Prolonged Field Care (PFC) is utilized by the US Military to deliver field medical care beyond planned timelines of evacuation in order to decrease patient mortality and morbidity. PFC utilizes limited resources to sustain care until the patient arrives at the next level of care. Life-threatening medical conditions requiring evacuation, pose a significant risk of loss of life and mission for long duration exploration missions Astronaut crews evacuating to earth will deliver prolonged field care without real-time decision support. NASA will need to develop prolonged field care protocols that incorporate autonomous decision support.
Nahlia Inc demonstrated an Autonomous Medical Response Agent (AMRA) in previous research efforts. AMRA is a multi-criteria feedback control Bayesian clinical decision support tool. Clinical history, physical exam, laboratory and imaging assessments, vehicle and environmental data are combined. Calculated post-test likelihood distributions of disease, clinical and mission outcomes (Med09) guide the sequence of evidence-based protocols. Inventory and astronaut personal preference (Med03) filter choices and just-in-time training provides point-of-care instruction to CMO's. Outcomes measures provide a multi-organ system state estimate of health and contributes to an estimated risk posture for crew and mission (Med08, Med09). Differences between current and goal health state, defined by NASA STD3001, sustain AMRAs guidance until a goal state is achieved. AMRA sends information to Mission Control, coordinating asynchronous care (HARI02).
The proposal seeks to establish the benefits and feasibility of a systematic capability to develop, guide, and train PFC protocols for space. Tasks include (1)systematic approach to evidence-based autonomous PFC protocols (2) Clinical Case Simulator to test PFC protocols, (3) Mission Coordinator to facilitate collaboration with Mission control 4) Case-Based Trainer to prepare Astronauts for PFC in Space.
High severity of illness, rapid decision making, where real-time telemedicine support is not available makes Prolonged Field Care scenarios the most likely lead to loss of crew and loss of life on long duration missions. For example: Acute respiratory distress, Undifferentiated Shock, MultiOrgan system Trauma
Autonomous decision support, proposed here, will be required to support training and guiding Crew Medical Officers performing PFC in space.
Coordinated Bayesian Decision support can be used to automate the standard of care, decrease cognitive overload in other arenas. Military Prolonged Field Care, Disaster response, rural medical care, pandemic response,