At the Steinberg Centre for Simulation and Interactive Learning, an interdisciplinary team has been peering into the unknown to adapt healthcare training to the challenging realm of deep-space travel.
With plans underway to establish a base camp on the Moon, travel to – and residency on – the red planet is becoming a distinct possibility.
But preparing a crew to meet their own medical needs while on assignment can raise tricky questions: Should astronauts have their appendix removed before departure? Would a dialysis machine be among the items packed into the crowded space capsule? And can surgeries be guided robotically from Earth?
“The Canadian Space Agency is looking to our expertise to see how we can work together to better provide health care in space,” says Dr. Dan Deckelbaum (BMus’96, MDCM’01, PGME’06), director of surgical education and procedural skills at the Centre, as well as associate professor in the Department of Surgery in the divisions of Trauma and General Surgery.
He is the Ă山ǿĽé lead in a budding partnership with the Canadian Space Agency (CSA). This collaboration is part of Health Beyond, an initiative that, according to the CSA website, is “exploring how Canada could contribute to remote health care in space and on Earth," especially for “people living in remote communities.”
Deckelbaum explains how the Ă山ǿĽé facility landed on the radar of the CSA: “This all began with a visit from David Saint-Jacques.”
In 2018, before embarking on a Canadian record-breaking 204-day mission to the International Space Station, astronaut Dr. David Saint-Jacques, OQ (PGME’07), returned to Ă山ǿĽé, where he had completed a residency in family medicine a decade earlier. This time, he set up shop in the Steinberg Centre.
“He spent some time with me and Tarek Razak [BSc’89, MDCM’93, PGME’98] to prepare for certain life-saving skills and procedures that might need to be performed in space,” says Deckelbaum.
As a former co-chief of medicine at Inuulitsivik Health Centre in Nunavik, Saint-Jacques was already acquainted with the challenges of providing health care to a remote community.
In the Centre’s high-fidelity simulation rooms, he practiced how to intubate, as well as how to perform a cricothyroidotomy, an incision to secure an emergency airway.
Located near Ă山ǿĽé’s downtown campus in the lower level of Galeries du Parc, the 31,000-square-foot Centre welcomes 18,000 learners a year, primarily medical students and residents, as well as students of nursing and of physical and occupational therapy. With the help of the Ă山ǿĽé Office of Ed-TECH (Education Technology and E-Learning Collaboration for Health), it also provides virtual training, including in another initiative led by Deckelbaum, to help non-surgeon medics in Ukraine perform potentially life-saving interventions to victims of war.
CSA Portfolio Manager Annie Martin says teaming up with the Steinberg Centre makes sense because of the Centre’s expertise in medical simulation. “We don’t want to reinvent the wheel,” she says. “When we worked with the Steinberg facility, it was very impressive to see how they train healthcare professionals for a variety of procedures.”
Associate Dean of Education Technology & Innovation Dr. Gerald Fried (BSc’71, MDCM’75), who is director of the Steinberg Centre, believes the Centre's unique mix of education technologies, research, innovation and global outreach helped attract the federal space agency: "The Steinberg Centre for Simulation and Interactive Learning was a natural partner for the CSA in this exciting Health Beyond initiative."Â
As an initial step in the Centre’s contract with the CSA, it organized a competition last November for five innovators who presented diagnostic and treatment devices for a space clinic. (The winner created a device that eliminates potential human error from calculating medicine dosage.)
Another part of the contract has the Centre preparing a framework for astronaut training. Assistant professor, internist and medical education scholar Dr. Jeffrey Wiseman (BSc’72, MDCM’76, MA’05) is director of education at the Centre. His Ă山ǿĽé affiliations include the Institute for Health Sciences Education and the Division of General Internal Medicine. He sums up this aspect of the mandate: “What they asked us was how one would go about educating astronauts who are doctors, and those who are not, to respond to both emergency and non-emergency cases.”
While deep-space journeys are a mainstay of film and television, the real world’s most extensive missions have been limited to the International Space Station, a mere 400 kilometres from Earth. This is logistically less complex than the Moon (384,400 kilometres away) and Mars (an astounding 225 million kilometres away). It’s estimated that a voice signal sent from Earth to Mars can take 30 minutes to arrive, while travel to the red planet will likely take six months. That complicates medical communications and makes it impossible to return home for pressing care.
Wiseman sees deep-space healthcare planning as a two-fold challenge: “First, there are emergencies that can kill you quite quickly that require a rapid response by an actual human being who’s present, and then there are the things that can wait until contact is established with Earth.” He also brings up the problem of zero gravity, where working a common device such as a defibrillator would be a challenge, with the paddles floating away as one applies the electrodes.
A positive factor of working with learners on their way to Mars is that they will essentially be a captive audience with plenty of time to integrate new material, says Tamara Carver, director of the Office of Ed-TECH, which is based at the Steinberg Centre. She is also an associate professor at the Institute of Health Sciences Education, which like the Centre, is part of the Faculty of Medicine and Health Sciences. She says some of the answers to unknowns can be mitigated via online learning and virtual reality modules.
“One of the knowns is the lag time between the Earth and their destination. That’s six months for you to educate them before they actually get to Mars.”
She’s referring to the astronauts not just learning on the ground in a simulated clinic but also in flight in a container-like clinic that will mirror the practice one used on Earth.
Martin says the CSA is not starting from scratch when it comes to deep-space health training. “Everything we’ve learned from the current mission on the International Space Station will be extremely useful for planning the future,” she says, mentioning in particular the impact of microgravity and isolation on astronauts.
But she admits that travel to the Moon and Mars will introduce new challenges in healthcare delivery—those previously mentioned delays in communication can sometimes stretch to a couple of days. “When thinking worst-case scenario, the crew needs to be ready to be autonomous if there’s a medical emergency.”
For Deckelbaum, the realities of space remind him of the work he’s done with those in war zones and under-resourced areas of the world. “You’re trying to develop a way of delivering your remote medical care. And you have to become very adaptive.” Though, he realizes there’s a big difference here. “In a developing country, you don’t have to worry about gravity.”
