52
Spaceflight Decompression Sickness Contingency Plan Joe Dervay, M.D. https://ntrs.nasa.gov/search.jsp?R=20070024711 2018-07-28T11:50:10+00:00Z
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
ySp
acef
light
D
ecom
pres
sion
Sick
ness
C
ontin
genc
y Pl
an
Joe
Der
vay,
M.D
.
https://ntrs.nasa.gov/search.jsp?R=20070024711 2018-07-28T11:50:10+00:00Z
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
•A
ppro
ach
•D
CS
Con
tinge
ncy
Plan
Ove
rvie
w•
Extr
aveh
icul
ar A
ctiv
ity (E
VA) C
uff C
lass
ifica
tions
•O
n-or
bit T
reat
men
t Phi
loso
phy
•Lo
ng F
orm
Mal
func
tion
Proc
edur
e (M
AL)
•M
edic
al C
heck
list
•Fl
ight
Rul
es•
Cre
w T
rain
ing
•Fl
ight
Sur
geon
/ B
iom
edic
al E
ngin
eer (
BM
E) T
rain
ing
•D
CS
Emer
genc
y La
ndin
g Si
te
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
yM
issi
on S
uppo
rtM
issi
on S
uppo
rtO
n-or
bit F
light
Con
trol R
oom
(FC
R) S
taffi
ng
Surg
eon
Con
sole
-FC
R
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
•C
urre
nt IS
S Pr
ebre
athe
Pro
toco
ls–
Four
hou
r In-
suit
(Orig
inal
ly a
ccep
ted
by te
stin
g.
Cur
rent
ly a
ccep
tabl
e by
ana
lysi
s)
–C
ampo
ut
(Acc
epte
d by
ana
lysi
s of
rela
ted
data
/sim
ilarit
y to
shu
ttle
10.2
psi
sta
ged
prot
ocol
)–
Exer
cise
Pre
brea
the
(Acc
epte
d by
test
ing
utili
zing
the
crite
ria b
elow
)
•A
ccep
t Crit
eria
for I
SS E
VA P
rebr
eath
e Pr
otoc
ols*
–O
ne-y
ear “
DC
S R
isk
Def
initi
on &
Con
tinge
ncy
Plan
” ef
fort
des
igna
ted
acce
pt c
riter
ia o
f res
earc
h pr
otoc
ol»
Dec
ompr
essi
on S
ickn
ess
(DC
S) <
15 %
at 9
5% C
L»
Gra
de 4
Ven
ous
Gas
Em
boli
(VG
E) <
20 %
at 9
5% C
L»
No
Type
II (s
erio
us) D
CS
* Thi
s cr
iteria
was
not
app
lied
to th
e sh
uttle
pro
toco
ls
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
•O
pera
tiona
l Exp
erie
nce
–To
dat
e, th
ere
have
bee
n 14
1 pe
rson
-EVA
s co
nduc
ted
with
10.
2 ps
i Sta
ged
PB P
roto
col
Fina
l PB
»12
-16
hr s
tay
at 1
0.2
---20
75 m
in»
16-2
0 hr
sta
y at
10.
2 ---
460
min
»20
-24
hr s
tay
at 1
0.2
---12
50 m
in»
24 h
r >
stay
at 1
0.2
----1
0540
min
–In
no
case
has
ther
e be
en a
ny re
port
ed s
ympt
oms
or s
igns
of
DC
S
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
OB
JEC
TIVE
:
•D
evel
op e
nhan
ced
plan
to d
iagn
ose,
trea
t, an
d m
anag
e on
-orb
it D
CS
–A
chie
ve n
ew le
vel o
f DC
S a
war
enes
s am
ong
fligh
t con
trolle
rs,
astro
naut
s, a
nd th
e m
edic
al c
omm
unity
•H
isto
rical
ly, f
ew d
river
s to
mod
ify e
xist
ing
plan
•S
igni
fican
t upc
omin
g in
crea
se in
EV
A a
ctiv
ity to
bui
ld a
nd m
aint
ain
ISS
-“W
all o
f EV
A’s
”
•Im
porta
nt to
invo
lve
Inte
rnat
iona
l Par
tner
s w
ith p
lan
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
APP
RO
AC
H:
•Jo
hnso
n S
pace
Cen
ter m
ulti-
disc
iplin
ary
team
: Med
ical
Ope
ratio
ns,
Ast
rona
ut O
ffice
, EV
A O
ffice
, Mis
sion
Ope
ratio
ns D
irect
orat
e
•C
onsu
ltatio
n w
ith m
ilita
ry, c
ivili
an, a
nd c
omm
erci
al e
xper
ts
•R
evie
w o
f lite
ratu
re a
nd d
atab
ases
•A
naly
sis
of p
ast M
issi
on C
ontro
l “S
imul
atio
n” s
cena
rios
•O
vera
ll pl
an re
view
ed b
y ex
pert
com
mitt
ee c
haire
d by
Dr.
Lam
berts
on(1
998)
DC
S C
ontin
genc
yP
lan
EV
A
Che
cklis
tD
evel
opm
ent
Impr
oved
O
n-O
rbit
DC
STr
eatm
ent
DC
SFl
ight
Rul
esD
evel
opm
ent
Gro
und
Sup
port
Infra
stru
ctur
e
DC
SD
ispo
sitio
nP
olic
y
Insu
itTr
eatm
ent
BTA
Mod
s
Hyp
erba
ric
Cha
mbe
r Te
chno
logy
Dev
.
Adj
unct
ive
Dru
g Th
erap
y
Mis
sion
Con
trol
DC
S S
imul
atio
nP
rogr
am
Cre
wFl
ight
Sur
geon
Trai
ning
Coo
pera
tive
USA
F/N
ASA
Pro
gram
s
Prim
ary
Hyp
erba
ricLa
ndin
g S
ites
Shu
ttle
/ EM
U
ISS
/ E
MU
Rus
sian
/ O
RLA
N
Rus
sian
E
MS
Pla
n
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
EVA
“C
UFF
CLA
SSIF
ICA
TIO
N”
SYST
EM :
•S
impl
e op
erat
iona
l cla
ssifi
catio
n of
DC
S s
ympt
oms
rele
vant
to E
VA
cr
ewm
embe
r
•P
rovi
des
clea
r com
mun
icat
ion
of s
ympt
oms
and
asso
ciat
ed o
pera
tiona
l re
spon
se.
•D
efin
es a
ctio
ns re
quire
d to
pla
ce p
aylo
ad in
saf
e co
nfig
urat
ion
and
repr
ess
affe
cted
cre
wm
embe
r
•S
ensi
ble
syst
em to
enc
oura
ge s
ympt
om re
porti
ng
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
EVA
CU
FF C
LASS
IFIC
ATI
ON
S
Cuf
f Cla
ssSy
mpt
oms
Res
pons
eR
atio
nale
1M
ild p
ain,
at s
ingl
e or
mul
tiple
Rep
ort i
n po
st E
VA
1-8
site
s an
d/or
sing
le e
xtre
mity
PMC
. N
o fu
ture
EV
Apa
rest
hesi
a. D
iffic
ult t
o im
pact
.di
stin
guis
h fro
m s
uit p
ress
ure
poin
ts.
-Sym
ptom
s do
not
inte
rfer
ew
ith p
erfo
rman
ce.
2M
oder
ate
cuff
1 sy
mpt
oms
Term
inat
e E
VA
for b
oth
3,6
that
inte
rfer
e w
ith
crew
mem
bers
, per
form
9-1
0pe
rfor
man
ce.
wor
ksite
cle
an-u
p on
ly,
min
imiz
e ac
tivity
of
affe
cted
cre
w m
embe
r.P
erfo
rm re
pres
s.
Set u
p PM
C p
ost r
epre
ss.
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
EVA
CU
FF C
LASS
IFIC
ATI
ON
S (c
ont.)
Cuf
f Cla
ssSy
mpt
oms
Res
pons
eR
atio
nale
3Se
vere
cuf
f 1 s
ympt
oms
orTe
rmin
ate
EV
A.
12,1
3m
igra
tory
, tru
nkal
or m
ultip
leA
ssis
ted
retu
rn o
f si
te p
ares
thes
ia, u
nusu
alaf
fect
ed c
rew
mem
ber
head
ache
.to
airl
ock,
bud
dy p
erfo
rmw
orks
ite s
afin
g, th
en
airlo
ck re
pres
s. S
et u
pPM
C.
4S
erio
us s
ympt
oms
–C
entra
lAb
ort E
VA
. Cre
w14
-19
neur
olog
ical
, car
diop
ulm
onar
y.as
sist
ed re
turn
to a
irloc
k.R
epre
ss a
ffect
ed c
rew
mem
ber.
Bud
dy p
erfo
rmw
orks
ite s
afin
g, th
enai
rlock
dep
ress
, rep
ress
.S
et u
p P
MC
.
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
RA
TIO
NA
LE :
•S
pace
suit
itsel
f cre
ates
pre
ssur
e po
ints
, joi
nt p
ains
, and
loca
lpa
rest
hesi
as
•M
ajor
ity o
f pai
n sy
mpt
oms
(86%
) in
hist
oric
dat
abas
e im
prov
ed o
rre
mai
ned
the
sam
e w
ith ti
me
•Lo
w ri
sk o
f mild
or m
oder
ate
sym
ptom
s pr
ogre
ssin
g to
ser
ious
•W
orks
ite s
afin
gim
porta
nt fo
r pot
entia
l Shu
ttle
de-o
rbit
as w
ell a
s S
tatio
n op
erat
ions
•M
ay re
quire
30-
45 m
in. t
rans
it to
airl
ock
from
wor
ksite
loca
tion
•W
ith s
erio
us s
ympt
oms,
may
nee
d to
repr
ess
affe
cted
cre
wm
embe
r AS
AP
w
hile
sol
o cr
ewm
embe
r com
plet
es c
lean
-up
task
s
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
TREA
TMEN
T PH
ILO
SOPH
Y:
•O
xyge
n, p
ress
ure,
and
tim
e ar
e de
finiti
ve m
easu
res
–Fl
uids
and
med
icat
ions
are
adj
unct
ive
•P
rovi
de h
ighe
r pre
ssur
es a
nd lo
nger
tim
es th
an p
rove
n 2-
hr. G
roun
d Le
vel
Oxy
gen
(GLO
) –tre
at g
as p
hase
, not
just
sym
ptom
s
•A
void
bre
akin
g su
it in
tegr
ity fo
r 20-
30 m
in. f
or in
stal
latio
n of
Ben
ds T
reat
men
t A
ppar
atus
(BTA
) [in
crea
ses
suit
pres
sure
to 8
psi
]
•D
evel
opm
ent o
f tre
atm
ent f
low
s, e
xten
sion
s
•C
onve
rsio
n in
to M
alfu
nctio
n (M
AL)
Pro
cedu
res
•E
nhan
ced
Med
ical
Che
cklis
t–
Afte
rcar
e–
Add
ress
es la
te a
nd re
curr
ent “
hit”
Term
inat
e EV
A; I
n A
irloc
k on
SC
UTe
rmin
ate
EVA
; In
Airl
ock
on S
CU
Rep
ress
Rep
ress
If S
TS a
t 10.
2 ps
iIf
STS
at 1
0.2
psi
If S
TS a
t 14.
7 ps
iIS
S at
14.
7 ps
iIf
STS
at 1
4.7
psi
ISS
at 1
4.7
psi
Rem
ain
in S
uit
Add
ition
al 1
60 M
in.
Rem
ain
in S
uit
Add
ition
al 1
60 M
in.
PMC
PMC
Stay
in P
ress
Mod
e20
Min
in S
uit
(10.
2 +
4.3
= 14
.5 p
si)
No
Rx
Req
uire
dN
o R
x R
equi
red
-CM
O P
E/N
euro
Che
ck-H
ydra
te (I
soto
nic
Flui
d po
, 1 li
ter/h
r)-L
imit
activ
ity-P
MC
-CM
O P
E/N
euro
Che
ck-H
ydra
te (I
soto
nic
Flui
d po
, 1 li
ter/h
r)-L
imit
activ
ity-P
MCDof
f Sui
tD
off S
uit
Afte
rcar
e
-RTD
24
Hrs
.-M
edic
al C
heck
Prio
r to
EVA
( 72
Hr)
Afte
rcar
e
-RTD
24
Hrs
.-M
edic
al C
heck
Prio
r to
EVA
( 72
Hr)
AA
1
Poss
ible
Sui
t LiO
H C
hang
e ou
t
Rep
ress
STS
to 1
4.7
psi
Rep
ress
STS
to 1
4.7
psi
Yes
No
Rem
ain
in S
uit 1
50 M
in.
(14.
7 +
4.3
= 19
psi
)R
emai
n in
Sui
t 150
Min
.(1
4.7
+ 4.
3 =
19 p
si)
20 M
in. E
xten
sion
20 M
in. E
xten
sion
Dof
f Sui
tD
off S
uit
Blo
ck
(+) 2
Hr O
2by
Mas
k
Blo
ck
(+) 2
Hr O
2by
Mas
kIf
any
sym
ptom
s rem
ain,
Che
ckM
CC
/PM
C(P
ossi
ble
Add
ition
al O
2, B
TA, O
rlan
Ops
.)
20 M
in. E
xten
sion
20 M
in. E
xten
sion
Blo
ck 1
Blo
ck 1
Afte
rcar
e
-Per
iodi
c M
edic
al E
val.
-RTD
24
Hr.
-Red
uced
Pre
ssur
e/EV
A(C
ase
by C
ase)
(72
Hr.
-7 D
ays)
Afte
rcar
e
-Per
iodi
c M
edic
al E
val.
-RTD
24
Hr.
-Red
uced
Pre
ssur
e/EV
A(C
ase
by C
ase)
(72
Hr.
-7 D
ays)
BB
1
Cla
ss2,
3
x
Sx R
esol
ved
Sx U
nres
olve
d,W
orse
or N
o C
hang
eSx
Unr
esol
ved,
Wor
se o
r No
Cha
nge
Sx U
nres
olve
d,W
orse
or N
o C
hang
e
Sx U
nres
olve
d,W
orse
or N
o C
hang
eSx
Unr
esol
ved,
Wor
se o
r No
Cha
nge
Cla
ss 1
Sx R
esol
ved
Sx R
esol
ved
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
DC
S N
euro
logi
cal e
xam
:
•S
impl
e ex
am to
ass
es s
ympt
oms,
and
follo
w o
ver t
ime
(in-s
uit &
out
-of-
suit)
•C
an b
e pe
rform
ed b
y no
n-ph
ysic
ian
Cre
w M
edic
al O
ffice
r (C
MO
)•
Cha
lleng
e to
per
form
exa
m w
ith p
atie
nt in
the
suit
Fac
ial N
erve
s 16
F
acia
l Mus
cles
: Cre
wm
embe
r rai
ses
eyeb
row
s,
sque
ezes
eye
s sh
ut a
nd p
uffs
up
chee
ks w
ithou
t di
ffic
ulty
.
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
Stre
ngth
17
A
rm B
end
ing
Stre
ngth
: C
rew
mem
ber
bend
s el
bow
, with
pal
m to
war
ds f
ace
and
hold
s fo
r tw
o se
con
ds a
gain
st e
xam
iner
res
ista
nce.
Rep
eat b
oth
side
s.
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
18
Leg
Ben
din
g St
reng
th:
Cre
wm
embe
r ben
ds k
nee
and
hold
s fo
r tw
o se
cond
s ag
ains
t exa
min
er
resi
stan
ce.
Rep
eat b
oth
side
s.
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
Coo
rdin
atio
n F
un
ctio
ns
19
Fin
ger-
to-F
inge
r: S
tart
ing
with
han
ds w
ide
apar
t, C
rew
mem
ber
easi
ly a
nd a
ccu
rate
ly to
uche
s fi
nger
tips
toge
ther
with
eye
s cl
ose
d.
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
Sen
sory
Fu
ncti
on
20
Gro
ss S
ensa
tion
: E
xam
iner
squ
eeze
s Cr
ewm
embe
r’s
fore
arm
s, f
eet a
nd k
nees
thro
ugh
suit.
Cre
wm
embe
r sh
ould
feel
squ
eezi
ng o
f the
fo
rear
ms,
fee
t and
leg
s.
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
AB
NL
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
MED
ICA
L K
ITS
•IV
Flu
ids
–Sh
uttle
: 3
.1 li
ters
nor
mal
sal
ine
–IS
S:
12.1
lite
rs n
orm
al s
alin
e
•M
edic
atio
n–
Com
pile
d to
cov
er b
road
rang
e of
pot
entia
l con
ditio
ns»
Incl
udes
lim
ited
quan
titie
s of
Dex
amet
haso
ne a
nd
Lido
cain
e
•IS
S R
espi
rato
r –A
utov
ent2
000
(Alli
ed H
ealth
)
•IS
S D
efib
rilla
tor –
PD 2
000
(Zol
l Med
ical
)
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
FLIG
HT
RU
LES:
•P
re-e
stab
lishe
d ru
les
for F
light
Con
trol T
eam
to re
spon
d in
coo
rdin
ated
m
anne
r
•A
void
mis
com
mun
icat
ion
acro
ss m
ultip
le d
isci
plin
es
•D
ocum
ents
Cuf
f Cla
sses
, deo
rbit
requ
irem
ents
to P
rimar
y H
yper
baric
C
are
site
(3 C
ON
US
, Hic
kam
, Gua
m),
deor
bitw
ithin
10
hrs.
for
unre
solv
ed T
ype
II sy
mpt
oms
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
TRA
ININ
G:
•A
stro
naut
s–
MA
L ch
eckl
ists
–N
ew c
lass
on
Med
ical
Eva
luat
ion
of D
CS
»P
hysi
olog
y, s
ympt
oms,
trea
tmen
t, ne
uro
exam
»V
ideo
of D
CS
Neu
rolo
gica
l exa
m
•Fl
ight
Sur
geon
/Bio
med
ical
Eng
inee
r–
DC
S s
ylla
bus,
con
sole
requ
irem
ents
, C
ME
cou
rses
•M
issi
on C
ontro
l Sim
ulat
ions
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
DC
S EM
ERG
ENC
Y LA
ND
ING
SIT
ES
•Pr
imar
y H
yper
baric
Car
e La
ndin
g Si
tes
–C
ham
ber c
apab
ilitie
s, p
roxi
mity
to tr
aum
a ce
nter
, poi
nts
of c
onta
ct b
eing
coo
rdin
ated
with
DD
MS
med
ical
pe
rson
nel
•R
ussi
an L
andi
ng S
ite C
apab
ility
and
Res
pons
e–
Wor
k in
pro
gres
s to
furth
er d
ocum
ent p
lan
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
PRP
EXER
CIS
E PR
P EX
ERC
ISE
STR
ATE
GIE
SST
RA
TEG
IES
Upr
ight
dua
l arm
an
d le
g cy
cle
exer
cise
(AL
E)
Upr
ight
dua
l arm
an
d le
g cy
cle
exer
cise
(AL
E)
Sem
i-rec
umbe
nt in
term
itten
t lig
ht e
xerc
ise
sim
ulat
ing
astr
onau
t tas
ks(I
LE
)
Sem
i-rec
umbe
nt in
term
itten
t lig
ht e
xerc
ise
sim
ulat
ing
astr
onau
t tas
ks(I
LE
)
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
RES
ULT
S: 2
HO
UR
R
ESU
LTS:
2 H
OU
R
PRO
TOC
OLS
PRO
TOC
OLS
(not
to s
cale
)(n
ot to
sca
le)
Phas
e I
Phas
e I
Phas
e II
Phas
e II
Phas
e II
IPh
ase
III
Phas
e IV
Phas
e IV
40 m
in40
min
Lig
htL
ight
Wor
kW
ork9
DC
S/47
tria
ls =
19%
9 D
CS/
47 tr
ials
= 1
9%
0/45
= 0
%0/
45 =
0%
2/10
= 2
0%2/
10 =
20%
(1 c
ereb
ral D
CS)
(1 c
ereb
ral D
CS)
Res
tR
est
Res
tR
est
Res
tR
est
Res
tR
est
Tim
e (m
in) 0
1
00
110
150
1
70
180
21
0 2
15
25
Tim
e (m
in) 0
1
00
110
150
1
70
180
21
0 2
15
25 0
2
80
5
20 5
250
28
0
52
0 5
25
Alti
tude
Alti
tude
1010 min
min
75%
75%
VO
VO
2 pe
ak2
peak
95 m
in L
ight
Wor
k95
min
Lig
ht W
ork
8/57
= 1
4%8/
57 =
14%
4 hr
4 hr
EV
AE
VA
Sim
uSi
mu --
latio
nla
tion
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
yM
issi
on S
uppo
rtM
issi
on S
uppo
rt
Ext
rave
hicu
lar A
ctiv
ity (E
VA
) Mon
itorin
g
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
yD
CS
Con
tinge
ncy
Pla
n
EV
A
Che
cklis
tD
evel
opm
ent
Impr
oved
O
n-O
rbit
DC
STr
eatm
ent
DC
SFl
ight
Rul
esD
evel
opm
ent
Gro
und
Sup
port
Infra
stru
ctur
e
DC
SD
ispo
sitio
nP
olic
y
Insu
itTr
eatm
ent
BTA
Mod
s
Hyp
erba
ric
Cha
mbe
r Te
chno
logy
Dev
.
Adj
unct
ive
Dru
g Th
erap
y
Mis
sion
Con
trol
DC
S S
imul
atio
nP
rogr
am
Cre
wFl
ight
Sur
geon
Trai
ning
Coo
pera
tive
USA
F/N
ASA
Pro
gram
s
Prim
ary
Hyp
erba
ricLa
ndin
g S
ites
Shu
ttle
/ EM
U
ISS
/ E
MU
Rus
sian
/ O
RLA
N
Rus
sian
E
MS
Pla
n
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
EVA
“C
UFF
CLA
SSIF
ICA
TIO
N”
SYST
EM :
Sim
ple
oper
atio
nal c
lass
ifica
tion
of D
CS
sym
ptom
s re
leva
nt to
EV
A c
rew
mem
ber
Prov
ides
cle
ar c
omm
unic
atio
n of
sym
ptom
s and
as
soci
ated
ope
ratio
nal r
espo
nse
Def
ines
act
ions
req
uire
d to
pla
ce p
aylo
ad in
safe
co
nfig
urat
ion
and
repr
ess a
ffec
ted
crew
mem
ber
Sens
ible
syst
em to
enc
oura
ge sy
mpt
om r
epor
ting
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
FLIG
HT
RU
LES:
Pre-
esta
blis
hed
rule
s for
Flig
ht C
ontr
ol T
eam
to
resp
ond
in c
oord
inat
ed m
anne
r
Avo
id m
isco
mm
unic
atio
n ac
ross
mul
tiple
dis
cipl
ines
Doc
umen
ts C
uff C
lass
es, d
eorb
itre
quir
emen
ts to
Pr
imar
y H
yper
bari
c C
are
site
(3 C
ON
US,
Hic
kam
, G
uam
), de
orbi
twith
in 1
0 hr
s. fo
r un
reso
lved
Typ
e II
sym
ptom
s
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
RES
ULT
S: 9
0 M
IN P
RO
TOC
OLS
RES
ULT
S: 9
0 M
IN P
RO
TOC
OLS
(not
to s
cale
)(n
ot to
sca
le)
VV-- 11
VV-- 22
3 D
CS/
10 tr
ials
= 3
0%3
DC
S/10
tria
ls =
30%
0/2
= 0%
0/2
= 0%
Res
tR
est
Res
tR
est
Tim
e (m
in) 0
160
20
0
T
ime
(min
) 0
1
60
200
250
5
5025
0
550
Alti
tude
Alti
tude
(ft)
(ft)
44 m
in44
min
2/2:
60%
2/2:
60%
30K
30K 00
4 hr
EV
A4
hr E
VA
Sim
ulat
ion
Sim
ulat
ion
34 m
in34
min
3/2:
60%
3/2:
60%
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
4 hr
In-s
uit P
roto
col T
imel
ine
(Not
e: P
re-s
leep
tim
e no
t sho
wn)
C/L
Dep
ress
(30
min
)
POST
SLE
EP 7
5 m
in
* It
is p
ossi
ble
to p
erfo
rm M
ETO
X C
hang
e-O
ut (m
anne
d) to
allo
w fo
r max
imum
EV
A P
ET c
apab
ility
. Pro
vide
d th
at C
rew
Day
Len
gth
viol
atio
ns c
an b
e ap
prov
ed,
we
coul
dsu
ppor
t a 6
:30
EVA
PET
.
EVA
PR
EP 9
0 m
inPu
rge
1:
152:
45
EMU
PR
EBR
EATH
E 4
hou
rs6:
57
*EV
A P
ET =
6:3
0R
epPO
ST E
VA
w/o
H2O
13:5
715
:17
Ck
EMU
Don
ning
55
min
7:27
2:57
Not
e: A
ssum
e de
pres
s pum
p an
d EM
ERG
MPE
V &
AL
VA
J; 3
0 m
in C
-Lk
depr
ess w
ithou
t bui
lt in
hol
d at
5ps
i. W
ith 2
hou
rs o
f Pre
-sle
ep, S
TS
Cre
w D
ay le
ngth
= 1
7:17
.
* M
etox
C/O
EV
A D
AY
SU
MM
AR
Y•P
ost S
leep
(1 h
our 1
5 m
ins t
otal
)•E
VA
Pre
p (1
hou
r 30
min
s)–E
VA
Pre
p fo
r Don
ning
(30
min
s)–S
uit D
onni
ng a
t 10.
2 (1
hou
r)•S
uit P
urge
(12
min
s)–A
irloc
k R
epre
ss to
14.
7•I
n-su
it Pr
ebre
athe
(4 h
ours
)•C
rew
lock
Dep
ress
to v
acuu
m (3
0 m
ins)
•EV
A ta
sks (
6 ho
urs 3
0 m
ins)
•Airl
ock
Rep
ress
(20
min
s)•P
ost E
VA
with
out E
MU
H2O
Rec
harg
e or
MET
OX
Reg
ener
atio
n (1
hou
r)•P
re S
leep
(2 h
ours
)
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
CEV
IS E
xerc
ise
Prot
ocol
Tim
elin
e(N
ote:
Pre
-sle
ep ti
me
not s
how
n)
EVA
DAY
SU
MM
ARY
•Po
st S
leep
(1 h
our 1
5 m
ins)
•EV
A P
rep
(Tot
al o
f 2 h
ours
50
min
s)–
Mas
k Pr
ebre
athe
(1 h
our 2
0 m
ins)
–10
min
s ex
erci
se fo
r EV1
–10
min
s ex
erci
se fo
r EV2
–10
.2 p
si A
irloc
k D
epre
ss (2
0 m
ins)
–M
ask
Preb
reat
he T
erm
inat
ion
–Su
it D
onni
ng a
t 10.
2 (1
hou
r)•
Suit
Purg
e (1
2 m
ins)
–A
irloc
k R
epre
ss to
14.
7•
In-s
uit P
rebr
eath
e (6
0 m
ins)
•C
rew
lock
Dep
ress
to v
acuu
m (3
5 m
ins)
•EV
A ta
sks
(6 h
ours
30
min
s)•
Airl
ock
Rep
ress
(20
min
s)•
Post
EVA
with
out E
MU
H2O
Rec
harg
e or
MET
OX
Reg
ener
atio
n (1
hou
r)•
Pre
Slee
p (2
hou
rs)
POST
SLE
EP 7
5 m
inEV
A P
REP
170
min
Exer
cise
PB
/Pre
p fo
r Don
ning
-80
min
on
mas
k to
tal
50 m
in o
n m
ask
prio
r to
star
t of 1
0.2
depr
ess
20 m
in D
epEV
1 ex
*R
eqd
45 m
in m
ask
P/B
afte
r exe
r
Purg
e
Ck
EMU
Don
ning
55
min
1:15
4:05
Rep
EM
U P
rebr
eath
e (6
0 m
in)
C/L
Dep
(35
min
)
5:17
5:52
EVA
PET
= 6
:30
Rep
POST
EV
A w
/o H
2O12
:22
13:4
245
min
reqd
bef
ore
belo
w 1
1.8
psi
EV2
ex*
4:17
* EV
1 m
ust s
tart
exer
cise
with
in 1
0 m
in a
fter P
B in
itiat
e, E
V2
mus
t sta
rt ex
erci
se w
ithin
25
min
afte
r PB
initi
ate
to m
aint
ain
45 m
inut
e of
mas
k tim
e af
ter e
xerc
ise
per F
R
Not
e: A
ssum
e de
pres
s pum
p an
d EM
ERG
MPE
V &
AL
VA
J; 4
0 m
in C
-Lk
depr
ess w
ith b
uilt
in h
old
at 5
psi P
ET =
25.
W
ith 2
hou
rs o
f Pre
-sle
ep, S
TS
Cre
w D
ay le
ngth
= 1
5:42
.
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
A/L
Dep
(15
min
)
Not
e: A
ssum
e de
pres
s with
AIR
LK D
EPR
ESS
vlv;
15
min
. W
ith 2
hou
rs o
f Pre
-sle
ep, S
TS
Cre
w D
ay le
ngth
= 1
4:17
.
Shut
tle 1
0.2
PSI S
tage
d Pr
otoc
ol T
imel
ine
(Not
e: P
re-s
leep
tim
e no
t sho
wn)
EVA
PET
= 6
:30
Rep
POST
EV
A w
/o H
2O
10:5
312
:13
60 m
in M
ask
PB
45 m
in b
efor
e 12
.5
*12
HO
UR
S A
T 10
.2 p
si10
.2 D
ep
* If
the
EVA
is sc
hedu
led
with
in 3
6 ho
urs o
f 10.
2 D
ep, t
his t
able
may
be
used
to c
alcu
late
the
Fina
l EM
U P
B ti
me.
POST
SLE
EP 7
5 m
inEV
A P
REP
90
min
Purg
e
1:15
2:45
EMU
PR
EBR
EATH
E 75
min
**4:08
Ck
EMU
Don
ning
55
min
2:53
INIT
IAL
PREB
REAT
HETI
ME A
T 10
.2 PS
IFI
NAL
PREB
REAT
HE
60 M
INUT
ES24
HOU
RS40
MIN
UTES
60 M
INUT
ES20
HOU
RS50
MIN
UTES
60 M
INUT
ES16
HOU
RS60
MIN
UTES
60 M
INUT
ES12
HOU
RS75
MIN
UTES
4:23
** T
he le
ss ti
me
spen
t at 1
0.2,
the
long
er th
e Fi
nal E
MU
Pre
brea
the
time
will
be;
thus
, res
ultin
g in
an
over
all
long
er c
rew
day
leng
th.
See
char
t.
***
If th
e EV
A is
sche
dule
d la
ter t
han
36 h
ours
from
10.
2 D
ep, t
he in
itial
PB
may
be
elim
inat
edan
d th
e fin
al in
-sui
t PB
is 4
0 m
ins.
1 O
R M
OR
E D
AY
S P
RIO
R T
O E
VA
DA
Y•
Mas
k Pr
ebre
athe
(1 h
our)
•D
epre
ss S
huttl
e C
rew
Cab
in to
10.
2 ps
i (12
ho
urs
min
imum
)
EV
A D
AY
SU
MM
AR
Y•
Post
Sle
ep (1
hou
r 15
min
s to
tal)
•EV
A P
rep
(1 h
our 3
0 m
ins)
–EV
A P
rep
for D
onni
ng (3
0 m
ins)
–Su
it D
onni
ng a
t 10.
2 (1
hou
r)•
Suit
Purg
e (8
min
s)
EV
A D
AY
SU
MM
AR
Y (c
ontin
ued)
•In-
suit
Preb
reat
he (4
0 to
75
min
s dep
endi
ng o
n th
e tim
e at
10.
2 ps
i)•C
rew
lock
Dep
ress
to v
acuu
m (1
5 m
ins)
•EV
A ta
sks (
6 ho
urs 3
0 m
ins)
•Airl
ock
Rep
ress
(20
min
s)•P
ost E
VA
with
out E
MU
H2O
Rec
harg
e or
MET
OX
Reg
ener
atio
n (1
ho
ur)
•Pre
Sle
ep (2
hou
rs)
Med
ical
Ope
ratio
nsSp
acef
light
Dec
ompr
essi
onSi
ckne
ss C
ontin
genc
y Pl
anD
r. Jo
e D
erva
y
Preb
reat
he P
roto
cols
-Obs
erve
d an
d Es
timat
ed R
isks
*Inc
lude
s ope
ratio
nal m
argi
n, m
icro
grav
ity si
mul
atio
n (n
on a
mbu
latio
n), a
ccou
nts f
or e
xerc
ise
with
CEV
IS p
roto
col.
Pub
lishe
d/pe
er-r
evie
wed
mod
els.
**cl
is u
pper
95%
bin
omia
l con
fiden
ce li
mit,
bas
ed o
n ob
serv
atio
n of
test
resu
lt.**
*ci i
s the
upp
er p
art o
f the
95%
con
fiden
ce in
terv
al, b
ased
on
a st
atis
tical
regr
essi
on.
Tabl
e 1
Preb
reat
he P
roto
col
Obs
erve
d R
isk
F
light
( tot
al D
CS
)
E
xper
ienc
eG
roun
d Tr
ials
Pre
dict
ed R
isk
Acc
ount
ing
for F
light
Fa
ctor
s* (m
icro
grav
ity, p
urge
, lea
k ch
eck,
dep
ress
uriz
atio
n ra
te, e
tc.)
Pre
dict
ed R
isk
(ser
ious
Typ
e II
DC
S) A
ccou
ntin
g fo
r Flig
ht F
acto
rs*
EXE
RC
ISE
(CE
VIS
)
N45
0 /
34
DC
S0%
(<6.
5% @
95%
cl)*
*1.
7%
(<4.
0% @
95%
ci)
***
1 / 4
972
(1/3
447
–1/
8928
ci)
Gra
de IV
VG
E6.
6%
(<16
.3%
@ 9
5% c
l)3.
8%
(<12
.4%
@ 9
5% c
i)
4.0
HO
UR
(In-
suit)
N28
0
/ 4
DC
S21
%
(<38
.0%
@ 9
5% c
l)4.
6%
(<
9.4%
@ 9
5% c
i)1
/ 137
2 (1
/960
–1/
2402
ci)
Gra
de IV
VG
E39
%
(<56
.6%
@ 9
5% c
l)9.
9%
(<32
.2%
@ 9
5% c
i)
CA
MP
OU
T (IS
S)
NN
o di
rect
gro
und
test
s
N
/A
DC
S2.
8%
(<5.
9% @
95%
ci)#
1 / 9
36 (
1/65
6 –
1/16
35 c
i)#
Gra
de IV
VG
E5.
8%
(<19
.0%
@ 9
5% c
i)#
10.2
PS
IA S
TAG
ED
N35
0 /
141
DC
S23
% (
<37.
5% @
95%
cl)
3.8%
(<
7.6%
@ 9
5% c
i)1
/ 311
(1/2
17 –
1/54
9 ci
)
Gra
de IV
VG
E23
% (
<37.
5% @
95%
cl)
8.0%
(<
26.0
% @
95%
ci)
