to, for example, kneel to
collect samples, and the constant bending movement of walking would risk
dislodgement of the through-the-suit IO provision.
6. Spacesuit Barrier – IO access can also be established through the clavicle.
However, astronaut clavicle access would not be possible because it is blocked by
105
spacesuit components which would be difficult to go through, i.e., shoulder joints,
helmet, and/or HUT to helmet connection.
7. Dust Contamination – The lower torso is made of soft materials which attract
more dust than hard or smooth surfaces. The lower torso, i.e., boots and legs, are
also more exposed to dust than other spacesuit components. Assuming the
through-the-suit IO device is located in the leg, it would make it more susceptible
to dust contamination.
8. Push Force - The push force required to insert the through-the-suit IO device into
bone would be greater than that required to push a through-the-suit IV design into
the skin to the chest port. This would not be advantageous as every step in an
emergency EVA scenario should be simplified.

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CHAPTER 9: VASCULAR ACCESS DEVICES (VADs)

A VAD is an indwelling catheter used to obtain venous access. There are two
types of VADs: Peripheral IV Access and Central IV Access. VADs are performed when
patients need IV antibiotic treatment, chemotherapy or anti-cancer drugs, long-term IV
feeding for nutritional support, hemodialysis (used to treat patients whose kidneys are not
working properly), blood transfusions, or have difficulty receiving a simple IV line
(VAD, 2009).
9.1 Peripheral IV Access
Peripheral IV access is the most common intravenous access method in both
hospitals and pre-hospital services (Figure 9.1-1) (Peripheral IV, 2009). A peripheral IV
line consists of a short catheter (length 1 in. – 8 in.) inserted through the skin into a
peripheral vein - any vein that is not in the chest or abdomen (Allen, 2005). Arm and
hand veins are typically used although leg and foot veins are occasionally used
(Hammerschmidt, n.d.). Peripheral IV access is intended for days to weeks. It is coated
with anticoagulant and antimicrobial materials and has single to multiple connections.
The metacarpal, cephalic, badilic and median vein are recommended for peripheral IV
insertion, and areas of flexion should be avoided (Allen, 2005). Advantages include
economical cost, ease of insertion and removal, very low infection rate, and quick access.
Disadvantages include routine site change resulting in repetitive venipunctures, limited
function, i.e., only for isotonic drugs and fluids (pH 7.35 – 7.45), increased risk of
infiltration and extravasation, and increased patient discomfort (Allen, 2005).
107

Figure 9.1-1: Peripheral IV in Hand
44

As part of this research, this author completed a one week IV Training Course to
obtain an accurate appreciation of the intricacies with administering an IV line (Appendix
E - Intravenous Training Course). The course not only included the theory of IV
administration, but hands-on training on both a manikin and a person, i.e., classmates.
Prior to attending the course, this author performed extensive research on IV
administration. However, having to perform an actual IV insertion into a manikin and a
person provided invaluable insight into this procedure.
9.2 Central IV Access
Central IV access lines flow through a catheter with its tip within a large vein,
usually the superior vena cava or inferior vena cava, or within the right atrium of the
heart. This has several advantages over a peripheral IV: (1) it can deliver fluids and
medications that would be overly irritating to peripheral veins because of their
concentration or chemical composition, e.g., total parenteral nutrition; (2) medications

44
Source: Hammerschmidt (n.d.)
108
reach the heart immediately, and are quickly distributed to the rest of the body; and (3)
there is room for multiple parallel connectors within the catheter, so that multiple
medications can be delivered at once, even if they would not be chemically compatible
within a single tube (Central Venous Catheters, 2007). There are three main types of
central IVs, depending on the route that the catheter takes from the outside of the body to
the central vein, i.e., Central Venous Lines (Non-Tunneled and Tunneled), Peripherally
Inserted Central Catheter (PICC), or Implanted Venous Ports (IVPs).
9.2.1 Central Venous Lines
Central Venous Lines take a direct route into central veins and can be in the form
of a Non-Tunneled Central Venous Catheter (CVC), or a Tunneled CVC. In general,
Non-Tunneled CVCs are used for short periods (up to 1-2 weeks), while Tunneled CVCs
can be used from 6 months to a year (Tunneled and Non-tunneled catheters, n.d.).
9.2.1.1 Non-Tunneled CVC

A Non-Tunneled CVC (Figure 9.2.1.1-1) is a catheter which is directly inserted
into a subclavian vein, i.e., Subclavian Inserted Central Catheter (SICC), or internal
jugular vein, i.e., Jugular Inserted Central Catheter (JICC), and advanced toward the heart
until it reaches the superior vena cava or right atrium. Because all of these veins are
larger than peripheral veins, central lines can deliver a higher volume of fluid and can
have multiple connectors. Non-Tunneled CVCs are short (about 7.9 in), and can have
single to multiple connector catheters. Advantages include quick access (mostly used
under emergency situations), reliability (fully functioning central access), and provision
for multiple connections. Disadvantages include high insertion complications, infection
109
rate of 28 – 35%, limited dwell time (7 days recovery), and patient discomfort (Allen,
2005).

Figure 9.2.1.1-1: Non-Tunneled CVC (SICC)
45

9.2.1.2 Tunneled CVC

Tunneled CVCs (called a Hickman line or Broviac catheter) (Figure 9.2.1.2-1) are
inserted into the target vein and then "tunneled" under the skin to emerge a short distance
away. This reduces the risk of infection since bacteria from the skin surface are not able
to travel directly into the vein. These catheters are also made of materials that resist
infection and clotting. Tunneled CVCs are used for patients who need prolonged IV
therapy, i.e., post-transplant patients, and X-rays are required for surgical placement. As
depicted in Figure 9.2.1.2-1, with a Tunneled CVC there is still a portion of the catheter
that lies outside the skin (Tunneled Catheter, 2007). Advantages include prevention of

45
Source: Non-Tunneled Catheter (2003)
110
organism migration and dislodgment prevention. Disadvantages include high insertion
complications, high infection rate, and costly insertion procedure (Allen, 2005).

Figure 9.2.1.2-1: Tunneled CVC
46

9.2.2 Peripherally Inserted Central Catheter (PICC)
PICC lines are used when IV access is required over a prolonged period of time,
as in the case of long chemotherapy regimens, extended antibiotic therapy, or total
parenteral nutrition. The PICC line is inserted into a peripheral vein under ultrasound
guidance, usually in the arm, and then carefully advanced upward until the catheter is in
the superior vena cava or the right atrium (Figure 9.2.2-1). From the outside, a single-
connector PICC resembles a peripheral IV, except that the tubing is slightly wider. A
larger sterile dressing than would be required for a peripheral IV is needed due to the
higher risk of infection if bacteria travel up the catheter. However, a PICC poses less
systemic infection risk than other central IVs (except IVPs) because bacteria would have
to travel up the entire length of the narrow catheter before spreading through the

46
Source: Tunneled Catheter (2007)
111
bloodstream. Advantages include ease of insertion (compared to other central lines),
relatively low risk of bleeding, externally unobtrusive, can be left in place for months to
years for patients who require extended treatment, safe and reliable IV access, fully
functioning as central lines, rare insertion complications, and very low catheter-related
infection rate. The major disadvantage is that the PICC must travel through a relatively
small peripheral vein and is therefore limited in diameter. It is also vulnerable to
occlusion, damage, or dislodgement from movement or squeezing of the arm (Allen,
2005) (Appendix F – PICC Practical Experience).

Figure 9.2.2-1: Peripherally Inserted Central Catheter (PICC) Description
47

9.2.3 Implanted Venous Ports
IVPs, often referred to as Port-a-Caths, PermaCaths, or Chest Ports, are centrally
or peripherally implanted CVCs that do not have an external connector. Instead, they
have a small port (height: 0.37 – 0.67 in.; diameter: 0.94 – 1.97 in.) that is covered with

47
Source: Non-Tunneled Catheter (2003)
112
silicone rubber and is implanted under the skin (Allen, 2005). The center is raised and
designed to receive a needle (Figure 9.2.3-1). The raised center can be felt under the skin
(Port, 2009). The self-sealing silicone allows the IVP to be punctured hundreds of times
with a special needle. There is a plate under the IVP, so the needle cannot go all the way
through the IVP. Attached to the base of the IVP is a narrow flexible tube, called the
catheter (Port, 2009). In turn, this catheter is threaded into the right side of the heart (right
atrium) (PermaCath Insertion, n.d.). Medication is administered by placing a small needle
through the skin (90 degree angle), piercing the silicone, into the IVP. When the needle is
withdrawn, the reservoir cover reseals itself. The cover can accept hundreds of needle
sticks during its lifetime (Port Removal, 2009).
IVPs are frequently used for patients needing long-term IV therapy. It is possible
to leave the IVPs in the patient's body for years (Czarnik, 2009). However, prolonged use
would require monthly heparin flushes to prevent clotting (dehydrated heparin takes up
little room and has a shelf life of 3 years). Also, this flush could easily be done by a
trained crewmember (Czarnik, 2009). The IVP is inserted during a brief operation, and is
most often placed under the skin below the left or right collarbone (chest) (Port, 2009).
The incision is made halfway between the clavicle and nipple; the right side of the chest
is generally preferred since the innominate vein curves down more directly to the
superior vena cava (SVC) (Nursing Link, 2009). In some cases, IVPs may be placed in
the abdomen, between the breasts, under the arm on the side of the chest, or in the upper
or lower forearm (Port, 2009). These less-used locations are chosen when the chest is not
an option for conventional port placement. These ports vary in septum size depending on
113
the location. However, method of access, assessment, and maintenance of the device are
similar to the implanted chest port (Macklin, 2005). It should be noted that alternate sites
provide less stability for the port when accessed than on the chest (Nursing Link, 2009).
The surgeon will create a small pocket for the IVP and then insert the catheter
into a vein. A few stitches will be needed to complete the operation. In most cases the
procedure is done under local anesthesia using numbing medicine at the site (Port,
2009). Advantages of IVPs include lowest infection rate among all CVCs, long-term
access, least inconvenience, and least impact on activities of daily life (ADL) (Allen,
2005). Disadvantages include: needle access required, possible needle dislodgement and
extravasation, and highest cost among CVCs.

Figure 9.2.3-1: Implanted Venous Port
48

48
Source: ‘A’ - Implanted Venous Access Ports (2009), ‘B’ - Port-A-Cath (2009), ‘C’ - Central Venous
Catheter (2009), ‘D’ - Implanted Port (2009).
A
C
D
B
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9.3 Conclusion
This chapter provides a detailed explanation of the two types of VADs (Peripheral
IV Access vs. Central IV Access). It discusses the advantages and disadvantages of each
VAD, which among others include topics such as infection rates, long-term access, least
inconvenience, impact on ADL, dislodgement risk, and cost. The following chapter
discusses the trade study conducted to determine the type of VAD that would be most
suitable for an astronaut in an EVA pressure-spacesuit.
115
CHAPTER 10: VAD TRADE STUDY AND ANALYSIS
10.1 VAD Trade Study
VADs are conduits for IV interventions, e.g., saline, drug therapy, and other
needed emergency fluids. Selecting the right VAD depends on several factors including,
duration and type of therapy (Hsiai, 2009). Utilizing the above depicted VAD data, a
trade study was conducted to determine which IV access method would be most suitable
for an EVA crewmember. A common method to select among multiple alternatives was
used called Simple Multi-Attribute Rating Technique (SMART) (Goodwin and Wright,
2003), taking into consideration six factors (Table 10.1-1): (1) catheter accessibility
(spacesuit dependent), (2) freedom of movement (post catheter insertion), (3) catheter
ease of insertion and removal, (4) catheter durability, (5) catheter infection rate, and (6)
catheter device cost.
Each factor was assigned a weight percent, which together added to 100%. These
weights were established upon discussion with research advisors. The weight percent was
assigned by determining the importance that a specific factor would have. For example,
catheter infection rate and catheter durability were the most important factors in selecting
a VAD for an astronaut. Given that astronauts would go on long-term expeditions, it
would be essential that the selected VAD has the lowest infection rate and highest
durability. As a result, these two factors were assigned a weight of 25. Freedom of
movement (post catheter insertion) was assigned a weight of 20 because an astronaut will
116
need as much flexibility and freedom to perform the various foreseen EVA tasks. A VAD
which would allow for highest freedom of movement would be the preferred selection.
Catheter ease of insertion/removal and catheter device cost were assigned the lowest
weights, 10 and 5, respectively. In the case of catheter ease of insertion/removal, all
VADs insertions are commonly used in hospitals, so the risk to the astronaut would not
be high. Lastly, catheter device cost was assigned the lowest weight because this factor
would have minimal impact to NASA budget and no impact to an astronaut. In order of
importance (from highest to lowest), the criteria were weighted in the following order: (1)
catheter infection rate, (2) catheter durability, (3) freedom of movement, (4) catheter
accessibility, (5) catheter ease of insertion and removal, and (6) catheter device cost.
Once the criteria weights were determined, the scoring process was initiated. This
score scale ranged from 1-10 (Low-1 and High-10). Each VAD device was assessed on
how they performed against each factor. Scores were primarily determined by utilizing
literature
49
which compared various VAD factors, i.e., infection rates, durability, and
cost, among others. If a VAD performed well against a factor, it was assigned a high
score; and vice-versa. For example, Implanted Venous Ports (IVPs) had the best (highest)
“catheter durability” and best (lowest) “catheter infection rate,” so against these two
factors IVPs were assigned a score of 9. On the other hand, Peripheral IV Access VADs
performed poorly against “catheter durability,” since it had the lowest life span; it was
assigned a score of 2.

49
Source: Allen (2005)
117
It should be noted that no matter what VAD is selected, thrombotic catheter
occlusions and catheter-related bloodstream infections are currently still considered the
most critical management issues for VADs (Weinstein, 2007). Fortunately, there are
provisions in place to mitigate these risks. For example, VADs can be kept from clotting
off from non-circulating blood when they are not being used to infuse fluids, by using a
Heparin (anticoagulation) flush; they are also flushed with normal saline solution. These
are routine procedures used to maintain catheter patency. Furthermore, air bubble
formation can be prevented by using filters (Hsiai, 2009).

118
Table 10.1-1: Type of Catheter Device Trade Matrix

Criteria Peripheral IV Access Central IV Access
Central Venous
Lines (Non-
Tunneled)
Central Venous
Lines (Tunneled)
Peripherally Inserted
Central Catheter
(PICC)
Implanted Venous
Port (IVP)
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Catheter
accessibility
(spacesuit
dependent)
15 7 105 5 75 5 75 7 105 5 75
Freedom of
movement (post
catheter insertion)
20 3 60 7 140 7 140 3 60 7 140
Catheter ease of
insertion and
removal
10 9 90 6 60 5 50 5 50 3 30
Catheter durability
(life span)
25 2 50 4 100 7 175 7 175 9 225
Catheter infection
rate (lowest)
25 7 175 4 100 5 125 7 175 9 225
Catheter device
cost
5 8 40 7 35 6 30 5 25 4 20
Total 100 520 510 595 590 715

Note: The Criteria Factors add up to 100; while the Scores range from 1-10 (Low-1, High-10).

118
119
10.2 VAD Analysis
According to Hadaway (2009), the traditional approach of utilizing peripheral
access as the automatic first choice for every patient is being challenged. Conventional
wisdom once dictated that short peripheral catheters be used until all peripheral
venipuncture sites were exhausted. At that point, if the patient still needed infusion
therapy, he/she would receive a CVC, usually as a last resort. This approach was based
on the assumption that CVCs are more prone to complications, including such serious
ones as thrombosis and infection. Today, IV treatment traditional approach is being
challenged and peripheral access is no longer the automatic first choice for every patient.
Some types of central VADs, such as tunneled central catheters and IVPs, are actually
becoming ideal choices for IV treatment (Hadaway, 2009).
This is supported by the VAD Trade Study (Table 10.1-1), which depicts that the
most suitable VAD for an EVA pressure-suited crewmember would be an IVP (total
score of 715). IVPs get a low mark on “catheter accessibility” because the upper chest
area of spacesuits is covered by the hard upper torso (HUT) and the Display and Control
Module (DCM). However, this research assumes two things: (1) that an area would be
allocated into the spacesuit HUT to allow access to the IVP, and (2) that future DCMs
will either be smaller and/or will be located in a place which allows access to the IVP.
IVPs also got low marks for “ease of insertion” and “cost,” because they require complex
surgical implants and have the highest cost of all VADs. IVPs can cost around $6,000,
while a PICC line runs around $500 (Macklin, 2005).
120
On the other hand, IVPs got high scores for the remaining three criteria.
“Freedom of movement (post insertion)” was scored a 7 because the chest area would not
hinder astronaut movement, and IVPs in general have the least impact on activities of
daily life (ADL). With regards to durability (life span), IVPs were rated the highest (score
of 9) because they have the longest durability (life span) among all VADs. According to
Cohn, et al. (2001), the median time of port duration in patients with a functional IVP
was 21.6 months. IVPs removed for malfunction with their tips located centrally had a
significantly longer median duration of functional use than those whose tips were located
peripherally (78 versus 44 months) (Cohn, et al., 2001). Last but not least, IVPs were
assigned a score of 9 for “catheter infection rate.” According to Peynircioglu, et al.
(2007), a review of hospital charts and electronic database of 17 patients with IVPs
yielded an IVP infection rate of 0.19/1000 catheter days, and according to Lucas (1992),
most studies report that IVPs have the lowest reported rates of catheter-related
bloodstream infection when compared with externally placed CVADs. Conclusively,
compared to other VADs, IVPs have the lowest infection rates (Allen, 2005). Note that
there are meticulous steps necessary to prevent infection to all VADs which have an
exposed catheter (all except an IVP); these steps would add complexity to already replete
space operations manual.
The VADs with lowest marks for “freedom of movement” were Peripheral IVs
and PICCs, because they would be located in flexion areas of high use by astronauts, e.g.,
hands and arms. These VADs impede lifting or carrying something without positioning
items correctly in arms to avoid the VADs; pressure against these VADs can also be
121
painful. As a result, these VADs would not be good candidates for a through-the-
spacesuit concept. As depicted in Table 4.2-1, planetary surface EVA astronauts will
perform many activities which will require full use of both arms; however, a PICC limits
movement. There is also the risk of damage to these VADs while performing routine IVA
operations.
10.3 Conclusion
Based on the VAD Trade Study and subsequent analysis, an IVP is the best
alternative for an EVA through-the-spacesuit IV administration concept. This conclusion
is supported by Dr. Jensen (Adjunct Faculty in the Space Studies Department at the
University of North Dakota), Dr. Katz (Interventional Radiologist at USC), Dr. Czarnik
(Faculty, Aerospace Medicine Program, Wright State University).

122
CHAPTER 11: INTRAVENOUS FLUID RESEARCH IN SPACE
11.1 Precedence
According to Barratt and Pool (2008), CMOs and mission specialists performing
biomedical investigations have inserted IV catheters on orbit in antecubital veins with
success rates similar to those in ground operations
50
. The greatest challenges in
accomplishing venous catheterization in microgravity or partial gravity are restraint of
hardware and patient. Phlebotomy and catheterization are otherwise somewhat easier
once the CMO and patient are well restrained. No obvious differences have been
observed in flashback or fluid flow through IV tubing, and blood control is rendered
simpler by the predominance of surface tension in the absence of gravity. Air elimination
filters that use a hygroscopic membrane were shown to perform adequately in removing
air bubbles in the continuous microgravity conditions of the Spacelab Life Sciences-1
mission (STS-40). The filters can dry out, however, and a continuous pressure head is
required to maintaining filter filling. Such pressure can be provided by squeezing the IV
bag or by placing the bag in a blood pressure cuff and inflating it to between 50 and 75
mmHg.
From a historical precedent perspective, inserting an astronaut with an IV line is
not a new concept and it has been done before. Dr. Norman E. Thagard
51
twice launched

50
It should be noted that NASA also has surgical experience in space. In 1998, the crew of STS-90
Neurolab mission performed the first survivable surgical procedure on animals. The results validated that
surgical procedures were no more difficult to perform in microgravity than in 1-G, so as long as appropriate
restraints are provided and the individual operator has adequate 1-G surgical skills (Barratt, 2008).
51
Dr. Thagard was a mission specialist on STS-7 in 1983, Flight Engineer on STS-51B in 1985 and STS-
30 in 1989, the Payload Commander on STS-42 in 1992, and was the Cosmonaut Researcher for the 18
th

Primary Expedition to the Russian Mir Space Station in 1995 (Space Explorers, 2007).
123
with a peripheral IV in place under a pressure suit; in January 1992, the suit was the
Shuttle LES (STS-42) and in March 1995, it was the Russian Sokol suit worn in the
Soyuz capsule. Of course, there was no access to the IV until the suit was doffed
following orbital insertion (Thagard, 2009). Dr. Thagard was the first to propose and use
IV administration of the drug, Phenergan, in the successful treatment of Space Motion
Sickness (SMS) (Space Explorers, 2007). The IV peripheral line was inserted in the
antecubital vein (also called cephalic vein), which is a superficial vein located on the
lateral side of the arm (Figure 11.1-1). It was inserted 4 hours before launch.

Figure 11.1-1: Arm Veins - Cephalic Vein
52

According to Thagard (2009), in neither case was there any problem with the
peripheral IV lines, e.g., discomfort or interference with activities, although in both cases,
the IV infiltrated (clotted off and became unusable) toward the end of the first day on
orbit. However, both worked long enough for Dr. Thagard to take several minimal (12.5
mg) IV doses of Phenergan and thereby avoid SMS problems. The peripheral IV lines

52
Uzwiak (2009)
124
were only worn in the ascent and early on-orbit flight phases; never on entry, nor were
they worn on an EVA. They were removed on-orbit after IV administration. Figure 11.1-
2) depicts Dr. Thagard working in the International Microgravity Laboratory-1, launched
on STS-42.

Figure 11.1-2: Dr. Thagard working in IML-1 Module
53

Dr. Thagard also had a central venous line inserted as part of preparation for STS-
40 (Dr. Thagard was not part of the STS-40 crew). During STS-40, a crewmember was
inserted with a central venous line as part of Experiment No. 294, ‘Cardiovascular
Adaptation to Microgravity.’
54
The purpose of the central venous line was to determine

53
Source: STS042-14-005 (n.d).
54
Cardiovascular Adaptation to Microgravity - The experiment intended to increase the understanding of
microgravity-induced changes in the cardiovascular structure and function responsible for a common
problem during return to normal gravity of orthostatic hypotension or the inability to maintain normal
blood pressure and flow while in an upright position. The central venous line was used to measure central
venous pressure. Measurements of changes in the blood pressure in the great veins near the heart were
observed in one crew member. A cardiologist inserted a catheter into a vein in the arm and positioned it
near the heart prior to flight. Measurements were recorded for 24 hours beginning prior to launch and
extending for at least 4 hours into space flight, at which time the catheter was removed. The catheter data
indicated the degree of body fluid redistribution and the speed at which the redistribution occurred (STS-40
Press Kit, 1991).
125
the change, if any, in central venous pressure upon orbital insertion; it was not used for,
nor was it intended for, IV fluid administration. To test the efficacy of inserting a central
venous line, Dr. Thagard had a central venous line in place for 24 hours, which included
a simulated bailout and water landing in the Launch Entry Suit (LES). The central venous
line was inserted through the brachial vein, located in the upper arm (Figure 12.1-3), into
the right atrium. Dr. Thagard volunteered as a ground test subject for this trial run
because at that time he was the Astronaut Office representative to the Human Use
Committee
55
at the Johnson Space Center (Thagard, 2009).
During ground testing, Dr. Thagard experienced little, if any, decrease in arm
mobility with the line in place. However, the arm movement associated with the bailout
and water landing exercise did result in bleeding. There was no blood in the water tank,
but a lot was found inside the arm of the LES, which was water tight. The blood was not
seen until Dr. Thagard, with the assistance of a suit technician, removed the LES at the
end of the bailout simulation. In spite of this, the central venous line was not scrubbed,
and during STS-40, Payload Specialist Drew Gaffney had a central venous system
catheter inserted in his right arm. Figure 11.1-3 depicts STS-40 Mission Specialist (MS)
James P. Bagian (left) removing the central venous system catheter from Payload
Specialist F. Drew Gaffney's right arm. The two crewmembers are shown in front of
Spacelab Life Sciences 1 (SLS-1) module Rack 10 as they conduct this procedure
associated with Experiment No. 294 (STS040-201-015, n.d). It is noteworthy to mention

55
The JSC Human Use Committee decides whether investigators can use Astronauts as subjects in medical
experiments.
126
that at least one payload specialist refused to allow the line to be placed; however, he still
flew the mission (Thagard, 2009).

Figure 11.1-3: Catheter removal from Payload Specialist Gaffney's arm
56

Even though, functionally, the central venous lines inserted into Dr. Thagard and
Payload Specialist Gaffney were not intended for IV administration, they were physically
similar to a PICC line. Meaning, a catheter is inserted in the arm and is guided all the way
to the heart. Dr. Thagard’s experience, however, depicts the complications, i.e., bleeding
from movement, that can arise from a PICC line. To prevent this, an IVP is a better
alternative for a through-the-suit concept, because the skin incision would be completely
healed and the port would be protected by being underneath the skin.

56
Source: STS040-201-015 (n.d).
127
Inserting astronauts/cosmonauts with an IV has never become common practice.
In fact, NASA has never routinely inserted IVs into astronauts. However, the purpose of
presenting Dr. Thagard’s experience with IVs is to demonstrate that this has been done.
11.2 Drug Absorption in Reduced Gravity
An area that needs further study is the effect of drugs administered in reduced
gravity environments, as they may not have the same anticipated local, regional, or
systemic effects and may manifest different adverse effects profiles in space compared
with those observed on Earth (Ball and Evans, 2001). A case study of 21 crewmembers in
microgravity, i.e., Space Shuttle, given 25 to 50 mg of promethazine intramuscularly
reported only a 5 percent sedation rate, whereas a 60 to 73 percent rate was observed on
Earth (Bagian and Ward, 1994). The decreased effectiveness of the sedative could have
been due to SMS or the sheer excitement associated with the space mission (Ball and
Evans, 2001). Oral medication in microgravity may have similar decreases in anticipated
effects due to gastric emptying, gastric motility, and hepatic blood flow (Tietze and
Putcha, 1994). Drug distribution may also be affected by the redistribution of fluids from
the lower body to the head and torso in microgravity (Tietze and Putcha, 1994). This
latter effect may have an impact on drug administration if, for example, a given drug may
be intended for a lower limb, but may not have the desired effect due to fluid
redistribution.
Regardless of the drug administration method used, microgravity appears to have
an effect on drug absorption. That said, if drug bioavailability decreases in reduced
gravity environments, IV administration should be used since this method would still
128
provide the highest drug absorption, as compared, for example, to oral or intramuscular
administration. That said, if effect on drug absorption reduces as the gravity environment
decreases, such as on the Lunar or Martian surface, further study in this area is warranted.
11.3 IV Fluids Administration Procedures
Administration procedures of IV medications are not problematic in
weightlessness, i.e., in-flight, or partial gravity environments, i.e., planetary surface.
However, in weightlessness, IV Fluids cannot be administered in the same manner as on
Earth, i.e., by using gravity-driven free-flow devices. Instead, automated pumps need to
be used, such as ones that administer continuous or controlled-dose medications. On
planetary surfaces (1/6
th
or 1/3
rd
of Earth gravity), gravity-driven free-flow devices may
be possible in internal pressurized habitats, with proper flow-rate adjustments made to
reflect the reduced gravities. For purposes of a through-the-suit IV concept, however, an
IV pump will be administration method of choice.
Prototypes of powered infusion pumps have been tested during space flight, and a
small commercially available device has been adapted and included in the ISS medical
inventory (Barratt and Pool, 2008). A through-the-suit IV concept would utilize a similar
infusion pump with modifications made to incorporate external manual or automated
initiation.
11.4 IV Fluids Packaging
Injection fluids must be specially packaged with a minimum amount of air, and
care must be taken while preparing the infusing system to avoid introducing further air
129
into the line. Additional air-fluid separation may be facilitated with an in-line filter
system, or a ‘bubble trap’ (Barratt and Pool, 2008).
Storing large quantities of IV fluids will represent a significant overhead in launch
mass and stowage. Moreover, most IV fluids have 1-year shelf lives. A more efficient use
of resources would be to produce sterile injection-grade fluid as needed during flight
from potable water. Exploration-class missions should have this capability. In fact,
technology to produce sterile injection-grade fluid for space flight using ion exchange
columns and premeasured electrolyte and drug aliquots has been extensively examined
(Barratt and Pool, 2008).
11.5 Conclusion
IV administration in space has been researched by NASA for years, highlighting
NASA’s plan to utilize IVs in space. Prototypes of powered infusion pumps have been
tested during space flight, and a small commercially available device is part of the ISS
medical inventory. However, drug absorption in space is an area that still needs further
study, as they may not have the same anticipated effects and may manifest different
adverse effects profiles in space compared with those observed on Earth. Additionally,
storage of IV fluids will have to be further research, as storing large quantities of fluids
will represent a significant overhead in launch mass and stowage.
130
CHAPTER 12: ETHICS AND AMENABILITY

12.1 Ethics of Implanted Venous Ports
Implant ethics is defined as the study of ethical aspects of the lasting introduction
of technological devices into the human body. The use of implants dates back at least to
the ancient Egyptian practice of hammering sea shells into the jaw to replace missing
teeth. However, it was only in the 20
th
century that a wide selection of implanted devices
was introduced in surgical treatment (Hansson, 2004). With respect to IVPs, the major
ethical issues include safety, communication and choice, activities of daily life (ADL),
body image, and consent.
a. Safety - The issue of safety is one which has to be clearly communicated to
astronauts. Despite the most up to date technology, all VADs are susceptible to
undergo thrombosis or give rise to infection (rates vary depending on usage-
frequency and sterile technique). There are medical mitigations to deal with these
possibilities, however, they are still a risk.
b. Communication and Choice - Communicating the details of an IVP (with risks
and benefits), will give the astronaut the ability to make the most informed
decision. This will improve his/her confidence levels regarding the implant. And,
placing the ultimate decision on him/her will give the astronaut the ability to exert
control over a very important and invasive procedure (Macklin, 2005). In essence,
an astronaut should have the ultimate choice of accepting or declining an IVP
and/or other invasive procedures (Thangavelu, 2009).
131
c. Activities of Daily Life (ADL) - Whether an astronaut will be able to do normal
activities depends on the location of the VAD. This research proposes and IVP
which is usually located in the chest area. This location has the least impact on
ADL among all VADs. However, there are still restrictions to the astronaut before
launch, such as avoiding heavy contact sports, or during IVAs, such as impact
with large equipment.
d. Body Image – With respect to body image, an IVP is placed under the skin,
leaving a noticeable bump the size of a quarter. Apart from the bump, there is a
minor scar. According to Diehl Martin (2006), a cancer patient who cataloged his
experience with an IVP, fears of physical scarring from having an IVP installed is
a particularly baseless fear. Mr. Martin added that “…given two weeks of healing,
and other than the lump where the port is, you would never know anything
happened; there is no reason to be concerned about an IVP procedure.” However,
though this may be a minor issue for some, for others, this may bring about a
negative body image causing emotional stress. As vain as this issue may appear, it
should not be taken lightly.
e. Consent – For purposes of this research, the ethical issue of consent includes: (1)
consent to have the procedure performed, and (2) consent for through-the-
spacesuit IV treatment in an EVA emergency. For the former (Item 1), choosing
an IVP will enable safe administration of IV fluids through-the-spacesuit, which
could potentially safe his/her life. However, for a myriad of reasons, the astronaut
may simply refuse the implant, and his/her right to refuse must be respected. For
132
the latter (Item 2), obtaining advance consent from the astronauts for IV treatment
would be of utmost importance, because during an EVA emergency (1) there
would be limited time for discussion with the injured astronaut, (2) the astronaut
may be unconscious, or (3) the astronaut may be mentally unstable, i.e., requiring
restraint from other crewmembers to inject IV treatment.
The NASA medical community and astronauts must assess these ethical issues,
and weigh the risks against the benefits of IVPs. Ideally, astronauts will be willing to
accept the added responsibility and consent for IVPs. However, for those that wish not to
consent, not only should their decisions be respected, but they should not be precluded
from spaceflight eligibility.
12.2 Amenability to Implanted Venous Ports
Astronauts will continue to accept significant risks to further the cause of space
exploration. Nevertheless, performing invasive procedures, such as a venous port
implant, on otherwise healthy astronauts, raises medical ethical issues that cannot be
ignored. That said, an astronaut’s willingness to have an IVP procedure performed on
him/her would likely not be an impediment to astronauts wishing to undergo preparation
for truly long-duration spaceflight, e.g., a multi-year piloted Mars mission. It is already
anticipated that astronauts being considered for these would likely have to undergo
certain elective procedures such as removal of the appendix, removal of un-erupted
molars, or LASIK. An IVP, by contrast, is a relatively simple and reversible procedure
(Czarnik, 2009). Nonetheless, in terms of certain elective procedures for long-duration
missions, these issues will remain controversial.
133
12.3 Conclusion
This chapter presents a discussion of the ethical issues involved with implanted an
astronaut with an IVP. It also discusses the amenability that astronauts may have with
this type of VAD; it is assumed that an astronaut’s willingness to do an IVP procedure
would likely not be a restraint to astronauts wishing to undergo preparation for long-
duration planetary surface missions. Future research will have to include a survey
57
of
astronauts regarding their amenability to IVPs.

57
Efforts were made to perform this survey; however, as of release date of this research, efforts were futile.
134
CHAPTER 13: SPACESUITS
Future planetary surface spacesuit design will be a unique challenge. At this time,
it is difficult to predict the configuration of such spacesuit; however, there are four
general guidelines that can be followed in its design: 1) the environment that the EVA
spacesuit must operate in; 2) the mission architecture as presently seen by NASA; 3)
extrapolation of candidate EVA systems based on present knowledge and technology;
and 4) the choice of hardware that private industry and NASA have elected to explore in
advanced suit development programs to meet the mission architecture (Harris, 2001).
13.1 Spacesuits Overview
To perform EVAs, spacesuits are required. As depicted in Figure 13.1-1, these are
spacecraft themselves, as they are the integration of multiple and complex systems used
to provide protection from the environment. A spacesuit must:
a. Provide a pressurized atmosphere
b. Provide oxygen
c. Provide water
d. Remove carbon dioxide (contaminant control)
e. Provide temperature control (cooling)
f. Provide thermal protection
g. Protect from micrometeoroids
h. Protect from radiation (to some degree)
i. Provide power
j. Provide field of view
135
k. Allow for mobility inside spacesuit
l. Provide communications (ground controllers, other astronauts)
m. Provide glove dexterity and tactility

Figure 13.1-1: EVA Spacesuit Schematic
58

58
Source: Harris (2006)
136
13.2 Spacesuit Layers
A spacesuit is not one single component, but rather several layered defenses
against the elements that work in combination to reduce the effects of the
environment. There are approximately 14 layers of protection in a spacesuit (Figure
13.2-1). These layers of distinct materials such as thermoplastic polymers (polyamides
and polyester), elastomers and fluorocarbons, combine great fatigue properties, high
strength and modulus, chemical resistance, moisture regain and elongation properties.

Figure 13.2-1: Spacesuit Layers
59

59
Source: Hoffman (2004)
137
13.2.1 Layers 1 to 3 – Liquid Cooling and Ventilation Garment (LCVG)
The most significant factor in temperature control is the LCVG, which is made up
of the three inner layers. The layer closest to the body is made up of a soft, light weight
Nylon/Tricot (sewn to the restraint to aid donning and doffing and to provide a comfort
layer between the tubing and the crewmember's skin) and the next two layers are made up
of stretchy spandex (Nylon/Spandex) mesh and 91 m (300 ft) of water-filled plastic
tubing (Spacesuit Science, 2012). These plastic tubes are used to transport cool water for
temperature control (EMU, 2001). The LCVG is a form-fitting, stretchable undergarment
consisting that covers the entire body to the neck, ankles and wrist. The LCVG cools and
ventilates the crew member using water and oxygen supplied by the PLSS. The chilled
water removes excess heat by moving around the crewmembers entire body through a
network of flexible tubing. Ventilation gas is drawn from the helmet down to the hands
and feet, where it is recirculated back to the PLSS through the LCVG by means of a vent
system (LCVG, 2005); the intent of this process is to draw moist air from the wearer.
13.2.2 Layer 4 – Pressure Garment
The pressure bladder helps keep the body under a controlled amount of pressure
while in space. The pressurized suit prevents the air in the astronaut’s lungs from rushing
out and it also prevents the gases in the spacewalker’s body fluids from expanding and
boiling off. The pressure garment is made of nylon that is dipped in rubber (urethane)
(Urethane Coated Nylon) at least six times to create an impermeable barrier between the
pressure of pure oxygen inside the spacesuit and the vacuum of space outside of the
spacesuit (EMU, 2001).
138
13.2.3 Layer 5 – Pressure Garment Restraint Layer
The material of the pressure garment restraint layer is Dacron®. The purpose of
this layer is to restraint the pressure bladder and to maintain the shape of the spacesuit
(EMU, 2001).
13.2.4 Layer 6 – TMG Liner
This inner layer of Neoprene, coated with Nylon Ripstop, is the final layer of
micrometeroid protection (EMU, 2001).
13.2.5 Layers 7 to 13 – TMG Insulating Layers
These seven layers form the thermal micrometeoroid garment, which offer the
required thermal protection (EMU, 2001). These layers assure protection from solar heat
(radiated and conducted) and micrometeoroids. They are made of materials that are flame
resistant, highly-reflective and that permit the conservation of the internal metabolic
temperature of the astronaut (Zea and Diaz, 2008). A vacuum sits between each layer.
With a gap devoid of gas molecules between layers, heat cannot transfer by conduction
(direct contact between hot and cold matter), or convection (mixing of different-
temperature gas molecules). And the silver coating helps bounce radiant heat off
(Spacesuit Science, 2012).
13.2.6 Layers 14 – Micrometeoroid/Tear Protection Layer
The outermost layer is an Ortho-Fabric which is a blend of Gortex®, Kevlar®,
and Nomex®. The Ortho-Fabric is particularly good for thermal control and for
protecting the pressure bladder and the pressure restraint layer from micrometeoroids
(EMU, 2001).
139
All these layers make incorporating an injection provision through the spacesuit
challenging, but not impossible. In fact, it was done with the Apollo spacesuit design.
However, the Apollo spacesuit provided access to a muscular area for an intramuscular
(IM) injection. IV injections are feasible, yet hesitation still exists among spacesuit
engineers who do not like the idea of puncturing a spacesuit, as they are a weak spot in
the spacesuit that is always concerning. It is hard enough to contain pressure in a
spacesuit without adding in complexity and more areas to seal. Spacesuit decompression
is not the main concern, so much as the extra interruption of the pressure layer and all the
extra precautions and complexity; engineers prefer not to interrupt this layer (Harris,
2007).
13.3 Spacesuit Manufacturing
The manufacture of a spacesuit is a very complicated process. It can be broken
down into two phases of production: 1) Individual components are constructed, and 2)
Parts are brought together and assembled, i.e., NASA headquarters in Houston. The EMU
manufacturing process is shown below (Spacesuit, 2000). While, this may not be the
same process followed by future spacesuits, it is included here to depict the complexities
of this process.
13.3.1 Helmet and Visor Assembly
The helmet and visor are constructed using traditional blow molding techniques.
Pellets of polycarbonate are loaded into a injection-molding machine. They are melted
and forced into a cavity which has the approximate size and shape of the helmet. When
the cavity is opened, the primary piece of the helmet is constructed. A connecting device
140
is added at the open end so the helmet can be fastened to the hard upper torso. The
ventilation distribution pad is added along with purge valves before the helmet is
packaged and shipped. The visor assembly is similarly fitted with "head lamps" and
communication equipment (Spacesuit, 2000).
13.3.2 Portable Life-Support System (PLSS)
The life support systems are put together in a number of steps. All the pieces are
fitted to the outer backpack housing. First, the pressurized oxygen tanks are filled,
capped, and put into the housing. The carbon dioxide removal equipment is put together.
This typically involves a filter canister that is filled with lithium hydroxide which gets
attached to a hose. The backpack is then fitted with a ventilating fan system, electrical
power, a radio, a warning system, and the water cooling equipment (Spacesuit, 2000). As
discussed in Chapter 18.4 (Portable Life Support System), an IV Pump and IV fluid
compartment could also be fitted into the backpack to allow for a through-the-suit IV
capability. When completely assembled, the life support system can attach directly to the
hard upper torso.
13.3.3 Control Module
The key components of the control module are built in separate units and then
assembled. This modular approach allows key parts to be easily serviced if necessary.
The chest mounted control module contains all of the electronic controls, a digital display
and other electronic interfaces. The primary purge valve is also added to this part
(Spacesuit, 2000). Note, future spacesuits may include improvements in electronic
controls; what now requires complex command codes will eventually be done with the
141
push of a single button. Additionally, for the through-the-suit IV concept being proposed,
a control module (as is currently designed) would have to be redesigned, i.e.,
miniaturized, or relocated to allow the ‘feedthrough connector’ to be attached to the
HUT.
13.3.4 Liquid Cooling Ventilation Garment
The LCVG is worn inside the pressure layers. It is made out of a combination of
nylon, spandex fibers and liquid cooling tubes. The nylon tricot is first cut into a long
underwear-like shape. Meanwhile, the spandex fibers are woven into a sheet of fabric and
cut into the same shape. The spandex is then fitted with a series of cooling tubes and then
sewn together with the nylon layer. A front zipper is then attached as well as connectors
for attachment to the life support system (Spacesuit, 2000). The University of North
Dakota (UND) Space Suit Laboratory has performed extensive LCVG design, fabrication
and testing. According to de Leon (2011) (UND Space Suit Laboratory Director),
allocating a ‘tube-free’ area on the LCVG on top of an implanted chest port would not be
an issue.
13.3.5 Upper and Lower Torso
The lower torso, arm assembly, and gloves are made in a similar manner. The
various layers of synthetic fibers are woven together and then cut into the appropriate
shape. Connection rings are attached at the ends and the various segments are attached.
The gloves are fitted with miniature heaters in every finger and covered with insulation
padding. The hard upper torso is forged using a combination of fiberglass and metal. It
has four openings where the lower torso assembly, the two arms, and the helmet attach.
142
Additionally, adapters are added where the life support pack and the control module can
be attached (Spacesuit, 2000). For purposes of a through-the-suit IV concept, a rear-entry
spacesuit, which seamlessly integrates the HUT to the spacesuit, i.e., rear hatch door
60
,
would facilitate the integration of the IV Pump, IV fluids, and IV connector.
13.3.6 Final Assembly
All the parts are shipped to NASA where they assembled and tested prior to use in
space. While, this manufacturing process is well established, future material
improvements are possible which may improve manufacturing. For example, the use of
composite materials will make spacesuits lighter, stronger, and easier to manufacture and
assemble.
13.4 Past and Present Spacesuit Injection Implementation
The situation of a healthy and fit individual needing emergency injections of
medicines during the performance of hazardous duty is analogous to military
operations. In fact, the technology of performing injections through clothing has been
around since the 1950’s (Schrunk, 2007). A historical spacesuit review was performed as
part of this research to determine whether through-the-spacesuit emergency provisions, if
any, had been designed into previous spacesuits to date (Appendix G – Historical
Spacesuit Review). Research yielded that only the Apollo spacesuit had such a provision
in the form of the Apollo Spacesuit Biomedical Injection Patch (Figure 13.4-1)
61
; this
provision allowed IM administration only. According to Carson, et al. (2002), this patch

60
As opposed to the waist-entry configuration of the EMU, a rear entry configuration allows both for
simple don/doff procedure and maximum control over shoulder/arm flexibility and range.
61
Buzz Aldrin's Apollo 11 Suit – “Right Knee” picture and “Open Access Flap” picture.
143
was built into the right thigh portion of the torso-limb spacesuit, just above the knee, to
permit a crewman to self-administer a hypodermic injection without jeopardizing the gas
retention quality of the pressurized garment assembly (PGA). It was made of a soft
durometer rubber, which would self-seal after a needle was removed.

Figure 13.4-1: Apollo 11 Medical Injection Patch
62

This injection provision was never used in flight (Thomas, 2009). However, it
went through rigorous development and verification testing (DVT) and certification
testing, e.g., leak tests
63
, and Richard Ellis, an Apollo spacesuit subject, was injected
saline through the patch while pressurized in the spacesuit as part of the
DVT/Certification testing (Ayrey, 2009).

62
Source: Ayrey, et al. (2007)
63
The Apollo spacesuit specification leak rate was 180 sccm (pre-flight) and 740 sccm (post-flight); actual
leak rate values were 105 sccm (pre-flight) and 400 sccm (post-flight) (Wagner, 2006). Nominal leak rates
for the Shuttle/ISS EMU is 136.5 sccm (Epler, 2007). A small leak is normal, as long as it does not
decrease the spacesuit pressure at a rate greater than 1.38 kilopascals per minute (Vogt, 1998). If the leak
rate is higher, and the primary system cannot maintain pressure in the suit (due, for example, to a 1/8-inch
hole), the secondary oxygen pack (pressurized to 5,000 psi) will open its valve and maintain the pressure
(Suit Puncture, 2007).

Medical Injection Patch
Urine Collection Device
144
Apart from the Apollo spacesuit, there was no similar capability incorporated into
any other pressure spacesuit, i.e., Mercury, Gemini, Shuttle, or ISS Programs, that would
have allowed penetration of the bladder by a needle through a port. Mr. Harris
64
, Mr.
Thomas
65
, and Mr. McMann
66
, widely considered leading experts in spacesuit history and
technology, concur with this conclusion. According to Mr. Thomas, upon review of his
technical archives, he found no spacesuit provisions for injecting medications into a
crewman with the spacesuit pressurized other than Apollo. Mr. McMann confirmed these
findings, and added that the reason for this feature being unique to the Apollo spacesuit
design was the long duration before being able to return to the surface of the Earth to
receive medical attention (Thomas, 2008). Note that even though John Glenn (Mercury
Program) had a syrette available to inject himself through his spacesuit, the Mercury
spacesuits did not have an injection port provision (Harris, 2009).
Upon extensive literature technical review and consultation with established
experts on spacesuit technology, it is definitively concluded that no prior spacesuit,
American or Russian
67
, has had an IV capability incorporated into its design.
13.5 Spacesuit IV Port Location
As the vascular access device (VAD) study depicted in Chapter 11 concluded, an
IVP is the best alternative for an EVA through-the-spacesuit IV administration concept.
From a spacesuit perspective, there are two main reasons why the HUT area was selected

64
Mr. Gary L. Harris – UND Space Suit Laboratory Consultant and author of the “The Origins and
Technology of the Advanced Extravehicular Space Suit.”
65
Mr. Kenneth S. Thomas – Hamilton Sundstrand; considered an expert in the Gemini spacesuit and who is
an EMU Engineer having worked the pressure spacesuit side of the system for many years.
66
Mr. Harrold J. McMann – Retired NASA lead engineer of the Shuttle Extravehicular Mobility Unit
(EMU); worked for NASA supporting spacesuits from Mercury II (that became Gemini in 1962).
67
Mr. Pablo De Leon (UND Space Suit Laboratory) confirmed no Russian spacesuit had an IV provision.
145
as the location of the ‘through-the-suit’ IV connector location: 1) Freedom of Movement,
and 2) Stability.
13.5.1 Freedom of Movement
IVPs can be implanted in the upper chest (just below the clavicle or collar bone),
abdomen, between the breasts, under the arm on the side of the chest, in the upper or
lower forearm, and even in the groin area. All these alternatives offer various levels of
complications with regards to freedom of movement. The port locations with lowest
‘freedom of movement’ are ones located in areas of high use by astronauts, e.g., hands,
arms, legs. These locations impede lifting, carrying, or walking; furthermore, pressure
against these ports can also be painful. As a result, the port location with the least impact
on ‘freedom of movement’ is the chest area. Ports in this area do not hinder astronaut
movement and have the least impact on activities of daily life.
From the strict standpoint of suited operations and comfort combined with
interference with operations, the chest type of IV would be desired over the extremities,
particularly the arms. Everything about the suited operations revolves around use of the
hands/arms and legs so following one minute of any pressurized task with an IV in any of
these areas. Furthermore, the chest area of the suit provides a large surface area that
basically stays in position relative to the chest cavity (Ayrey, 2010).
13.5.2 Stability
From a physiological stability perspective, non-chest location ports provide less
stability to the port when accessed than does the chest location (Nursing Link, 2009).
This is due to the stable support platform that the rib cage provides to the implanted port.
146
From a spacesuit perspective, the torso area also provides the most structural stability for
the ‘through the suit’ connector, as the HUT is the most rigid component of a spacesuit.
The HUT forms a rigid enclosure about the upper body of the occupant, providing
pressure containment for this part of the body, and incorporating structural attachment
points for the arms, lower torso, helmet, and PLSS. HUTs are constructed from
composite materials, which make these components lightweight and very strong. An
example of a composite HUT is NASA’s MK-III (Figure 13.5.2-1), which is
manufactured from carbon/graphite fiber and weighs roughly 17.0 lbs (Airlock, 2011).

Figure 13.5.2-1: NASA MK-III HUT
68

13.6 Conclusion
This chapter discusses spacesuit principles to give the reader an appreciation of
the difficulty in incorporating an IV connector provision into a spacesuit. It also
summarizes the historical review performed, which yielded that only the Apollo suit had
a through-the-spacesuit provision, but it allowed IM administration only.

68
Source: Airlock (2011)
147
CHAPTER 14: SURFACE ENVIRONMENTAL FACTORS
The salient surface environmental factors, i.e., Moon and Mars, affecting EVA
Systems design are gravity, atmosphere composition, surface pressure, dust, winds,
radiation, thermal gradients, and terrain (Table 14-1). Out of these, the ones that are most
relevant to this research are partial gravity and terrain, thermal gradients and atmospheric
pressure, and dust.
Table 14-1: Comparison of Environments
69

Environment Factor Mars Moon Earth
Gravity 0.38 of Earth 0.16 of Earth 1G
Atmosphere Gases (%)
- Carbon Dioxide
- Nitrogen
- Argon
- Oxygen

95.30
2.70
1.60
0.13

N/A

0.03
78.08
0.93
20.90
Surface Pressure 0.136 – 0.19 psi
(~ 1/100 of Earth
sea level; equivalent
to 100,000 ft alt.)
N/A 14.7 psi
Dust Deep dust layers of
very fine material
Deep dust
layers of
very fine
materials
Varied dust
composition
(depending
on location)
Radiation Flux Solar
Constant W/Atm
0.0615 0.1387 0.1387
Thermal Gradients -140 to 30°C -170 to 150°C -50 to 40°C
Terrain Varied topography Varied
topography
Varied terrain
composition
(depending on
location)

14.1 Partial Gravity and Terrain
The activities inherent in exploration and exploitation of resources will require the
use of heavy EVA suits, carrying heavy loads, and operating tools for construction and

69
Data from Harris (2001), Tables 8-4 and 8-5.
148
excavation. These will be risky operations which will take place in environments with
reduced gravity and unfamiliar terrains. Even though Lunar EVA falls did not lead to
injuries, traversing more challenging terrain (augmented by unfamiliar body mechanics
due to an altered gravity) might lead to serious injuries. Carrying loads and obtaining
samples may also induce muscle strain injuries, as occurred during the core drilling
operation on one Lunar mission. Construction activities could also lead to penetrating
trauma whereby an EVA suit environment is compromised and injury is sustained
(Barratt and Pool, 2008).
Terrestrially, most major trauma is associated with forces in events such as motor
vehicle accidents and falls. Surface vehicles were used on the Moon and will certainly be
required for future Lunar and Mars exploration. Rover operations will be carefully
planned, however, uncharted and unfamiliar terrain may lead to accidents, i.e., rollovers,
impacts with other vehicles or rocks.
14.2 Thermal Gradients and Atmospheric Pressure
Temperature extremes of several hundred degrees Centigrade occur between
Lunar day night (Schrunk, et al., 1999). Similarly, Mars has a climatic temperature that
varies from Sub-Arctic to temperate. The temperature can even vary from morning to
noon, and evening to night. Mars also has winds (which affect thermal flux), seasonal
temperature changes (which affect atmospheric pressure), thermal and cosmic radiation
hazards, and a diverse topography that can cause the atmospheric pressure to deviate
several Torr (Harris, 2001).
149
The internal spacesuit atmospheric pressure is of utmost importance for a
through-the-suit IV concept. The pressure integrity of the spacesuit cannot be jeopardized
by the incorporation of a connector provision. The surface pressure at the Moon is
negligible and is considered vacuum. Similarly, the surface pressure at Mars is very low
and it ranges from 0.136 to 0.19 psi (0.94 to 1.31 kPa). The pressure inside a spacesuit is
around 4.7 psi (32.4 kPa), so it is important to incorporate a connector which will prevent
the pressurized oxygen to leak to the Martian or Lunar environment. Table 14.2-1
provides vacuum quality terminology and its relation to Earth, Mars and Lunar surface
pressures. These ranges do not have universally agreed definitions, but this is a typical
distribution.
Table 14.2-1: Pressure Levels
70

Pressure Level
Pressure
Location
Torr Pa
Atmospheric Pressure 760 101.3 kPa Earth: 101.3 kPa
Low Vacuum 760 to 25 100 kPa to 3 kPa
Medium Vacuum 25 to 1×10
−3
3 kPa to 100 mPa Mars: 0.94 kPa to 1.31 kPa
High Vacuum 1×10
−3
to 1×10
−9
100 mPa to 100 nPa
Ultra High Vacuum 1×10
−9
to 1×10
−12
100 nPa to 100 pPa Moon: 0.3 nPa
71

Extremely High
Vacuum
<1×10
−12
<100 pPa
Outer Space 1×10
−6
to <3×10
−17
100 µPa to <3fPa
Perfect Vacuum 0 0 Pa

70
Source: Table modified from Vacuum (n.d.)
71
Source: Lucey, et al. (2006)
150
14.3 Dust
Because Mars and the Moon are virtually dry environments, dusty soil is an
insidious, omnipresent engineering problem. Mars and the Moon both contain deep dust
layers of very fine material that ranges from a medium sand (40 to 130 micrometers) to a
medium silt (20 micrometers), with the average grain size about 70 micrometers (Harris,
2001). This loose, unconsolidated rock material is known as regolith.
Due to low gravity and a thin atmosphere, dust will be kicked up by all surface
movement. Walking, plumes from roving vehicle tires, excavation, and wind (on Mars)
will create dust streams that will cover everything on its path. Due to projected Mars and
Lunar operations, dust protection and removal from EVA systems is going to be a
priority design consideration (Harris, 2001).
During the Apollo missions, Lunar dust established itself easily as a nuisance
because of its physical properties and associated difficulties in its control and cleanup.
With the lack of an atmosphere and in low-gravity conditions, Lunar dust is easily
dislodged from the surface by walking, by operating machinery, or by engine plume. For
example, Lunar dust was introduced into the cabin atmosphere after ingress from a
surface EVA. Although largely chemically inert, Lunar dust did evoke symptoms of
respiratory irritation in some crewmembers; however, no lasting respiratory effects were
seen on returning Apollo crewmembers. Pneumoconiosis (interstitial lung disease caused
by dust exposure and the lung’s subsequent reaction to the dust) from Lunar dust will
also unlikely because exposure to the dust would not be expected to be long nor direct,
i.e., spacesuit barrier, suit contamination prevention, etc.; compared to the time periods
151
associated with terrestrial pneumoconiosis. The main health hazard associated with Lunar
dust will be probably interference with environmental and life support systems and
pressure seals, as well as a greater chance of foreign bodies in the eye because of the
reduced gravity and possibly skin irritation from direct contact with this abrasive material
(Barratt and Pool, 2008).
Although engineers were always concerned about Lunar dust during Apollo, it
was never to the large degree of concern that there is today for future missions. They
learned during Apollo that the dust was a much bigger problem than anticipated and that
future suits need to focus on this issue. That said, the Apollo connectors were not
immune from dust penetration, and on later missions where the EVA time was greater, so
were the problems between Lunar EVAs. Once disconnected following the first EVA, it
was found that some cleaning had to be done in the Lunar Module before the next EVA.
The dust would cling to the outer surfaces of the connectors, but because they were self-
sealing when the male connectors were separated, dust generally did not get inside the
suits by way of these ports (Ayrey, 2010).
According to Wagner (2008), Apollo astronauts learned, first hand, how problems
with dust impact Lunar surface missions. Lunar dust contamination on EVA suit bearings
made movement difficult. Dust clinging to EVA suits was transported into the Lunar
Module. Once microgravity was reestablished on return to Earth, the dust became
airborne and floated through the cabin, causing the crewmembers to inhale the dust and
irritating their eyes. Additionally, mechanical systems aboard the spacecraft were
damaged due to dust contamination. Space suit anomalies caused by Lunar dust created
152
problems for the Apollo program. Table 14.3-1 summarizes salient spacesuit anomalies
during the Apollo program, and Table 14.3-2 summarizes the recommendations made by
the various Apollo Missions.
Table 14.3-1: Dust Effects on Connectors
72

Apollo Mission Effect Due to Dust Exposure
Apollo 12 Wrist and suit hose locks became difficult to operate, suit fabric was abraded and
leak rates increased. Following the missions, there were post-flight leakages that
were generally higher in value than pre-flight values. This was due partly to dust
in the pressure sealing zipper closures (Ayrey, 2010).
Apollo 14 Crew reported helmet visor scratches that decreased visibility
Apollo 15 Crew was hampered by difficulty in connecting and disconnecting PLSS PGA
connection and disconnection
Apollo 16 Dust in zippers led to difficult operation; wrist ring pull connectors were covered
with dust, degrading mobility; PLSS RCU displays were abraded and could not be
read; and dust in helmet visor mechanisms resulted in over visors that would not
retract.
Apollo 17 Crew reported stiff glove connectors, stickiness in helmet visor retraction, and
reduced visibility due to scratches and dust accumulation on visors.

72
Source: Wagner (2006).
153
Table 14.3-2: Apollo Crew Dust Recommendations
72

Apollo Mission Recommendation
Apollo 12
Mission Report
“Some type of throwaway over-garment for use on the Lunar surface may be
necessary.” Source: Apollo 12 MR (1970).
Apollo 14
Mission Report
“It should be noted that the wrist-ring and neck-ring seals on both pressure
garment assemblies were lubricated between extravehicular activities. At that
time, there was very little evidence of grip or dirt on the seals. Lubricating the
seals between extravehicular activities is a procedure that should be continued on
subsequent missions.” Source: Apollo 14 MR (1971).
Apollo 15
Technical Debrief
Scott said, “Yes, that’s true. I might comment that Lunar dust is very soluble in
water. It seems to wash off very easily. I would say if you ever have a connector
problem that was really stiff, you could take the water gun and spray it in and
loosen it up.”
Scott noted, “We tried to brush them off and clean them off. We found that the
booties which had been placed over the PLSS connectors were good protection
from the dirt.”
Scott recommended, “put booties over all the connectors or some sort of
protective device. In the old days, they had a bib to keep them clean – or for
double protection, I guess. Something like that would sure prevent problems later
on and would save time cleaning the connectors. They sure get dirty. If you are
going to go out there and do the job, you are going to get dirty. If you try to keep
everything clean, you are just not going to be able to do the job on time. I think
those little booties are a pretty good idea. They were no problem on the donning
and doffing.
Source: Apollo 15 TD (1971).
Apollo 15
Mission Report
“Neck ring dust covers were provided to keep Lunar dust out of the pressure
garment assemblies when not being worn.” Source: Apollo 15 MR (1971).
Apollo 16
Mission Report
“The extravehicular mobility unit was modified to improve its operational
capability, safety, and to provide increased dust protection…Dust protections
were added to the oxygen purge system gas connectors and portable life support
system water connectors…Velcro was added to the battery covers to provide
increased protection against dust. Reflective tape was added to provide more
radiative cooling…New underseat stowage bags with dust covers were
provided…The thumper selector switch was modified to provide a more positive
detent and all openings around the thumper selector knob and arming firing knob
were covered with dust protectors.” Source: Apollo 16 MR (1972).

In 2008, NASA performed an assessment to identify applicable documents
relevant to Lunar and Martian dust, identify Lunar and Marian human support systems
that will be affected by dust, determine the requirements that will need to be written,
perform a gap analysis to determine what information is still needed to write the
requirements, and recommend experiments and measurement on the Earth, moon, and
154
Mars to obtain needed information (Wagner, 2008). Of relevance to a through-the-suit IV
capability, this assessment concluded that connectors are one of the components that
would be affected by dust. Table 14.3-3 summarizes these effects.
Table 14.3-3: Dust Effects on Connectors
73

Connector Type Effect Due to Dust Exposure
Fluid Connector Sliding seals can get scratched and lead to leakage.
QDs/Connectors Seal degradation, leaks, higher spares/maintenance.
IVA Connectors Abrasion
Electrical Connectors Dust in battery contacts cause power drain and potential short circuit.
Data Connectors Dust in data connectors may cause degraded performance or failure.

Mars surface dust, although only studied remotely, should be somewhat easier to
control than Lunar dust, given the presence of a low pressure atmosphere and a somewhat
greater gravitational field. A particular hazard condition on Mars that should be carefully
considered is the known ability of dust particles to become windborne (Barratt and Pool,
2008), which could mean dust particles readily dispersing to cover a broader area.
Additionally, study results obtained by Robotic Martian missions indicate that Martian
surface soil is oxidative and reactive. Exposures to the reactive Martian dust will pose an
even greater concern to the crew health and the integrity of the mechanical systems
(Wagner, 2008).
14.4 Conclusion
Environmental factors for planetary surface EVAs will have to be considered, as
their effects on spacesuits, specifically on a through-the-suit IV provision, could be

73
Source: Wagner (2008).
155
significant if they are not mitigated. The salient surface environmental factors affecting a
through-the-suit IV capability are partial gravity and terrain, thermal gradients and
atmospheric pressure, and dust. However, the design provisions provided for this concept
(as described in the various design cycles chapters) satisfactorily address their impact.
156
CHAPTER 15: SYSTEMS ENGINEERING APPROACH

Systems Engineering is an interdisciplinary process that ensures that the
customer's needs are satisfied throughout a system's entire life cycle. This process is
comprised of the following seven tasks (Figure 15-1) (Bahill, 2009):
1. State the Problem - Stating the problem is the most important systems
engineering task. It entails identifying customers, understanding customer needs,
establishing the need for change, discovering requirements and defining system
functions.
2. Investigate Alternatives - Alternatives are investigated and evaluated based on
performance, cost and risk.
3. Model the System - Running models clarifies requirements, reveals bottlenecks
and fragmented activities, reduces cost and exposes duplication of efforts.
4. Integrate - Integration means designing interfaces and bringing system elements
together so they work as a whole. This requires extensive communication and
coordination.
5. Launch the system - Launching the system means running the system and
producing outputs -- making the system do what it was intended to do.
6. Assess performance - Performance is assessed using evaluation criteria, technical
performance measures and measures -- measurement is the key. If you cannot
measure it, you cannot control it. If you cannot control it, you cannot improve it.
157
7. Re-evaluation - Re-evaluation should be a continual and iterative process with
many parallel loops.

Figure 15-1: Systems Engineering Process
74

15.1 State the Problem
The problem statement is a description of the top-level function that the system
must perform or the deficiency that must be ameliorated. The problem statement for this
dissertation is the following: There is currently no capability to administer IV
medication to a spacesuited astronaut. To arrive at the problem statement, a deficiency
vs. benefit assessment was performed (Table 15.1-1), which led to the need for a through-
the-suit IV capability was identified. It was determined that there were medical
emergencies that could occur during terrestrial EVA operations, which would require IV
administration. However, these conditions could not be medically treated, as current
spacesuits do not have a capability for through-the-suit IV administration.

74
Source: Bahill and Gissing (1998)
158
Table 15.1-1: Deficiencies vs. Benefits

Issue Current Deficiency Benefit
1 Spacesuit medical provisions are
ineffective in providing intravenous
access.
Through-the-suit IV provision would increase
astronaut’s probability of survival.
2 Medical administration is limited to oral
and intramuscular administration.
Through-the-suit IV administration will compliment
current oral and IM medical administration
capabilities.
3 Lack of a spacesuit intravenous
administration hinders EVA first-aid
emergency response capability.
Intravenous administration during the ‘golden hour’
can significantly increase the patient’s probability
of survival.

15.1.1 Functional Requirements
Based on this, system-level functional requirements were developed which
describe what must be done (not how it will be done) to bring about a solution to the
problem statement:
1. The spacesuit system shall provide an interface provision to allow
administration of IV fluids to an astronaut.
2. The spacesuit system shall provide a through-the-suit IV administration only
when other routes of medical administration cannot be administered.
3. The spacesuit system shall provide an IV administration capability for the full
duration of an 8 hour EVA.
These requirements were used to develop lower level component design and
environmental requirements, which are described in the following section.
15.1.2 Component Requirements
15.1.2.1 EVA Connector

This section provides EVA connector design considerations and requirements,
obtained and modified, where applicable, from NASA-STD-3000 (Man-Systems
159
Integration Standards), Volume 1, Section 14 (Extravehicular Activity) (NASA-STD-
3000, 2008).

15.1.2.1.1 EVA Connectors Design Considerations
EVA connectors should be designed based on the following:
a. Clearance - Sufficient clearance should be allowed around the connector for
access by a space suit gloved hand. Otherwise, additional provisions should be
made to access connector.
b. Mate/Demate - Design limits should be placed on the torque required to
mate/demate connectors, and connector type and spacing.
15.1.2.1.2 EVA Connectors Design Requirements
Table 15.1.2.1.2-1 depicts the top level requirements for EVA connectors. The
color code is as follows:
a. Requirement Complies –
b. Requirement Will Comply –
c. Requirement Not Applicable –

Table 15.1.2.1.2-1: EVA Connector Design Requirements

No. Requirement Requirement Compliance Assessment
1

Glove Interface – All connectors with the
potential to be operated by an EVA
crewmember shall be operable by a crew
member wearing a pressurized EVA space suit
glove.
Comply – IV connector and cap has design
features which allow it to be operated with
pressurized suit gloves.
2 Clearance – Clearance shall be provided for
gloved- hand operation of connectors as shown
in Figure 15.1.2.1.2-1.
Comply – Required clearance margins are
provided.
3 Wing Connectors – EVA wing connectors,
similar to Figure 15.1.2.1.2-2, shall be used
wherever appropriate. Wing length shall be
Comply – Wing connector design has been
incorporated into connector cap.
160
No. Requirement Requirement Compliance Assessment
proportional to the torque required.
4 Multiple Connectors – Clearance between single
and staggered rows of connectors shall be at
least 3.8 cm (1.5 in.) as shown in Figure
15.1.2.1.2-3.
Comply – Required clearance margins are
provided between through-the-suit IV
connector and other gas/fluid connectors.
5 Spacing – Spacing of connectors shall allow the
gloved hand access to the connector in all
directions.
Comply – Gloved hand access is provided.
6 Status – Methods such as visual indications,
shall be provided to indicate connector mating
status.
Comply – Latching mechanism lets
astronaut know that cap is mated/demated.
7 Protecting Caps – All connector protective caps
shall be tethered near the connector.
Comply – Connector cap is tethered to
connector base.
8 Linear Actuation Force – The actuation force to
linearly displace a mechanical connector shall
not exceed 22.2 N (5lbf)
75
.
Comply – The INFICON FPU016-H
vacuum feedthrough actuation breakaway
force was tested with a mechanical force
meter. The force to actuate the connector
was 1lbf (Figure 15.1.2.1.2-4). After
actuation force was reached, the required
translation force was 0.8lbf. It should be
noted that needle skin penetration force
ranges from 0.1N (0.02lbf) to a maximum
of 3N (0.67lbf).
76

9 Leak Rates – The leak rate through the
connector shall not exceed 5.923x10
-3
sccm
77
.
(generally considered "watertight”)
78
.
Comply – The IV connector static leak rate
is 5.923x10
-8
sccm
79
; the dynamic leak rate
ranges from 5.923x10
-8
sccm to 5.923x10
-3

sccm.
10 Inadvertent Actuation – Protection shall be
provided for all EVA controls to prevent
inadvertent actuation. Toggle switches mounted
on the pressure suit in sagittal or the transverse
plane shall have their normal EVA operational
position toward the crewmember.
Comply – Inadvertent actuation protection
is provided by the connector cap, as well a
linear locking mechanism in the IV
connector design.
11 Field of View – Connectors mounted on the
EVA space suit should be within the field of
view of the suited crewmember.
Comply – IV connector is located in the
upper HUT area, making it visible to a
rescuing EVA astronaut.

75
Source: S684-10111 (2009), Table 3.3.7.2.4 (External Limit Loads).
76
Needle Skin Penetration Force - Measured insertion needle forces range from approximately between 0.1
and 3 N, which is sufficiently low to permit insertion by hand (Davis, et.al., 2003). According to Mayer
and Knappertz (2009), needle penetration mean forces (the force applied on the needle point to pierce skin),
ranged between 0.30 and 0.74 N; forces were measured with a detector that calculates the load produced as
the needle is inserted.
77
A leak rate of 5.923x10
-3
sccm is equivalent to 1x10
-4
mbar l/s, per Leak Flowrate Conversion (2012).
78
A leak rate of 5.923x10
-3
(1x10
-4
mbar l/s) is generally considered as ‘watertight’, which corresponds to a
volume of gas equal to the size of a fine grain of salt per second (Adixen, 2012). If a material can hold
water, then it can hold off dust (Harris, 2011).
79
A leak rate of 5.923x10
-8
sccm is equivalent to 1x10
-9
mbar l/s, per Leak Flowrate Conversion (2012).
Table 15.1.2.1.2-1: Continued
161
No. Requirement Requirement Compliance Assessment
12 Labeling – Labeling and color coding of EVA
connectors should be consistent with IVA
labeling, when possible, considering
environmental visual factors such as glare,
contrast, and illumination available.
Comply – IV connector is properly labeled
and color coded to differentiate it from
other connectors, if present, on the HUT.
13 Actuation Torque – The actuation torque to mate
or demate connector shall not exceed 4 N-m (35
in/lb) for the preferred diameter of 5.75 cm (2.25
in.) for connectors.
Will Comply – Actuation torque testing will
be conducted for the connector cap.
14 Mechanical Feedback – Mechanical control
feedback shall be sufficient to override space
suit glove attenuation so that the EVA
crewmember receives positive indication that
the control function is completed. The
mechanical feedback actuation force shall be
detectable but not less than 15.5 N (3.5 lbs).
Will Comply – Mechanical feedback
actuation force testing will be conducted for
the connector cap.
15 Load – EVA connectors shall withstand crew-
imposed loads of 1,254 N (~1.3 kN) in all
directions or be protected from these loads.
Will Comply – Impact load testing will be
conducted for IV connector. Operationally,
1) connector cap helps dissipate imposed
loads (TBR), and 2) crew will be trained to
protect from impact loads.
16 Pressure – Pressurized pneumatic connectors
and lines shall be tethered or otherwise captured
to the main structure.
Not Applicable – IV connector is not a
pneumatic connector.
17 Strain Relief – Strain relief (cable support that
attaches directly to the body of the connector)
shall be provided to prevent inadvertent
breakage due to induced loads.
Not Applicable – IV connector does not
have externally exposed cables (protected
by connector cap).
18 Alignment – All connectors shall have
provisions to ensure proper alignment during
mating and demating and visible alignment
markings.
Not Applicable – IV connector incorporates
internal alignment mechanism. IV
connector is not removed by EVA crew.
19 Scoop Proof – All connectors shall be scoop
proof. Scoop Proof refers to the impossibility of
a mating receptacle connector being
inadvertently cocked into a mating plug and
damaging or electrically shorting the contacts.
Not Applicable – IV connector is not
removed by EVA crew.
20 Electrical Hazards – All electrical connectors
shall have provisions for alignment and mating
of connector shells prior to electrical path
connections. Electrical paths shall be broken
prior to connector disconnections.
Not Applicable – IV connector does not
provide electricity.
Table 15.1.2.1.2-1: Continued
162

Figure 15.1.2.1.2-1: EVA Gloved Hand Clearances for Wing Tab Connectors
80

80
Source: NASA-STD-3000, Vol. 1, Section 14 (EVA)
163

Figure 15.1.2.1.2-2: EVA Wing Tab Connector (Large Size)
80

Figure 15.1.2.1.2-3: Minimum Clearance Between Wing Tab Connectors
80

164

Figure 15.1.2.1.2-4: Actuation Force Test – Mechanical Force Meter

15.1.2.2 IV Pump Design Requirements

Table 15.1.2.2-1 depicts the top level requirements for the IV Pump. The color
code is as follows:
a. Requirement Complies –
b. Requirement Will Comply –
c. Requirement Not Applicable –

Table 15.1.2.2-1: IV Pump Design Requirements

No. Requirement Requirement Compliance Assessment
1 Functional – The infusion pump shall provide
continuous and intermittent infusion of IV
fluids.
Comply – NASA IV Infusion Pump can be
adjusted to desired flowrate.
2 Mass – The infusion pump shall have as small
weight as permissible to reduce the overall
weight of the PLSS.
Comply – The NASA IV Infusion Pump is
lightweight. It weights 390 g (13 oz.) with
battery.
81

3 Volume – The infusion pump shall be as small
as permissible to be integrated into the PLSS.
Comply – The NASA IV Infusion Pump is
small. Size: 14 cm W x 6 cm H x 4.4 cm D
(5.5" W x 2.3" H x 1.75" D)
.81

4 Installation – The infusion pump shall be
installed in the PLSS compartment.
Comply – The NASA IV Infusion Pump is
small enough to be incorporated into future
PLSS designs; refer to PLSS section
(18.2.4).
5 Pump to Needle Holder Assembly Interface –
Infusion pump plastic tubing shall connect the
infusion pump to the needle holder assembly.
Comply – The NASA IV Infusion Pump
plastic tubing connects to a Luer connector
(LC34-9).
6 Pump to IV Fluid Containers Interface –
Infusion pump shall connect to IV fluid
Will Comply – Connection mechanism
designs between infusion pumps and IV

81
Source: IVantage (2006) – Volumetric Ambulatory Infusion System User Manual
165
No. Requirement Requirement Compliance Assessment
containers. bags/containers are well established.
Incorporating these connections is feasible.
7 Failure – The infusion pump shall have no single
point of failure.
82

Comply – The NASA IV Infusion Pump has
failure provisions in its design. It has alarms
for the following: set occluded, air-in-set,
battery low, change internal battery,
battery depleted, change batteries, reservoir
empty, reservoir low.
81

8 Down Pressure Sensor – The infusion pump
shall include a ‘down pressure’ sensor which
detects when the astronaut's vein is blocked, or
the line to the patient is kinked.
Comply – The NASA IV Infusion Pump has
alarms for the following: set occluded, air-
in-set, battery low, change internal battery,
battery depleted, change batteries, reservoir
empty, reservoir low.
81

9 Up Pressure Sensor – The infusion pump shall
include an ‘up pressure’ sensor which detects
when IV fluid container/s are empty.
Comply – The NASA IV Infusion Pump has
alarms for the following: set occluded, air-
in-set, battery low, change internal battery,
battery depleted, change batteries, reservoir
empty, reservoir low.
81

10 Air Filter – The infusion pump shall include an
air filter to keep air out of the astronaut's veins.
Comply – The NASA IV Infusion Pump has
an air filter to prevent any possibility of air
embolisms.
81

11 Air Detection – The infusion pump shall include
an ‘air-in-line’ detector which will use an
ultrasonic transmitter and receiver to detect
when air is being pumped.
Comply – The NASA IV Infusion Pump has
an air-in-line detector.
81

12 Electronic Log – The infusion pump shall
include an internal electronic log which keeps
track of the therapy events.
Comply – The NASA IV Infusion Pump has
Memory retention provisions; permanent
(>10 years)
13 Wireless Control – The infusion pump shall be
capable of being controlled wirelessly.
Will Comply – Wireless remote control is a
well established technology.
83
Incorporating
this to an infusion pump is feasible.
14 Power–Out Condition – The infusion pump shall
be able to successfully function during a power-
out condition.
Will Comply – NASA IV Infusion Pump
will be modified to connect to the PLSS
battery supply. If the NASA IV Infusion
Pump’s own battery supply is depleted or
malfunctions, the pump will use the PLSS
battery supply as a secondary power source.

82
No single cause of failure should cause the pump to silently fail to operate correctly. It should at least
stop pumping and make at least an audible error indication. This is a minimum requirement on all human-
rated infusion pumps.
83
An example of a wireless infusion pump is the MEDRAD Continuun MR Infusion System. This wireless
infusion pump enables a consistent and reliable connection from the Infusion Pump inside the scan room to
the Remote Display positioned in the control room. Benefits include: 1) reduces inefficient trips into the
scan room, 2) user can titrate flow rates, program and deliver bolus, and remotely start or stop an infusion,
3) ability to program drug name into the remote, providing improved visibility to all staff about what drugs
are being administered (Wireless Remote, 2012).
Table 15.1.2.2-1: Continued
166
15.1.3 Environmental Requirements
Table 15.1.3-1 depicts the top level environmental requirements. The color code
is as follows:
a. Requirement Complies –
b. Requirement Will Comply –
c. Requirement Not Applicable –

Table 15.1.3-1: Environmental Requirements

No. Requirement Requirement Compliance Assessment
1 Dust – The through-the-suit IV connector
assembly shall include provisions to protect it
against Lunar or Martian dust contamination.
Comply – Externally, the TMG flap protects
the connector from dust contamination.
Internally, the through-the-suit connector
includes provisions to prevent dust
contamination of the needle, in case a small
particles breaks through.
2 Thermal – The through-the-suit IV connector
assembly hall include provisions to protect it
from thermal gradients on the surface of the
Moon or Mars.
Comply – The connector will be covered
with a thermal micrometeoroid garment
(TMG) flap, velcroed to the rest of the
spacesuit TMG. The TMG insulates
components and prevents heat loss.
3 MMOD – The through-the-suit IV connector
assembly shall include provisions to protect it
against micrometeoroid impacts on the Lunar or
Martian surface.
Comply – The connector will be covered
with a thermal micrometeoroid garment
(TMG) flap, velcroed to the rest of the
spacesuit TMG. The TMG protects the
connector from micrometeoroids and other
orbital debris.
4 Solar Radiation – The through-the suit IV
connector assembly shall include provisions to
protect it against solar radiation.
Comply – The connector will be covered
with a thermal micrometeoroid garment
(TMG) flap, velcroed to the rest of the
spacesuit TMG. The TMG shields the
connector from solar radiation.

15.2 Investigate Alternatives
Alternative designs were evaluated based on performance and risk criteria. Trade
studies were conducted to yield the most suitable through-the-suit IV design solution.
These trade studies supported three major design cycles, which also included prototype
development and demonstration tests. The major components of the trade studies
167
included: Problem statement, Evaluation criteria, Weights of importance, Alternative
solutions, Evaluation data, Scoring functions, Scores, Combining functions, and Preferred
alternatives. Figure 15.2-1 depicts the trade study tree, and Tables 15.2-1 to 15.2-6
summarize the various trades that supported the preferred design solution.

Figure 15.2-1: Trade Study Tree
Planetary
In-Flight Operations
EVA
Hab Depress Constant
Availability
Emergency Transport Constant EVA
Central Venous
Lines (Non-
Implanted Port PICC
Legs Arms Chest
Central IV Access Peripheral IV Access
Through-the-Suit IV
Central Venous
168
Note: The Criteria Factors add up to 100; while the Alternative Scores range from 1-10 (Low-1, High-10).

Table 15.2-1: Planetary vs. In-Flight Operations Trade Matrix

Criteria (Weighted)
Planetary Surface
Operations
In-Flight
Operations
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Likelihood of Injuries
Requiring Through-Suit-IV 30 8 240 6 180
Impact of Proximity to Habitat 30 8 240 5 150
Gravity/Atmosphere Impact to
IV Hardware 30 2 60 2 60
Cost (Least Expensive) 10 2 20 2 20
Total 560 410

Table 15.2-2: Through-the-Suit IV Availability Trade Matrix

Criteria (Weighted)
Constant
Availability
Hab Depress
Scenarios
EVA
Operations
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Likelihood of Injuries
Requiring Through-Suit-IV 50 6 300 4 200 8 400
Least Required IV Fluids 40 2 80 6 240 6 240
Cost (Least Expensive 10 2 20 4 40 6 60
Total 400 480 700

168
169

Table 15.2-3: EVA Coverage Trade Matrix

Criteria (Weighted)
Emergency
Transport to Habitat
Constant EVA
Coverage
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Least Required IV Fluids 50 8 400 2 100
Highest Impact on Crew
Survival 409 360 3 120
Cost (Least Expensive) 10 8 80 6 60
Total 840 280

Table 15.2-4: IV Access Trade Matrix

Criteria (Weighted)
Central IV Access Peripheral IV Access
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Catheter accessibility (spacesuit
dependent) 156 90 7 105
Freedom of movement (post
catheter insertion) 20 6 120 3 60
Catheter ease of insertion and
removal 105 50 9 90
Catheter durability (life span) 25 7 175 2 50
Catheter infection rate 25 6 150 7 175
Catheter device cost 5 5 25 8 40
Total 610 520

169
170

Table 15.2-5: Central IV Access Trade Matrix

Criteria (Weighted)
Central Venous Line
(Non-Tunnel)
Central Venous Line
(Tunneled)
PICC

Implanted
Port
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Catheter accessibility (spacesuit
dependent) 15 5 75 5 75 7 105 5 75
Freedom of movement (post
catheter insertion) 20 7 140 7 140 3 60 7 140
Catheter ease of insertion and
removal 10 6 60 5 50 5 50 3 30
Catheter durability (life span) 25 4 100 7 175 7 175 9 225
Catheter infection rate 25 4 100 5 125 7 175 9 225
Catheter device cost 5 7 35 6 30 5 25 4 20
Total 510 595 590 715

Table 15.2.6: Implanted Port Location Trade Matrix

Criteria (Weighted)
Arms Legs Chest
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighted
Score
Score
(1-10)
Weighte
d Score
Freedom of Movement 50 4 200 6 300 8 400
Injection Stability 50 4 200 6 300 8 400
Total 400 600 800
170
171
15.2.1 Planetary vs. In-Flight Operations Trade Study
This trade study concluded that a through-the-suit IV capability would be better
suited for planetary surface EVA operations. Given that planetary exploration will
involve more hazardous activities, it is more likely that astronauts may get injured and
need IV treatment. Additionally, planetary surface EVAs will take place at distances
away from their habitats, in less controlled and more dynamic operational conditions (as
opposed to in-flight EVAs which take place in the proximity of the spacecraft). In
general, planetary EVAs will provide an array of additional factors that can potentially
injure the EVA crew. The gravitational and atmospheric impacts on a through-the-suit IV
provision will be the same in both a planetary surface and in-flight environment; this is
because all IV related equipment will be contained within the pressurized spacesuit
system. Lastly, the cost to implement a through-the-suit IV capability would be the same
for both.
15.2.2 IV Capability Coverage Trade Study
This trade assessed whether a through-the-suit IV capability should be provided
for Habitat Depress only, EVA Operations only, or both. The study concluded that a
through-the-suit IV capability would be better suited for planetary surface EVA
Operations only. As mentioned, planetary exploration will involve more hazardous
activities, which will increase the probability of the EVA crew getting injured and
requiring IV administration. Allocating IV fluids for EVA emergencies only, would
require the least amount of fluids. For example, one of NASA’s DRMs for Orion was a
‘144 Hour Depressurization’ scenario which would require the crew to don their
172
spacesuits for up to 6 days. It would not be feasible for a spacesuit to be able to provide
IV treatment to an astronaut for that amount of time. Furthermore, even if IV fluids could
somehow be provided to the crew from an external source, an injury requiring IV entails
other medical treatments which would require removal of the spacesuit. From a cost
perspective, a through-the-suit IV capability for EVA Operations only would be the least
expensive given the amount of IV fluids required.
15.2.3 EVA Coverage Trade Study
This trade assessed whether a through-the-suit IV capability should be provided
just for the time necessary to transport the patient back to the habitat, or for the full
duration of an EVA, i.e., 8 hours. Allocating IV fluids for a full EVA duration would be
very difficult, if not impossible, to package in the PLSS due to the increased volume
requirements. The carrying load for the astronaut would also be impacted due to the
increased mass. There is also the issue of what option would provide the most benefit. An
EVA scenario where an IV would be required for several hours, would imply that the
crew would not be able to reach and/or ingress the habitat. This would be a dire situation
for the EVA crew, as his injury/illness could not be medically treated; as a result, limiting
the benefits of IV fluid administration. On the contrary, limiting IV administration solely
for the purpose of keeping the patient alive while he/she is being transported to a
pressurized habitat would bring the most benefit to an injured astronaut. On Earth, it is
well established that providing first-response medical treatment, i.e., IV administration,
during the first 30 to 60 minutes after the onset of an injury significantly increases the
probabilities of survival. Lastly, the costs to provide a through-the-suit IV provision for
173
the full duration of an EVA would be significantly higher. As a result, this trade
concludes that a through-the-suit IV provision should only be available during the period
when the injured crew is being transported back to the pressurized habitat.
15.2.4 Additional Trade Studies
The last three trade studies (IV Access, Central IV Access, and Implanted Port
Location) are discussed in detail in Chapter 11 (VAD Trade Study and Analysis). As
Chapter 11 concludes, a Central IV Access, namely an Implanted Port, in the chest area is
the best suited option for a through-the-suit IV provision.
15.3 Model the System
The system was designed in six major design cycles described in Chapters 17
through 22. The design process began with initial designs of the through-the-suit IV
connector and support equipment produced by hand drawing (Figure 15.3-1). These
drawings were then transferred onto MS PowerPoint (Figure 15.3-2), where component
details were defined and issues consolidated. After selecting a configuration, a CAD
design was produced for every component using SolidWorks software (Figure 15.3-3a
and 15.3-3b). Upon CAD models being approved, the parts were manufactured in
Aluminum 6061T6, or 3D printed
84
in ABS plastic (Figure 15.3-4).

84
3D Printing was performed at the Information Sciences Institute (ISI). ISI is a research and development
unit of the University of Southern California’s Viterbi School of Engineering, which focuses on computer
and communications technology and information processing.
174

Figure 15.3-1: Sample Concept Hand Drawing

Figure 15.3-2: Sample MS PowerPoint Drawing
175

Figure 15.3-3a: Sample SolidWorks CAD 3D Drawing

Figure 15.3-3b: Sample SolidWorks CAD Detailed Measurements
176

Figure 15.3-4: Sample 3D Printed Components

15.4 Integrate System Components
After the various components were built, they were integrated and functionally
checked out prior to testing. This included needle assembly mating/demating, tubing
connection, alignment support adhesion, Leur-Type connectors mating/demating, and
feedthrough to simulated HUT adhesion. Figures 15.4-1 and 15.4-2 depict some
integration pictures for the Demo Test #1.
177

Figure 15.4-1: Alignment Support Adhesive Installation - Bottom View

Figure 15.4-2: Integration Complete - Side View
178
15.5 Launch the System, Assess Performance, Re-Evaluation
The launching, assessment and re-evaluation of the through-the-suit IV design are
discussed in Chapters 23 through 27. There were four major tests conducted.
1. Demonstration Test #1 – Chest Port to LCVG Relative Movement Assessment
2. Demonstration Test #2 – Manikin Through-the-Suit IV Assessment
3. Demonstration Test #3 – Manikin Through-the-Suit IV Assessment
4. Demonstration Test #4 – HUT to Chest Port Relative Movement Assessment
5. Demonstration Test #5 – Human Subject Through-the-Suit IV Assessment
These tests subjected the through-the-suit IV design through rigorous testing to ensure
human test subject safety and concept feasibility. Tests included IV fluid withdrawal and
administration, volumetric assessment, and integration to manikin and human subject
assessments.
15.6 Conclusion
The development of the through-the-suit IV concept has been an interdisciplinary
process, which has involved coordination with experts in various fields, including
medicine, physics, and engineering. The development has utilized a Systems Engineering
approach commonly used in the aerospace industry. The process included the following
major steps: 1) State the Problem, 2) Investigate Alternatives, 3) Model the System, 4)
Integrate, 5) Launch the system, 6) Assess performance, and 7) Re-evaluation.
179
CHAPTER 16: DEVELOPMENT PROCESS
16.1 Medical Device Development
Because the through-the-suit IV provision being proposed in this research is of a
medical nature, it followed a similar medical development process as a medical device.
This process starts with a single idea. Preliminary concepts go from sketches, to drawings
to CAD models. From there, models are taken to a medical machine shop. These shops
are experienced in the specificity and accuracy required for medical instrumentation, and
they also know how to work with the medical industry in making sure these devices are
distributed. For this research, due to funding limitations, the CAD model was sent to the
USC’s Information Sciences Institute for 3D prototype printing. This model becomes the
basis for testing that will resolve any potential problems before full production of the
device begins. Once the model has been finalized, the medical device development
process culminates in the full production of the mode. From that point, medical machine
shops are often willing to work with the developers to set up an order and shipping
process so this new device can be used all over the world to help people in need (Medical
Device-1, 2012). The latter step is where the through-the-suit IV concept differs most
from the traditional medical development process. The through-the-suit IV concept
would not be for commercial use. Instead, it would be for a singular cohort of exploration
astronauts.
In general, the medical development process is a long, arduous and expensive
developmental path from early concept to introduction into clinical practice. It includes
the following salient steps (Medical Device-2, 2012):
180
1. Product Design / Concept Design
2. Product Development
3. Prototype Fabrication
4. Device Performance Testing & Analysis
5. Device Validation Build & Test
6. Clinical Device Fabrication
7. Regulatory Documentation
8. Process Development Engineering
9. Continuous Improvement Engineering
Given that this research was conducted as part of a PhD dissertation, all these
steps were not completed. However, several of the steps, in varying degrees, were. That
is an important accomplishment, given the schedule and funding constraints of a PhD
program. Apart from the many design iterations and demonstration tests, which are part
of normal medical device development, the most difficult aspect was perhaps the Human
Subject IRB Approval, which took over a year to complete. The IRB process requires
demonstration of both safety and efficacy and is highly regulated by the FDA. The IRB
process has become significantly more arduous in the wake of recent misadventures in
drug and gene therapy testing. Taken together, these factors account for the 1- to 3-year
delays in the introduction of new device technologies into general clinical practice within
the United States (Kaplan, A., et. al., 2003).

181
16.2 Conclusion
It is noteworthy to mention that during the through-the-suit IV connector
development process, several spacesuit prototype and replica developer companies were
contacted. Their insight and support was crucial for the successful design, prototype
development, and testing. For example, even though UND’s NDX-1 or NDX-2 prototype
planetary spacesuits could not be modified to incorporate the through-the-suit IV
connector, i.e., too costly to modify, the NDX-2 was used to perform HUT
85
to LCVG
relative movement tests. Mr. Pablo de Leon and Mr. Gary Harris from the UND’s
Spacesuit Laboratory provided valuable insight from the beginning design phases. They
are both experts in the area of spacesuit designs. Similarly, two spacesuit replica
companies were contacted, i.e., Global Effects Inc. and Wonder Works, which showed
great interest in a through-the-suit IV provision. Unfortunately, due to cost issues, their
spacesuit replicas could also not be modified. Their support is mentioned here because of
the importance they had in the development of the through-the-suit IV concept.

85
The NDX-2 actually has what is called a Malleable HUT (M-HUT). When pressurized, it mimics a hard
upper torso, yet when unpressurized, it mimics the stowability of a soft suit structure. For purposes of this
research, the NDX-2 M-HUT will from this point forth be referred to as the NDX-2 HUT.
182
CHAPTER 17: DESIGN CYCLE #1

The baseline “through-the-suit” IV preliminary design was to utilize a “Vein
Finder” (Figure 17-1) to locate a vein through-the-spacesuit, and then inject a needle in a
peripheral IV line. The major baseline components included (Figure 17-2a and 17-2b): 1)
Vein Finder, 2) Spacesuit Mechanical Interface Port, and 3) Inflatable Cuff.

Figure 17-1: Georgia Tech University - Vein Finder
86

Figure 17-2a: Pre-Loaded Syringe

86
Source: Becker, T.J. (2006).
183

Figure 17-2b: Initial Through-the-Spacesuit IV Concept
87

87
Source: Alejandro R. Diaz
184
17.1 Vein Finder
The need to be able to locate a vein has been a challenge since IV treatment first
began. Many of us have had to suffer uncomfortable, and at times painful, situations of a
nurse trying to locate a vein in our arms. As a result, several technological concepts have
been proposed, which aim to facilitate the identification of veins to simplify the
placement of an IV line. Their main intended use would be for patients who have
conditions which make their veins hard to locate. These patients include diabetic patients,
obese patients (veins covered by layers of fat), cardiac patients (hearts not pumping
properly), or dehydrated patients (blood vessels lacking normal volume) (Becker, 2006).
After a preliminary review of the current technology readiness of these concepts,
the leading concept in vein-identification is being developed by a team of Georgia
Institute of Technology researchers. The Georgia Tech (GT) research is developing an
inexpensive, handheld device that uses Doppler ultrasound technology to find veins
quickly. Compared to static skin and tissue, blood is a moving substance, so ultrasonic
waves reflected from blood vessels have different characteristics than transmitted ones,
providing critical 3-D information about a vein’s location. By applying a narrowly
focused beam of ultrasonic energy at a certain angle, the vein finder uses the Doppler
Effect to detect moving blood and determines the direction of flow (Becker, 2006).
According to Becker (2006), GT’s patent-pending vein finder is composed of two
parts: A reusable unit houses the electronics and signal processing components, while a
disposable coupler box holds a reflector and needle guide. The needle guide is positioned
parallel to the sound beam being transmitted by a transducer in the device’s reusable
185
section. As medics move the device along a patient’s peripherals (arms or legs), the
transducer emits a thin acoustical beam, about the size of pencil lead, into the reflector.
The reflector then directs the ultrasonic waves into the patient’s skin at a slight angle. The
device can determine the direction of blood flow to distinguish arteries (which carry
blood away from the heart) from veins (which carry blood to the heart). Once the device
detects a vein, an alarm is triggered, and medics insert the needle. The vein finder
component would have a rounded contour design to avoid sharp edges in the inside of the
spacesuit. The vein finder would be externally capped by a “connector cap,” which would
be removed by the aiding astronaut before mating the syringe to it. The needle would be
located within the vein finder component, and would only come out to inject the skin
when the GTVF identifies the vein. The GTVF would also have the capability to swivel
in two directions to allow it to locate the vein.
17.2 Spacesuit Mechanical Interface Port
The Spacesuit Mechanical Interface Port only allows fluid passage once the
syringe is mated to the GTVF connector. When the aiding astronaut removes the
connector protective cap, the external side of the GTVF is exposed to the environment,
but there is no leakage because it is sealed. This interface is only internally unsealed
when the syringe is successfully mated. The syringe subcomponent also has large “Finger
Grapple Points” to allow spacesuit glove handling requirements, consistent with NASA-
STD-3000 (Man-Systems Integration Standards) guidelines for spacesuit glove
operations.
186
17.3 Inflatable Cuff
An Inflatable Cuff is part of a sphygmomanometer device, i.e., blood pressure
meter. The purpose of the inflatable cuff is to restrict blood flow to aid in pressure
measurement. The inflatable cuff would be placed around an astronaut’s upper arm. It
would go underneath the spacesuit, but above the LCVG. In case of an IV injection, the
inflatable cuff would be inflated to distend the vein and help identify it.
17.4 Conclusion
As research progressed, it was concluded that even if a “Vein Finder” was able to
locate a vein through-the-spacesuit, three major factors would make this approach very
difficult to accomplish. The first factor is that this approach assumed a perpendicular
needle insertion. This would not be suitable for IV access, given that IV administration is
given with the needle inserted parallel to the vein. The second factor is that even though
this approach would utilize a “Vein Finder” to locate a vein, it is not clear how the “Vein
Finder” would account for veins that collapse or shift during insertion. The third factor is
that this approach omits the use of a catheter, which is central to IV administration. With
this in mind, an alternate and more feasible approach was derived for Design Cycle #2.
187
CHAPTER 18: DESIGN CYCLE #2

During this design cycle, the following components were removed: 1) Vein
Finder, 2) Spacesuit Mechanical Interface Port, and 3) Inflatable Cuff. The following
components were incorporated (Figures 18-1a - 18-1d): (1) an Implantable Venous Port
(IVP), (2) a needle push-button device, (3) a PLSS IV infusion pump and IV fluids, and
(4) a contamination resistant connector.

IVP Needle Push-Button Device

Advanced PLSS Contamination Resistant Connector
Figure 18-1a: Proposed Components
88

88
Source: IVP (Implanted Venous Access Port , 2009), Needle Push-Button Device (Push-Button, 2009),
Advanced PLSS (Hoffman, 2004), Contamination Resistant Connector (Caizza, et al., 2000).
188

Figure 18-1b: Through-the-Spacesuit IV Concept
89

Figure 18-1c: PLSS to Spacesuit Interface
90

89
Source: Alejandro R. Diaz
90
Source: Alejandro R. Diaz
189
18.1 Implanted Venous Port
As Section 9.3 shows, IVPs have a small port that ranges in height from 0.37 to
0.67 in, and diameter from 0.94 to 1.97 in (Allen, 2005). The IVP modeled for this
research was provided by Bard Access Systems (Figure 18.1-1). Figure 18.1-2 describes
the IVP, and Figure 18.1-3 depicts the port dimensions.

Figure 18.1-1: Bard Access System IVP

Figure 18.1-2: IVP Component Description
91

91
Source: Implantable Port (2012). Septum diameters vary in diameter; the port provided by Bard Access
Systems had a septum diameter of 0.5 inches.
190

Figure 18.1-3: IVP Dimensions

18.2 Needle Push-Button Device
A needle push-button device will serve as the interface between an external fluid
source and an IVP. A spacesuit is a highly complex system; adding complexity to it
should be avoided. However, a simple push-button device provides the least amount of
impact on the spacesuit physical and functional designs. The purpose of this device
would be to allow the ill/injured astronaut, or another crewmember, to push on an
external push-button to inject the needle into the IVP. Once the needle is injected, it
would have to stay in place until conclusion of IV treatment. Upon conclusion, the
ill/injured astronaut, or other crewmember, would push the external button again to
retract the needle from the IVP.
191
The needle push-button device will be shaped to accommodate the fingers of a
gloved-hand, so as to be easily pushed. The push-button will utilize a spring to return the
needle to its unretracted state. Such a spring concept is an arrangement that is often used
for various applications in mechanical engineering (Push-Button, 2009). For purposes of
this research, the needle would be connected to the push-button. Upon pushing the
button, the needle will penetrate the IVP and it will lock. To unlock and remove the
needle, the push-button is pushed again returning the device to its unretracted position.
Figure 18.2-1 depicts a sample needle push-button device concept in its unretracted and
retracted position.

Figure 18.2-1: Push-Button Spring Mechanism
92

18.3 IV Infusion Pump and Fluids
On Earth applications, IV port administration is delivered preferably by an
infusion pump so as to prevent overfeeding or clotting in the line. Numerous pumps that
can be used for solution administration are available commercially (Outpatient IV
Administration, 2011). For orbit applications, the principal means for delivering IV fluids

92
Source: Push-Button (2009)
192
will be with an IV infusion pump; gravity flow will not be feasible. For surface
applications, even though there is gravity (Moon has 1/6
th
Earth’s gravity, while Mars has
1/3
rd
Earth’s gravity), an IV infusion pump will be needed for the IV administration
method proposed in this research to maintain and regulate the IV infusion.
Presently, NASA manifests an IV Infusion Device as part of its ISS Medical Kit
(JSC-48522-E4, 2001) (Figure 18.3-1), though to date, it has never been used in orbit
(Gonzalez, 2010). It is intended for continuous IV infusion at a specified flow rate. The
IV Pump has an air filter to prevent any possibility of air bubble infusion which could
cause an embolism.
93
Detailed pump operation instructions are provided in JSC-48522-
E4 (International Space Station Integrated Medical Group (IMG) Medical Checklist); it
includes the following procedures: equipment preparation, patient preparation, flow rate
adjustment. The IV pump went through a series of tests/certifications, e.g., EMI,
outgassing, acoustic, and functional test, before it was flown to the International Space
Station (Appendix H – Pre-Flight IV Infusion Device Testing) (Clement, 2011).

93
Injecting air into the venous system is definitely a problem. However, it is possible for humans to have
small amounts of gas bubbles in the vascular system. For example, during invasive or surgical procedures,
such as insertion of a central venous catheter, air embolisms can be introduced into patients. However, in
reality this is a very rare problem because it really would take a large amount of air injected to really pose a
threat (between 30cc's and 100cc's of air). Additionally, the amount of air in a needle prior to injection is
extremely negligible and would not pose any problems with patients (Garcia, 2010).
193

Figure 18.3-1: NASA ISS IV Infusion Device
94

Table 18.3-1: IV Infusion Device Hardware Specific Parameters
94

IV Pump Specifications Value/Description
Operating Principle Rotary peristaltic
Power Requirements Four (4) 9V alkaline batteries
Battery Power Duration
New Battery Life: 24 hours at 100 mL/hr with
battery save mode
Battery Saving Mode: Option for rates >60 ml/hr
Flow Rate 0.1-999 mL/hr
Flow Rate Accuracy +/-5%
Flow Continuity Continuous > 60 mL/hr
Volume To Be Infused 1-9999 mL
KVO Rate 0-9.9 mL/hr
Occlusion Pressure
Adjustable;
Low: 310 mmHg
2
/6 psi
3

Medium: 465 mmHg/9psi
High: 620mmHg/12 psi
Air-in-Set Detection Ultrasonic, selectable limit 75 μL or 300 μL
Dimensions
(of the Microstar IV infusion pump alone)
Height: 2.31”, 5.9 cm
Width: 2.09”, 5.3 cm
Length: 8.07”, 20.5 cm
Weight: 1.43 lbs, 650 grams

94
Source: Gonzalez (2010)
194
Table 18.3-2: IV Infusion Device Battery Specifications
94

# of
Batteries
P/N Vendor
Battery
Size
Battery
Type
Battery
Voltage
Battery
Capacity
(for
each)
Shelf
Life
Power
Duration
4
(in parallel)
L522FP Energizer 9V lithium 9V
1200
mAh
10
years
24 hours at
100 mL/hour

Table 18.3-3: Approximate Weights and Dimensions
94

Part Name Part Number Dimensions Mass Reference
ALSP IV
Administration
Pack
SEG52101145-
301
Length: 10”, 25.4cm
Width: 6.25”, 16 cm
Height: 5.2”,13.5 cm
3.13 lbs.,
1.42 kg
TPS
#7T0622195
IV Pump
Assembly
KLSH320042-
302
Length: 8.07”, 20.5 cm
Width: 2.32”, 5.9 cm
Height: 2.09”, 5.3 cm
1.43 lbs.,
0.65 kg
(including
batteries)
per vendor
manual for
Alaris
Microstar
model
(written for the
NASA/JSC
configuration)
IV Infusion Pump
(pump only;
without the
battery pack,
housing, and
bracket)
690-0000
Length: 5.57”, 14.14 cm
Width: 2.5”, 6.35 cm
Height: 1.75”, 4.45 cm
0.52 lbs.,
0.236 kg
measurements
taken of a
training unit

For a through-the-suit IV provision, the most important IV fluids that could be
used with the IV Infusion Device for foreseeable emergencies would be: Epinephrine
(cardiac arrest/ventricular fibrillation, severe allergic reaction, bronchoconstriction), a
liter of Normal Saline (volume replacement for acute hemorrhage, hypotension or
dehydration), Atropine (asystole, bradycardia) and Morphine (pain) (Czarnik, 2010).
Post-doctoral research will incorporate the IV Infusion Device and IV fluid
compartments into a PLSS design. Additionally, a built-in wireless IV Infusion Device
capability will be researched to allow IV fluid infusion by a rescuing EVA astronaut.
195
18.4 Portable Life Support System (PLSS)
In 1996, NASA began a PLSS Advanced Technology Test Article Demonstrator
Program to explore the requirements of a Mars EVA suit that could also be altered for use
on the Moon. To help define suit and PLSS technologies that could meet NASA’s
projected Maras Exploration Reference Mission, and to help guide contractors, NASA
also determined that the suits had to meet certain criteria, among which was the
following: First Aid/evacuation provisions “on back” (Harris, 2001). This criteria is in
line with this research in that it envisions the use of PLSS to incorporate medical
emergency provisions, such as an IV Pump and IV fluids.
Incorporating an IV infusion pump and IV fluids compartments into a current
spacesuit PLSS design will be a challenging endeavor. To understand this challenge, a
brief description of a PLSS follows. A PLSS provides crewmembers six primary
functions to an EVA crewmember: breathing air, thermal control, power, communication,
biomedical monitoring, and a backup emergency capability should primary subsystems
fail (Clickable Suit, 2008; Hoffman, 2004). Since the PLSS is worn like a backpack, a
major driver has always been to reduce its mass as much as possible. This is corroborated
by eight of the eleven Apollo astronauts who landed on the Moon, who mentioned they
would prefer a PLSS that has less mass (Hoffman, 2004). Apart from mass however, a
PLSS is also a very compact volume with very limited, to no, free space (as depicted in
Figure 18.4-1).
196

Figure 18.4-1: Apollo PLSS and Shuttle EMU PLSS
95

Therefore, the IV pump and IV fluids to be added will need to be lightweight and
take up minimum volume. These additions will not possible on current PLSSs, but may
be on advanced PLSS systems. These advanced PLSSs will require a suite of
technological and operational advances, which will aim to reduce PLSS mass, while
retaining (or improving) functional capabilities (Hoffman, 2004).
According to Hoffman (2004), a study was conducted by NASA to develop a new
PLSS packaging concept that would be capable of being maintained by the crewmember,
adaptable to technological changes, minimized weight, and reduced volume. Three
unique PLSS packaging concepts evolved that could satisfy design requirements (Figure
18.4-2). All concepts targeted maintainability by addressing access and handling of
components or modules. These capabilities would be beneficial for the proposed IV
pump and IV fluids concept because it would allow for accessing, removal and

95
Source: Hoffman (2004)
197
replacement of IV fluid compartments, and/or malfunctioning IV pumps. Weight and
volume were reduced in all designs through use of advanced materials, sharing of
functions, and effective component configuration (Hoffman, 2004). So even though this
study did not specifically address the addition of an IV pump or IV fluids compartments,
it does demonstrate that future PLSSs designs may be flexible enough to allow
incorporation of IV equipment.

Figure 18.4-2: Advanced Developmental PLSSs for EVA
96

The spacesuit design for incorporation of an IV Pump into a PLSS is the NDX-2
spacesuit. This is a rear-entry suit
97
, which contains the PLSS inside the pressurized
spacesuit environment. The IV Pump will be incorporated into the PLSS; therefore, the
pump and its components, e.g., tubing, will not be exposed to the vacuum environment.
Furthermore, from a gravity perspective, lack of gravity will make no difference on fluid
flow, as the IV Pump will move the fluid from the IV Pump into the spacesuit (Ayrey,

96
Source: Hoffman (2004)
97
One of the key features of any space suit is the entry method. Some of the critical suit features affected
by entry type are suit don/doff capability, suit sizing, suit mass, suit volume, and suit comfort. In general,
rear-entry designs provide better don/doff capabilities.

198
2010). An additional advantage of this approach is that any leakage in the PLSS
plumbing or connectors will harmlessly flow into the suit volume rather than be lost
overboard to the vacuum of space (Harris, 2010). Similar to the NDX-2, the Russian
Orlan (Figure 18.4-3) and NASA Mark III spacesuits are also rear-entry suits, and have
their PLSS contained within the suit pressurized environment.

Figure 18.4-3: Astronaut Clayton Anderson enters Orlan Suit through Rear Hatch
98

One concept for planetary exploration is to have an unpressurized vestibule
attached to a rover, and have the spacesuit attached to the rover wall acting as an air lock
(Figure 18.4-4). This scenario is best supported by a rear entry design minimizing the
amount of dust and dirt entering the habitat (Graziosi, et. al, 2005). If this approach was
selected and utilized with a through-the-suit IV capability, the assumption would be that
the suit would have to be brought in periodically into a pressurized “garage”
99
for
required repair and maintenance procedures. These procedures would entail through-the-
suit IV connector checks and cleaning. That said, utilizing a ‘rover / rear-entry suit’ and

98
Orlan Suit (2005)
99
The pressurized "garage" would have a proper entrance for the rover and an airtight door; it would be
connected by a pressurized tunnel to the habitat. In this “garage” the rover/suit could be maintained in a
shirt sleeve environment (de Leon, 2012).
199
through-the-suit IV provision approach would require further research. At this point, the
baseline is to use a rear-entry suit, but not have it attached to a rover.

Figure 18.4-4: Astronaut Entering Suit / Disconnecting from Suitport
100

In dissimilarity, in Apollo spacesuits and EMU designs, the PLSS is mounted
outside the pressurized volume of the spacesuit (like a backpack). This means that the
connecting plumbing, hoses, pipe connectors, fittings, etc., of the PLSS are exposed to
the vacuum of space (Harris, 2010). If the spacesuit baselined for a through-the-suit IV
approach was one with a PLSS outside the pressurized suit environment, it would not
impact the overall functionality of the IV pump. The pressure differential should make
little difference, as there is only a delta of about 4.5 psi (spacesuit internal pressure). All
pumps work on the principal of pushing fluids through to overcome pressure drops, and
this slight pressure differential would be insignificant. With regards to the IV pump
tubing that is exposed to vacuum, this would also not be an issue. The IV pump in the
PLSS would connect to the tubing carrying the IV fluid to the suit. The inside of this
tubing is essentially seeing 4.5 psia since the end is inside the pressurized suit. If the
inside of the suit is at 4.5 psia and all of the tubing back to the pump is at 4.5 psia, then so

100
Suitport (2009)
200
is the pump head itself. This means that at static conditions, all the pump has to do is
provide slightly above the 4.5 psia (or perhaps 4.6 psia) and it would then be pushing
fluids into the suit (astronaut). The wall of this tubing that is exposed to the vacuum of
space (from the pump to the entrance into the suit) is only pressurized at 4.5 psia, but can
easily withstand this pressure without collapsing. It is very easy to find tubing that can
withstand hundreds of pounds of pressure, so the 4.5 psia is very manageable for any
standard tubing to sustain (Ayrey, 2010).
18.5 Contamination Resistant Connector
Proposed is a connector patented by Caizza, et al. (2000). According to Caizza, et
al. (2000), its patented connector (U.S. Patent 6,077,259), general related to medical
infusion devices, “…enables a substantially drip-free connection and disconnection of a
fluid handling device to a patient. When the portions of the device are disconnected, all
fluid path surfaces are covered.” The connector of the invention substantially prevents
inadvertent fluid contaminations (Figures 18.5-1 and 18.5-2). Below find an excerpt from
U.S. Patent 6,077,259, which summarizes the connector features:
“A contamination resistant connector of the present invention for medical tubing
includes a first portion with a first fluid passage therethrough occluded by a
covered normally closed first valve and a second portion with a second fluid
passage therethrough. The second portion is conjugate to and releasably
attachable to the first portion. The second portion fluid passage also is occluded
by a covered normally closed second valve. The first valve and the second valve
are both only uncovered and opened so that the first fluid passage and the second
fluid passage are fluidly communicatively connected, and closed and covered by
the respective conjugate engagement and disengagement of the first portion and
the second portion...The connector of the invention enables a substantially drip-
free connection and disconnection of a fluid handling device to a patient. When
the portions of the device are disconnected, all fluid path surfaces are
201
covered…The connector of the invention substantially prevents…inadvertent
contaminations…”

Figure 18.5-1: Contamination Resistant Connector (Disconnected)
101

Figure 18.5-2: Contamination Resistant Connector (Connected)
101

The proposed concept would provide for an external source of IV fluids to be
connected to the spacesuit of the ill/injured astronaut in case there is either a malfunction
of the IV infusion pump in the PLSS, or the PLSS IV fluids are depleted. An umbilical
from another crewmember’s PLSS, or from an IV fluid compartment in an unpressurized

101
Source: Caizza, et al. (2000)
202
rover
102
(Figure 18.5-3), could be connected to the injured astronaut’s spacesuit to
provide IV fluids. To provide this capability, this IV fluid umbilical must provide dust
contamination prevention features, such as the ones provided by U.S. Patent 6,077,259.

Figure 18.5-3: Surface Rover with Umbilical
103

Future research will also look into the umbilical connector design of the Apollo
spacesuits’ Buddy Secondary Life Support System (BSLSS). In the BSLSS system, by
using a length of connecting hose, one astronaut’s system could support the second

102
According to Hoffman (2004), one of the proposed additional capabilities for unpressurized rover is an
augmented supply of PLSS consumables and functions – power, breathing gases, and thermal control. An
EVA crew could tap in to this additional resource while riding on the rover to conserve the limited supply
in a backpack unit. It is conceivable that an additional PLSS consumable could be IV fluids.
103
Figure 8-15 from Harris (2001)
203
astronaut’s system by supplying oxygen. Note, the system was never called upon to be
used during an Apollo mission (Shayler, 2000). However, it is assumed that the Apollo
connector design also incorporated dust contamination provisions into its design.
Therefore, future research will need to determine whether the Apollo BSLSS connector
design would suffice for IV fluid connection purposes, or whether a connector such as
U.S. Patent 6,077,259 would be needed.
18.6 Conclusion
The following components were incorporated in this design cycle: (1) an
Implantable Venous Port (IVP), (2) a needle push-button device, (3) a PLSS IV infusion
pump and IV fluids, and (4) a contamination resistant connector. IVPs are vascular access
devices that are commonly used; they provide the best alternative for a through-the-suit
IV provision. The needle push-button device incorporates a method to access a chest port;
however, further research has to be performed to maintain the suit pressure and mitigate
dust contamination; this is addressed in Design Cycle #3. The IV infusion pump
baselined is the same as the one currently manifested in the ISS Medical Checklist for IV
fluid treatment inside the space station. The contamination resistant connector proposed
would be used to connect the umbilical coming from the PLSS into the spacesuit, which
provides the fluids from the IV Pump to the IV Needle Holder.
204
CHAPTER 19: DESIGN CYCLE #3

During this design cycle, the following components were removed: 1) Needle
push-button device and 2) Contamination resistant connector. The following components
were incorporated: 1) Through-the-Suit Connector (and related components), 2)
Connector Cap (and related components), 3) Dust Retardant, and 4) Plate Cover.
19.1 Through-the-Suit Connector and Cap
Figures 19.1-1 to 19.1-5 depict the Through-the-Suit Connector components
(knob, needle, needle holder, IV tube attachment), and Connector Cap (cover, release
lock, casing, tether), dust retardant, and plate cover.

Figure 19.1-1: Through-the-Suit Connector Components

205

Figure 19.1-2: Through-the-Suit Connector Components Layout

Figure 19.1-3: Needle Holder and Fluid Inflow

206

Figure 19.1-4: Through-the-Suit Connector Assy Preliminary Dimensions

Figure 19.1-5: Through-the-Suit Connector Casing Dimensions with Thread Detail

207
Figures 19.1-6 and 19.1-7 depict two Through-the-Suit Connector dust contamination
(retardant) proposals. Approach A includes a latex type material, which connects from
the Needle Holder down to the bottom portion of the Through-the-Suit Connector Casing.
Apart from preventing dust from getting into the Needle and IVP area, the Dust Retardant
Cover prevents the Needle Holder from rotating. This allows the Through-the-Suit
Connector Knob from rotating freely without rotating the Needle Holder. Approach B
includes the same latex type material, which connects from the Through-the-Suit
Connector Knob to the upper portion of the Through-the-Suit Connector Casing. If
possible, both Dust Retardant Covers will be incorporated to minimize the potential of
dust particles infiltrating the Through-the-Suit Connector. Figure 19.1-6 also depicts a
proposed Plate Cover, which would be located at the bottom of the Through-the-Suit
Connector Casing. Its purpose would be to prevent the skin to be directly exposed to the
needle. A concept needs to be derived to remove the Plate Cover.

Figure 19.1-6: Dust Retardant Cover Approaches
208

Figure 19.1-7: Approach A – Dust Retardant Cover
Figures 19.1-8 to 19.1-11 depict the Through-the-Suit Connector Cover Release Lock
mechanism. The Through-the-Suit Connector Release Lock is turned to release the
Through-the-Suit Connector Cover and expose the Through-the-Suit Connector Knob.
The Through-the-Suit Connector Cover protects the Through-the-Suit Connector from
dust contamination and inadvertent actuation, i.e., rotation. As noted in Table 14.3-2,
during the Apollo program, booties were placed over the PLSS connectors to protect
them from dust. This is accomplished in this research by the use of the Connector Cover.

209

Figure 19.1-8: Through-the-Suit Connector Cover, Cover Lock, and Casing

Figure 19.1-9: Through-the-Suit Connector Cover Lock
210

Figure 19.1-10: Through-the-Suit Connector Cover Removal

Figure 19.1-11: Through-the-Suit Connector Cover Lock Detail Layout

211
The through-the-suit connector concept is four-fault tolerant, which exceeds the
two-fault tolerant requirement of NASA Human Space Systems. The first fault protection
is the Through-the-Suit Connector Cover Lock, the second is the Through-the-Suit
Connector Cover, the third is the Through-the-Suit Connector Knob (needs to turn 360
deg. for spring to be pushed down), and the fourth is the Cover Plate. With the
incorporation of these safety mechanisms, the following salient risks have been
minimized: (1) inadvertent needle activation, (2) failure to activate needle, and (3)
inadvertent needle deactivation. Future design cycles address the risk of needle
misalignment, which may lead to missing the IVP.
A built-in push-button capability, which would permit ground-control or habitat
control to remotely activate needle insertion, might also be explored. This capability
might be useful in cases where there is an unconscious astronaut and his/her “EVA
buddy” is not able to initiate IV administration, e.g., due to his/her own injury. Upon a
remote activation command, the needle would be deployed through the skin into the IVP,
providing an IV line. This remote capability may be further enhanced with a voice-
activation provision.
19.2 Conclusion
This design cycle incorporates several Through-the-Suit Connector components
which provide a four-fault tolerant protection against inadvertent activation. The first
protection is the Through-the-Suit Connector Cover Lock, the second is the Through-the-
Suit Connector Cover (and tether), the third is the Through-the-Suit Connector Knob, and
the fourth is the Cover Plate.
212
CHAPTER 20: DESIGN CYCLE #4

During this design cycle, the following components were updated: 1) Through-
the-Suit Connector, i.e., updated to Vacuum Feedthrough Connector approach, and 2)
Connector Cap. The following components were incorporated: 1) Needle Gauge Size and
Attachment Considerations, 2) Alignment Provisions, i.e., Leur-Type Connectors,
Circular Alignment Supports, and 3) Infection Prevention Provisions.
20.1 Vacuum Feedthrough Connector
Because of the challenges with pressure containment and dust protection of the
‘Design Cycle #3’ through-the-suit connector, vacuum feedthroughs were researched to
assess their applicability for this research. A vacuum feedthrough is a device that
transmits electrical current, fluids, or mechanical motion through the walls of a vacuum
chamber, while maintaining the integrity of the vacuum chamber. A mechanical
feedthrough is used for rotation and/or translation of components under vacuum; it can be
used to manipulate objects in the vacuum chamber. The standard use of a vacuum
feedthrough is to go from a pressurized environment into vacuum. However, for a
spacesuit application, it would have to go from vacuum (or low atmosphere) to a
spacesuit pressure of about 4.5 psi.
There are various types of vacuum feedthroughs, each transfer device having its
own particular advantages and disadvantages. The vacuum feedthrough method chosen
depends on the application and is normally a ‘best compromise’ solution against cost and
performance; for human space applications, safety becomes the most important factor.

213
All vacuum feedthrough types cover different aspects of the same basic
requirement - to mechanically move an object that is inside a vacuum chamber and under
vacuum. These devices can provide precise, repeatable movement or coarse positioning.
They may move the object just a few micrometers or a few feet. They may provide rotary
motion, linear motion, or a combination of both. The most complex devices give motion
in three axes and rotations around two of those axes. The mechanical movement may be
generated by two basic mechanisms: a vacuum-tight seal on a mechanical device that
moves through the vacuum wall or a magnetic coupling that transfers motion from air-
side to vacuum-side (Motion Feedthrough, 2011). Appendix I (Vacuum Feedthrough
Technology) describes the various types of vacuum feedthroughs.
20.1.1 Background
A detailed assessment of various companies that manufacture vacuum
feedthroughs was performed. Among others, companies such as MDC Vacuum
104
,
Trelleborg Sealing Solutions
105
, Applied Industrial Technologies
106
, INFICON
107
and
Ferrotec Corporation
108
were contacted and provided with the following vacuum
feedthrough requirements (Table 20.1.1-1)
109
:

104
Company URL: http://www.mdcvacuum.com/Index.aspx
105
Company URL: http://www.tss.trelleborg.com/global/en/homepage/homepage.html
106
Company URL: http://www.applied.com/
107
Company URL: http://www.inficon.com/en/index.html
108
Company URL: http://www.ferrotec.com/
109
The vendor responses received were varied. Some responded stating they did not have feedthroughs that
could support the requested application, others did not have resources to respond, while others responded
with suggested feedthrough connectors.

214
Table 20.1.1-1: Vacuum Feedthrough Requirements Sent to Manufacturers
No. Title Requirement
1 Functional The purpose of the vacuum feedthrough is to be able to inject a needle
into a 'Port-A-Cath'; implantable medical device. The needle needs to go
in at 90 deg relative to the skin. The needle will be connected to the end
of the vacuum feedthrough. Feedthrough must provide protection from
dust contamination into the suit and loss of suit pressurization. Only
linear displacement needed.

2 Displacement Total displacement of no more than 1 inch.
3 Length No more than 3 inches above vacuum interface

4 Diameter No more than 1 inch
5 Material Must be similar to current spacesuit connectors, which are made of
aluminum, with some smaller parts made from stainless steels and the
seals are synthetic rubber variations.
6 Maximum
Tolerable Leak
Rate (Static and
Dynamic)
Since this is a human rated application, lowest leak rate is required
(5.923x10
-3
= 1x10
-4
mbar l/s is generally considered as ‘watertight’).
7 Actuation Force As low force as necessary to actuate the connector with gloved hands.

8 Operating
Temperature
Range
10 to 38 degrees C (about 50 to 100 degrees F).

INFICON was the company that provided the most input and showed great
disposition to research in this area. Even though none of their vacuum feedthroughs
satisfied all the requirements, INFICON’s Technical Division provided ample
information about feedthroughs in general and suggestions on possible modified
feedthroughs applicable for a through-the-suit IV application. Below find INFICON’s
responses (Table 20.1.1-2):

215
Table 20.1.1-2: INFICON Responses
110
to Requirements
No. Requirement Requirement Compliance Assessment
1 Functional “For a functional test the rotary/linear motion feedthrough FCH016-H
offers the best fit to test a through-the-suit IV application. For a more
dedicated test, we do not have an alternative standard product. Anyhow,
technically it is not a problem to design a feedthrough that maches to
your needs. It is only a cost issue, which we normally decline for very
small production quantities.”

2 Displacement “Technically not a problem.”
3 Length “Technically not a problem.”
4 Diameter “Technically not a problem.”
5 Material “Aluminum is okay, but for very low temperatures especially, the sealing
material (synthetic rubber) has to be chosen very carefully.”
6 Maximum
Tolerable Leak
Rate (Static and
Dynamic)
“A leak rate of 1E-4 mbarl/s is only during the motion during a short
time acceptable. Anyhow this can be reached also by a simple o-ring seal
for dynamic application”
7 Actuation Force “Depending on the sealing system and materials, it might be a problem to
reach low actuation forces (< 10 N). As far as I can see, the major issue is
the initial breakaway torque which should be below 5 N. The initial
breakaway torque can be reduced when the leak rate specification can be
reduced. To do so, the sealing shape and material has to be chosen to
meet these properties.

In terms of initial breakaway torque there is nearly no difference between
linear or linear/rotatable type of feedthrough. The shaft sealing needs to
be optimized for low initial breakaway torque. If the shaft should not be
rotatable, the shaft has to be locked in radial direction, which is not
complicate. Anyhow, in your application the shaft sealing is the key
issue, all other aspects are standard mechanical design issues.

The manual rotary/linear motion feedthrough has no specific breakaway
force neither for the radial as well for the lateral motions. The major
factor defining the breakaway force is the lubrication and the involved
sealing materials and their counterparts. Anyhow, elastomer sealing
systems usually show a large spread in terms of breakaway force and
that’s the reason, why this value is not specified.”

8 Operating
Temperature
Range
“No technical problem. It is different when very low or very high
temperatures are involved.”

110
Source: Untermarzoner (2010/2011)
216
20.1.2 Vendor Vacuum Feedthrough Recommendations
Among the several recommendations received, INFICON suggested two vacuum
feedthroughs: 1) FCH016-H (Rotary/Linear Motion Feedthrough ISO-KF) and 2)
FPU016-H (Linear Motion Feedthrough CF).
20.1.2.1 FCH016-H Rotary/Linear Motion Feedthrough

Because of its volumetric compatibility and linear displacement functionality, an
FCH0-16-H feedthrough (Figure 20.1.2.1-1a and 20.1.2.1-1b) was procured from
INFICON and utilized for demo testing.

Figure 20.1.2.1-1a: INFICON FCH016-H
111

Figure 20.1.2.1-1b: INFICON FCH016-H Callouts
112

111
Source: INFICON (2003).
112
Source: Untermarzoner (2010/2011).
217

Figure 20.1.2.1-1c: INFICON FCH016-H Dimensions and Technical Data
111

20.1.2.1.1 Seals

As Figure 20.1.2.1-1b shows, the sealing is done by O-rings
113
and special shaped
elastomers
114
filled with high vacuum grease; the O-ring (Viton/FPM) used on callout
#14 (see cut view) is the static seal between the feedthrough flange (ISO-KF) (Figure
20.1.2.1.1-1) and the counterpart, e.g., process chamber; it provides a static leak rate of
1E-9 mbar l/s. Note, high-vacuum systems below 10
−9
Torr use copper or nickel O-rings.
The operational temperature of this vacuum feedthrough is 50°C. However, it can be used
in temperature environments as low as -15°C; this is limited, amongst others, by the use
of the sealing material, which is FPM/ Viton (Untermarzoner, 2010/2011). Note, vacuum

113
O-Ring – An elastomer vacuum seal available in various materials; torus or doughnut shaped, typically
circular in cross-section; may be a dynamic or static seal.
114
Elastomer – A flexible material used for completing a vacuum seal between two flat surfaces. Synthetic
material, usually rubber, nylon, or a polymer.
218
systems that have to be immersed in liquid nitrogen use indium O-rings, because rubber
becomes hard and brittle at low temperatures.
The ISO-KF (International Standard Organization – Klein Flange) flange uses a
single clamp system design to create a static vacuum seal. The purpose of the ISO-KF
flange is to connect the chamber and feethrough together. It is made with a chamfered
back surface that is attached with a circular clamp and an O-ring that is mounted in a
metal centering ring.

Figure 20.1.2.1.1-1: ISO-KF Flange
115

As opposed to the ISO-KF flange, which is a static seal, the internal seal has to be
dynamic because the shaft must stroke. The shaft glides through two special shaped FPM
dynamic seals
116
(callout #2). Those two dynamic seals (FPM) are v-shape types (filled
with high vacuum grease) with an integrated spring (Figure 20.1.2.1.1-2), e.g., garter
spring
117
, to perform a constant sealing pressure onto the gliding shaft; it provides a

115
Source: ISO-KF (2012)
116
Dynamic Seal – A seal that moves. They include oil seals, hydraulic and pneumatic seals, exclusion
seals, labyrinth seals, bearing isolators, and piston rings. They create a barrier between moving and
stationary surfaces in applications such as rotation shafts and piston rings.
117
Garter Spring – A coil spring tied end-to-end to provide a clamping force around and object. Often used
to maintain the function of radial shaft seals by keeping the elastomer seals tight against the rotating shaft.
219
dynamic leak rate of up to 1E-4 mbar l/s. The spring in the seal keeps the load on the
sealing area constant (it is not exposed to the vacuum side). The relatively big volume of
high vacuum grease is used to ensure the lubrication over the life-time. There is a small
quantity of air in this cavity, because the compartment cannot be filled without trapping a
minimum of air (Untermarzoner, 2010/2011). Appendix J (Seals) depicts common seal
types, e.g., dynamic, vacuum, and oil/grease seals.
.
Figure 20.1.2.1.1-2: Spring Energized Seal (Garter Spring)
118

20.1.2.1.2 Pressure Direction

The pressure direction is defined by the seal position and seal type. It is not so
critical in terms of pressure difference or pressure direction. The shaft is gliding through
the 2 special shaped FPM sealings. For a through-the-suit IV concept, pushing the
feedthrough from a vacuum environment (outside of spacesuit) to a pressurized
environment (inside of spacesuit ~4.5 psi) would not be a problem, i.e., the pressure
direction is not important. The seal design can cover a differential pressure of 1bar (15
psi) (Untermarzoner, 2010/2011).

118
Source: Garter Spring (2011)
220
20.1.2.1.3 Vacuum Grease

Vacuum grease is a lubricant with low volatility and is used for applications in
low pressure environments (Figure 20.1.2.1.3-1). Lubricants with higher volatility would
evaporate, causing them to not be present to provide lubrication. As well as a lubricant,
vacuum grease is also used as a sealant for joints in vacuum systems. Note, where O-
rings are used for static seals, these should not be greased as it can cause the O-rings to
become permanently distorted when compressed (Ward, 1967). Vacuum grease is
suitable for lubrication in a temperature range from -20°C to 250°C, it has extremely low
outgassing in a vacuum environment (HVG-1, 2012), it is chemically inert (stable) and
non-toxic, it is easy to use and remove, it has a long shelf life (average of 10 years), and it
has a proven track record including use by NASA, NATO, US & UK military (HVG-2,
2012).

Figure 20.1.2.1.3-1: Vacuum Grease
119

119
Source: SPI Supplies (2012)
221
20.1.2.1.4 Assessment

The FCH0-16-H feedthrough was selected as the updated baseline connector
because it provided suit pressure containment, dust protection, and linear displacement.
The dimensions were larger than desired, but the assumption was that a future design
cycle would reduce the overall size. This feedthrough was used for the Demonstration
Test #1.
20.1.2.2 FPU016-H Linear Motion Feedthrough (CF)
INFICON also suggested a bellow sealed vacuum feedthrough (FPU016-H) that
only provides linear displacement (Figure 20.1.2.2-1a, 20.1.2.2-1b, 20.1.2.2-1c); this type
of connector would actually be more applicable for a through-the-suit IV application, as
rotation is not necessary. Bellow sealed vacuum feedthroughs provide the tightest seals
possible; tighter than elastomer seals (Untermarzoner, 2010/2011).

Figure 20.1.2.2-1a: INFICON FPU016-H
111

222

Figure 20.1.2.2-1b: INFICON FPU016-H Callouts
112

Figure 20.1.2.2-1c: INFICON FPU016-H Dimensions and Technical Data
111

223
20.1.2.2.1 Bellow Welded Seal
As Figure 20.1.2.2-1a shows, the sealing is done by an edge-welded below, which
acts as a flexible seal when designed as a feedthrough, allowing movement of a shaft
within a sealed environment (Mechanical Feedthrough, 2011). Edge welded bellows
provide the lowest vacuum feedthrough leak rate possible (<1E-10 mbar l/s)
(Untermarzoner, 2010/2011). The bellow provides a dynamic seal, which eliminates the
need for dynamic elastomer seals. Edge welded bellows can be exposed to extreme
temperatures and media with a wide selection of materials. Both the inside and outside of
the bellows can be exposed liquids and gases. Edge welded metal bellows also have a
high cycle life to produce repeatable results (Mechanical Feedthrough, 2011). The edge
welded bellows allows axial stroke by expanding its length. It allows movement of the
adjacent parts, mainly in direction of the axis for easy assembly, for easy shifting and for
easy disalignment (Edge Welded Bellow, 2010). For mechanical purposes, the pressure
inside the vacuum chamber is zero, so there is a big force trying to compress the bellows.
It is therefore necessary to have a rather bulky mechanical construction to keep the
bellows stretched and the flanges parallel to each other (Linear Motion Feedthrough,
2012).
20.1.2.2.2 Conflat Flanges (CF)
As Figure 21.1.2.2-1a shows, edge-welded bellow feedthroughs utilize conflate
flanges (CF) to provide the static seal (Figure 20.1.2.2.2-1a and 20.1.2.2.2-1b). Typical
flange materials are stainless steel types 304L, 316L, 316LN; they use a copper gasket
and knife-edge flange to achieve a vacuum seal. Each face of the two mating CF flanges
224
has a knife edge which cuts into the softer metal gasket, providing an extremely leak-
tight, metal-to-metal seal. Deformation of the metal gasket fills small defects in the
flange, allowing CF flanges to operate from 760 Torr (1013 mbar) to 1 x 10-13 Torr
(<1.3 x 10
-13
mbar) pressure, and within the temperature range -196° C to 450° C. The
gasket is partially recessed in a groove in each flange. The groove helps hold the gasket
in place, which aligns the two flanges and also reduces gasket expansion during bake-out.
Care is taken to ensure that the ends of the bolts are tightened evenly and progressively
around the flange to keep the mating faces parallel. CF flanges are sexless and
interchangeable (CF Flanges, 2012).

Figure 20.1.2.2.2-1a: Conflat Flange (CF) – Figure A
120

120
Source: Conflat Flange-1 (2012)
225

Figure 20.1.2.2.2-1b: Conflat Flange (CF) – Figure B
121

Regular nuts and bolts are not suitable for CF flange applications. Various high-
tensile strength nut/bolt combinations made from low magnetic permeability, 18-8
stainless steel are used. It is strongly recommended that all bolt, nut, plate-nut
combinations are lubricated, either by one component being silver-plated or the
application of a suitable thread lubricant. Hex-head bolts (socket hex head for the mini
flange) are long enough to penetrate two (through-hole) flanges and leave sufficient
length for washers, nuts, or plate-nuts. For tapped and blind-tapped flanges, a shorter bolt
length is used that does not penetrate the tapped flange or bottom out in a blind-tapped
flange (CF Flanges, 2012).
20.1.2.2.3 Copper Gaskets
The most common form of copper used in high vacuum technology is certified
OFHC (oxygen free high conductivity) copper (Figure 20.1.2.2.3-1). OFHC copper
contains at least 99.98 Cu and no oxygen. It offers ductility, nonporosity, and extremely
high electrical and thermal conductivities. Due to its high plasticity, it is widely used for

121
Source: Conflat Flange-2 (2012)
226
gasket seals in demountable systems, such as conflate flanges (Weissler, 1979). OFHC
copper is normally used as this sealing material is very clean, can easily be formed to
shape, has a wide temperature range, and has a low outgassing rate (Gasket, 2012)

Figure 20.1.2.2.3-1: Copper Gasket
122

20.1.2.2.4 Assessments
The FPU016-H Feedthrough was considered a very good alternative, as it
provides the best seal capability with the use of an edge welded below. However,
contamination issues made this feedthrough less favorable for a through-the-suit IV
provision.
As Figure 20.1.2.2.4-1 shows, in a ‘standard application,’ as the feedthrough is
contracted, air inside the below is released to the ambient environment. The air inside the
bellow, i.e., when the bellow is extended, escapes through the gaps between the housing
and the shaft as the feedthrough is contracted. This is not a problem for vacuum chamber
applications here on Earth, where the air goes into the atmosphere; it is assumed that the
vacuum chamber is in a clean environment (meaning no contaminants enter the bellow as
the feedthrough is extended). However, contamination would be an issue for a ‘spacesuit

122
Source: Gasket (2012)
227
application’ on the Martian or Lunar surface, where EVA tasks would be exposed to dust
which could enter the bellow and impact feedthrough performance.

Figure 20.1.2.2.4-1: Standard
111
and Spacesuit Application
123

As a result of this contamination concern, a bellow feedthrough connector was
designed (Figure 20.1.2.2.4-2), which placed the bellow on the ‘vacuum’ side, i.e.,
Martian or Lunar surface pressure side. Air inside the bellow would still be pushed
through the spaces between the housing and shaft, and into the spacesuit pressurized
environment. There would be no risk of external dust contamination, as the edge wedge
bellow would provide a very tight seal. However, this design would incorporate a risk of
air pushing internal particles, e.g., grease, into the internal spacesuit breathing
environment. More importantly, contaminants could go directly near the needle, which
would be a significant safety concern. Grease seals
124
would protect against
contamination, but the possibility of air pushing contaminants into the spacesuit, would
bring about an ‘unnecessary’ risk.

123
Modified Picture from INFICON (2003).
124
Oil/Grease Seal – Seal with flexible lip that rubs against a shaft or housing to prevent the leakage or
ingress of fluids and dirt.
228

Figure 20.1.2.2.4-2: Spacesuit Bellow Feedthrough Concept
125

20.1.2.3 Magnetic Linear Motion Feedthrough (CF)
Another feedthrough that considered was a magnetic linear motion feedthrough
(Figure 20.1.2.3-1 and 20.1.2.3-2). This feedthrough uses a permanent magnet and
"teeth" cut either on the shaft, or occasionally, on the stationary pole-piece to create a
localized magnetic field gradient in a small radial gap between the shaft's teeth and the
stationary pole-piece. Magnetic fluid
126
is drawn into this gap and held in place by the
magnetic forces - in practice, the fluid forms a hermetically sealing liquid o-ring seal
above the tooth. The "captured" magnetic fluid will resist any attempts to move it from
this gap and will therefore sustain a pressure differential (Magnetic Rotary Feedthrough,

125
Source: Author (Alejandro R. Diaz)
126
Magnetic Fluid – Fluid that is attracted to a magnet, like iron. In the 1960s, NASA developed magnetic
fluid as part of the space program. Magnetic fluid has three main constituents: ferromagnetic particles such
as magnetite and composite ferrite, a surfactant, and a base liquid such as water or oil. The surfactant coats
the ferromagnetic particles, each of which has a diameter of about 10nm. This prevents coagulation and
keeps the particles evenly dispersed throughout the base liquid (Magnetic Fluid, 2012)
229
2012). This feedthrough provide negligible leakage (typically <1.0 x 10
-10
standard cc
helium/sec.) because its nonmagnetic barrier wall shuts off the vacuum and atmosphere
from each other. Since rubber is not used, this type of seal can be used in high and low
temperature environments. Since magnetic seals are sealed with standard magnetic fluid,
there is no solid-solid contact, i.e., shaft to housing contact, causing no friction or wear.
(Magnetic Seals, 2012). As a result, vacuum cleanliness is maintained, as no dust is
generated from friction (Magnetic Linear, 2012). It is a characteristic of magnetic fluid
that non-magnetic particles are actively rejected and gases are effectively sealed, making
it virtually impossible for them to pass through the magnetic fluid (Magnetic Rotary
Feedthrough, 2012).

Figure 20.1.2.3-1: Magnetic Rotary Feedthrough
127

127
Source: Magnetic Rotary Feedthrough (2012)
230

Figure 20.1.2.3-2: Magnetic Lineary Feedthrough
128

20.1.2.3.1 Assessment
After careful consideration, it was determined that this connector, while it has
many advantages, would not be the best selection for a through-the-suit IV provision.
There are several disadvantages worth noting: 1) Bearings – These components have
shown to experience substantial axial loads caused by internal feedthrough magnetic
attraction (Magnetic Shaft Couplings, 2012). This raises the risk of bearing malfunction,
and as a result, the risk of the connector not linearly displacing; 2) Cost – Out of all the
vacuum feedthroughs evaluated these were the most expensive (initially). However, it
should be noted these connectors will have a longer life compared to contact seals
feedthroughs; 3) Magnetic Impact – Given that these feedthroughs contain magnets

128
Source: Magnetic Linear Feedthrough (2012)
231
inside, it would not be advisable to use them if stray magnetic fields are present, as these
could affect connector functionality. Martian EVAs will entail the collection of rocks,
which may have remnant magnetic anomalies. A study on nearly billion-year-old rocks in
Norway showed a remnant magnetic anomaly comparable in scale to those observed on
Mars. The remnant magnetic anomaly dominates the local magnetic field to such a
degree that more than half the Earth's field is cancelled. It is nearly impossible to use a
compass in the area, which cannot point correctly north because of the strong remnant
magnetization in the rocks (Science Daily, 2007). In such a case that an astronaut would
place a magnetized rock near his chest, i.e., location of vacuum feedthrough, it is possible
that the magnetic feedthrough functionality could be impacted.
20.1.3 Temperature Considerations
Protection against the temperature extremes of Martian (-140 to 30°C) or Lunar
(-170 to 150°C) surface operations is of utmost importance. Apollo A7L spacesuits used
hoses and cables that connected the PLSS to the suit (Figure 20.1.2-1). These connectors,
male and female, were made of aluminum. Because aluminum expands and contracts
with temperature, both parts were made of the same material, so that they could expand
and shrink together (Thomas, 2010).
232

Figure 20.1.2-1: Apollo A7L Connectors
129

With the Shuttle EMU its back-pack connections pass directly through the back of
the Hard Upper Torso. There are no hoses or cables that connect externally to the suit.
With the Russian Orlan EVA suits, all of the life support components are contained
within the suit, so there is no external exposure. The new University of North Dakota
NDX-2 planetary prototype suit is also designed to contain all of the life support
components inside the suit pressure envelope (Figure 20.1.2-2). Great pains are taken to
not expose any of the metal parts of an EVA suit to direct sunlight (such as helmet
retainer ring, life support attachments, or wrist bearings). If they were exposed to direct
sunlight they would get very hot, as much as 250 degrees F. That could destroy the static

129
Source: Ayrey (2010).
233
or dynamic elastomer seals of the connector and cause them to leak (Harris, 2010). The
proposed concept baselined for this research is the UND NDX-2, which as noted is a
rear-entry suit. This would mean that the vacuum feedthrough would be the only external
spacesuit component. As a result, temperature mitigations have to be evaluated to protect
the vacuum feedthrough.

Figure 20.1.2-2: NDX-2 Spacesuit
130

130
Source: de Leon (2010)
234
Vacuum feedthrough operational temperature varies depending on the connector
selected. Taking the FCH016-H (Rotary/Linear Motion) feedthrough as an example, it is
verified to function at an operating temperature of max 50°C (Figure 20.1.2.1-1c).
This feedthrough can be used at lower temperatures than 50°C, but the lowest
temperature is limited, amongst others, by the sealing material, which for O-rings
(Viton/FPM) is -20ºC (max is +200ºC). At this low temperature, O-rings contract, freeze,
and eventually break up, jeopardizing the integrity of the static seal. As a result,
INFICON does not recommend the FCH016-H feedthrough be used at these low
temperatures (Kern, 2010-2011). Additionally, other feedthrough components can shrink,
e.g., stainless steel diameter, which may impede linear displacement; however, the
expansion and shrinkage of materials, such as Al, SS or Ti, are taken into account in the
material tolerances. This is not a huge consideration for the steady state temperature of
spacesuit connectors (Boxleitner, 2010/2011).
20.1.3.1 Indium Seals
To address the issue of elastomer seals in low temperatures, different elastomer
materials were investigated which could full-fill a secure and tight operation at the
Martian or Lunar surface temperatures. It was determined that the usual solution is to
employ Indium
131
metal O-rings to create a static seal. Indium is a metal that in the form
of a wire is used as a vacuum seal and a thermal conductor in cryogenics and ultra-high
vacuum applications (Weissler, 1979). Indium is quite soft at room temperature and when

131
Indium – Chemical element with the symbol In and atomic number 49. It is a rare, very soft, malleable
and easily fusible post-transition metal.
235
compressed tightly between two surfaces it fills any gaps between them, making a
reliable gas-tight seal. Figure 20.1.2.1-1 shows a typical Indium seal which retains its
integrity at very low temperatures. It is made by squashing a think (~1 mm diameter)
Indium wire between the flanges (Figure 20.1.2.1-2). It is wrapped around the flanges
and overlapped at the ends to form an unbroken seal (Kent, 1993). It should be noted that
there is some unconfirmed evidence that suggests that Indium compounds have a low
level of toxicity, which can damage the heart, kidney, and liver, and may be teratogenic.
On the other hand, pure Indium in metal form is considered non-toxic by most sources. In
the welding and semiconductor industries, where indium exposure is relatively high,
there have been no reports of any toxic side-effects (Indium, 1995).

Figure 20.1.2.1-1: Indium O-Ring - Flange Application
132

Figure 20.1.2.1-2: Indium Wire
133

132
Source: Kent (1993)
133
Source: Indium Wire (2011)
236
20.1.3.2 Heaters
In addition to different elastomers that could sustain low temperatures, the
incorporation of heaters to the through-the-suit IV connector was considered. The idea
would be to incorporate similar heaters to the ones NASA has incorporated to the EMU
spacesuit gloves
134
. The heaters are attached to the inner surface of the TMG. These
heaters are purposely placed outside the suit’s bladder because any sort of spark or short
circuit in the pure oxygen environment could start a fire (Spacesuit Thermal Protection,
n.d.). Thermofoil heaters are attached inside each of the fingertips in one of the layers of
the glove, and have an on-off switch near each of the gloves' wrists (Facts About
Spacesuits, 2009). Heaters are only placed on the gloves because of two reasons: 1) Lack
of heat is felt first at the body's extremities, notably the fingers tips, and 2) As opposed to
boots which can be heavily insulated to keep toes warm, glove insulation is limited by the
need for manual dexterity; EVA efficiency can be adversely affected when astronauts'
hands become uncomfortably cold (Spacesuit Gloves, 2012).
20.1.3.3 Assessment
Upon review of the Apollo spacesuits, it was determined that its external
connectors were protected from the temperature extremes of the Lunar surface by the
TMG layer (they were attached to the pressure restraint and bladder layers as they passed
through the suit). The connectors were not exposed to wide temperature variations; the
main heat they were affected by was primarily from metabolic heat produced by the

134
Note, the general principle behind spacesuit thermal control is that the astronaut's body makes heat that
is controlled by the life support system. If it gets to hot in the spacesuit, either because the astronaut is
working hard or is in direct sunlight, the water cooling removes the heat. The reverse problem is when the
astronaut cannot put enough heat into the spacesuit to stay warm (Spacesuit Gloves, 2012).
237
astronaut (Harris, 2010). These spacesuit connectors were used for oxygen, coolant
water, and communications purposes. They were mostly aluminum with some smaller
parts made from stainless steels, and the seals were synthetic rubber variations (Ayrey,
2009). Current spacesuit connectors are made of similar materials, i.e., Al 6061, Al 7075,
SS 316, Ti 6-4 (Boxleitner, 2010). The TMG maintained the temperature of the Apollo
spacesuit connectors within limits of 10 to 38°C (about 50 to 100°F) (Harris, 2011).
Since Apollo, material science has advanced significantly and current TMGs, i.e., EMU,
can protect greater thermal protection for the astronaut. The outermost layer of the EMU
TMG is a white Ortho-Fabric covering (made of a blend of Gortex, Kevlar and Nomex),
which can withstand temperatures from −184 °C ( −300 °F) to 149 °C (300 °F) (EMU
TMG, 2001).
Utilizing the same approach and using a TMG flap to protect the through-the-suit
IV connector would eliminate the need to resort to Indium seals or heaters to sustain the
low temperatures the vacuum feedthrough will experience on the Martian (-140°C) or
Lunar (-170°C) surfaces. The TMG flap will cover the feedthrough connector and it will
be attached to the spacesuit with the use of Velcro straps. It should be noted that there
will be a time period where the 'EMT' astronaut will have to remove the Velcro straps to
remove the connector cap and push the feedthrough connector into the implanted chest
port of the injured astronaut. This should not take long; on the order of no more than 60
seconds. Once the needle is in, the connector cap would be placed back and the TMG flap
will be reattached. The time period when the TMG flap is removed is of no concern for
the connector to increase/decrease in temperature. On the lit side of the moon, if the
238
connector metal is polished and reflective (like chrome) it will not get hot during such a
brief exposure. In fact it could stay exposed for quite a few minutes before it started to
warm. On Mars it would start to slowly cool, but due to the Martian atmosphere being
only between 7 to 10 Torr (mm Hg) it would cool very slowly as the only heat loss would
be through infrared radiation, rather than conduction (Harris, 2011). In any case, an
approach to mitigate even the slightest possibility of heat loss/gain during this brief time
period could be for the 'EMT astronaut to have a TMG material 'flap' that he 'velcroes' to
his wrist so that as he/she is removing the connector cap and linearly displacing the
feedthrough connector, the TMG material would cover the whole connector area.
20.2 Connector Cap
The objectives of the connector cap are to 1) provide dust protection to the
vacuum feedthrough connector, 2) provide protection against inadvertent linear
activation, and 3) provide protection against any lateral impacts. In turn, the connector
cap is protected from environmental effects, e.g., dust, thermal gradients, etc., by the
TMG layer. The connector cap extends the length of the vacuum connector and screws on
to the cap base, which is adhered to the HUT. The connector cap has grooves designed
into its top portion, which increase the gripping capability for the astronaut. This allows
the EVA gloved-handed astronaut to provide the torque required to rotate the cap (Figure
20.2-1). Connector cap dimensions and attachment to HUT are depicted in Figures 20.2-2
and 20.2-3, respectively.
239

Figure 20.2-1: Connector Cap and Cap Base

Figure 20.2-2: Connector Cap and Cap Base Dimensions
240

Figure 20.2-3: Cap Base and Feedthrough Attachment to HUT
20.3 IV Needle Size and Attachment Considerations
Needle size descriptions include a number, then a G, then another number. The
first number (in front of the G) indicates the gauge of the needle. The gauge of a needle
represents the outer diameter of the needle; smaller gauge numbers indicate larger outer
diameters and vice versa. The second number indicates the length of the needle. For
example, a 22 G 1/2 needle has a gauge of 22 and a length of ½ an inch (Galan, 2009).
241

Figure 20.3-1: Needle Gauge Chart
135

For subcutaneous injections, which go into the fatty tissue below the skin, require
a smaller, shorter needle. A needle that is ½ inch to 5/8 of an inch long with a gauge of
25 to 30 is usually sufficient to administer the medication. For intramuscular Injections,
which go into the muscle below the subcutaneous layer, the needle must be thicker and
longer to ensure that the medicine is being injected into the proper tissue. Twenty (20) or
22 G needles that are an inch or an inch and a half long are usually appropriate for this

135
Source: Needle Gauge (2012)
242
type of injection. A person who is thin, with very little fatty tissue can use the inch long
needle; a heavier person may need to use the inch and a half long needle (Galan, 2009).
For chest port injections, a Huber needle is used. This is an especially designed
hollow needle, which has a long, beveled tip that can go through the patient’s skin, as
well as the silicone septum of the implanted chest port's reservoir. The beveled tip of a
Huber needle will not remove a core of silicone from the port – this prevents a chunk of
silicone or skin from lodging in the catheter line and makes the port last longer. Port
infusion needles are sized to match the type of implanted port the patient has; ports have
different thicknesses (Stephan, 2011). Most manufacturers provide needles ranging from
0.5 to 1.5 inches in length, and are usually color-coded. The general guideline for Huber
needles is that the needle needs to get to the back of the chest port. The needle length
depends on the specific patient and includes factors such as skin thickness, fat tissue, and
type of implanted chest port. For example, a 1-inch Huber needle should be used for thin
adults, a 1.5” Huber needle for heavier adults and a 3/4-inch Huber needle for children
(Faith, 2011). Additionally, according to Dr. Katz (2010), for chest port applications,
needle gauges range from 19 to 22. Considering these factors, a 20G x 0.5” needle was
selected for this design cycle because of constraint dimensions between the patient’s
chest and the HUT, i.e., 2 in distance
136
.
Several chest port and Huber needle manufacturers were contacted, including
Bard Access Systems
137
, Navilyst Medical
138
, Smiths Medical
139
, MedComp
140
, RITA

136
According to de Leon (2012), the distance between the chest and HUT is approximately 2 inches. The
distance between the person’s back and the spacesuit is about 4.5 inches; however, that depends on the test
subject body size. Note, these distances were obtained using the NDX-2 spacesuit.
137
Bard Access Systems website: http://www.bardaccess.com/catalog-ports.php#
243
Medical Systems
141
, and AngioDynamics
142
. Most provided valuable information and
Bard Access Systems provided sample chest ports and Huber needles in support of this
research. Bard Access Systems manufactures the ‘SafeStep Huber Needles’ (Figure 20.3-
2), which are the most popular used chest port needles in hospitals today (Eckert, 2010).
Taking into account the chest port thickness (approximately 0.6 in (1.5 mm)) and skin
thickness, a 1 inch needle is recommended (Katz, 2011) to ensure the needle tip reaches
the back of the port. The needle holder is incorporated into the vacuum feedthrough with
the use of a needle holder adaptor. The needle holder adaptor has a M3 x 0.5 Screw
143
,
which screws into the vacuum feedthrough shaft (Figure 20.3-3).

Figure 20.3-2: SafeStep Huber Needle
144

138
Navilyst Medical website: http://www.navilystmedical.com/about/index.cfm/1
139
Smiths Medical website: http://www.smiths-medical.com/customer-support/contact-us.html
140
MedComp website: http://www.medcompnet.com
141
RITA Medical Systems website: http://wwwhmpforlife.com/
142
AngioDynamics website: http://www.angiodynamics.com/about/contact-us/
143
Source: McMaster-Carr website: http://www.mcmaster.com/#catalog/109/2893/=g8pnrg
144
Source: Huber Needle (2012)
244

Figure 20.3-3: Vacuum Feedthrough to Needle Holder Attachment
20.4 Alignment Provisions
Alignment of the vacuum feedthrough to the implanted chest port is of utmost
importance. A misaligned feedthrough could miss the chest port and/or be injected into
other chest areas. This is what is commonly called a ‘missed hit’. This is a phrase used to
describe swelling which appears around an injection site during or immediately after
injection. It may be caused by fluid entering the tissue surrounding the vein because the
needle has not entered the vein properly, entered the vein and slipped out again, entered
the vein and gone through the opposite wall; or entered the vein correctly but excess
pressure caused the vein to split. A ‘missed hit’ will mean that the drug is absorbed much
245
more slowly by the body, so that the effect will be less pronounced. It can also lead to
other problems such as abscesses, cellulitis, and cutaneous foreign body granulomas
(Vein Damage, 2003). In the case of an implanted chest port, needle misalignment can
lead to port damage, which would render the through-the-suit IV provision useless.
As a result, alignment is needed to ensure the needle is adequately aligned with
the implanted chest port. The issue is that there is some relative movement between the
HUT (where the vacuum feedthrough is connected to) and the astronaut’s chest (location
where the port is located). This movement varies depending on body position, suit
pressure, and time spent inside the suit. According to Harris (2010), the movement of the
upper torso with respect to the HUT is minimal, i.e., the chest stays in about the same
spot inside the HUT (side-to-side). Similarly, Fabio Sau (NDX-1 Spacesuit Test
Subject)
145
also noted that this displacement was minimal, i.e., less than 5 centimeters on
up-down axis and 1 or 2 centimeters on the side-to-side axis (Sau, 2010). To confirm
these preliminary assessments, a test was conducted at the University of North Dakota’s
Spacesuit Laboratory to determine the movement of the body inside the suit; the test
description is depicted in Chapter 26 - Demonstration Test #1. Results yielded that the
HUT moves approximately 2 inches left to right, and about one inch up down (de Leon,
2011).

145
The NDX-1 Prototype Planetary Spacesuit was designed based on the anthropometric dimensions of Mr.
Fabio Sau. It was tailored made for him; built for a test subject measuring 5’10” and weighing around
160lbs (Sau. 2010). Therefore, his experience should e a more accurate representation of how much a torso
moves relative to the HUT.
246
20.4.1 XY Plane Vacuum Feedthrough
To mitigate this alignment displacement between the chest and HUT, the first
approach considered was a linear vacuum feedthrough with the capability to be
maneuvered in the X and Y axis (axes in the same plane as the HUT). A feedthrough
which meets these characteristics is the MDC V-Plane® Dual Axis XY Manipulator
(Appendix I). However, these connectors are not only heavy, i.e., 24 lbs, but they are also
bulky; on average, 5in x 7in x 8in (Bitz, 2010). An attempt was made to conceptually
integrate this connector into a spacesuit HUT, but volumetrically it was simply too
intrusive. Advanced research will have to be conducted to miniaturize this type of
connector. However, even if the size and weight issue are eventually constrained, the
connector appears to bring too much complexity for a through-the-suit IV provision.
20.4.2 Alignment Supports
Initially, the objective was to design only one alignment support (#1) that would
encircle the chest port and take the lateral and shear forces, and torsion that the would
otherwise go through the Luer-Type LCVG-to-HUT Male and Female Adaptors
146

(described in Section 20.5.1). However, it was determined that a second alignment
support (#2) would also need to be incorporated on the opposing side of the astronaut’s
chest to prevent a HUT offset. Without alignment support #2, the HUT offset could force
alignment support #1 to bend or twist. These supports have holes designed into them to
allow air circulation through them. They are mated/demated to the LCVG and the HUT
with the use a connection mechanism discussed in Chapter 22 (Design Cycle 6).

146
Note, as Section 20.5.1 depicts, these Luer adaptors protect the Huber Needle from contamination by
creating a closed compartment where the needle resides.
247

Figure 20.4.2-1: Alignment Supports

Figure 20.4.2-2: Alignment Support Dimensions
A side effect that alignment support #1 provides is protection to the astronaut
from inadvertent contact with the Huber needle tip. According to Harris (2010), NDX-2
testing shows that part of the time the astronaut’s chest touches the inner wall of the
0.5”
248
HUT. The alignment support creates a barrier between the chest and the HUT, in turn,
preventing the chest from pushing into the needle and scraping the skin.
20.4.3 Padding for Alignment
The real trick to getting good spacesuit mobility is to get as good a fit as possible,
i.e., minimize the relative movement of the astronaut to the suit. Once in there, the
astronaut should be in there pretty tight. An additional benefit to a tight fit is that it
prevents possible skin chafing from torso, i.e., shoulder rubbing against the inside of the
spacesuit (Harris, 2011). During the Apollo era, each person had their own suit, i.e., the
suits were custom-made to fit each astronaut. This is also one of the philosophies behind
the Russian way of building spacesuits (Sau, 2010).
It is envisioned that astronauts will get fitted and the fit of their HUT will be snug.
However, as Demonstration Test #4 concluded, there is some relative movement between
the HUT and the astronaut’s chest. This is of particular importance for a through-the-suit
IV connector design concept. To mitigate the impact of HUT to Chest relative movement,
in addition to the alignment supports, the recommendation is for padding to be
incorporated at specific places, i.e., side torso, over shoulders, etc., between the astronaut
torso and the HUT. The padding would be similar to the type of padding used during
NBL training; these are inserted on top of the LCVG (Figure 20.4.3-1). In the NBL
application, the padding is needed because gravity pulls the astronaut into areas of the
Hard Upper Torso (HUT) when he/she is in an inverted position underwater (Ayrey,
2011). This type of padding was not used during Apollo as those spacesuits were custom
fitted for each astronaut. They are also not baselined for use during zero-g EVAs since
249
the internal interfaces are more comfortable, i.e., no pressure points. However, NASA has
used padding in the upper body for some astronauts in the EMU (Harris, 2011).
Additionally, it is envisioned that hard suits like the AX-5, would require additional
internal padding for astronauts in order to reduce the risk of injury due to contact with the
hard interior of the suit.

Figure 20.4.3-1: Padding Use During NBL Training
147

From a LCVG functionality perspective
148
, adding padding on top of the LCVG
raises two issues. The first one deals with the internal spacesuit ventilation process.
Adding padding would hinder the free flow of air inside the suit. Hoses go to the legs and
arms and circulate the air around the suit. To resolve this potential issue, the padding
would have to have openings integrated into its design, which would allow for continued

147
Source: Ayrey (2011)
148
Padding would not impact LCVG heat removal, as the majority of the heat would be removed by the
LCVG between the skin and the LCVG (underneath the padding) via conduction and convection processes.
250
circulation. The second concern deals with the squeezing and collapsing of the PVC
LCVG tubing, which could hinder liquid circulation (de Leon, 2011). The LCVG tubes
are hard, but further research would need to be conducted to determine whether they can
sustain the pressure from the body and the padding.
20.4.4 LCVG to Skin Alignment
According to Harris (2010) and Polanski (2010), the LCVG is a tight fitting
garment, which yields relatively no movement with respect to the skin, especially in the
upper torso (Figure 20.4.4-1). The movement relative to the skin is about the same as a
close fitting suit of long-john underwear (Harris, 2010). Movement is only extremely
minimal in certain areas, away from joints (Polanski, 2010). Nonetheless, given the
importance to maintain the needle aligned to the chest port, it must be ensured that the
LCVG will not move relative to the skin. It should be noted that a circular area (~2"
diameter) will be exposed, i.e., no LCVG material/tubes, on top of the chest port location
to allow insertion of the Huber needle. According to de Leon (2011), the creation of a
special area in the LCVG where no tubing is present is totally possible; re-tubing of the
LCVG tubing was successfully performed for the NDX-2 LCVG.
To ensure the LCVG garment does not flex and move over the exposed area,
double-sided tape will be used between the skin and the LCVG. The double-sided tape
will go around the circular edge of the LCVG hole; this is discussed in Section 20.4.5. On
the other side of the LCVG, the Luer-Type Female Adaptor will be adhered. LCVGs
typically have various sensors and connectors attached to it, so there would be no
problem with adapting a connector to the LCVG over this area (de Leon, 2011).
251

Figure 20.4.4-1: NDX-2 LCVG
149

20.4.5 LCVG Adhesive
As depicted in Section 20.4.4, the LCVG provides a very tight fit for the
astronaut. However, due to the importance of maintaining the circular area
150
on top of
the chest port accessible, it must be ensured that the LCVG does not move relative to the
astronaut’s chest. To achieve this, double-sided tape will be used to secure an area of the
skin and garment so no movement is possible (de Leon, 2011). The concept of adhering
equipment to a person’s skin is a well developed and commonly used practice. A salient
example is the adhesion of medical devices, such as EKG elctrodes
151
, to the skin surface.

149
Source: de Leon (2010)
150
LCVG circular area will be free of tubes or material.
151
EKG electrodes usually consist of a conducting gel, embedded in the middle of a self-adhesive pad onto
which cables clip; sometimes the gel also forms the adhesive (EKG, 2012).
252
To this end, several adhesive material companies were contacted, including 3M
152
and
Scapa,
153
and the requirements listed in Table 20.4.5-1 were provided to them.
Table 20.4.5-1: Double-Sided Tape Requirements Sent to Manufacturers
No. Requirement Requirement Compliance Assessment
1 Adhesion Materials One side of the adhesive shall adhere to the medical device, i.e., nylon
type material, while another side would adhere to the skin.

2 Skin Moisture The adhesive shall be able to retain its adhesive properties after exposure
to skin moisture (sweat). [Even though the inside of a spacesuit has a
system to remove moisture and control temperature, the adhesive must
still work if the astronaut starts to sweat.]
3 Reusability The adhesive shall be reusable. [Identify how many times it can be
reused]
4 Skin Protection Adhesive shall not cause any damage to the skin (blood pooling, rashes,
etc).
5 Duration The adhesive shall retain its adhesive properties after being on the skin
for up to 8 hours (longer if possible).

Both companies responded and provided double-sided tape samples. After testing the
samples, it was determined that Scapa’s gel adhesives had stronger adhesive properties
between the skin and a cloth garment (LCVG). Scapa’s medical-grade silicone gels
adhesives are made for direct skin contact, and are available in various breathable thermal co-
polymer films and non-woven materials. The tapes can be removed, cleaned, and reused, as they
wash off with water and regain adhesion when properly dried. Their main areas of use include
neonatal care, wound care, medical device attachment, and hypertrophic scarring reduction
(Silicone Gel Adhesive, 2006).
The double-sided samples that Scapa sent were especially prepared by Scapa for
evaluation for this research. They include an improved gel formulation for higher skin
adhesion (Cristobal, 2011). The two double-sided samples sent were 1) UNIFILM®

152
3M website: http://solutions.3m.com/wps/portal/3M/en_US/WW2/Country/
153
Scapa website: http://www.scapa.com/en/
253
UP5040 (adhesive) / BIOFLEX® RX1400P (silicone gel adhesive) (Figure 20.4.5-1), and
2) UNIFILM® U880 (adhesive) / BIOFLEX® RX1400P (silicone gel adhesive) (Figure
20.4.5-2). These double-sided samples were custom-made by Scapa to satisfy the specific
needs of this through-the-suit-IV research (Figure 20.4.5-3). As a combined double-sided
tape, these samples are not commercially product; however, as individual components
they are, i.e., BIOFLEX® RX1400P single coated silicone gel adhesive, UNIFILM®
U880 single coated acrylic transfer adhesive, UNIFILM® UP5040 single coated acrylic
pressure sensitive transfer film (Wingfield, 2012). BIOFLEX® RX1400P is intended for
wound dressings, sensitive skin and neonatal applications, medical device attachment,
scar management, skin therapy, and adhesive bras. While, UNIFILM® U880 and
UNIFILM® UP5040 are adhesives which provide good adhesive shear strength for
materials such as nylon and urethane foams; this is especially important for a through-
the-suit IV provision because it would hinder relative lateral movement between the
astronaut’s chest and the LCVG. The specifications of these three adhesives are depicted
in Appendix K (LCVG Adhesive Descriptions).

Figure 20.4.5-1: Double-Sided Adhesive – Layers Callouts
254

Figure 20.4.5-2: Double-Sided Adhesive Samples Provided
154

Scapa’s development of these samples demonstrates that manufacturing of double-
sided tapes for skin and nylon adhesion for a through-the-suit IV provision is possible. As
Chapter 23 (Demonstration Test #1) depicts, these adhesives demonstrated very strong
adhesive properties during sample testing.
20.5 Internal Contamination Provisions
Every precaution must be taken to avoid contamination of the IV needle. The IV
route can be a dangerous route of administration because it bypasses all of the body's

154
Source: Samples provided by Scapa North America (http://www.scapa.com/en/)
255
natural barriers. As a result, a contaminated needle can have very serious consequences:
infections, emboli
155
, and occlusions
156
(McAuley, 2011).
According to Paul (2010), lunar dust did infiltrate the inside of the space suit
during Apollo EVAs, according to lessons learned from the Apollo missions. Since
Apollo, some knowledge has been acquired regarding the contaminants and level of
infiltration that can be expected from lunar and Mars dust, however, risk mitigation
strategies and filtration designs that will prevent contamination within a spacesuit life
support system are yet undefined (Cognata, et. al, 2009). It is entirely likely that the inner
layers of the suit, including the LCVG, will collect dust just as a filter does (Cognata,
2010). As a result, NASA is conservatively assuming that dust can get practically
anywhere inside the space (Conger, 2010). Not only would dust inside the spacesuit
environment be problematic for astronaut inhalation (Cognata, et. al, 2009), but it also
could be an issue if it entered the Huber needle before penetrating the skin (Conger,
2010). As a result, provisions need to be incorporated to prevent needle contamination
prior to injection (Paul, 2010).
20.5.1 Luer-Type Connectors
Luer adaptors are standardized small-scale fluid fittings used to provide leak-free
connections between a male fitting and its mating female part on medical and laboratory
instruments, including hypodermic syringe tips and needles, IV tubing, etc. (ISO 594-1,
1986). Luer fittings are securely joined by means of a tabbed hub on the male fitting

155
Emboli - An embolus (plural emboli) is any detached, itinerant intravascular mass (solid, liquid, or
gaseous) carried by circulation, which is capable of clogging flow in a blood vessel.
156
Occlusion - An obstruction or a closure of a blood vessel.
256
which screws into threads on the female fitting. This concept was modified and
incorporated to the proposed through-the-suit IV design to provide a closed compartment
for the Huber needle to reside in. This protects the needle from dust contamination that
may have entered the internal pressurized environment.
The Luer-Type Male Adaptor is attached to the HUT inner wall, shown in ‘green’
in Figure 20.5.1-1, and the Luer-Type Female Adaptor is attached to the LCVG exterior,
shown in ‘yellow’ in the same figure. The adaptor dimensions are depicted in Figure
20.5.1-2. The Luer-Type Lock is loosely connected to the Luer-Type Male Adaptor.
During assembly the Luer-Type Male Adaptor is inserted into the Luer-Type Female
Adaptor. To secure the two adaptors, the Luer-Type Lock is rotated clockwise, so that the
Luer-Type Female Adapter screws into threads in the Luer-Type Lock.

Figure 20.5.1-1: Luer-Type Adaptors
257

Figure 20.5.1-2: Luer-Type Adaptor Dimensions
Using a similar concept, an LC34-9 Luer Coupler
157
(provided by Value Plastics,
Inc.) (Figure 20.5.1-3) is incorporated (permanently adhered) into the upper side-wall of
the Luer-Type Male Adaptor. This creates a ‘fluid feedthrough’ connection from the
outside to the inside of the Luer-Type Male Adaptor, maintaining the closed
compartment dust free. The female side of the LC34-9 Luer Coupler is located on the
outside of the closed compartment, while the male side of the LC34-9 Luer Coupler is
located on the inside of this compartment. Tubing on both sides of the Luer-Type Male
Adaptor connect to the LC34-9 Coupler to make the connection from the IV Pump to the
Needle Holder Assembly. For disinfection purposes, both ends of the Luer Coupler must

157
LC34-9 – Male Luer Integral Lock Ring to Female Luer Thread Style Coupler, Clear Polycarbonate.
258
remain capped when not in use. Additionally, disinfectant fluid should be used to clean
the Luer Coupler before and after use, as well as during IVP maintenance procedures.

Figure 20.5.1-3: Luer Coupler – LC34-9
158

20.6 Conclusion
This design cycle demonstrates that incorporation of a vacuum feedthrough, as a
through-the-suit IV connector, into a spacesuit design is feasible. Figures 20.6-1 through
20.6-5 provide an overview of this design cycle. Figure 20.6-2 shows the linear
displacement lock, which prevents inadvertent linear actuation, as well as the rotation
stopper, which prevents rotational movement. Figure 20.6-4 shows the vacuum
feedthrough in its stowed (un-injected) and displaced (injected) positions. Appendix L
(Design Cycle 4 Engineering Drawings) depicts the detailed engineering drawings for
each Design Cycle 4 component.

158
Source: Luer Couplers (2012)
259

Figure 20.6-1: Design Cycle 4 Overview

Figure 20.6-2: Design Cycle 4 Callouts
260

Figure 20.6-3: Design Cycle 4 Length Dimensions

Figure 20.6-4: Feedthrough Locked and Inserted Positions
261

Figure 20.6-5: Notional Location of Vacuum Feedthrough
262
CHAPTER 21: DESIGN CYCLE #5
21.1 Prototype Connector Design
The objective of this design cycle was to manufacture a prototype feedthrough
connector (non-functional vacuum feedthrough), which eliminated the rotation capability
and overall volume of the FPU016-H vacuum feedthrough. The prototype connector
manufactured incorporates a simplified representation of a linear anti-rotation
feedthrough. A cylindrical solid metal piece, i.e., the ‘housing,’ with a rectangular linear
displacing rod (‘displacer’) substitutes the FPU016-H vacuum feedthrough. A rectangular
hole/slot was created in the cylindrical piece for the ‘displacer’ to be inserted into. Both
the ‘housing’ and ‘displacer’ were manufactured
159
from Aluminum 6061-T6. A
surrogate HUT was also manufactured from Aluminum 3003 sheet metal
160
.
The ‘displacer’ is inserted inside the slot of the ‘housing’ and locked in place with
the Push Pin (92384A013). The needle holder adaptor is screwed into the ‘displacer’, just
as the Design Cycle #4 baseline. The pin prevents the ‘displacer’ from sliding up or down
before injection and after injection. It has small locking bearings that hold the pin in
place; they are lowered when the button on the head of the pin is pressed and locked back
when the head is released. Two holes are placed in the ‘displacer’ for the pin to go
through.

159
Manufacturing was performed by Josue Porres (Aerospace Engineer) at AeroWorx (http://www.aero-
worx.com/). The machines used were the HAAS VF 2 VOP-5 for milling operations and HAAS SL VOP-B
10 for turning operations.
160
Material procured at M&K Metal Co. (http://mkmetal.net/); an Amada DCT3013 was used to shear the
sheet metal.
263
21.2 Conclusion
This design cycle demonstrates that manufacturing of a surrogate feedthrough
with reduced dimensions is feasible. Figures 21.2-1 through 21.2-4 provide an overview
of this design cycle. Appendix M (Design Cycle 5 Engineering Drawings) depicts the
detailed engineering drawings for each Design Cycle 5 component.

Figure 21.2-1: Prototype Connector Components
264

Figure 21.2-2: Prototype Connector Integration with HUT

Figure 21.2-3: Prototype Connector Integration with Needle Holder Adaptor
265

Figure 21.2-4: Prototype Connector Push-Pin
161
(Linear Displacement Lock)

161
Source: Quick-Release Pins (2005)
266
CHAPTER 22: DESIGN CYCLE #6
22.1 Proposed Flight-Like Design
Using all the knowledge gained through the previous design cycles, Design Cycle
6 proposes a ‘Flight-Like Design’ which is to be interpreted as the point-of-departure
(POD) for future design and analysis cycles leading up to a critical design review (CDR).
The objectives of the ‘Flight-Like Design’ are to 1) take the best design aspects from
each design cycle, and 2) simplify
162
and miniaturize, as much as possible, the connector
feedthrough design. In doing so, it assumes that future spacesuit companies and suppliers
will have the ability to develop components to fit the needs of a through-the-suit IV
provision, e.g., smaller vacuum feedthrough.
During this design cycle, these were the notable incorporations (Figures 22.1-1
and 22.1-2): 1) connector cap updated to include EVA wing type handle, tether, and lock
mechanism; 2) CF flanges, which reduce the overall length of the vacuum feedthrough
connector extruding from the HUT; 3) two seals to provide a vacuum dynamic capability
and contamination prevention (axial seal); 4) linear lock device to prevent inadvertent
activation and deactivation; 5) shaft grapple fixtures for better EVA glove connector
handling; 6) attachment mechanism between the alignment supports and LCVG; and 7)
Luer-Type Female Adaptor base updated to reduce the circle through hole.

162
According to Harris (2010), efforts should always be made to make spacesuit design engineering as
simple as possible.
267

Figure 22.1-1: Design Cycle Overview

Figure 22.1-2: Design Cycle Callouts
268
22.1.1 Connector Cap
The connector cap was redesigned to incorporate EVA glove design
recommendations. First, the cap was given a spherical shape near the top to eliminate any
sharp edges. Secondly, per NASA-STD-3000, an EVA Wing Tab design (Figure
15.1.2.1.2-2) was selected (Figures 22.1.1-1 and 22.1.1-2), which provides higher torque
capability to the gloved-hand astronaut to unscrew the connector cap.
In zero-g EVA support operations, tethering is a means of securing EVA
equipment at all times to prevent inadvertent loss. In the case of planetary surface
operations, tethering is important to prevent the cap from falling to the surface and being
contaminated. The tether is permanently adhered on one end to the cap base and on the
other end to the top portion of the connector cap (near the EVA wing type design)
(Figures 22.1.1-1).

Figure 22.1.1-1: Cap and Feedthrough Dimensions

269

Figure 22.1.1-2: Cap and Cap Base Dimensions

A cap lock was also incorporated into the cap to hold it in place and prevent
inadvertent cap removal. The cap base has a male protrusion and the cap lock has the
female receptacle. Once the cap is completely screwed into the cap base (it rotates twice
during insertion), the lock rotates to secure the cap. During insertion, the lock must align
to the cap base in order for correct insertion and removal. To remove the cap, the process
is reversed (Figures 22.1.1-3 through 22.1.1-5).
270

Figure 22.1.1-3: Cap Lock to Cap Base Connection

Figure 22.1.1-4: Cap/Lock Alignment
271

Figure 22.1.1-5: Cap/Lock Rotation

22.1.2 CF Flanges
As Design Cycle 4 showed, the use of ISO-KF flange creates a larger protrusion
out from the HUT. This is due to the clamp that is necessary to mate the feedthrough and
the chamber to create a vacuum seal; O-ring is mounted between the feedthrough and
chamber in a metal centering ring. The wing nut closure incorporated into the clamp also
caused the connector to have a wider footprint, causing the connector cap to have a wider
diameter.
To mitigate these disadvantages with the ISO-KF flange, CF flanges were
incorporated (Figures 22.1.2-1 and 22.1.2-2). The CF flange design selected for inside the
suit is a blind-tapped flange; for this flange, holes are drilled only part way through the
272
flange and do not break through. This internal-suit CF flange is welded to the HUT. The
CF flange external to the suit is a standard through-hole flange, and is part of the vacuum
feedthrough housing. This approach only uses bolts (no nuts), meaning the bolt enters
through the external-suit flange and bottoms out in the internal-suit flange, i.e., blind-
tapped flange. The bolt may be shorter in length, but still allows for full gasket
compression before the bolt bottoms out. Both the internal and external CF flanges have
holes that provide threads through their entire thicknesses.
Blind-tapped flanges are used in high vacuum applications to reduce leak paths
via the through-holes. They are also used when accessing the nuts is difficult or
impossible. For this application, accessing the nuts would not be an issue; post-EVA, the
needle adaptor would be removed (unscrewed), making the nuts accessible. However,
using a blind-tapped flange provides mass reduction, albeit small, with the elimination of
the nuts; something that is desirable in all space applications.

Figure 22.1.2-1: Conflat Flange Attaches to HUT with Bolts (blue)
273

Figure 22.1.2-2: CF Flanges and Needle Holder Adaptor
163

22.1.3 Dynamic and Contamination Seals
The objectives of the dynamic and contamination seals are to provide a vacuum
seal between stationary and moving surfaces; i.e., a dynamic environment such as a linear
vacuum feedthrough where the shaft is being linearly displaced within the housing
(Figure 22.1.3-1). The proposed dynamic seal is derived from a dynamic seal called the
DMR™ Metric Series - 409012-DL (Figure 22.1.3-2). The modified seal combines two
of these dynamic seals into one (Figure 22.1.3-3). The intent of this combined seal
approach is to contain vacuum grease within the seal, yet still make contact with the
shaft. Apart from serving as a lubricant, the vacuum grease also acts as a vacuum sealant.
The combined dynamic seal contains two garter springs, which are contained within the

163
As this figure shows, the needle holder adaptor maintained its design from previous design cycles.
274
seal, and press the sealing lips against the shaft (creating a vacuum seal) (Figure 22.1.3-
3). The sealing lips (only two) are designed in a conical form to obtain a minimum
contact area between the shaft and seal, thus considerably reducing friction, heat and
wear. The seal membrane is made from polymer material for its elastic properties, which
are necessary to reduce friction with the shaft. To seal maintains its shape with the use of
metal inserts that are contained within the membrane. Even though the combined
dynamic seal provides protection against dust contamination, given the nature of this
research, i.e., for human applications, a secondary a contamination seal was incorporated
to add fault-tolerance to the design (Figure 22.1.3-4). This seal has no gater springs or
vacuum grease, and it is just composed of a polymer membrane with metal inserts. It has
one contamination lip which is pressed against the shaft to prevent contaminants, e.g.,
dust particles, grease outgassing, etc., from entering the spacesuit. These Design Cycle 6
seals are depicted in Figure 22.1.3-5.
275

Figure 22.1.3-1: Vacuum Seal Approach

Figure 22.1.3-2: DMR™ Metric Series - 409012
164

164
Source: DMR Dynamic Seal (2012)
276

Figure 22.1.3-3: Modified Dynamic Seal

Figure 22.1.3-4: Contamination Seal

Figure 22.1.3-5: Dynamic and Contamination Seal
277
22.1.4 Linear Lock
The linear lock is used to secure the shaft in its location (Figures 22.1.4-1 and
22.1.4-2). Prior to linear displacement, the linear lock is pressed against the shaft
preventing axial movement. Once the linear lock is unscrewed the shaft is able to be
displaced. Once the desired position is achieved, i.e., the needle has inserted the chest
port septum, the shaft (needle) is secured by re-screwing the linear lock, tightening it
until it is pressed against the shaft. To prevent damage to the shaft, the linear lock has a
polymer based tip.

Figure 22.1.4-1: Linear Lock

278

Figure 22.1.4-2: Linear Lock
22.1.5 Shaft Grapple Fixtures
IV administration is a procedure that requires utmost control of the IV equipment,
i.e., syringe. For this research, the alignment is provided by alignment provisions;
however, the EVA EMT still requires adequate control of the connector to slowly
displace the needle into the injured astronaut’s chest port. The proposed shaft handle
incorporates an ergonomic design; it utilizes wide grapple fixtures (Figure 22.1.5-1),
which allow for a better grip with greater control. The astronaut will use his/her index
and middle fingers to grip the two shaft grapple fixtures, and inject the needle into the
chest port.
279

Figure 22.1.5-1: Shaft Grapple Fixture
22.1.6 Alignment Support Attachments
The alignment supports (Figure 22.1.6-1) are permanently adhered to the HUT;
however, their connection to the LCVG is removable. This allows easier access to the
needle compartment for needle replacement. Additionally, it makes it easier for spacesuit
donning/doffing operations. The Alignment Support-to-LCVG attachment mechanism
entails two connectors, composed of a male component adhered to the LCVG and a
female component which is part of the alignment support. The red button, depicted in
Figures 22.1.6-2 through 22.1.6-6, is pushed in and held in place by a spring in the back
(not shown). When pressed, the button allows the LCVG alignment lock to be inserted
280
into the button groove. Once in place, the button is released and securing the LCVG
alignment lock.

Figure 22.1.6-1: Alignment Supports

Figure 22.1.6-2:Alignment Support-to-LCVG Connection Mechanism
281

Figure 22.1.6-3: Button Deactivated

Figure 22.1.6-4: Button Activated
282

Figure 22.1.6-5: LCVG Alignment Lock inserted into Button

Figure 22.1.6-6: Button Released – LCVG Alignment Lock Secured

283
22.1.7 Luer-Type Female Adaptor
Per recommendation of Dr. Michael Katz (Interventional Radiologist), an
additional alignment aid provision was incorporated into the Luer-Type Female Adaptor
(Figure 22.1.7-1). The objective was to reduce the diameter of the Luer-Type Female
Adaptor through hole. The chest port is under the skin and it extrudes outward; therefore,
the intent is for the through-hole (Figure 22.1.7-2) to encircle the top of the port (septum).
To ensure that the Luer-Type Female Adaptor does not move relative to the chest port,
double-side medical grade tape would be used to adhere the LCVG to the skin.

Figure 22.1.7-1: Luer-Type Adaptors

284

Figure 22.1.7-2: Luer-Type Female Adaptor - Base Hole
22.2 Conclusion
This design cycle integrates design features from the previous design cycles and
demonstration tests. It provides a simple, yet elegant approach for a flight-like through-
the-suit IV design. The design dimensions (Figure 22.2-1) and features would be
adequate to be incorporated into a planetary surface prototype spacesuit. Figures 22.2-2
depicts the proposed linear displacement approach for this design cycle, and Appendix N
(Design Cycle 6 Engineering Drawings) depicts the detailed engineering drawings for
each Design Cycle 6 component.

285

Figure 22.2-1: Side Section View - Dimensions

Figure 22.2-2: Linear Displacement

286
CHAPTER 23: DEMONSTRATION TEST #1
23.1 Test Description
The objective of Demonstration Test #1 was to test the adhesion capabilities of
the two double-sided tapes that Scapa North America provided: 1) UNIFILM® UP5040
(adhesive) / BIOFLEX® RX1400P (silicone gel adhesive) (Figure 20.4.5-1), and 2)
UNIFILM® U880 (adhesive) / BIOFLEX® RX1400P (silicone gel adhesive) (Figure
20.4.5-2). The proposed approach is for a circular ring (approximately 2” thick) of
double-sided tape to be placed on top of the astronaut’s skin (surrounding the chest port);
the other side of the tape would adhere to the edge of the LCVG circle, which provides
the ‘free’ area on top of the chest port.
For purposes of this test, a surrogate LCVG was used for the demonstration.
Several concepts which would simulate the tight fit of an LCVG were researched, e.g.,
wetsuits, thermo-clothing, long-john pajamas, etc. Ultimately, a upper body garment
called the BodyGuard™ Compression Shoulder Brace was selected (Figure 23.1-1). This
brace is designed to reduce the effects of shoulder separations/subluxations, shoulder
dislocations, shoulder joint instability, post operative rehabilitation of the shoulder joint
and impact trauma to the shoulder and upper back (AntiBody, 2012).
The test subject donned the BodyGuard™ Compression Shoulder Brace, and the
double-sided tape sample was used to adhere the brace to the subject’s chest.
Furthermore, alignment supports were also glued to the brace on top of subject’s chest.
The test subject performed the following tasks: 1) jump up and down, 2) bend forward
and backwards, 3) rotate left and right, and 4) extend arms outwards.
287

Figure 23.1-1: BodyGuard™ Compression Shoulder Brace
165

23.2 Test Pictures

Figure 23.2-1: Alignment Supports Connected to Simulated LCVG

165
Source: Gilliam (2010)
288

Figure 23.2-2: Test Subject with Arms Down

Figure 23.2-3: Test Subject with Arms Up

Figure 23.2-4: Test Subject with Arms Extended Outward

289
23.3 Conclusion
Figures 23.2-1 through 23.2-4 depict the subject performing the various test tasks.
The test demonstrates that the alignment support did not move, relative to the skin
adhesion point, while performing any of the tasks. Furthermore, the subject noted no
discomfort when the alignment support was removed.
290
CHAPTER 24: DEMONSTRATION TEST #2
24.1 Test Description
The USC IRB required that a manikin test be performed before development
moved into human subject testing. To that end, the objective of Demonstration Test #2
was to perform a preliminary bench test with a manikin to evaluate the proposed through-
the-suit IV provision. The manikin selected was the Chester Chest™
166
. This life-sized
anatomical human torso model enables clinicians and others to develop total competence
with two of the most common types of long-term vascular access routes within one
simple, compact, and portable training aid. The Chester Chest™ is equipped with a
prepositioned surgically placed central catheter (chest port) and a peripherally placed
central catheter (PICC). The distal ends of each catheter are attached to “blood” reservoir
bags (Chester-Chest, 2012).
The components that were integrated with the Chester Chest™ during this test
were: 1) Vacuum feedthrough, 2) Simulated HUT, 3) Alignment supports (2), 3) Leur-
Type Male Adaptor, 4) Luer-Type Female Adaptor, 5) Luer-Type Adaptor Lock, 6)
Huber Needle (20G x 0.5”), 7) Needle Holder Adaptor, 7) Double-sided adhesive
samples, 8) Simulated ‘blood’ reservoir bags, 9) Syringe, and 10) Syringe Tubing.

166
Initially, the intent was to purchase a Chester-Chest™, however, their average cost is between $1500
and $2000 dollars. As a result, the Chester-Chest™ at the Mt. San Antonio College (MSAC) Health
Careers Resource Center (HCRC) was used. To do so, the author had to register for the HCRC Laboratory
course. HCRC’s policy is to only allow students who are in a MSAC health occupation course to register
for the Lab; however, Kathy Killiany (HCRC Coordinator) waived that requirement for this author. MSAC
is located in Walnut, CA. The Health Careers Resource Center (HCRC) website is
http://www.mtsac.edu/instruction/continuinged/noncredit/health/resource_center.html
291

Figure 24.1-1: Chester Chest Components
167

Figure 24.1-2: Chester Chest Port
167

167
Source: Chester-Chest (2012)
Simulated ‘Blood’
Reservoir Bag
Chest Port
Simulated
Skin
292
24.2 Test Pictures

Figure 24.2-1: Manikin – Port Exposed/Unexposed

Figure 24.2-2: Double Sided Adhesive Installation

Figure 24.2-3: Feedthrough Connector Installation

293

Figure 24.2-4: Syringe Tubing Installation

Figure 24.2-5: IV Administration Test with Chester Chest Skin

Figure 24.2-6: IV Administration Test without Chester Chest Skin
294

Figure 24.2-7: Simulated Blood Extracted into Syringe

24.3 Conclusion
As Appendix O discusses, the USC IRB required that a manikin test be performed
before development moved into a human subject testing phase. In support of fulfillment
of that requirement, this first manikin test was conducted at the MSAC Health Careers
Resource Center in November 2011. The Huber needle was injected into the manikin
chest port, demonstrated by the successful simulated blood withdrawn into the syringe
(Figure 24.2-7). However, there were several issues with the clearances allocated in the
design. Namely, the 20G x 0.5 in. needle was too short to penetrate the simulated
manikin skin, and the needle had too small of a clearance between its tip and the manikin
skin. Table 24.3-1 describes the issues encountered during the test, as well as their
proposed solutions.

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Table 24.3-1: Demonstration Test #1 - Results and Recommendations
No. Issue Description Recommendation
1 Cap Holder / Cap
Diameter
Cap holder and cover cap
inner diameter is too small.
Vacuum Feedthrough Anti-
Rotation Lock and ISO-KF
Flange does not fit.
Design Cycle 6 will include a
proposed flight-like concept which
will incorporate internal anti-rotation
mechanism and CF flanges. These
changes will reduce the overall
diameter of the cap holder and cap.
2 Vacuum
Feedthrough
Connector Housing
Housing contact surface area
is small, not allowing proper
adhesion to HUT surface.

Design Cycle 6 will incorporate a
flange on the lower section to increase
the contact surface area between the
vacuum feedthrough connector and
the HUT surface.
3 Cap Holder / Cap
Attachment
Cap cover does not screw into
its proper location. This might
be due to the tight fit in the
grooves, increasing friction.
CAD model was reviewed and the cap
holder grooves appeared to be
adequately spaced. It appears this was
a 3D printing error. Post-doctoral
research will entail re-printing
connector cap and cap holder.
4 Vacuum
Feedthrough Anti-
Rotation Lock
Anti-rotation mechanism and
ISO-KF flange design is too
big.
Design Cycle 6 will incorporate
internal anti-rotation mechanism and
CF flanges. The updated vacuum
feedthrough will be a smaller
redesigned connector.
5 Needle Length The needle used (0.5 in. long)
was not long enough to
penetrate the simulated skin
and enter the port reservoir
Incorporate a 20Gx1in. needle to be
able to penetrate the port reservoir.
This will impact the Luer-Type Male
Adaptor and alignment supports (2).
These design updates will be re-3D
printed and retested using the manikin
(Demonstration Test #3).
6 Needle Clearance The needle tip had a 0.25 in.
clearance. This was
determined to be too close to
the manikin skin.
Increase the Luer-Type Male Adaptor
to provide a larger clearance between
the needle tip and the manikin skin.
Objective is to obtain at least a 0.5 in.
clearance between the needle tip and
manikin skin.

296
CHAPTER 25: DEMONSTRATION TEST #3
25.1 Test Description
Following up on the results and recommendations from Demonstration Test #2,
several design updates were incorporated and tested during Demonstration Test #3. The
test objectives were: 1) evaluate whether the increased Huber needle would be able to
penetrate the manikin chest port (with simulated skin layer attached), and 2) evaluate the
clearance between the Huber needle tip and the manikin simulated skin. The test setup
was the same, except for the following updated components: 1) Alignment supports
increased to a height of 2 inches, 2) Luer-Type Male Adaptor increased to a height of
1.875 inches, and 3) Huber Needle updated to 20G x 1 in.
25.2 Test Pictures

Figure 25.2-1: Alignment Supports Located on Manikin

297

Figure 25.2-2: Connector to Needle Holder Assembly

Figure 25.2-3: Test Setup Assembly Complete

Figure 25.2-4: Connector Inserted Into Chest Port

298
25.3 Conclusion
Figures 25.2-1 through 25.2-4 depict the updated components 3D-printed in white
ABS Plastic material. The test successfully demonstrated that the Huber needle could be
injected into the manikin chest port, demonstrated by the successful simulated blood
withdrawn into the syringe. Additionally, the clearance between the Huber needle tip and
the manikin simulated skin was deemed acceptable. This test confirmed the dimensions
selected and the updated configuration was used to perform the human subject test
(Chapter 27 - Demonstration Test #5).
299
CHAPTER 26: DEMONSTRATION TEST #4
26.1 Test Description
Relative alignment between the HUT and the astronaut’s chest is important to
maintain the Huber needle (attached to HUT) aligned with the chest port. According to
Harris (2010), the movement of the upper torso with respect to the HUT is minimal, i.e.,
the chest stays in about the same spot inside the HUT (side-to-side). This preliminary
assessment was verified with a test that was coordinated with Mr. Pablo de Leon at the
University of North Dakota’s Spacesuit Laboratory.
For the test, Mr. de Leon (test subject) donned a long-john type pajama and went
into the NDX-2 spacesuit. A marker, on an attachment box assembly
168
(Figure 26.2-1),
was adhered with double-sided tape
169
perpendicular to the inside wall of the HUT
(Figure 26.2-2). The marker was located flushed against the subject’s chest, so that as Mr.
de Leon performed pre-coordinated movements (Figure 26.2-3), the marker drew
markings on the pajama (Figure 26.2-4). The subject moved vigorously inside the suit,
just as an astronaut would during actual physical work during an EVA (de Leon, 2012).

168
The attachment box assembly was made of aluminum. A hole was made to it to insert the marker.
169
The double-sided tape was standard 3M double-sided tape with a 1 mm thick plastic cushion.

300
26.2 Test Pictures

Figure 26.2-1: HUT to LCVG Indicator (Pen)

Figure 26.2-2: Indicator (Marker) Installation

301

Figure 26.2-3: HUT to LCVG Relative Movement Test

Figure 26.2-4: LCVG Marking Results

302
26.3 Conclusion
Test results yielded that the HUT moves approximately 2 inches horizontally, and
about 1.25” vertically (Figure 26.2-4) (de Leon, 2011). This validates experimentally the
preliminary assessments that were provided by Mr. Gary Harris and Mr. Fabio Sau. The
author’s conclusion is that these displacements are minimal and can be limited with the
alignment provisions proposed for a through-the-suit IV provision (Section 20.4).

303
CHAPTER 27: DEMONSTRATION TEST #5
27.1 Objectives
The objectives of Demonstration Test #5 were: 1) assess the ability of a doctor
(trained in IV administration) to inject a needle into a human subject’s chest port, without
having any visibility to his/her chest, 2) demonstrate that blood can be successfully
withdrawn, and 3) assess any discomfort that the patient may have during the procedure,
i.e., other than what he/she is already accustomed to as part of his/her regular treatment
with a chest port. Appendix O (Human Subject – USC IRB) describes the process that
had to be undertaken to be able to use a human subject as part of this demonstration test.
During the test, the simulated spacesuit HUT created a visual barrier to the chest
port; therefore, the doctor had to be guided simply by the alignment design incorporated
into the connectors that aligns the spacesuit hard-upper-torso to the circular area over the
chest port. Patient assessment could not be obtained with the use of a manikin, and the
doctor assessment had higher fidelity with the use of a human subject. To obtain this
assessment, the use of only one human subject was necessary. There was no need to
perform this test on various human subjects, as the chest port IV administration aspect of
this test is a well established and understood medical practice.
The test took place in a sterile environment, as it occurred during a chest port
removal procedure. During the time of the subject's scheduled clinic visit, the treating
physician (Dr. Katz) provided the potential subject with information on the study. The
study was described, it was emphasized that study would take place during his/her chest
304
port removal procedure, and that there was minimal risk to his/her well being. After the
patient indicated interest in the study, the consent process was initiated.
Prior to removal of chest port, Dr. Michael Katz (Faculty Study for this Study)
accessed the chest port with the aid of through-the-suit connector design. Once the chest
port was accessed, Dr. Katz attempted to withdraw blood to confirm venous access (chest
port access). The test included the following components: 1) Vacuum feedthrough, 2)
Alignment supports (2), 3) Luer-Type Male/Female Adaptors, and 4) Surrogate HUT.
Dr. Katz identified a human subject with an implanted chest port, who was
referred to him for chest port removal. There was no additional training the staff received
for this test. The test procedures were as follows (Figures 27.2-1 through 27.2-8):
a. Alignment support (yellow) was used as stencil to draw HUT alignment support
(white) outline on subject’s chest.
b. Simulated spacesuit HUT was placed over the subject’s chest.
c. Chest port was accessed without visualization
d. Withdrawal of a small amount of blood was attempted
e. Chest port was be de-accessed
f. Simulated spacesuit HUT was removed
g. Skin was be re-cleaned
h. Standard chest port removal procedures were initiated
305
27.2 Test Pictures

Figure 27.2-1: Pre-Procedure Assembly

Figure 27.2-2: Alignment Support Marking

Figure 27.2-3: IV Administration – Test Run #1
306

Figure 27.2-4: IV Administration – Test Run #1

Figure 27.2-5: IV Administration – Test Run #2

Figure 27.2-6: IV Administration – Test Run #2

307

Figure 27.2-7: IV Administration – Test Run #3

Figure 27.2-8: IV Administration – Test Run #3

27.3 Conclusion
Three attempts were made to withdraw blood via the chest port using the through-
the-suit IV connector. In all three cases, the needle hit the chest port, however, in a
location other than the septum, which prevented blood from being withdrawn. Since the
needle did not penetrate the septum, the needle was actually pushing the septum away
and there was push-back effect on the connector; observation that was noted by Dr. Katz.
Figure 27.3-1 depicts the three approximate needle insertion locations. As can be seen, all
three tests missed the septum (center point).
308

Figure 27.3-1: Test Insertion Locations
170

The main reason for this misalignment was a feature of the demonstration test
setup, rather than the design itself. For this demonstration test, the alignment provision
which aligns the LCVG to the Alignment Supports was not incorporated. As Design
Cycle #6 shows, the LCVG is connected to the Alignment Supports via the use of
detachable connectors, which were not 3D prototyped for this demonstration due to
schedule and cost constraints. An alternative for this demonstration would have been to
adhere the simulated LCVG, i.e., BodyGuard™ Compression Shoulder Brace used in
Demonstration Test #1, to the Alignment Supports; however, this ‘permanent’ adhesion
would have made accessing the needle, and associated components, very challenging for
Dr. Katz. As a result, it was decided not to include the simulated LCVG. Another reason
the LCVG was not included was that the test subject was not identified until the morning
of the test. Given that each person has a unique chest port location, it would have been
impossible to identify where the hole in the LCVG should have been made prior to the

170
Septum shown is not the one used during the test; septum shown is for illustration of approximate needle
insertion locations.
309
test. As Figure 27.3-1 shows, the septum was not missed by much; the needle insertions
were approximately 0.5” (1.27 cm) from the septum center and only a few millimeters
from the edge of the port. This may not seem like much, but it represents the difference
between a successful and unsuccessful chest port access. Furthermore, it highlights the
importance of incorporating a precise alignment design. The demonstration test
alignment tolerances were not precise enough to have the needle hit the center of the port.
The alignment needs to be with the port septum rather than the port itself, and the septum
is only approximately 0.5” in diameter.
During the procedure, Dr. Katz asked the human subject on several occasions,
whether he felt any discomfort. The human subject responded that apart from the needle
going into the port, he had no other discomforts. This verifies the assumption that was
made prior to the test.
This test demonstrates that use of an implanted chest port, Huber Needle
assembly, and a vacuum feedthrough connector is a feasible way of delivering through-
the-spacesuit IV administration. However, precise alignment is essential. The LCVG to
Alignment Support Alignments detachable connectors and updated Luer-Type Female
Adaptor design (Chapter 22 - Design Cycle #6), as well as the LCVG to Skin double side
adhesive (Section 20.4.5 - LCVG Adhesive), need to be incorporated into future testing
to demonstrate their effectiveness to access the chest port septum. Figure 27.3-2 depicts
Dr. Katz’ demonstration assessment.

310

Figure 27.3-2: Dr. Katz Demonstration Assessment
311
CHAPTER 28: MATERIALS ENGINEERING
28.1 Materials for Use in Vacuum
Materials for use in space applications are materials showing very low rate of
outgassing (Appendix P - Outgassing) in vacuum. The requirements grow increasingly
stringent with the desired degree of vacuum (Table 14.2-1). Materials can produce gas by
several mechanisms: 1) Molecules of gases and water can be adsorbed on the material
surface (therefore materials with low affinity to water have to be chosen, which
eliminates many plastics); adsorbed gases can be reduced by bakeout; 2) Materials may
sublimate in vacuum (this excludes some metals and their alloys, most notably cadmium
and zinc); 3) The gases can be released from porous materials or from cracks and
crevices. Traces of lubricants or residues from machining can be present on surfaces.
Materials for space use must consider mechanical properties, thermal properties and gas
loading; requirements for which are identified in Table 28.1-1. Additionally, Table 28.1-2
provides an assessment of what materials are, or are not, recommended for use in vacuum
environments (Schmaus, 2000).
Table 28.1-1: Material Property Requirements
171

Property Description
Mechanical Properties 1. The material must be capable of being machined and fabricated.
2. It must have adequate strength at maximum and minimum
temperatures to be encountered, and must retain its elastic, plastic,
and/or fluid properties over the expected temperature range.
Thermal Properties 1. The material's vapour pressure must remain low at the highest
temperature.
2. Thermal expansion of adjacent materials must be taken into
account, especially at joints.
Gas Loading 1. Materials must not be pourous.
2. Materials must be free of cracks and crevices which can trap

171
Source: Schmaus (2000)
312
Property Description
cleaning solvents and become a source of virtual leaks later on.
3. Surface and bulk desorption rates must be acceptable at extremes of
temperature and radiation.

Table 28.1-2: Materials for Vacuum Use Assessment
171

Material Description
Metals 1. Austenitic Stainless Steel is the most commonly used metal for high and ultra-
high vacuum systems since it fulfills all of the requirements above. U.S. 321,
347, and 304 are chosen most frequently for satisfactory argon-arc welding.
Stainless steel is relatively economical,has acceptable outgassing rates,and can
be fabricated easily
2. Aluminum and Aluminum Alloys are very cheap, easy to machine, and have
a low outgassing rate as long as the alloy does not have a high zinc content.
They have the disadvantage of low strength at high temperatures and high
distortion when welding. Aluminum that will be exposed to vacuum should
never be anodized due to serious outgassing problems.
3. Mild Steel may be used down to about 10E-3 mbar or lower if plated. High
permeability to hydrogen and possible rusting make this material unsuitable for
lower pressure vacuum envelopes.
4. Oxygen Free High Conductivity (OFHC) Copper is easily machined with
good corrosion resistance, and is widely used for vacuum applications. It is not
generally used for vacuum envelopes that require baking due to possible heavy
oxidation, scaling, and the difficulty of brazing in a hydrogen atmosphere.
5. Brass has good corrosion resistance and may be suitable for some applications.
Brass components to be used in vacuum are usually Nickel plated to reduce
outgassing due to the Zinc content in Brass.

Metals Used in
Demountable
Seals
1. Copper Rings are commonly used for high and ultra-high vacuum
applications. CF flanges use a copper ring compressed between two knife
edges, are bakeable to 450 Degrees C ,and are widely used.
2. Aluminum Wire Rings are very cheap and bakeable to 200 Deg C
3. Indium Wire can be used between flat flanges. It is very soft and continues to
flow after initial tightening.
2. Gold wire is often used for Ultra-High Vacuum seals between flat surfaces,
and can be baked to 450 Degrees C.. Gold is somewhat easier to recycle than
Indium, offsetting its high initial cost.

Plastics The use of plastics should be kept to a minimum due to their high gas permeability
and high desorption rates compared with metals, glass and ceramics. In spite of
this, plastics are often used in vacuum systems because of their insulating
properties, elasticity, and price.
1. PTFE has self-lubricating properties, a relatively low outgassing rate, is a
good electrical insulator, and can be used at higher temperatures than other
Table 28.1-1: Continued
313
Material Description
plastics. High permeability makes PTFE unsuitable as part of the vacuum
envelope.
2. Nylon has self lubricating properties but a high outgassing rate and a high
adsorption rate for water.
3. Acrylics have the same undesirable vacuum properties as nylon.
4. Polycarbonates and Polystyrene have moderate outgassing rates and water
adsorption characteristics and are good electrical insulators.
5. PVC has a high outgassing rate but does find application for rough vacuum
lines and temporary connections such as leak detectors.
6. Polyethylene may be usable if well outgassed.
7. Nalgene ™ bell jars are available from Fisher Scientific and in some cases
may be a cheaper substitute for glass bell jars if some discretion is used.
8. Vespel® Polyimide is ultra-high vacuum compatible, easily machined and an
excellent insulator from DuPont. Guide pamphlets on Vespel are available
from DuPont at 1-800 222 VESP . (Wilmington,DE 19898,U.S.A.) Vespel
tends to be very expensive.
9. G10 Glass Epoxy is available in blocks, difficult to machine, and has a high
initial outgassing rate. I know of at least one Boulder, Colorado company that
uses G10 Glass epoxy as a substitute for Vespel and tolerates the long initial
outgassing time as a cost saving measure.
10. Fluoroplastics include Kel-F ™, PVDF (Kynar ™), TFE - Kel F has a fairly
tolerable outgassing rate, is not subject to cold flow, and while expensive, is
much cheaper than Vespel for some applications.
Elastomers 1. Nitrile Rubber a.k.a. Buna ™ is widely used in demountable seals, i.e., "O"
rings.
2. Viton® is bakeable to 200 Degrees C. and more suitable at lower pressures.
Viton® does have a tendency to compression set.
High Vacuum
Compatible
Lubricants
1. Krytox is a fluorether-based vacuum grease, useful from -75 to over 350 °C,
not flammable even in liquid oxygen, and highly resistant to ionizing radiation
2. Polyphenyl ether greases
3. Torrlube is a syringe applicable, vacuum compatible lubricant for moving parts
in vacuum.
Vacuum
Compatible
Epoxys
1. Varian Torr Seal is a solvent free epoxy resin that can be used at pressures of
10e-09 mbar and below at temperatures from -45 Degrees C. to bake
temperatures of 120 Degrees C. Torr seal dries to a hard, white consistency,
and tends to be a bit pricey.
2. Kurt J. Lesker KL-325K is a solvent free epoxy packaged in a divider pouch.
KL-320K is useful in the 10e-05 to 10e-07 torr range. Lesker also sell a
conductive epoxy ( KL-325K ) but it's not recommended for pressures below
10e-03 torr.
3. Vacseal is a low vapour pressure silicon resin available in aerosol spray cans
and brush-on applicator bottles. The manufacturer claims it's good for
applications from liquid helium temperatures to 450 Degrees C.
Vacuum 1. 3M 850 Polyester Film Tape has a low outgassing rate and is sometimes used
Table 28.1-2: Continued
314
Material Description
Compatible Tapes to attach low power sputtering targets, in lieu of the expensive Silver bearing
epoxy techniques used at higher power levels.
Materials that
should not be
used in vacuum
1. Cadmium, often present in the form of cadmium plating, or in some soldering
and brazing alloys
2. Zinc, problematic for high vacuum and higher temperatures, present in some
construction alloys, e.g., brass.
3. Magnesium
4. PVC, usually in the form of wire insulation
5. Paints
6. Many plastics, namely many plastic tapes.

28.2 Dust Considerations in Material Selection
Lunar dust did not seem to adhere to coater fabrics or smooth surfaces during the
Apollo EVAs, at least not as much as woven fabrics. This fabric trait would indicate that
Martian or Lunar surface suits should be fabricated from tightly woven fabrics that have
special dust resistive coatings, or made from as many hard, smooth components as
possible (or both if it is a hybrid suit). In the 1990s, a polytetrafluoroethylene-coated
expanded tetrafluoroethylene fabric was investigated for this dust resistive use and
seemed to hold promise. An all-hard suit would resist dust due to their smooth surfaces
(Harris, 2001; Kosmo, 1990).
A vacuum compatible lubricant can be soaked into a compressed felt strip to act
as a dust trap. The many options for fabricating the felt to serve as a dust trap include
adhesive coatings of fibers to encourage dust retention, use of vacuum oils and greases,
proper selection of fiber shape and length, and selection of pore size. The present
knowledge of felts is such that it could serve with confidence as an adequate bearing seal
Table 28.1-2: Continued
315
material with only intermittent maintenance. This same approach could also be used to
keep dust from EVA suit closure connections, sizing inserts, and space vehicle and
habitat airlock closures (Harris, 2001; Kosmo, 1990).
28.3 Conclusion
Selecting the right materials for space applications is of utmost importance.
Outgassing and dust considerations are important issues that need to be considered. For a
through-the-suit IV concept, the vacuum is on the outside of the pressurized spacesuit
environment. Any gases liberated from the through-the-suit IV connector would go to the
planetary surface environment. There is a small risk that they be readsorbed on other
spacesuit surfaces, but that is unlikely. In either case, the materials selected for the
through-the-suit IV connector, which will be exposed to vacuum will be a combination of
stainless steel (304 or 321) and aluminum, e.g., the knob (Feedthrough, 2012). The inside
components will also be metals, surface treated to lower outgassing (Linear Drive, 2012).

316
CHAPTER 29: HABITAT MEDICAL CAPABILITY AND PROCEDURES
29.1 Planetary Surface Habitat Medical Capability
Phase 3 type exploration missions to the Moon or Mars must have an on-board,
autonomous medical care system, which is capable of fulfilling the medical needs of the
crew. Planning for Phase 3 type missions must include judicious analysis of the
limitations on mass, volume, power and medical training (Barratt and Pool, 2008). The
capabilities of the CMO and the medical hardware available in the habitat will determine
the medical, including surgical, capabilities of the planetary surface medical system
(Barratt and Pool, 2008).
Assumption ‘b’ in Chapter 1 states that “In an EVA emergency, the primary
objective is to transport the injured/ill EVA crewmember back to a pressurized habitat
where the spacesuit can be taken off and medical treatment administered.” This means
that after the injured EVA crewmember is in the habitat and his/her spacesuit has been
removed, the habitat must have the required medical capabilities to treat the
crewmember. Not having such provisions would render a ‘through-the-suit IV’ capability
null, since the intent of a ‘through-the-suit IV’ capability is to keep a patient alive only
during the ‘golden period’. At the very least, the habitat medical module must consist of a
surgical workstation (similar to an operating table), x-ray capability, a ventilator, a
defibrillator, monitors, an intravenous pump, a medical computer, restraint capabilities,
and storage for medical and surgical supplies.
A major concern applicable to this research is the ability to maintain a proper
cleanliness environment inside the habitat medical module. Significant efforts were made
317
to incorporate dust prevention provisions inside the suit to protect the needle from
contamination. Similar efforts must be incorporated in the habitat; however, it is
understood that this will be a much more difficult endeavor. There is a major theoretical
contamination concern associated with performing surgical procedures in planetary
surface habitats (as compared with a standard operating room). Planetary habitats are
expected to be relatively dirty environments, which could increase the incidence of
wound infections. For example, the amounts of particulates and colony-forming units in
spacecraft atmospheres are higher than in a conventional operating room atmosphere by a
factor of 10. Furthermore, there is evidence which suggests that the relative numbers of
pathogenic bacteria on skin and surfaces may increase during long-duration space flights,
and that medical facilities may be located near waste-management facilities, kitchen, or
exercise areas on future planetary surface habitats; these factors may lead to complication
with medical treatment, e.g., contamination of wounds (Barratt and Pool, 2008).
These concerns may be mitigated through the use of surgical overhead canopy
and laminar flow devices, which have been shown to lower these counts logarithmically.
In addition, a habitat medical module should be incorporated, which would adhere, as
much as possible, to similar cleanliness requirements as medical facilities on Earth. This
module would be separate from waste-management facilities, kitchen, or exercise areas
(Barratt and Pool, 2008). During an EVA emergency, the crew would enter an
‘emergency room’ airlock, where dust would be removed with dust removal equipment,
such as: 1) ‘Air-shower’ concept which utilizes repressurization air to blow off dust
(loose dust is collected in filters in airlock floor); 2) ‘Vacuum Hose’ could also be used to
318
remove dust; 3) Crew can also use electrostatic brushes to remove dust; 4) Adhesive-
sheets floor mats could also be used to remove any remaining dust on the spacesuit boots
prior to entering the habitat. After the crew exits the airlock, they would enter into an
EVA Equipment area, where the spacesuit would be removed and stored. Further
cleaning procedures are performed before finally entering the habitat medical module.

Figure 29.1-1: Representative Habitat Medical Module
172

172
Source: Hoffman (2001)
319
29.2 IVP Maintenance Procedures
For human spaceflight, IVPs could be used in three salient scenarios: (1) IVA
medical emergency, (2) IVA regular IVP maintenance, or (3) EVA medical emergency.
Table 29.2-1 depicts a sample set of IVP procedures for these scenarios.
1. Scenario 1 (IVA medical emergency) – For this scenario, there is no spacesuit
interface as operations are conducted in shirt-sleeve environment. IV procedures
for ISS are well established, as depicted in the “International Space Station
Integrated Medical Group (IMG) Medical Checklist,” JSC-48522-E4. It is
assumed that, at the very least, missions to other planets would include equivalent
medical provisions as are currently in the ISS. An IVP would augment ISS
medical provisions, and could be used as an alternative when an astronaut needs
IV treatment, but his/her veins cannot be readily accessed, e.g., dehydration.
2. Scenario 2 (IVA regular IVP maintenance) – For this scenario, there is no
spacesuit interface as operations are conducted in shirt-sleeve environment. IVPs
must be maintained if they are not regularly accessed. They are kept from clotting
by infusing Heparin (anticoagulation) and Saline solution. This maintenance
would be done approximately every month (Czarnik, 2009).
3. Scenario 3 (EVA medical emergency) – Before every EVA (pre-EVA
Operations), the IVP must be prepared in case there is a need to use it during an
EVA emergency. The IVP is sterilized and flushed. A sterile needle is also
connected into vacuum feedthrough connector.
320
Te
Table 29.2-1: IVP Maintenance Procedures
173

Procedure
Step
Scenario 1: IVA
Emergency,
e.g., IV infusion, blood
draw, etc.
Scenario 2: IVP
Maintenance
(IVA)
Scenario 3: EVA Emergency
(Pre-EVA Operations)
1 Wash hands with
antibacterial soap or
alcohol hand gel for 30
seconds.
Wash hands with
antibacterial soap or alcohol
hand gel for 30 seconds.
Wash hands with
antibacterial soap or alcohol
hand gel for 30 seconds.

2 Open the sterile glove
package to set up a sterile
field.
Open the sterile glove
package to set up a sterile
field.
Open the sterile glove
package to set up a sterile
field.

3 Peel open the normal saline
and heparin flush
packages. Lay them down
next to the sterile field.
Open two large sterile 4 x
4 gauze squares on sterile
field.
Peel open the normal saline
and heparin flush packages.
Lay them down next to the
sterile field. Open two large
sterile 4 x 4 gauze squares
on sterile field.
Peel open the normal saline
and heparin flush packages.
Lay them down next to the
sterile field. Open two large
sterile 4 x 4 gauze squares on
sterile field.

4 Open the needle and valve
and drop them onto sterile
field. Be careful not to
touch any part of needle.
Open the needle and valve
and drop them onto sterile
field. Be careful not to touch
any part of needle.
Open the needle and valve
and drop them onto sterile
field. Be careful not to touch
any part of needle.

5 Put on your sterile gloves.
Twist the valve onto the
needle extension set.
Put on your sterile gloves.
Twist the valve onto the
needle extension set.
Put on your sterile gloves.
Twist the valve onto the
needle extension set.

6 Clean the IVP site and 2-3”
of skin around the area (1
min); use back and forth
friction.
Clean the IVP site and 2-3”
of skin around the area (1
min); use back and forth
friction.
Clean the IVP site and 2-3”
of skin around the area (1
min); use back and forth
friction.

7 Allow to air dry. Do not
blot, wave at, or blow dry
the area. While drying, do
not allow your clothing to
come in contact with
cleaned area.
Allow to air dry. Do not
blot, wave at, or blow dry
the area. While drying, do
not allow your clothing to
come in contact with
cleaned area.
Allow to air dry. Do not blot,
wave at, or blow dry the area.
While drying, do not allow
your clothing to come in
contact with cleaned area.

8 Be sure to keep all supplies
sterile. The outsides of the
saline and heparin flush
syringes are clean, not
sterile.
Be sure to keep all supplies
sterile. The outsides of the
saline and heparin flush
syringes are clean, not
sterile.
Be sure to keep all supplies
sterile. The outsides of the
saline and heparin flush
syringes are clean, not sterile.

9 Pick up the saline syringe
with a sterile 4 x 4 and
twist it on the end of the
Pick up the saline syringe
with a sterile 4 x 4 and twist
it on the end of the valve.
Pick up the saline syringe
with a sterile 4 x 4 and twist
it on the end of the valve.

173
Table adapted from Health Facts for You (Port, 2009)
321
Procedure
Step
Scenario 1: IVA
Emergency,
e.g., IV infusion, blood
draw, etc.
Scenario 2: IVP
Maintenance
(IVA)
Scenario 3: EVA Emergency
(Pre-EVA Operations)
valve. Push the saline
through until you see it
drip out the other end. Lay
the set down on the sterile
field.
Push the saline through until
you see it drip out the other
end. Lay the set down on
the sterile field.
Push the saline through until
you see it drip out the other
end. Lay the set down on the
sterile field.

10 Maintain sterility of the
needle and tubing. By
holding the wings and
syringe in your dominant
hand, remove the cap on
the needle with the other
hand. Feel for the IVP
while your dominant hand
guides the needle into the
IVP at a 90° angle. Press
firmly until the needle
touches the back wall of
the IVP. Pick up a
transparent dressing and
place it over the top of the
IVP to secure the needle in
place.

Maintain sterility of the
needle and tubing. By
holding the wings and
syringe in your dominant
hand, remove the cap on the
needle with the other hand.
Feel for the IVP while your
dominant hand guides the
needle into the IVP at a 90°
angle. Press firmly until the
needle touches the back wall
of the IVP.
Maintain sterility of the
needle and tubing. By
holding the wings and
syringe in your dominant
hand, remove the cap on the
needle with the other hand.
Feel for the IVP while your
dominant hand guides the
needle into the IVP at a 90°
angle. Press firmly until the
needle touches the back wall
of the IVP.
Since needle is being left
in for IV therapy, put a
sterile tape over wings of
the needle to secure it.
Then, cover it with a
transparent dressing.

Since this is a monthly flush
(as on trip to or from Mars),
skip the dressing and go to
step 13.
Since this is a pre-EVA flush,
skip the dressing and go to
step 13.
11 Slowly pull back the
plunger until you see blood
in the tubing.

N/A N/A
12 Make sure you check for
air in the flushes and
remove all air before using.
N/A N/A
13 Push down on the plunger
and flush the IVP with 10
mL of normal saline.
Clamp, attach, and flush an
additional 10 mL of normal
saline.
Push down on the plunger
and flush the IVP with 10
mL of normal saline.
Clamp, attach, and flush an
additional 10 mL of normal
saline.
Push down on the plunger
and flush the IVP with 10 mL
of normal saline. Clamp,
attach, and flush an
additional 10 mL of normal
saline.

Table 29.2-1: Continued
322
Procedure
Step
Scenario 1: IVA
Emergency,
e.g., IV infusion, blood
draw, etc.
Scenario 2: IVP
Maintenance
(IVA)
Scenario 3: EVA Emergency
(Pre-EVA Operations)
14 Clamp and attach 5 mL
syringe of heparinized
saline. Unclamp, flush, and
clamp.
Clamp and attach 5 mL
syringe of heparinized
saline. Unclamp, flush, and
clamp. Leave the syringe
attached to remove the
needle.
Clamp and attach 5 mL
syringe of heparinized saline.
Unclamp, flush, and clamp.
Leave the syringe attached to
remove the needle.

15 Connect IV medication
tubing to needle tubing.
Infuse medication.

N/A N/A
16 Repeat Steps 13 and 14.

N/A N/A
17 To remove the needle:
While securing the IVP
with two fingers of one
hand, pull out the needle
and dispose of it in a
Sharps Box.
To remove the needle:
While securing the IVP with
two fingers of one hand,
pull out the needle and
dispose of it in a Sharps
Box.
To remove the needle: While
securing the IVP with two
fingers of one hand, pull out
the needle and dispose of it in
a Sharps Box.
18 N/A N/A Clean the IVP site and 2-3”
of skin around the area (1
min); use back and forth
friction.
19 N/A N/A Open separate needle and
valve and drop them onto
sterile field. Be careful not to
touch any part of the needle.
20 N/A N/A Connect needle to
Feedthrough-Connector.

21 N/A N/A IVP Interface ready for EVA
Emergency use.

29.3 Spacesuit Preparation and Donning Operations
This section expands on Step 20 in Table 29.1-1. It explains the proposed
spacesuit preparation and donning operations. These are procedures that must be strictly
adhered to ensure a safe through-the-suit IV provision.

Table 29.2-1: Continued
323
Spacesuit Preparation
1. Needle Holder inserted into Needle Adaptor
2. Needle Adaptor screwed into Vacuum Feedthrough shaft
3. Needle Assembly tubing connected to LC34-9 coupler.
4. IV pump tubing connected to LC34-9 coupler.
5. IV Pump checked and IV Flush performed to ensure system is working.
Spacesuit Donning
1. Astronaut dons LCVG (which includes Leur-Type Female Adaptor)
2. Astronaut enters spacesuit assembly (legs first, torso next)
3. Alignment Supports (connected to HUT) are aligned and connected to the LCVG.
Red button is pushed in, allowing LCVG alignment lock to be inserted into button
groove; button is released securing the LCVG alignment lock.
4. Remaining nominal spacesuit and pre-EVA procedures performed.
29.4 Conclusion
The IVP maintenance procedures and spacesuit preparation/donning operations
described herein would be added to IVA/EVA Checklists. It is noteworthy to mention
that proper care of an IVP is the single most important factor in reducing the risk of
complications (Baranowski, 1993). One study in AIDS patients suggested that the most
significant factor associated with risk of IVP infections is non-adherence to
recommended device care (Settle, et. al., 1994). Diligent care must also be ensured for a
through-the-suit IV application prior to EVA operations.
324
Appendix Q (IV Infusion using an IVP), provides Mr. Diehl Martin’s IVP
treatment procedure experience, which demonstrates the ease of utilizing an IVP. There is
no reason why a similar IVP treatment procedure could not be performed in a pressurized
module in space, e.g., spacecraft or planetary surface habitat.
325
CHAPTER 30: POST-DOCTORAL RESEARCH
30.1 Research Topics
Given the schedule constraints of a PhD dissertation, not all issues were resolved.
Undoubtedly, there are several items that require further research. The following topics
will be studied as part of Post-Doctoral Research:
Planetary Surface EVA Emergency Probability
a. NASA has not conducted emergency probability studies for Phase 3 (extended
planetary surface missions) type medical conditions, which would potentially also
include accidents during EVAs, as a result of falling, mechanical failures, etc. As
NASA DRMs evolve, it will be important to identify the specific probabilities for
EVA events requiring IV administration.
b. A readily available database of EVA injuries and health issues, that would be
extensive enough to be able to draw statistically significant conclusions from and
to extrapolate to advanced planetary surface EVA operations, does not exist.
Perhaps, a Monte Carlo simulation would be necessary to identify each EVA
emergency scenario. Unfortunately, the modeling problem would be a dissertation
task in itself.
BioSuit™ Through-the-Suit IV Incorporation
a. The through-the-suit IV provision presented in this research is intended for use
with a gas filled spacesuit. Future research should also consider the incorporation
of a similar concept into a mechanical counter pressure (MCP) suit, such as MIT’s
BioSuit™.
326
IV Infusion Pump
a. NASA currently includes an IV Pump in the ISS Medical Equipment List for use
within the ISS pressure modules. Future design will incorporate the IV Infusion
Device and IV fluids compartments into proposed advanced PLSS systems. The
IV Pump will have to be reconfigured to integrate it with the IV fluid
compartments. If needed, the IV Pump dimensions will also have to be reduced to
fit into the PLSS volume.
b. A wireless control system will be incorporated into the IV Pump for external
activation/deactivation by rescuing EVA personnel. And a fluid vacuum
feedthrough mechanism will be incorporated so that external additional fluids can
be connected (by the rescuing EVA personnel) to the IV Pump inside the PLSS.
Internal Inflatable Cylindrical Bags
a. According to de Leon (2012), the distance between the person’s back and the
spacesuit is about 4.5 inches (using the NDX-2 spacesuit); however, that depends
on the test subject body size. This clearance creates a problem when the astronaut
is on his back. In the supine position, due to gravity, his back will go down as
much as allowable towards the spacesuit HUT. This can affect the alignment
provisions between the HUT and the chest port. To mitigate this risk, inflatable
plug
174
could be incorporated inside the spacesuit on the back of the astronaut.

174
Inflatable plugs collapse so they can be inserted through a relatively small hole in the pipe wall. Once it
is inside the pipe, the plugs are inflated. The plug is made of cylindrical inflatable gum rubber with a
rugged polyester waterproof casing. It can be inflated to a high internal pressure to hold pipe pressure
(Inflatable Plug, 2012).

327
These cylindrical shaped bags would only be inflated when the astronaut is on
his/her back. The bag would inflate and push the astronaut’s torso upwards
towards the front of the HUT.

Figure 30-1: Inflatable Plug
175

Aseptic/Disinfectant Techniques
a. Silicone Disk - A silicone disk (Figure 30-2) could be connected to the Luer-Type
Female Adaptor. During EVA preparation, the Huber needle tip would be
penetrated through the silicone disk
176
and come out the other side. Thus, the
needle tip would always be encapsulated by the Luer-Type Female Adaptor, the
silicone disk, and the astronaut’s chest. This would add an additional level of

175
Inflatable Plug (2012)
176
The silicone disk would be similar in design to the chest port silicone septum, which can be injected
hundreds of times.
328
protection against contamination. Furthermore, it would add a level of alignment
for the needle, since the silicone disk would prevent needle lateral movement.

Figure 30-2: Silicone Disk Installed
177

b. Sterile Patch – Incorporation of a sterilizing patch placed on the skin on top of the
chest port could also prevent infection. The risk with this option is to ensure that
the Huber needle does not shear off a circle of the patch, entering the IV through
the needle and creating a potentially dangerous embolism.
c. Antiseptic Gel - An easy and common approach to providing protection against
infection is by swabbing the skin with an antiseptic gel, such as antiseptic hand
wash. This gel would have to endure the time span of a standard EVA (~8 hours),
where an emergency may happen requiring IV administration. The issue is that
since astronauts perspire heavily, the gel might smear off. As a result, the
antimicrobial gel would only kill the bacteria extent on the surface at the time it

177
Silicone disk shown from Agilent Technologies (2006)
329
was applied. Nonetheless, this would significantly lessen the subsequent bacterial
count on the surface, and since it is very easy to do as part of donning the EVA
suit it should be incorporated. The type of antimicrobial gel would need to be
further researched, but a possible candidate would be a dual purpose antiseptic
gel, which in addition to being effective skin disinfectants are also capable of
drying to form skin protective film with residual antibacterial properties. This
antiseptic gel, while primarily applied as skin disinfectants for pre- and post
surgery, dermatological infections, burn treatment as well as first aid for
superficial wounds, cuts and abrasions, offer the additional advantage of a
temporary or longer lasting skin and wound dressing depending on the film
forming polymer used, without impairing the normal physiological activity of the
skin (Antiseptic Gel, 2012).
d. Alcohol Spray – Another approach could be the incorporation of an alcohol spray
system, which would spray the chest port area before the vacuum feedthrough
begins to be displaced. The issue with this is the addition of complexity to the
overall system, would not be recommended. Nonetheless, further research is
warranted (Czarnik, 2010).
e. Prohylactic Antibiotics – This approach would just accept that the Huber needle
puncture will be through non-sterilized skin. The astronaut would then be started
on prohylactic antibiotics after the emergency has passed (Czarnik, 2010).

330
Detachable LC34-9 Luer-Coupler
a. The LC34-9 Luer Coupler (Figure 20.5.1-3) incorporated into the side-wall of the
Luer-Type Male Adaptor is permanently adhered. During Demonstration Test #5
(Human Subject Test), Dr. Katz recommended that this be a removable coupler. It
is understood that its permanent adhesion is to provide a dust-free compartment
for the needle; however, having it permanently adhered prevents its removal post
IV administration. A possible workaround is to use disinfectant fluid to clean the
coupler, as discussed in section 20.5. However, future research should incorporate
a detachable Luer Coupler design that would allow for the use of a sterile coupler
before each EVA, yet also allow for a dust-free needle compartment.
Patch-Like Infusion Patches
a. Non-needle injection methods, such as patch-like infusion patches, will be further
researched. These patches are used epicutaneously for applications such as local
anesthesia, anti-contraceptive, nicotine, etc. One of the main issues with this
approach deals with drug diffusion rates. It would appear that the diffusion rate
would be too slow for application into the EVA emergency scenarios, where fast
drug administration, e.g., saline, pain medication, etc, would be required. Even if
a person was covered with a patch which covered a large portion of his body, the
various layers of the skin, muscle, and other soft tissue, would prevent any
pharmaceutical agent(s) from being delivered faster than an intravenous infusion.

331
Dust Contamination Testing
a. Several contamination prevention components have been integrated into the
through-the-suit IV provision. Even though qualitative assessments conclude that
these provisions will prevent dust contamination to internal components of the
through-the-suit IV connector, especially the needle, tests should be conducted to
confirm these dust prevention designs. Specific requirements, such as ones
depicted in Table 30-1, will have to be developed.
b. The objective would be to utilize a pressure chamber that simulates the
atmosphere of Mars. Such a lab exists at NASA Ames Research Center and it has
been used to test
178
the UND NDX-1 spacesuit (Figure 30-4a and 30-4b). Dust
accumulation could be measured visually, i.e., based on expert evaluation, but
also by vacuuming different spots on the suit surface, and measuring collection of
dust in containers.
Table 30-1: Dust Contamination Notional Requirements
179

Title Requirement
Lunar Dust
Contamination
The system shall limit the levels of surface dust contaminants of less than TBD‚
and equal to or greater than TBD micron size in the internal atmosphere to below
TBD mg/m3.
Connector Dust
Migration
Protection
The Suit Element shall limit the migration of lunar dust into the suit via external
connectors to less than TBD grams per connection.
Dust Migration
During Stowage
The Suit shall limit the migration of lunar dust into the suit interior to less than
TBD mg/m3 while stowed for up to TBD months.

178
Dust Testing of the NDX-1 spaceuist was performed at NASA-Ames Reseach Center in California in
August 2009. Testing was performed under the direction of Pascal Lee (NASA Ames), Jim Gaier (NASA
Glenn), and Pablo de Leon (Space Studies, UND (Source: Dust Testing, 2012).
179
Source: Boxleitner (2010)
332

Figure 30-3a: NDX-1 Dust Test in Vacuum Chamber
180

Figure 30-3b: NDX-1 Dust Test in Vacuum Chamber
180

180
Source: de Leon (2009)
333
30.2 Conclusion
Given the schedule and funding restrictions during a PhD process, not all required
aspects could be researched. This chapter summarizes the salient topics which require
further research and which the author intends to perform as part of post-doctoral work.
Having worked in the aerospace industry for over a decade, the development process can
be a long and arduous process. This PhD process has been no different. The design and
testing to date has been successful; however, further design cycles and demonstration
testing are necessary to bring this concept to fruition.
334
CONCLUSION
Emergencies in space will happen, both inside and outside living habitats. For
those emergencies occurring during EVAs and which require IV administration, a
through-the-spacesuit IV provision is feasible with the incorporation of an implanted
venous port, a vacuum feedthrough connector and associated components, dust
contamination provisions, and incorporation of an IV pump and IV fluids into future
PLSS concepts. Table Con-1 summarizes the salient steps performed as part of this
research.
Table Con-1: Salient Research Steps
Step
Description
Assumptions Assumptions were established to define the focus of the research. Providing
medical provisions for a spacesuited astronaut entails various medical
administrations possibilities. The intent of this research is to concentrate on only
one of these medical provisions, namely, through-the-suit IV administration.
Golden Period The research is focused on providing medical provision during the onset of an
emergency to the time it takes to get the patient to a definitive care facility. This
time is called the ‘golden-period.’ Doctors say that if a critically injured patient is
able to obtain definitive care, within the casualty’s ‘golden period,’ the chance of
survival is greatly improved.
Subject Matter
Expert Engagement
Among others, medical doctors, and spacesuit and aerospace medicine subject
matter experts were engaged during the design, fabrication, and testing phases of
this study.
Medical Issues in
Space
Medical emergencies have occurred in past space missions and will continue to
occur in future planetary missions. If health problems/injuries take place during
EVAs, they have the potential of significantly impacting mission success.
EVA Tasks
(Phase 3)
Future planetary missions will entail an increasing array of EVA planetary tasks,
which will include tasks related to construction, maintenance, exploration. These
operations will increase the possibility of EVA emergencies.
Spacesuits Extensive literature technical review and consultation with established experts on
spacesuit technology concludes that no prior spacesuit has had an IV capability
incorporated into its design. Incorporating medical provisions into a spacesuit is
a challenging endeavor, complicated by the need to maintain the internal pressure
and prevent dust contamination.
Design Cycles /
Demonstration Tests
Six (6) design cycles and five (5) demonstration tests were completed as part of
this study. The design evolved from a vein finder approach to one utilizing
vacuum feedthrough technology. As part of typical systems engineering
processes, tests results were incorporated into the evolving design.

335
The proposed design (Design Cycle #6) includes components which have
technology readiness levels (TRLs)
181
that are acceptable at this point in the development
process. Table Con-2 depicts the NASA TRL definitions and Table Con-3 depicts the
TRL assessment for the salient components of the proposed through-the-suit IV provision
design. As Table Con-2 depicts, some of the TRL levels indicate that components or
systems must be tested in a relevant or space environment. Obviously, none of the
components proposed as part of this research have been tested on a planetary surface, i.e.,
space environment. However, for TRL assessment purposes, the relevant environment for
some of the components within the spacesuit can be assumed to be the same as a ground
environment, as both environments are pressurized to a level that allows normal human
physiological functioning.
Table Con-2: TRL Definitions
182

TRL Definition
1 Basic principles observed and reported
2 Technology concept and/or application formulated
3 Analytical and experimental critical function and/or characteristic proof-of-concept
4 Component and/or breadboard validation in laboratory environment
5 Component and/or breadboard validation in relevant environment
6 System/subsystem model or prototype demonstration in a relevant environment
(ground or space)
7 System prototype demonstration in a space environment
8 Actual system completed and “flight qualified” through test and
demonstration (ground or space)
9 Actual system “flight proven” through successful mission operations

181
TRLs are a systematic metric/measurement system that supports assessments of the maturity of a
particular technology. NASA has used the TRL approach in space technology planning for many years
(NASA TRL, 1995).
182
NASA TRL (1995)
336
Table Con-3: Through-the-Suit IV Major Components – TRL Assessment
Component TRL
TRL Justification
Huber Needle,
Needle Holder, IV
tubing
7 These components are certified and are successfully used in the
medical field for chest port injections. Furthermore, intravenous
administration has been tested in space as part of STS-40 and STS-42
(Chapter 11).
Implanted venous
port (IVP)
6 Relevant environment is considered to be ground testing. IVPs are
certified and commonly used to administer IV fluids.
Vacuum
Feedthrough
5 Vacuum feedthrough technology has been around for decade. Its
ability to maintain the spacesuit pressure integrity would not be
affected on a planetary surface.
Luer-Type
Female/Male
Adaptors
4 These prototype adaptors have been tested in a laboratory
environment, as part of Demo Test #2, 3 and 5.Since these
components are within the pressurized spacesuit environment, the
relevant environment is assumed to be ground environment.
Double-Adhesive
Tapes
4 These prototype adhesives have been tested in a laboratory
environment, as part of Demo Test #2, 3 and 5.Since these
components are within the pressurized spacesuit environment, the
relevant environment is assumed to be ground environment.
Alignment
Supports
4 These prototype adhesives have been tested in a laboratory
environment, as part of Demo Test #2, 3 and 5.Since these
components are within the pressurized spacesuit environment, the
relevant environment is assumed to be ground environment.
Connector Cap
components
4 As opposed to internal spacesuit components, the connector cap and
its components have not been tested in a relevant environment. Demo
Test #2, 3, and 5 are considered laboratory environments, i.e., do not
simulate the environment of a planetary surface.
IV Pump 8 The NASA IV Pump has been ‘flight qualified’ and is currently
manifested in the ISS Medical Equipment List. It is not given a TRL
of 9 because it has never been used in space.
Overall Through-
the-Suit IV
Provision
4 Further research is still required to increase the TRL of the overall
system. The design needs to be tested in a reduced gravity and
pressure environment, as well as tested for dust contamination.

The application of standard medical practice in a unique and challenging context,
i.e., through a spacesuit, called for the application of an interdisciplinary effort, which
among other disciplines, merged engineering and medicine. This study pulled engineers
into the world of doctors and vice versa. The result was a simple, elegant and innovative
approach to administering IV fluids through an EVA spacesuit (Design Cycle 6), which
has advanced spacesuit medical technology. These are the notable technological
advances:
337
 Vacuum feedthrough design (spacesuit pressure containment and dust prevention)
 Connector cap assembly design (dust prevention and inadvertent activation)
 Alignment supports design (alignment provision)
 Luer-type female/male connectors and lock design (dust prevention)
 LCVG to skin adhesion (alignment provision)
 Alignment supports to LCVG connection design (alignment provision)
Space will continue to be a dangerous place to get sick (mentally or physically)
and there is no question that with an increased presence in space, serious illnesses/injuries
will occur (Figure Con-1). The impact on health and mission will potentially be more
serious if these medical emergencies take place while on an EVA. To help mitigate these
risks, astronaut training programs will spend substantial attention on preparing for
planetary surface EVA emergency scenarios. Though emergency EVA protocols will first
be to transport an ill/injured EVA crewmember to a pressurized safe haven for medical
intervention, there will be situations where this will not be expeditiously possible.
Furthermore, even though most serious health risks will be diagnosed before flight, there
will be unforeseeable illnesses and injuries which will take place during EVAs that could
potentially require the use of IV fluid administration. In anticipation of these EVA
emergencies, this research concludes that the through-the-spacesuit IV provision
presented is a feasible IV administration approach. This was a unique opportunity to
investigate an area that was truly unexplored. Continued research of the proposed concept
(Design Cycle 6) will allow for enhanced patient accessibility during Phase 3 planetary
surface EVA emergencies.
338

Figure Con-1: Planetary Surface EVA Emergency
183

183
Source: Groemer, G.E., et al. (2005).
339
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362
APPENDIX A: DEPRESSURIZED MISSION PROFILE
MEDICAL CONDITIONS REQUIRING IV ADMINISTRATION
35

Table A-1: Depress Scenario - Medical Conditions Requiring IV Administration

Condition Clinical Priority Rationale
Diarrhea Diarrhea occurring in the suited depressurized contingency return scenario
can be a major inconvenience for the affected crewmember as well as a
health hazard, causing perianal skin breakdown and cellulitis, and
predisposing to UTIs. Treatment shall thus be manifested.
Infection – Cellulitis The prolonged suited transit involved in this contingency means many
hours of skin contact with used MAGs, which might lead to perineal skin
breakdown and secondary cellulitis. Although examination and diagnosis
will not be possible, treatment shall be available for cases with high clinical
suspicion.
Infection – Sepsis Sepsis is life threatening, and although the likelihood of sepsis developing
during the suited depressurized contingency return is low, treatment must
be available to prevent further deterioration. Treatment shall thus be
manifested.
Medication Overuse /
Misuse
Since medications with potential for overdose or misuse will be manifested
in the medical kit (including sleep aiding medications, and narcotics), the
ability to reverse these medications shall be provided.
Nausea / Vomiting Vomiting within the enclosed spacesuit can lead to aspiration, asphyxiation,
and chemical eye irritation/burn. Treatment for nausea and vomiting shall
thus be provided.
Seizure Seizures occurring during the suited depressurized contingency scenario
can be life threatening, as access to the crewmember for medical care will
be limited. Treatment capability in the form of IM anti-seizure medications
is vital, to ensure the safety of the entire crew. Thus, treatment shall be
manifested.
Space Motion Sickness -
SAS
Vomiting within the enclosed spacesuit can lead to aspiration, asphyxiation,
and chemical eye irritation/burn. Treatment for space motion sickness shall
thus be manifested.
Sprain / Strain Overuse
Syndromes
The suited nature of this contingency should protect the crew from new
sprains/strains/overuse injuries. In the event that these have occurred prior
to the contingency and are aggravated by the confinement of the suit,
pharmacologic treatment with analgesics (oral or intramuscular) should be
provided.
Toxic Exposure Toxic exposure is one of the three major non-medical emergencies that
could occur in spaceflight (along with cabin depressurization and fire), and
it is mandatory to be prepared with medical treatment for this potentially
life-threatening and/or mission ending scenario. Treatment shall thus be
manifested.
363

APPENDIX B: MODIFIED EVA STRETCHER

During MDRS Crew 61
184
, a crewmember simulating an injury noted the
following when being transported face-down: (1) being face down was generally
uncomfortable, (2) patient had to lift her head upward to get an airway, which would not
be advisable in the case she had suffered neck/spine injuries, (3) patient’s only view was
the ground, which did not allow her to have any visual contact with the EVA paramedic,
and 4) it became apparent that the weight of the PLSS and body itself could compromise
expansion of the chest when face down (Figure B-1). As a result, in order to transport a
patient in the supine position, a modified EVA emergency stretcher was developed by
MDRS Crew 61. This was accomplished by cutting an insertion into a traditional
emergency stretcher and connecting two securing-bands. This yielded a “pouch” where
the PLSS could fit through and rest on (Figure B-2). With a modified EVA emergency
stretcher, the injured EVA crewmember was transported in two ways: (1) carried by other
EVA crewmembers (Figure B-3), and (2) transported on an ATV, which at MDRS,
simulated an unpressurized rover (Figure B-4). Attention was placed on keeping the
patient immobilized as much as possible (no bending of neck or torso, no flailing of
arms/legs) (Schrunk, 2007). A third crewmember helped minimize patient motion.

184
Research author was the EVA Director for MDRS Crew 61, responsible for conducting EVA emergency
rescue simulations. Research pictures credit is to Alejandro R. Diaz (2007). MDRS Crew 61 crewmembers:
Chip Shepherd, Alejandro R. Diaz, Marcus Medley, Elizabeth Wolfe, Pieter Jan Van Asbroeck, and Irene
Schneider Puente. MDRS Crew 61 website: http://www.marssociety.org/MDRS/fs06/crew61/

364

Figure B-1: EVA Emergency Stretcher Transportation (face-down)
185

Figure B-2: EVA Emergency Stretcher Modification
186

Figure B-3: EVA Emergency Stretcher Transportation (supine position)
187

185
Face down transportation was uncomfortable for injured subject (Diaz, 2007).
186
Insertion cut into stretcher to allow PLSS placement and support (Diaz, 2007).
187
Crew carries injured patient (Diaz, 2007).
365

Figure B-4: EVA Emergency Stretcher Transportation
188

188
ATV Stand was designed and constructed for the EVA Emergency Stretcher to be securely placed on
the ATV (Diaz, 2007).

366

APPENDIX C: REMOTE MEDICAL ACCESS SUIT

According to Czarnik (2005), the challenge is to initiate medical care before being
able to access the patient. Perhaps even before being able to see the patient. Thus, the real
challenge is to have medical care built into a spacesuit. In his paper titled ‘Remote
Access Medical Suit,’ Dr. Czarnik proposes several salient spacesuit medical provisions
that could improve patient accessibility.
Appendix C.1 – Airway Obstruction
Airway Obstruction is Public Enemy Number 1. Without a patent airway, oxygen
cannot be delivered to the patient; without adequate oxygenation, medicines will have
little effect. Respiration and Circulation do no good if a patent airway is not maintained;
if no patent airway, patient dies. On Earth, an endotracheal tube (Figure C.1-1) is used to
maintain a patent airway, ensure oxygen is delivered to the lungs (not the stomach), and
to provide emergency route for some medicines. However, an endotracheal tube needs
access to the patient to place it. Therefore, it is not workable for a patient in an EVA suit
(Czarnik, 2005).

Figure C.1-1: Straight Blade Placement
189

189
Source: Czarnik (2005)
367

The number one cause of airway obstruction in the unconscious patient is the tongue. So
how can we remotely ensure a patent airway, especially if a neck fracture is suspected?
Proper placement of the head & jaw can remove tongue obstruction so the patient can
breathe. Not as effective as the endotracheal tube, but much better than nothing.
However, if neck fracture is suspected, head tilt must be avoided, neck maintained in a
straight line, and jaw pushed forward to get the tongue out of the back of the throat
(Figure C.1-2).

Figure C.1-2: Modified Jaw Thrust
189

Therefore, to perform remote access head & jaw positioning, need to modify
technology currently used for those with weak neck muscles (ALS, MG). Attachments to
the back of the helmet facilitate jaw thrust & (if desired) head tilt. The result is a new
Snoopy Cap (Figure C.1-3). The ‘Headband’ and Neck Elevator allow for head tilt, while
the Jaw Band allows for elevation and opening of the jaw. They can operate
independently to give jaw lift & thrust, with or without head tilt. And can be operated by
suit computer or remotely, from Hab.
368

Figure C.1-3: Modified Snoopy Cap
189

Appendix C.2 – Breathing Problems
Breathing Problems is Public Enemy Number 2. Airway does you little good if
the patient is not breathing on their own. If you maintain a patent airway but the patient is
not breathing, the crewmember dies. The problem is how to provide a respiratory force
remotely for a patient that cannot even be touched. There are two Possibilities: Positive-
Pressure and Negative-Pressure Ventilation. Positive-Pressure would use over-inflation in
the helmet to ‘push’ air into the lungs. This method uses less energy than negative (has to
move less air), moves air into lungs and esophagus, and can rapidly distend stomach
(causing regurgitation and airway obstruction). On the other hand, Negative-Pressure
would use suction in the suit’s thorax to ‘pull’ air into the lungs. This method places
strain on thorax (which is better suited to bear it), moves air into lungs only, and patient
can be on it for hours. The proposed solution is a ventilator (Figure C.2-1), which is built
369

into the suit thorax relatively easily. Air outtake from thorax ‘sucks’ air into the lungs; air
intake into thorax ‘pushes’ air out of lungs.

Figure C.2-1: Suit Ventilator
189

Appendix C.3 – Circulation
How can we remotely provide a) Enough circulating volume, b) Reliable venous
access, and c) IV medications, while the injured astronaut is still in a spacesuit? The
proposed solution is to shift fluids from the legs. The legs hold 2 liters of circulating
blood. In a trauma, this blood can be diverted to the chest and head (where it is needed)
by squeezing it out of the legs. This has the effect of a 2-liter auto-transfusion, increasing
blood flow to heart, brain and lungs. To accomplish this, MAST (Military Anti-Shock
Trousers) can be used (Figure C.3-1). MAST apply circumferential pneumatic pressure
around both legs, the pelvis, and the abdomen. They also work well for splinting legs, hip
and pelvic fractures. They could easily be built into a spacesuit, eliminating risk from
patient movement in an emergency.
370

Figure C.3-1: Military Anti-Shock Trousers (MAST)
189

Furthermore, the Remote Medical Access Suit also proposes a PermaCath
insertion to provide IV access to a spacesuited crewmember, which is similar to the one
being proposed by this PhD research. This PhD research has advanced this concept and
the plans to incorporate with other medical provisions proposed by the RAMS suit.

371

APPENDIX D: AMBULANCE RIDE-ALONG PETITION

Figure D-1: Ambulance Ride-Along Request
372

APPENDIX E: INTRAVENOUS (IV) TRAINING COURSE

With the objective of obtaining a better understanding and appreciation for the
difficult task of accessing IV lines, the author enrolled and completed an Intravenous and
Blood Withdrawal Training course in April 2010. The course was one-week long and it
entailed both theoretical and hands-on training (Table E.1).
Table E-1: Paramount Nurse Education
190
IV Training Course Syllabus
Condition Clinical Priority Rationale
A. Legal Responsibilities Section 1 - Legal implications of IV therapy
B. IV Fluids Physiology Section 2: Rationale for IV Therapy
Section 3: Fluid and Electrolytes
Section 4: IV Solutions
Section 5: Calculating Flow Rates and Medications
C. IV Therapy Clinical
Practice
Section 6: Psychosocial Patient Preparation
Section 7: Safety Factors
Section 8: Site Selection
Section 9: Needle/ Catheter Selection
Section 10: Initiating IV Therapy
D. IV Therapy
Management
Section 11: Managing Complications and Trouble Shooting
Section 12: Intravenous Therapy Equipment Preparation
Section 13: IV Management
Section 14: Intake and Output
Section 15: IV Medication Administration
Section 16: Blood Transfusions Management
E. Appendix A Detecting and managing IV therapy problems (video)
F. Appendix B Phlebotomy

190
Paramount Nurse Education website: http://paramountnurse-
ed.com/users/editorialdisp.php?mn=53695&fn=classdescription
373

Figure E-1: Author, Hands-On IV Training
191

191
Source: Garcia (2010)
374

Figure E-2: IV and Blood Withdrawal Program Certificate
375

APPENDIX F: PICC PRACTICAL EXPERIENCE

In May 2009, my son had the unfortunate experience of being diagnosed with
Septic Arthritis. In septic arthritis, germs infiltrate a joint, infect it and damage it, causing
severe pain and fever. Bacteria most commonly target the knee, though other joints can
be affected by septic arthritis, including the ankle, hip, wrist, elbow and shoulder (Septic
Arthritis, 2009).
In the case of my son, his right knee was affected
192
. He was hospitalized for a
total 16 days and before being released he was inserted with a PICC line (Figure F-1)
193

so that we could administer antibiotics intravenously for six weeks at home. We were
instructed by our doctors that our son could not utilize his right arm to lift, stretch, do any
harsh movements, or have any major contact in that area. Also, utmost care had to be
taken to not get the PICC line wet, as this could lead to infection. Worst case scenario
would be dislodgement of PICC line from superior vena cava (top of heart). My wife and
I were trained by nurses on the method of administering saline, the antibiotic, and a blood
thinner. Detail to maintaining the catheter clean was emphasized. Any bacteria entering
the PICC line could quickly spread through the body. Treatments were given three times
a day for one antibiotic and four times a day for another, with each treatment lasting
approximately 1 1/2 hours.

192
The University of Southern California (USC) Protection of Research Subjects (OPRS) Office instructed
this author that USC OPRS had no problems with me using my son’s PICC experience (including pictures)
in this research; it concluded it was not a Human Subjects issue. My son’s illness was just an unfortunate
coincidence with this research.
193
Picture taken at author residence on June 8, 2009.
376

Figure F-1: PICC Line
194

My overall impression of the IV antibiotic treatment using a PICC line is that it is
a very delicate in-home treatment. We were diligent in the cleaning procedures and
extremely careful in not allowing the PICC line to come into contact with contaminated
surfaces; this took a long time. Though my son could move his right arm, he was
extremely limited in what he could do with it. Contact of his arm with anything was also
avoided. In fact, he was instructed not to attend school any more for the remainder of the
school year to avoid accidental contact with the PICC line area.

194
Source: Diaz (2009)
377

APPENDIX G: HISTORICAL SPACESUIT REVIEW
A historical spacesuit review was performed to obtain a thorough understanding
of spacesuit evolution, and to determine whether a through-the-suit IV provision had
been previously incorporated into a spacesuit. The review concluded unequivocably that
no such provision has been implemented. As the following sections demonstrate,
spacesuits have evolved from aviation flying suits to the current Shuttle EMU; in the
process, experimenting with soft suits, hard suits, and hybrid suits (Figure G-1).

Figure G-1: Flowchart of EVA Suit Evolution
195

195
Figure 8-27 from Harris (2001).
378

Appendix G.1 - Flying Suits
Serious research and studies of the physiological effects of flying at high altitude
began in the nineteenth century. However, during the 1940’s, the military’s requirement
for high-flying aircraft provided the greatest incentive for the development of pressure
suits (Kozloski, 1993). The U.S., England, Italy, France, and Germany were all engaged
in the struggle to develop pressure suits that could be used in their increased altitude
military aircraft (Kozloski, 1993). Wiley Post experimented with a number of soft-suit
designs for record-breaking flights. However, the first successful fully pressurized suit
for this purpose was developed by Russell Colley who worked for B.F. Goodrich (Figure
G.1-1). These suits consisted of neoprene rubber-coated fabric that could inflate like a
balloon and a more rigid fabric over the neoprene to restrain the suit and direct the
pressure inward on the pilot. Hoses were attached from the aircraft to the suit to provide
oxygen. The B.F. Goodrich Mark IV Pressure Suit, originally developed for the crew of
high-flying aircraft, is now known as the forerunner of current spacesuits (Evolution of
Spacesuits, 2008).
379

Figure G.1-1: Test Pilots of the H-10 Series Lifting Body Aircraft
196

Appendix G.2 - Mercury Program
In the political and ideological atmosphere of the 1950s (Cold War), the objective
was to execute the quickest method of putting a human into space (Kozloski, 1993).
Initiated in 1958 and completed in 1963, Project Mercury was the United States' first
man-in-space program. The mission design objectives of the program, which made six
manned flights from 1961 to 1963, were: (1) orbit a manned spacecraft around Earth, (2)
investigate man's ability to function in space, and (3) recover both man and spacecraft
safely (Bellis, 2008).

The most influential mission design element was the restrictive
development timeline. This timeline forced designers to use the high altitude aviation
pressure suits as a baseline, and evolve its design into the first Mercury spacesuit
(developed in 1959). This was not an easy evolution as the high elevation pressure suits
required extensive modifications, particularly in their air circulation systems, to meet the

196
Source: Freudenrich (2009)
380

needs of the Mercury space pilots. Russell M. Colley was again responsible for the
Mercury spacesuit development, and led the modification of the famous Navy Mark IV
high-altitude jet aircraft pressure suit into the spacesuits worn by the Project Mercury
astronauts (Figure G.2-1), including fitting Alan B. Shepard Jr. for his historic ride as
America's first man in space on May 5, 1961 (Evolution of Spacesuits, 2008).
Compared to the jet suits, the Project Mercury spacesuit design (Figure G.2-1)
added layers of aluminized Mylar over the neoprene rubber (Bellis, 2008). The spacesuit
consisted of an inner layer of Neoprene-coated nylon fabric and an outer restraint layer of
aluminized nylon. Joint mobility at the elbow and knees was provided by simple fabric
break lines sewn into the spacesuit. But even with these break lines, it was difficult for a
pilot to bend his arms or legs against the force of the pressurized spacesuit. As an elbow
or knee joint was bent, the spacesuit joints folded in on themselves, reducing spacesuit
internal volume and increasing pressure (Bellis, 2008). The Mercury spacesuit served as
an emergency atmosphere for survival in case of capsule depressurization. The occupant
would remain in the capsule the entire flight and there was no plan for EVA or
emergency escape. Only limited survival gear was originally included due to weight and
volume constraints.
381

Figure G.2-1: Original Mercury Astronauts in their Spacesuits
197

Appendix G.3 - Gemini Program
The second U.S. manned space program was announced in January 1962. Gemini
involved 12 flights, including two unmanned flight tests. Its major mission design
objectives were: (1) subject man and equipment to space flight up to two weeks in
duration, (2) rendezvous and dock with orbiting vehicles and to maneuver the docked
combination by using the target vehicle's propulsion system, and (3) perfect methods of
entering the atmosphere and landing (Bellis, 2008).
When EVA was added to Gemini mission design requirements, EVA operations
began to dominate spacesuit development. The astronauts would now be performing

197
Source: Freudenrich (2009)
382

activities outside the confines of the spacecraft. As a result, a thermal and
micrometeoroid garment (TMG), thermal gloves and a protective helmet visor were
added (Kozloski, 1993). The EVA mission also introduced the potential of umbilical
oxygen disruption. Therefore an emergency life support pack was developed providing 9
minutes of emergency oxygen. The new EVA mission was established in March 1965
and planned for launch in June. This caused serious timeline pressure for spacesuit
engineers, especially after feedback from Ed White’s Gemini IV EVA (Figure G.3-1),
which revealed arm mobility difficulties, hands and fingers became fatigued quickly, and
spacesuit cooling was inadequate (LCVG, 2008). The Gemini spacesuit used a
combination bladder-link net construction in an effort to make the whole spacesuit
flexible when pressurized. This multi-layer design led to improved arm and shoulder
mobility (Bellis, 2008).

Figure G.3-1: Gemini 4 Astronaut Ed White During America's First Spacewalk
198

198
Source: Freudenrich (2009)
383

Appendix G.4 - Apollo Program
Walking on the Moon's surface a quarter million miles away from Earth presented
a new set of problems to spacesuit designers. Not only did the Moon explorers' spacesuits
have to offer protection from jagged rocks and the searing heat of the Lunar day, but the
spacesuits also had to be flexible enough to permit stooping and bending, as Apollo
crewmen gathered samples from the Moon, set up scientific data stations at each landing
site, and used the Lunar rover vehicle. The mission design objectives of the Apollo
mission, which spanned 5 years (from 1967 to 1972), and included 12 manned flights,
went beyond landing Americans on the Moon and returning them safely to Earth. The
goals had political implications as well: (1) establish the technology to meet other
national interests in space, (2) achieve preeminence in space for the United States, and (3)
develop man’s capability to work in the Lunar environment (Bellis, 2008).

In 1961, United Technologies Hamilton Sundstrand was named by NASA as the
prime contractor for the Apollo spacesuit (Kozloski, 1993). Their spacesuit design
utilized a single spacesuit (A7LB) for all Apollo phases, albeit the command pilot did not
need a TMG or capability for Personal Life Support System (PLSS) connections. The
Apollo spacesuit (Figure G.4-1) was designed to allow astronauts to venture outside of
the spacecraft. Apollo spacesuit mobility was improved over earlier spacesuits by the use
of molded rubber joints at the shoulders, elbows, hips, and knees. Modifications to the
spacesuit waist for Apollo 15 through 17 missions added even more flexibility making it
easier for crewmen to sit on the Lunar rover vehicle (Bellis, 2008).
384

Figure G.4-1: The Apollo Spacesuit As Used For Moonwalking
199
Appendix G.5 - Skylab and Apollo-Soyuz Programs
The Skylab spacesuits (Figure G.5-1) were modified versions of the Apollo
spacesuit. The spacesuit changes from Apollo to Skylab included a less expensive to
manufacture and lightweight TMG, elimination of the Lunar boots, and a simplified and
less expensive extravehicular visor assembly over the helmet (Apollo ASTP, 1975). The
liquid cooling garment was retained from Apollo, but umbilicals and astronaut life
support assembly (ALSA) replaced backpacks for life support during space walks. The
Apollo-type spacesuits were also used in the mid 1970’s when American astronauts and
Soviet cosmonauts rendezvoused and docked in Earth orbit in the joint Apollo-Soyuz
Test Project. There were no spacewalks scheduled for this mission, so astronauts used a
modified intra-vehicular Apollo spacesuit fitted with a cover layer that replaced the
thermal micrometeoroid layer (The Spacesuit, n.d.).

199
Source: Freudenrich (2009)
385

Figure G.5-1: Skylab 3 - Astronaut Jack Lousma
200

Appendix G.6 - Shuttle Program
For the Shuttle program, planners considered three options for their missions: (1)
no spacesuits, (2) one dual-purpose - LEA (Launch, Entry and Abort)/EVA spacesuit, or
(3) two spacesuits, LEA and EVA. Option three was chosen due to the availability of
existing equipment. A lightweight, all-soft aviation-style spacesuit would be comfortable
and easily storable for LEA (as well as IVA - Intravehicular Activity), and an A7LB-type
spacesuit could serve as the EVA spacesuit. Early thought was to increase the EVA
spacesuit pressure to 8 psi allowing for emergency EVA without pre-breath, but
development costs and risk were too high so a 4.0 psi spacesuit was funded through
Hamilton Standard. These decisions reveal how cost started to become dominant in the
post moon race era. In fact, NASA’s Shuttle Extravehicular Mobility Unit (EMU)
Request for Proposal (RFP) stipulated the use of existing/certified technology, where
possible, and the use of off-the-shelf Apollo helmet and neck-rings. Fortunately, fiscal
budget allocations for maintenance and repair allowed NASA to reevaluate parts near the

200
Source: A7L Spacesuit (2007)
386

end of their life-cycles and modify as needed, providing slow incremental upgrades. This
incremental approach continued as the Shuttle EMU (Figure G.6-1) evolved to
accommodate ISS which saw the need for extensive EVA for ISS construction (Harris,
2001).

Figure G.6-1: Shuttle Astronaut Donning EVA Spacesuit
201

Appendix G.7 - International Space Station (ISS) Program
ISS mission operations pushed EVA to a new level as on-orbit construction would
involve substantially more EVAs than all other previous programs combined. Again,
development cost became a top issue and Shuttle EMU redesigns were chosen instead of
a new spacesuit for the ISS. Enhancements occurred in nearly all spacesuit sub-systems,
such as communications, advanced gloves with heating, bearings and sizing rings,
pressure spacesuit bladders, and drink bag to meet ISS mission design.
The requirement for mission length was another serious factor. Shuttle missions
were on average 10 days with only a few EVAs. Spacesuits were returned for inspection

201
Source: History of U.S. Spacesuits (1997)
387

and maintenance immediately following mission completion. However, ISS missions
would last months, meaning less earth-based maintenance capability. As a result, parts
would need a longer shelf life, or designers had to accommodate for onboard inspection
or replacement. Additionally, the extensive EVAs created the need for an emergency
return device should the crewmember become untethered and completely detached from
the station. This led to the development of the Simplified Aid for EVA Rescue (SAFER)
(Figure G.7-1), which allowed the crewmember to pilot him/her self to safety (ISS
Familiarization, 1998).

Figure G.7-1: ISS Extravehicular Mobility Unit
202

Appendix G.8 - Future Planetary Surface Spacesuits
Expected manned Lunar mission objectives will be to conduct Lunar science,
exploration, and prepare for future exploration endeavors, such as Mars (CSSS RFP,
2006). Launch Entry and Abort (LEA), Intravehicular Activity (IVA), and Extravehicular

202
Source: STS-110-E-5616 (2002)
388

Activity (EVA) spacesuits are essential in achieving these objectives. Lunar missions will
utilize spacesuits for LEA, IVA, and both orbital and planetary surface EVA. Figure G.8-
1 depicts two proposed EVA planetary surface spacesuits: (1) the NASA Mark III
experimental EVA suit developed from a variety of NASA in-house components, and (2)
the UND NDX-1 spacesuit, which was a NASA-funded spacesuit designed and built with
the main objective of improving mobility and walking capabilities.

NASA Mark III UND NDX-1

Figure G.8-1: NASA Mark III
203
and UND NDX-1
204

203
Source: Hoffman (2004)
204
Source: De Leon (2007)
389

According to the Constellation Space Suit System (CSSS) RFP (2006), future
spacesuits will need to provide crew protection and survivability during LEA scenarios
(including spacecraft depressurization, egress mobility and water survival); zero-gravity
EVA for in-space EVA (including contingency crew transfer between vehicles); surface
EVA capability for Lunar sortie missions (less than two weeks); surface EVA capability
for Lunar outpost missions (up to six months); EVA capability for Mars missions; and
delivery of first spacesuits for 2011. This multi-purpose spacesuit concept is likely to
present design challenges beyond that of Apollo, especially in terms of cost, weight,
volume, and maintenance, topics high on NASA’s list (Dutton and Johnson, 2007). Given
recent cuts in NASA’s yearly budget, NASA can expect to keep items such as spacesuits
at a minimum cost. Furthermore, historical examples have shown that requirements
evolve quickly, which will provide spacesuit designers with new problems to solve.
The AX-5 is another design option, which has been researched for years and
provides a constant volume with the use of hard spacesuit (metal/composite components).
The AX-5 is a high pressure, zero prebreathe suit developed at NASA Ames Research
Center in the 1980s. Due to their rigid exoskeleton approach, hard suits maintain a
constant volume as the astronaut bends the joints. Although this minimizes the torque
required to bend the joints, it makes the suits heavy and potentially uncomfortable to
wear. Designers should note that the commercial deep sea diving community has
developed hard, pod-like suits and used them successfully (AX-5 Spacesuit, 2012). The
current Mark III (Figure G.8-1) advanced, high pressure hybrid fabric/hard suit
developed at NASA JSC offers improved mobility over the Shuttle/ISS EMUs.
390

Figure G.8-2: NASA Ames AX-5 Experimental Hard Spacesuit
205

Yet, another concept that continues to be researched is the Mechanical Counter
Pressure (MCP) suit. Research in this type of suit has been on-going since the early 70’s.
This work is currently being spear-headed by Dava Newman at MIT. The BioSuit™, as
the MIT MCP suit is known, would supply pressurized oxygen to the helmet but would
otherwise employ tight bands to squeeze the body at certain points to counteract the
dearth of external pressure. The BioSuit™, which is designed to enhance locomotion
during spacewalks or planetary exploration, is made of a stretchy fabric that is composed
of spandex, nylon and an unspecified plastic material to replace compressed air, making
it more lightweight and maneuverable. Micrometeorite and additional thermal protection
would be provided by an outer shell or garment; similar to current pressurized gas

205
Source: Hard-Shell Suit (1988)
391

spacesuit designs (Ashley, 2012). The MCP suit improves the range of activity and
decrease the energy cost of work associated with wearing conventional gas filled pressure
suits. Additionally, a MCP suit should be safer and more reliable than full pressure suits
since suit rupture would not mean loss of life supporting gas pressure. If designed
properly, a small tear in a MCP suit would only expose a local body region to reduced
pressures. This exposure would cause the wearer discomfort, and possibly pain, but
would allow them to return to safety without major injury. Major issues encountered with
the MCP suit include don/doff time and swelling/edema in parts of the body. The most
difficult areas to pressurize occur where the limbs join the torso; in order to prevent blood
pooling, the pressure across these egions needed to remain smooth (Newman, et. al,
2001).

Figure G.8-3: MIT BioSuit™ Spacesuit
206

206
Source: MIT BioSuit (2012). An astronaut on Mars is depicted donning the elastic Bio-Suit layer (1).
The components shown are the helmet (2), boots (3), hard torso shell (4), and PLSS (5).
392

APPENDIX H: PRE-FLIGHT IV INFUSION DEVICE TESTING

Figure H.1-1: IV Infusion Device Tests (Sheet 1 of 3)
207

207
Source: Clement (2011)
393

Figure H.1-2: IV Infusion Device Tests (Sheet 2 of 3)
207

394

Figure H.1-3: IV Infusion Device Tests (Sheet 3 of 3)
207

395

APPENDIX I: VACUUM FEEDTHROUGH TECHNOLOGY

Appendix I.1 – Rotation Motion
A rotary motion drive is essentially an air-side "handle" that rotates a vacuum-
side shaft or tube. At least five types of rotary drive exist, differentiated by actuator
mechanism, vacuum sealing, compatible pressure range, and application (Motion
Feedthrough, 2011).
Magnetic Coupling
An outer (air-side) rotating ring has a number of strip magnets (the strips parallels
to the ring’s center-line) mounted so one magnet’s poles are opposite in sign to its
immediate neighboring magnets. This outer ring magnetically couples through a stainless
steel vacuum sheath to a vacuum-side ring with an identical number of strip magnets. A
coupling places an outer N pole over an inner S pole. The inner magnet ring is fixed to a
shaft rotating on two (MoS2 impregnated) ball bearings. The lack of mechanical coupling
and one piece construction removes any possibility of leaks. All selected construction
materials enable baking to 250°C, making this a rotary drive with high vacuum and UHV
compatible. The maximum torque transmitted is determined by the force that decouples
the inner/outer magnets and for larger rotary drives this is ~40Nm. If the magnetic
coupling is not under high torque, this drive gives very precise rotary motion. It can be
mounted in any orientation and has a long-life under continuous rotation (max. 500–1000
rpm). The trade name for this popular device is MagiDrive
™
(Figure I.1-1) (Motion
Feedthrough, 2011).
396

Figure I.1-1: Magnetically Coupled Rotary Drives
208

Elastomer Seal

The vacuum seal on this rotary drive is an elastomeric o-ring (Figure I.1-2) or
"knife-edge" attached to the stationary body and rubs on the rotating shaft in what is
called a "dynamic seal". Gas leaks, permeation through the elastomer, and seal wear limit
this drive to 10
-5
Torr or 10
-6
Torr range at best. They are used in applications where
rotation is intermittent, rotation speeds are < 100 rpm, there is little side-loading on the
shaft, poor vacuum conditions are acceptable, but cost must be low. Any mounting
orientation is permitted (Motion Feedthrough, 2011).

Figure I.1-2: O-Ring Seal
208

208
Source: Motion Feedthrough (2011)
397

Ferrofluid Seal

This rotary drive is basically a flanged cylinder with two roller bearings
supporting a central rotating shaft. The shaft, a high magnetic-permeability material, is
machined in a series of circumferential peaks and valleys (in section it looks like a cross-
cut saw). A ring magnet, mounted in the cylinder, surrounds the shaft, creating a small
gap between the shaft’s peaks and the ring. This gap is loaded with a ferromagnetic fluid
- a low vapor pressure fluid in which extremely small magnetic particles are suspended.
The field concentration effect of each peak causes the ferrofluid to form liquid o-rings
that can sustain a 70 Torr differential pressure. That is, designs with >11 peaks provide a
non-wearing vacuum seal against atmospheric pressure. In general, ferrofluid outgassing
limits this drive to applications above 1x10
-8
Torr. Some models are capable of high
torque loading and high speed (10,000 rpm) with long life under continuous rotation.
They can be mounted in any orientation and the continuous shaft means these drives
provide precise rotations. The trade name for one manufacturer is Ferrotec
™
(Figure I.1-
3) (Motion Feedthrough, 2011).

Figure I.1-3: Ferrofluid Seal
208

398

Appendix I.2 – Linear Motion
Linear motion devices, like rotary drives, are essentially air-side "handles" that
control some motion in the vacuum. Unlike rotary drives, linear drives are differentiated
by what moves and how far it moves, rather than the sealing mechanism (Motion
Feedthrough, 2011).
Linear Positioners

Positioners are bellows-sealed or magnetically coupled rods that move along the
rod’s axis. The mechanisms are either manually or pneumatically actuated, allowing a
push-pull motion between two stop positions. Another method is a precise screw
mechanism, with manual or motorized actuation, that can be stopped at any intermediate
position between its travel limits. Positioners are used in applications needing
straightline, fixed distance movement, for example, beamstops, shutter actuators,
substrate movements, etc., at all pressures between atmosphere and UHV. Linear
positioners sealed with elastomeric o-rings or "knife-edge" seals are available and
perform the same functions. However, like other "dynamic seal" devices, they are
compatible with pressures between atmosphere and ~10
-5
Torr (Figure I.2-1) (Motion
Feedthrough, 2011). .

Figure I.2-1: Push-Pull Positioner
208

399

Linear Shifts

A linear shift is a pair of flanges connected by a bellows. One flange is free to
move along its axis in relation to the other. The motion is constrained by a rugged,
precise slide mechanism so the flange faces are always parallel. Linear shifts may be
viewed as the linear version of the rotary platform; that is, they allow wide diameter
devices to be inserted into the vacuum chamber and moved linearly between limits. The
action is similar to the Z-only manipulator, but its positioning precision and travel length
(and therefore cost) are lower. Linear shifts are actuated by hand-wheels or, for higher
precision, stepper motors. They are compatible with high vacuum and UHV, and find
applications moving heavier, larger-diameter loads than positioners (Figure I.2-2)
(Motion Feedthrough, 2011).
.
Figure I.2-2: Manual Linear Shift
208

400

Appendix I.3 – XYZ Manipulation
A device that precisely moves a sample to any point in space and any rotational
orientation (within the design travel limits) is called XYZ manipulator or occasionally
XYZ translator (Figure I.3-1 and I.3-2). There are six degrees of freedom for such
movement, one along each X, Y, and Z axis, and 3 rotations about these axes. For most
practical applications, no more than five (X, Y, Z plus two rotations) are necessary. In the
description below, the word motions is used only to describe travel along the X, Y, or Z
axes (when no specific direction is implied). Similarly, the word rotations covers
generalized rotation. The sample is typically mounted at some central position inside the
vacuum volume, enabling access for instrumentation or processes. The actuators and
devices controlling the motions and rotations are all outside the vacuum volume -
motions sealed by flexible bellows and rotations sealed by wobble bellows, linear-acting
bellows, or magnetic couplings. Accessories/ancillaries used with XYZ manipulators
include: 1) Sample/substrate holders or stages, 2) Heating stages (to raise the sample’s
temperature), 3) Cooling stages (for cryogenic studies on samples), 4) Tilt devices (to
incline the sample’s support probe), and 5) Motorizing motions and rotation (Motion
Feedthrough, 2011).
401

Figure I.3-1: Multi-Stage XYZ
208

Figure I.3-2: XY Stage
209

209
MDC Vacuum V-Planer XY Stage (MDC Vacuum V-Planer, 2011)
402

APPENDIX J: SEALS
Appendix J.1 – Dynamic Seals
Dynamic seals include oil seals, hydraulic and pneumatic seals, exclusion seals, labyrinth
seals, bearing isolators, and piston rings. They create a barrier between moving and
stationary surfaces in applications such as rotating shafts and pistons rings (Dynamic
Seals-1, 2012). Dynamic seals are ideal for oscillating motion, reciprocal motion, rotating
motion, pneumatic seal, seat seal, and vacuum seal (Dynamic Seals-2, 2012). An example
of a dynamic seal is the Dynamic V-Shape Seal. This seal mounts directly onto the shaft
and seals axially against a counterface, housing or bearing surface. The elastic body
allows for the seal to be stretched into place without having to disassemble the machine.
The rubber seal adheres to the rotating shaft while the actual seal occurs at the point of
contact between the lip and the counterface (Figure J.1-1) (V-Seals-1, 2012).

Figure J.1-1: V-Seals
210

.

210
Source: V-Seals-2 (2012).
403

Appendix J.2 – Vacuum Seals
Unlike pneumatic seals, even slight leakage is often unacceptable in vacuum
applications. The following factors should be considered for vacuum seals (Vacuum
Seals, n.d.):
a. Dynamic vacuum seals require proper lubrication due to the absence of system
liquids. Use of vacuum grease is also desirable with static seals.
b. An especially smooth finish in the gland is important to ensure contact between
the elastomer and the metal parts.
c. In applications where absolute minimum leakage is a necessity, gland depth
should be reduced to increase the amount of squeeze.
d. To minimize the possibility of gases being trapped under the 0-ring and escaping
into the vacuum, reduced groove width and the use of suitable vacuum grease to
fill the excess void are recommended.
e. O-rings may be used in series in vacuum applications, preferably with a separate
vacuum between them.
Appendix J.3 – Oil/Grease Seals
Oil seals and grease seals have a flexible lip that rubs against a shaft or housing to
prevent the leakage or ingress of fluids and dirt. Some oil seals and grease seals have a
spring to help keep the lip in contact with the shaft. The sealing orientation and direction
is important to consider for oil seals and grease seals. The orientation and direction can
be internal or rod seal, external or piston seal, symmetric seal, or axial seal. The
following are examples of oil, grease, and dirt seals (Oil and Grease Seals, 2012):
404

a. Rod seals are radial seals. The seal is press-fit into a housing bore with the sealing
lip contacting the shaft. Also referred to as a shaft seal.
b. Piston seals are radial seals. The seal is fit onto a shaft with the sealing lip
contacting the housing bore. V-rings are considered external lip seals.
c. A symmetric seal is symmetrical and works equally well as a rod or a piston seal.
d. An axial seal seals axially against a housing or machine component.
405

APPENDIX K: LCVG ADHESIVE DESCRIPTIONS

Figure K-1: BIOFLEX® RX 1400P
211

211
Source: Wingfield (2012)
406

Figure K-2: UNIFILM® U880
407

Figure K-3: UNIFILM® UP5040
408

APPENDIX L: DESIGN CYCLE 4 ENGINEERING DRAWINGS

Figure L-1: DC4 Engineering Drawing (Sheet 1 of 8)

Figure L-2: DC4 Engineering Drawing (Sheet 2 of 8)
409

Figure L-3: DC4 Engineering Drawing (Sheet 3 of 8)

Figure L-4: DC4 Engineering Drawing (Sheet 4 of 8)
410

Figure L-5: DC4 Engineering Drawing (Sheet 5 of 8)

Figure L-6: DC4 Engineering Drawing (Sheet 6 of 8)
411

Figure L-7: DC4 Engineering Drawing (Sheet 7 of 8)

Figure L-8: DC4 Engineering Drawing (Sheet 8 of 8)
412

APPENDIX M: DESIGN CYCLE 5 ENGINEERING DRAWINGS

Figure M-1: DC5 Engineering Drawing (Sheet 1 of 4)

Figure M-2: DC5 Engineering Drawing (Sheet 2 of 4)
413

Figure M-3: DC5 Engineering Drawing (Sheet 3 of 4)

Figure M-4: DC5 Engineering Drawing (Sheet 4 of 4)
414

APPENDIX N: DESIGN CYCLE 6 ENGINEERING DRAWINGS

Figure N-1: DC6 Engineering Drawing (Sheet 1 of 8)

Figure N-2: DC6 Engineering Drawing (Sheet 2 of 8)
415

Figure N-3: DC6 Engineering Drawing (Sheet 3 of 8)

Figure N-4: DC6 Engineering Drawing (Sheet 4 of 8)
416

Figure N-5: DC6 Engineering Drawing (Sheet 5 of 8)

Figure N-6: DC6 Engineering Drawing (Sheet 6 of 8)
417

Figure N-7: DC6 Engineering Drawing (Sheet 7 of 8)

Figure N-8: DC6 Engineering Drawing (Sheet 8 of 8)
418

APPENDIX O: HUMAN SUBJECT - USC IRB

Since the ultimate goal of a through-the-suit IV provision would be to eventually
use it on humans, it became apparent early in the development process that a human
subject should be incorporated into this research. The manikin, used prior to the human
subject test, yielded valuable data which helped to develop the design. However, research
on a human subject was the best way to get reliable results for this study. Assessment of
patient discomfort, or lack thereof, and assessment of the ability of a trained doctor to
administer the needle with the through-the-suit IV provision were major discriminators in
determining to use a human subject.
The process of using a human subject to test the through-the-suit IV provision
was a long and arduous endeavor. It entailed going back and forth between the IRB and
this author for revisions to make sure that the risks associated with the study were
accurately addressed. Ultimately, it was determined that the risk to the human subject is
small. The patient's chest port will only interface with the needle that he/she is already
accustomed to as part of their regular treatment. The risk of infection will be negligible,
as the chest port will be accessed immediately before chest port removal, and removed
immediately after accessing it.
The first step to initiate the process was to obtain an IRB Submission Tracking
And Review (iStar) account (iStar, 2012) and complete the required human subject
protection training, namely CITI and HIPAA certification. CITI stands for the
Collaborative IRB Training Initiative; it is the premiere online human subjects education
program. It is currently used at more than 800 institutions, and it was created, developed,
419

and maintained by experts from the human subjects research community. The CITI
program provides key personnel the opportunity to complete education modules and
quizzes relevant to their research and discipline. A pool of modules is offered from which
key personnel elect which ones to complete. A cumulative score of at least 80% is
required for a completion certificate to be issued. The certificate is automatically
uploaded into iStar, so there are no additional steps needed once you complete the
program. Mandatory CITI education fulfills USC's commitment to promote ethical
conduct towards human subjects in all research projects, funded or unfunded. An IRB
application, with key personnel listed who do not receive CITI certification, is not
approved by the IRB (CITI, 2012).
Federal law also required completion of the Health Insurance Portability and
Accountability Act (HIPAA) training. HIPAA protects how health information is used.
HIPAA does not allow health information to be used or released for certain purposes
without the patient’s written permission. The purpose of HIPAA is to establish minimum
Federal standards for safeguarding the privacy of individual’s identifiable health
information. The law generally prohibits health care providers such as health care
practitioners, hospitals, nursing facilities and clinics from using or disclosing "protected
health information" without written authorization from the individual. "Protected Health
Information" (PHI) is any identifiable health information relating to the individual's past,
present or future physical or mental health condition or payment for health care. Health
information protected under the law includes: medical and dental records, bills or other
payment records for health care received, tissue samples, x-rays, laboratory results and
420

other health information that identifies you. State laws also protect how your health
information may be used. HIPAA requires all faculty, staff and other USC employees, as
well as students, volunteers, agents and certain other individuals who have access to
patient health information through USC providers to complete an online course on PHI
(HIPAA, 2012).
After an iStar account was obtained, CITI (Figure O-1) and HIPAA testing
(Figures O-2 and O-3) was completed, and a Faculty Advisor
212
was identified, the IRB
application was completed and submitted. The study required a full committee review,
and it was submitted to the Health Sciences IRB (HSIRB), as they had the medical
expertise necessary to review this research (Figures O-4 through O-29). The IRB
application included several required attachments, including ‘Human Subject Bill of
Rights’ (Figure O-30), ‘Informed Consent Form’ (Figures O-31 through O-35), ‘HIPAA
Authorization Form’ (Figure O-36 through O-40, ‘Human Subject Compensation
Agreement’ (Figure O-41), and ‘USC Department of Radiology IRB Application
Approval’ (Figure O-42). The USC Health Sciences IRB Chair (Dr. Darcy Spicer) was
first contacted in June 2010, the IRB application processed was started in December
2011, and the application was submitted in March 2012. After several iterations, the USC
HSIRB approved the IRB application on December 5, 2012 (Figures O-43 through O-45).

212
A faculty advisor was required by the IRB to oversee the study. Given his biomedical background, this
author first contacted Dissertation Committee member, Dr. Hsiai, who referred the author to faculty that
could support this study. Faculty contacted were Dr. Hossein Jadvar (Associate Professor of Radiology and
Biomedical Engineering), Dr. Mohammad Pashmforoush (Assistant Professor of Medicine), Dr. Gerald
Loeb (Professor of Biomedical Engineering), Dr. Darcy Spicer (Oncologist, Health Science IRB Chair),
and Dr. Michael Katz (Chief Interventional Radiologist). All contacted provided valuable insight and
advice. Ultimately, Dr. Katz was the Faculty Advisor for this study.

421

Figure O-1: Collaborative Institutional Training Certification

422

Figure O-2: HIPAA Privacy Education Program Certification (Sheet 1 of 2)
423

Figure O-3: HIPAA Privacy Education Program Certification (Sheet 2 of 2)
424

Figure O-4: IRB Human Subject Application (Sheet 1 of 26)
425

Figure O-5: IRB Human Subject Application (Sheet 2 of 26)
426

Figure O-6: IRB Human Subject Application (Sheet 3 of 26)
427

Figure O-7: IRB Human Subject Application (Sheet 4 of 26)
428

Figure O-8: IRB Human Subject Application (Sheet 5 of 26)
429

Figure O-9: IRB Human Subject Application (Sheet 6 of 26)
430

Figure O-10: IRB Human Subject Application (Sheet 7 of 26)
431

Figure O-11: IRB Human Subject Application (Sheet 8 of 26)
432

Figure O-12: IRB Human Subject Application (Sheet 9 of 26)
433

Figure O-13: IRB Human Subject Application (Sheet 10 of 26)

434

Figure O-14: IRB Human Subject Application (Sheet 11 of 26)
435

Figure O-15: IRB Human Subject Application (Sheet 12 of 26)
436

Figure O-16: IRB Human Subject Application (Sheet 13 of 26)
437

Figure O-17: IRB Human Subject Application (Sheet 14 of 26)
438

Figure O-18: IRB Human Subject Application (Sheet 15 of 26)
439

Figure O-19: IRB Human Subject Application (Sheet 16 of 26)
440

Figure O-20: IRB Human Subject Application (Sheet 17 of 26)
441

Figure O-21: IRB Human Subject Application (Sheet 18 of 26)
442

Figure O-22: IRB Human Subject Application (Sheet 19 of 26)
443

Figure O-23: IRB Human Subject Application (Sheet 20 of 26)

444

Figure O-24: IRB Human Subject Application (Sheet 21 of 26)
445

Figure O-25: IRB Human Subject Application (Sheet 22 of 26)
446

Figure O-26: IRB Human Subject Application (Sheet 23 of 26)

447

Figure O-27: IRB Human Subject Application (Sheet 24 of 26)
448

Figure O-28: IRB Human Subject Application (Sheet 25 of 26)

449

Figure O-29: IRB Human Subject Application (Sheet 26 of 26)

450

Figure O-30: Informed Consent - Human Subject Bill of Rights (Sheet 1 of 5)
213

213
Research Participant name blacked out because of HIPAA
451

Figure O-31: Informed Consent (Sheet 2 of 5)

452

Figure O-32: Informed Consent (Sheet 3 of 5)

453

Figure O-33: Informed Consent (Sheet 4 of 5)
454

Figure O-34: Informed Consent (Sheet 5 of 5)
214

214
Research Participant name blacked out because of HIPAA
455

Figure O-35: Sponsor-Investigator Agreement Form
456

Figure O-36: HIPAA Authorization Form (Sheet 1 of 5)

457

Figure O-37: HIPAA Authorization Form (Sheet 2 of 5)

458

Figure O-38: HIPAA Authorization Form (Sheet 3 of 5)

459

Figure O-39: HIPAA Authorization Form (Sheet 4 of 5)

460

Figure O-40: HIPAA Authorization Form (Sheet 5 of 5)
215

215
Name of Research Participant blacked out because of HIPAA reasons
461

Figure O-41: Human Subject Compensation Agreement

462

Figure O-42: Human Subject Compensation Acknowledgement
216

216
Name of Research Participant blacked out because of HIPAA reasons
463

Figure O-43: USC Department of Radiology IRB Application Approval

464

Figure O-44: IRB Application Approval (Sheet 1 of 3)
465

Figure O-45: IRB Application Approval (Sheet 2 of 3)

466

Figure O-46: IRB Application Approval (Sheet 3 of 3)
467

APPENDIX P: OUTGASSING

Evaporation and sublimation into a vacuum is called outgassing. All materials,
solid or liquid, have a small vapour pressure, and their outgassing becomes important
when the vacuum pressure falls below this vapour pressure (Vacuum, 2012). NASA and
ESA maintains a list of low-outgassing materials to be used for spacecraft, as outgassing
products can condense onto optical elements, thermal radiators, or solar cells and obscure
them. Materials not normally considered absorbent can release enough light-weight
molecules to interfere with industrial or scientific vacuum processes. Moisture, sealants,
lubricants, and adhesives are the most common sources, but even metals and glasses can
release gases from cracks or impurities. Both Hydrogen and CO diffuse out from the
grain boundaries in stainless steel. The rate of outgassing increases at higher temperatures
because the vapour pressure and rate of chemical reaction increases. For most solid
materials, the method of manufacture and preparation can reduce the level of outgassing
significantly. Cleaning surfaces to ensure they are free of organic matter is important to
minimize outgassing. Additionally, ultra-high vacuum systems are usually baked,
preferably under vacuum, to temporarily raise the vapour pressure of all outgassing
materials and boil them off. Once the bulk of the outgassing materials are boiled off and
evacuated, the system may be cooled to lower vapour pressures to minimize residual
outgassing during actual operation (Schlappi, et al., 2010). That said, for purposes of a
through-the-suit IV connector, the vacuum side is the planetary surface, so if outgassing
were to be occur from any of the connector feedthrough components, gases would not go
into go into the pressurized suit environment.
468

APPENDIX Q: IV INFUSION USING AN IVP

This appendix contains an excerpt of Mr. Diehl Martin’s experience utilizing an
IVP for his chemotherapy treatment (Martin, 2006). Mr. Martin cataloged his treatment
on his website (http://diehlmartin.com/infusion/) until he passed on October 2007. Based
on the ample research conducted on IVPs for this research, this was by far the best
website describing a patient’s experience with these ports. Most websites I found
described IVPs from the point of view of doctors, hospitals, or medical device
developers; it was refreshing and enlightening to read a patient's perspective. Table Q-1
describes the various treatment steps; while Figures Q-1 and Q-2 depict pictures
referenced in Table Q-1.
Table Q-1: IVP Chemotherapy Treatment Procedure
217

Figure # , Picture Letter Procedure Description
Figure Q-1, Picture A The IVP is in the lump near the third button up. The IVP is entirely under
the skin, and is in the fat layer. There is a tiny catheter that goes from the
IVP up to the jugular vein in my neck. The IVP is painless, and doesn't itch.
In order to hook up to the IVP, I undo several buttons on my shirt, and that
provides all the room they need for access.
Figure Q-1, Picture B First the nurse puts down a barrier to keep any spills from staining my shirt.
It has an absorptive layer on the top, and a plastic barrier layer on the
bottom.
Figure Q-1, Picture C Next, the nurse applies a disinfectant to the skin over the IVP, to reduce the
risk of infection. The material they use seems to be iodine based, which
temporarily stains the area, letting them know exactly where the
disinfectant has been applied.
Figure Q-1, Picture D The area is then sprayed with a chemical which cools and numbs the skin
over the IVP, which makes it so that I can barely feel the attachment to the
IVP.
Figure Q-1, Picture E There is a special needle assembly which is made specifically to work with
an IVP. Here the nurse is about to puncture the skin with the needle, and
push it into the reservoir in the IVP.
Figure Q-1, Picture F This picture shows the configuration of the needle assembly. It looks
terrible, but I could barely feel it. It is made to hook into the IVP and to

217
Table adapted from Martin (2006).
469

Figure # , Picture Letter Procedure Description
stay hooked to it, and not fall out.
Figure Q-1, Picture G Once the special needle is inserted, it provides a pathway through which
blood may be drawn, and through which the necessary drugs may be
administered. This needle, once inserted for the day, is left in until all of the
day's procedures have been completed. Once again, I could barely feel it.
Figure Q-1, Picture H This close up view shows how the needle goes through the skin and into the
IVP. As compared to having an IV installed, this is easy and painless.
Figure Q-2, Picture I Once the IVP is set up, the procedures can begin. There are multiple vials
of blood drawn. The first one is always wasted as there is some
contamination possible in the sample, which would throw off the blood test
results. By the second vial, the blood is suitable for their tests.
Figure Q-2, Picture J The vials are actually little vacuum bottles, which draw the blood out
without requiring any mechanical aid on the part of the nurse.
Figure Q-2, Picture K Once the blood is drawn, the IVP is injected with heparin, which reduces
the possibility of the blood clotting in the IVP, and blocking it.
Figure Q-2, Picture L Next, the nurse adds some gauze pads to add some mechanical support to
the IVP, and tapes it all to my skin. This is necessary, as once I close my
shirt and head back to the waiting room, I could be bumped which might
cause things to shift. The gauze pads help prevent this from happening.
Figure Q-2, Picture M Once the IVP is accessed for the day, I can button up my shirt and have just
the access tubing sticking out of my shirt. Now I go out and wait until the
blood tests are completed. There are some problems which blood tests can
discover which would preclude them from giving me a chemotherapy
treatment. Until the tests are done, they do not know if they can proceed or
not.
Figure Q-2, Picture N After about an hour wait, I am then called back into the infusion room, and
seated in one of their big recliners. The nurse first injects an anti-nausea
medicine, since some forms of chemotherapy can cause nausea.
Figure Q-2, Picture O The nurse then hooks up the IVP access to her infusion pump, and starts
infusing saline solution (salty water, as Edna called it) while we wait for
the gemcitabine mix to be prepared in the pharmacy. Once the gemcitabine
is ready, the nurse sets the pump to inject it over a 90 minute period.
Figure Q-2, Picture P Once the gemcitabine is set to pump, there is little to do but lie there and
wait. Sometimes I read, and sometimes I sleep. If there are any other shots I
am to receive, I usually receive them sometime during the infusion. Once
the gemcitabine is done being pumped in, the nurse unhooks the access
tubing and needle from the IVP, puts on a band aid, and I am free to leave.
Table Q-1: Continued
470

Figure Q-1: IVP Chemotherapy Use, Part I
218

Figure Q-2: IVP Chemotherapy Use, Part II
219

218
Pictures compiled from Martin (2006).
219
Pictures compiled from Martin (2006).

Abstract (if available)

Abstract Future NASA space exploration strategic plans will call for extended human presence in space, with long term missions to the Moon and/or Mars. This human presence in extra-terrestrial locations will require use of Extra-Vehicular Activities (EVAs). Planetary surface EVAs will be an essential part of human space exploration, but involve inherently dangerous procedures which can put crew safety at risk. To help mitigate these risks, astronaut training programs will spend substantial attention on preparing for planetary surface EVA emergencies. And though EVA emergency protocols will be to transport an ill/injured EVA crewmember to a pressurized safe haven for medical intervention, there may be situations where this will not be expeditiously possible. Furthermore, even though most serious health risks will be diagnosed before flight, there will be unforeseeable EVA illnesses and/or injuries which may require the use of intravenous (IV) fluid administration. ❧ The purpose of this research is to propose a through-the-spacesuit IV administration concept approach for future spacesuits. This capability would allow for enhanced patient accessibility during EVA emergencies. In the case of serious injury and/or illness during an EVA, IV fluid administration might be necessary until the patient is transported back to a pressurized safe haven. To date, only Apollo spacesuits have incorporated a through-the-spacesuit injection provision, which allowed for intramuscular (IM) injections. However, no spacesuit has incorporated an IV capability. ❧ The methodology to conduct this research was to identify key researchers in the spacesuit design and aerospace medicine fields and engage them in this study. An extensive literature review was also performed, which concluded that no prior spacesuit had an IV capability incorporated into its design

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Asset Metadata

Creator Diaz, Alejandro R. (author)

Core Title Extravehicular activity (EVA) emergency aid for extended planetary surface missions: through-the-spacesuit intravenous (IV) administration

School Viterbi School of Engineering

Degree Doctor of Philosophy

Degree Program Astronautical Engineering

Publication Date 03/26/2012

Defense Date 03/06/2012

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Eva,Medicine,OAI-PMH Harvest,space

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Kunc, Joseph (committee chair), Erwin, Daniel A. (committee member), Gruntman, Michael A. (committee member), Hsiai, Tzung K. (committee member), Rygalov, Vadim (committee member)

Creator Email adiaz@usc.edu,alejandro.r.diaz@boeing.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c127-679395

Unique identifier UC1343799

Identifier usctheses-c127-679395 (legacy record id)

Legacy Identifier etd-DiazAlejan-544.pdf

Dmrecord 679395

Document Type Dissertation

Rights Diaz, Alejandro R.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

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