Medical Operations Team Activities

Working with International Partners
on health management operations on the ISS.

Health management operations for astronauts are largely categorized in three periods: before, during, and after spaceflight. The team performs necessary tasks to keep astronauts healthy during each of these periods. Particularly, in the case of in-flight health management operations on the ISS, which is an international collaborative project of five partner space agencies (CSA, ESA, FSA, JAXA, and NASA), medical operations teams of these agencies work closely together to carry out operations in an integrated fashion.

The dedicated flight surgeon supports astronaut ONISHI Takuya
on the day of returning to earth ©JAXA/NASA/Bill Ingalls

Pre-flight health management operations

Health management operations for astronauts begin with astronaut selection. Astronauts must undergo years of training on earth before they are assigned to a flight. During that period, they are expected to stay in excellent health to be able to perform space missions. Astronauts undergo medical tests every year. The JAXA and ISS medical certification boards review those test results and certify astronauts’ medical eligibility for spaceflight. The annual assessment on astronauts’ physical performance is conducted to give individual guidance on exercises. Other pre-flight tasks include selecting Japanese space foods and daily necessities, and engaging in the process for transporting them to space.

Health management operations during training

Astronaut training on earth include extravehicular activity training in the enormous pool at the Neutral Buoyancy Laboratory (NBL) at NASA’s Johnson Space Center, training using a centrifuge, NASA Extreme Environment Mission Operations (NEEMO) conducted for a long-duration under the sea, and survival training. Because these training activities have elevated risk, the flight surgeon accompanies the astronaut to ensure the astronauts’ health and safety.

JAXA astronaut KANAI Norishige participates in extravehicular activity training ©JAXA/NASA

Health management operations between mission assignment and launch

NASA Astronaut Kathleen Rubins, Russian Cosmonaut Anatoly Ivanishin, and JAXA Astronaut ONISHI Takuya attend a pressure check of their Russian Sokol launch and entry suit.

Once an astronaut is assigned to a specific mission, the pre-launch health management operations schedule is developed. Astronauts who will stay on the International Space Station (ISS) for a month or longer must participate in on-orbit medical operations training according to the Medical Operations Requirements.

Starting one year before launch, astronauts undergo medical testing and other procedures as required by the Medical Operations Requirements. Health management operations such as tests and examinations by the flight surgeon are conducted until launch day. Prior to launch, astronauts are quarantined. The crew members live together in the dedicated lodgings and are only allowed to interact with the adults who have passed the health check, and not with children who have higher likelihood to be the sources of infection.

In-flight health management operations

Health management operations for astronauts in flight are remotely conducted primarily by JAXA’s designated flight surgeon at NASA's Mission Control Center in Houston (MCC-H) and by the medical management team at Tsukuba Space Center.

Astronauts who will stay on the ISS for a month or longer must undergo various medical tests before, during, and after spaceflight as stipulated by the Medical Operations Requirement. The team comprehensively manages the health of astronauts on the ISS using these medical data, which includes medical interviews, examinations, and tests, in addition to the physical performance, nutrition, and mental health of each astronaut, environmental monitoring results such as the status of the life support system, the radiation environment on the ISS and of individual astronauts, and the environment inside the ISS itself.

Exercising on the Advanced Resistive Exercise Device (ARED) ©JAXA/NASA

Equipment used for medical operations on orbit

Medical tests on the ISS are performed using the medical operations equipment installed in the ISS such as blood and urine sampling kits, ECG machines, blood pressure cuffs, and diagnostic ultrasound systems. These are collectively referred to as the Crew Health Care System (CHeCS/IMS).

Health management operations equipment in the IMS

Health Maintenance System (HMS):
Collective term for medical instruments and emergency medical kits for use on orbit
Environmental Health System (EHS):
Collective term for various monitoring systems for water, air and microbes, and the radiation monitoring system
Countermeasures System (CMS):
Collective term for equipment such as treadmills, ergometers, and resistance exercise equipment

The Crew Medical Officer: the astronaut in charge of medical operations

The Crew Medical Officer, the astronaut in charge of medical operations, performs medical testing on astronauts in orbit.

Besides conducting medical testing, the Crew Medical Officer treats any astronaut who becomes ill or injured on orbit using medicine and medical instruments available in the ISS while following the advice of the flight surgeons back on earth. The ISS is equipped with intravenous drip infusion, intubation, eye washing kits, and basic surgery kits, but to this date no major medical incident that would require such equipment other than the eye washing kit has occurred.

The Crew Medical Officer continues regular training in emergency medicine while on orbit to maintain medical knowledge and skills in order to be prepared in case an astronaut becomes injured or suddenly ill. In this training, one of the astronauts plays the role of the injured or ill person, and the Crew Medical Officer simulates the necessary medical procedures to treat that injury or illness.

Astronaut FURUKAWA Satoshi undergoes medical testing by the Crew Medical Officer aboard the ISS ©JAXA/NASA

Exercise program

Spending an extended period in microgravity causes a loss of muscle in the lower limbs and a loss of bone mass. To prevent these, the Medical Operations Requirements stipulates that astronauts on the ISS must exercise at least two hours per day on three pieces of equipment: a treadmill, an ergometer, and resistance exercise equipment. In addition, physical performance assessments are conducted periodically on the ISS to evaluate the effects of exercise. Apparently, astronauts who are diligent about exercising in space quickly recover their muscle strength after returning to earth and spend less time in the rehabilitation program.

Station environment monitoring: Air, water, and microbes

On the ISS, air, water, and wall surface samples are collected and periodically analyzed. The composition of air in the ISS is regulated by devices that generate oxygen and absorb carbon dioxide, as well as HEPA filters, deodorizing filters, and a thermal purification system. The environment is constantly monitored to ensure it is not contaminated with toxic gases or microbes such bacteria or mold. As part of the Medical Operations Requirements, air (including sampling), microbes, and drinking water quality are monitored on the ISS.

Station environment monitoring: Radiation

Properly monitoring radiation exposure is also essential to keeping astronauts healthy. The Medical Operations Requirements require that the cumulative radiation dose be recorded on the personal dosimeters that each astronaut wears (analyzed post-flight) and radiation measurement devices installed inside the ISS be monitored in real time. Data such as space weather forecasts— which include estimates of solar-terrestrial radiation based on observation of the sun’s activity— are also used to control astronauts’ radiation exposure. When solar activity is high, monitoring is intensified, and at times when the sun is releasing large amounts of protons, astronauts must temporarily take refuge in the part of the ISS with thicker bulkheads to protect themselves from exposure.

Nutrition management

Meals are essential to maintaining the physical and psychological health of astronauts as they conduct important missions in the extreme environment of space. Astronauts’ diet aboard the ISS is monitored from ground to ensure optimal dietary intake and nutritional balance.

Psychophysiological support

Psychophysiological support is a major key to mission success because declining mental health could reduce astronauts’ work efficiency or cause fatigue. In accordance with the Medical Operations Requirements, the mental health and well-being of astronauts on the ISS are supported by offering private counseling and giving them time to call their families on a regular basis.

Monitoring of extravehicular activities

Spacesuits enable astronauts to conduct extravehicular activities in the extreme environment of space. NASA’s spacesuit is called the Extravehicular Mobility Unit (EMU) and can be used for six to seven hours of extravehicular activities. The inside of the spacesuit is filled with 100% oxygen pressurized to 0.29 atm higher than a vacuum. During extravehicular activities, astronauts’ ECG recordings and other measurements are monitored in real time from mission control centers back on earth.

Health management operations immediately before returning to earth

While astronauts are in space, their bodies adapt to microgravity. Because of this, they can experience low blood pressure when standing up, or in severe cases even lose consciousness, upon returning to an environment with gravity. As stipulated by the Medical Operations Requirement, astronauts on the ISS must undergo daily medical interviews with the flight surgeons and receive advice about fluid and salt supplementation beginning two days before returning to earth.

Post-flight health management operations

When astronauts go on long-term missions lasting around six months, their bodies undergo various physiological changes including reduced resistance of muscles against gravity and loss of bone mass. Due to these changes, they cannot return to normal life right away. Therefore, astronauts returning from a long space mission undergo a systematic, specially designed post-flight rehabilitation program of about 45 days to restore their body to its pre-flight condition. Their physical function, physical performance, and health are also checked as they undergo the program.

Astronaut HOSHIDE Akihiko is carried to the medical tent after landing
©JAXA/NASA/GCTC/Andrey Shelepin

Psychophysiological support after returning to earth

The Soyuz MS-07 crew KANAI Norishige of JAXA pose for pictures
during a welcome ceremony at Karaganda Airport in Kazakhstan ©JAXA/NASA/Bill Ingalls

Health management operations that support astronauts’ mental health are also important for long space missions. Once an astronaut is assigned to a mission, they must leave their family behind and travel to many different countries for rigorous and time-consuming training. Even when they return to earth, their schedule is packed full with events such as post-flight briefings, VIP visits, and press conferences.

Some astronauts have their life philosophy and values change radically after experiencing spaceflight, and others get burnout syndrome, where they become despondent or depressed after accomplishing such a major goal.

In many cases, Japanese astronauts come into the public spotlight after returning home and their schedule becomes extremely demanding, possibly even more so than the mission itself. This is why controlling astronauts’ schedules after they return home is another important aspect of health management operations.

Rehabilitation after returning to earth

The typical rehabilitation program consists of three phases. Phase 1, which lasts until three days after return, focuses on massages, stretches, and assisted walking. In Phase 2, which lasts until two weeks after return, astronauts transition to doing various exercises such as underwater walking, pedaling on a cycle ergometer, and light walking. In Phase 3, they start running and doing more intensive strength training. After 45 days, astronauts are allowed to return to their normal life while their individual recovery is monitored.

Under the guidance from experts in NASA, JAXA have accumulated the knowledge by implementing to prepare for prescriptions on exercise and to provide with guidance on exercise to Japanese astronauts. The rehabilitation period of Astronaut Onishi’s after returning to the Earth allowed us realize the first rehabilitation in Japan.

Working with International Partnerson health management operations on the ISS.