Eli5: What would be the protocol for the case of an Astronaut suffering a heart attack or similar serious medical condition, (and has it ever happenend before?) on the ISS?
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The ISS is not equipped for heavy, prolonged intensive care. Compromises therefore have to be made, targeting care provision at pathologies with the highest probability of incidence. These pathologies can be conventional, occurring spontaneously during flight and unrelated to the mission (such as a dental abscess), or circumstantial, i.e. favored or engendered by exposure to one of the many constraints of the space environment. However, in the event of a serious accident, treatment options would be rapidly overwhelmed. The station has no labile blood products (for transfusion purposes, for example), no heavy surgical equipment for urgent digestive or vascular operations, and no personnel to manage the large number of critical tasks involved in caring for a seriously injured person.
Could we simply opt for a medical evacuation in the event of threatening symptoms? After all, the Soyuz or Crew Dragon capsules, docked to the station, enable a return to Earth in just a few hours. The maximum time between a decision to evacuate and admission to hospital is estimated at around thirty hours. This means that the crew aboard an orbital station is closer to a modern hospital than some navigators or scientists wintering in Antarctica. For the latter, evacuation may take several days, or even be impossible due to weather conditions.
However, this advantage is offset by a number of difficulties that limit the option of medical evacuation. For example, it is currently impossible to envisage the transfer of an astronaut requiring critical care between the ISS and Earth, along the lines of the inter-hospital evacuations highlighted by the SARS-CoV-2 pandemic. This type of transfer of intubated, ventilated and sedated patients requires heavy logistics, in terms of therapeutic equipment (infusions, syringe pumps, respirator connected to the patient by an intubation tube), monitoring (monitor) and personnel. It’s simply not possible to fit so much medical equipment into a small capsule.
For the ISS, the decision to carry out a medical evacuation is therefore exposed to two strategic pitfalls. The first would be to unnecessarily evacuate, at high cost, a benign pathology that could have been treated with the on-board pharmacy. Conversely, it would be catastrophic to underestimate the initial or potential seriousness (in the event of an unfavorable evolution) of a condition, to miss the optimal time window for evacuation, and then to run out of therapeutic options within the station.
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