ICM and Aerospace Medicine

Code Red

The intercom crackled and it became difficult to decipher the words on the other end of the line.  The Flight Director informed me as the Chief Medical officer that there was a medical emergency.

We declared a ‘Code Red’ situation. The Mission Support Center (MSC) left simulated conditions to support the medical team in Oman in real-time (Figure 1).

Figure 1: Conceptual architecture of the AMADEE-18 mission. A 10 minute time delay reflects the communication delay between Earth and Mars. The Mission support centre is located in Innsbruck, Austria. The Mars habitat was simulated in the Dhofar desert region of Oman. (ref: https://oewf.org/en/)

Any medical incident constitutes as a major incident in the remote desert environment, until it is analysed and de-escalated. Especially if an Analog Astronaut (AA) is injured during an Extra-Vehicular Activity (EVA) exercise in the AOUDA suit (Figure 2).

Figure 2: Both photos show the AOUDA space suit (ref: https://oewf.org/en/)

In this case, it quickly materialised that an un-suited member of the field crew had sustained a fall from a quad bike, that had overturned on a sand dune and landed a few meters away. As the only member of the MSC crew that had been to the site in Oman during the bridgehead phase, I was able to offer an unique insight into the potential challenges of the desert site (Figure 3).

Figure 3: Photos of Rochelle during initial preparation phase (Bridgehead phase ) in Oman (ref- Claudia Kobald member of the crew)

After initial stabilisation by the medical personnel on site, the nearest military checkpoint ambulance was notified to retrieve the patient back to base on a spinal board. In parallel, the remote medical team relayed the ‘pre-flight’ patient medical history and sourced the details for an aeromedical transfer. Thankfully, the patient was able to convey a full history and the mechanism of injury was less severe than primarily anticipated. In addition, there were no positive findings after a full trauma survey. Although this case had a positive medical outcome, it emphasised the need for medical incident planning in the remote pre-hospital environment.

Career Planning

As a medical student reading a copy of a career-planning handbook, I had not envisaged that I would be aspiring to dual-accredit in Intensive Care Medicine (ICM) and Aerospace Medicine. Sometimes your career interests do not fit in a pre-determined box and it is good to realise that there are multiple paths in medicine. As my career has evolved numerous role models have influenced me through their exemplary mentorship.

Patience

My interest in a career in ICM started out at Birmingham Medical School when I undertook an elective at KEM hospital in Mumbai (Figure 4). This was an eye-opening experience that gave me an insight into ICM in a resource-poor setting, where relatives had to hand bag patients due to frequent power-cuts causing ventilator failure. This was also when I placed my first central line on the TB ward using anatomical landmarks, under the guidance of a female consultant. I remember being so proud that I had done one, only to be told that thirty more patients required central lines in the hospital that day. I remember this mentor having patience and hope that I have acquired this trait as I teach students as an ITU registrar.

Figure 4: KEM hospital ward in India (Daily pao newspaper)

Accessibility and constructive feedback

During the second half of my elective, I relinquished backpacking around Australia with my boyfriend (now husband) for an Aerospace Medical research elective in Porto Allegre, Brazil. I had packed for Rio, only to have a snowy welcome on arrival and distinctly recall spending much of my allowance on more appropriate clothing. The research involved long days evaluating rescuer physiology whilst performing CPR both on Earth and in simulated low gravity (see Figure 5).

My research supervisor was Prof. Thais Russomano; an inspirational researcher in the Aerospace medical field. She always made room in her busy schedule to critically appraise my research presentations and publication. With her support I achieved the AsMA ‘Stanley Mohler’ prize. She continues to give me advice for my research projects and career development.

Figure 5: CPR in space  – 3 methods

Rehnberg, L., Ashcroft, A., Baers, J.H., Campos, F., Cardoso, R.B., Velho, R., Gehrke, R.D., Dias, M.K., Baptista, R.R. and Russomano, T., 2014. Three methods of manual external chest compressions during microgravity simulation. Aviation, space, and environmental medicine, 85(7), pp.687-693.

Championing

After I graduated, I chose to pursue the NIHR academic medical pathway (Figure 6) as an AFP in Public Health Medicine, with a part-time Masters in Public Health. My dissertation focused on ‘Major Incident Planning’ with the University of Warwick. At this point in my career, I wanted to get a taster of research in an acute speciality. I also wanted to be somewhere close to my family, with a ‘Gilbert & Sullivan’ society within driving distance.

Nobody tells you that the next stage of applications come around very quickly. I was privileged that Prof. Lorraine Harper helped ally my fears about the application process and encouraged me to pursue a career in academia.  She mentored me throughout medical school and has always championed female medical researchers. With her support, I applied for an NIHR Academic Clinical Fellowship (ACF).

Figure 6: Academic training pathways in ICM Reference – FICM Academic training in ICM report 

Positive role modelling

I have recently completed this ACF, which enabled me to complete my clinical competencies in tandem with my research in ICM and Aerospace medicine. Both my academic and educational supervisors (Prof. Perkins and Dr Arora respectively) were very supportive in my role as a medical educator at the University of Birmingham, teaching medical students about extreme human physiology. I hope to emulate their passion for collaborative open-access medical education and research as a consultant.

Moreover, Dr Bonnie Posselt, who was the onsite medical officer during the ‘code red’ case in Oman, is an exceptional role model for female aerospace medical doctors.  Bonnie has given me advice about carving out a career in space medicine in the UK. This has been invaluable in following an alternative career pathway.

Future career trajectory…

It is because of the encouragement of all these positive role models and many more, that I am currently out of program pursuing my research interest in Aerospace Medicine. As part of this, I am working with the Space Generation Advisory Council Space Medicine Group affiliated to the United Nations Out of Space Affairs. I hope that I can inculcate some of these mentorship traits as I endeavour to forge a career in ICM and Aerospace Medicine.