Attachment A11_ACD-52105- ACD MORD_Baseline-FINAL.pdf

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June, 2022

Artemis Campaign Development

ACD-52105

INITIAL BASELINE

National Aeronautics and Space Administration RELEASE DATE: JUNE 16, 2022

ARTEMIS CAMPAIGN DEVELOPMENT (ACD)

MEDICAL OPERATIONS REQUIREMENTS

DOCUMENT (MORD)

Publicly Available: Release to Public Websites Requires Approval of Chief, Office of Primary Responsibility

Revision: Initial Baseline Document No: ACD-52105 Release Date: June 16, 2022 Page: 2 of 163 Title: ACD Medical Operations Requirements Document (MORD)

REVISION AND HISTORY PAGE

Revision No.

Change No. Description Release

Date

- ACD-C0022 Initial Release, approved at the Joint ACB/CECB on 06/16/2022 (Reference CR ACD-C0022, released on 06/28/2022)

06/16/2022

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TABLE OF CONTENTS

SECTION PAGE

Applicable Documents 8

Reference Documents 10

POSTFLIGHT)

Preflight Evaluations 22

In-flight Medical Evaluations 22

Postflight Medical Evaluations 24

Access to Crewmembers Medical Information 30

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Communication Priority 31

Termination of Care 31

In-flight Crewmember Fatality 32

In-flight Acoustics Assessments 37

Acoustic Countermeasures 38

Radiation Area Monitoring and Dosimetry 42

Crew Exposure Records and Health Risk Assessments 42

In-flight Medical Countermeasures 48

Postflight Medical Countermeasures 52

In-flight Behavioral Health and Performance Countermeasures 54

Postflight Behavioral Health and Performance 57

In-Flight Exercise Countermeasures 58

Postflight Exercise Countermeasures 59

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TABLES

TABLE 1.4.1-1 - APPLICABLE DOCUMENTS ………………………………………………………6

TABLE 1.4.2-1 - REFERENCE DOCUMENTS ………………………………………………………8

TABLE 8.1.2-1 - IN-FLIGHT SPACE ADAPTATION TIME REQUIREMENTS …………………46

TABLE 8.1.2-2 - IN-FLIGHT CREW DUTY DAY REQUIREMENTS …………………………….47

TABLE 8.1.2-3 - CREW AWAKE TIME ……………………………………………………………..48

TABLE 8.2.2-1 - HLS CREW IN-FLIGHT OFF-DUTY TIME ……………………………………..54

FIGURES

FIGURE 1.2-1 – RELATIONSHIP OF THE ACD MORD TO OTHER DOCUMENTS …….…..5

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1.0 INTRODUCTION

1.1 PURPOSE

The Artemis Campaign Development (ACD) Medical Operations Requirements Document (MORD) defines operational requirements (e.g., medical intervention and care, countermeasures, environmental health, radiation health and exposure monitoring, contingency operations, procedural training), of the flight support system and crew for Artemis and subsequent missions in accordance with NASA-STD-3001, National Aeronautics and Space Administration (NASA) Space Flight Human System Standard documents and in accordance with the responsibilities assigned by applicable NASA Policy Directives, Standards, Code of Federal Regulations, Artemis Programs charters, Artemis Programs commercial partner agreements, and Memoranda of Understanding (MOU).

Requirements in this document are intended to be tailored and flowed to individual Programs, per systems engineering processes per NPR 7123.1. Because these requirements are operational requirements, it is expected that they will flow to Program operational products such as flight rules, crew scheduling constraints, mission timelines, console handbooks, and training plans.

(TBR-52105-003)

1.2 SCOPE

This document defines the medical operations requirements for all phases of ground, flight, extravehicular activity (EVA), and payload/experiment-related oversight activities. These cross-program operational requirements pertain to the development of medical monitoring; response capability for in-flight medical events; EVA medical events; support of individual and crew behavioral health and performance; countermeasures definition and implementation;

environmental monitoring; Emergency Medical Services (EMS) support; establishment of a process for training and certification of crewmembers on Artemis missions, Flight Surgeons (FS), and other medical support personnel; and preflight activities such as reconditioning.

Applicable documents to the ACD MORD contain standards and guidelines governing implementation of medical and habitability requirements. The ACD MORD requirements are implemented at launch and landing and recovery sites via site-specific Medical Operations Support Implementation Plans (MOSIPs) as determined by the Program and by inter-agency Program Requirement Documents (PRDs).

Scheduling constraints for the in-flight timeline of crew activities are outlined in (TBD-52105- 019), Artemis equivalent to the Exploration Crew Scheduling Constraints and FOD-GR&C- ARTEMIS-XX (where “XX” is the Artemis mission designation), Mission Planning Ground Rules and Constraints Database. Additional rules governing real-time medical operations are contained in JSC 12820, Generic Artemis Operational Flight Rules.

Vehicle and system design requirements are not included in this document. These requirements are in Program documents, such as the MPCV-70024, Orion Multi-Purpose Crew Vehicle (MPCV) Program: Human Systems Integration Requirements (HSIR) Document; Orion System Requirements Documents (SRDs); Exploration Ground Systems requirements documents;

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Gateway Program Human Systems Requirements (HSR), GP 10017; Gateway System Requirements (GP 10000); Human Landing System (HLS) Requirements Document (HLS- RQMT-0XX) and xEVA Systems Requirements Document (xEVAS-SRD-001). Mission specific requirements are defined in the ACD-511XX (where “XX” is the Artemis mission designation), Artemis Mission Definition Baseline and are used as the basis for Flight Rules, Ground Rules and Constraints, and other operations related products. The high-level hierarchal flow of requirements into and from the ACD MORD can be seen in Figure 1.2-1 below. Figure 1.2-1 is not intended to show every relationship between documents, but rather to capture the primary inputs and outputs related to the MORD.

In the event of conflicting statements regarding medical operations between this document and specific mission-approved implementing and operational documents, the specific mission-approved documents will take precedence. Where the evaluation of ACD MORD requirements results in a variance, the implementing organization may request relief. These requests will be assessed with the goal to mitigate human health and performance impacts using established risk management processes. Request for relief from HMTA requirements will be adjudicated via the process in NPR 7120.11.

(TBR-52105-003)

FIGURE 1.2-1 RELATIONSHIP OF THE ACD MORD TO OTHER DOCUMENTS

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1.3 CHANGE AUTHORITY/RESPONSIBILITY

The appropriate NASA Office of Primary Responsibility (OPR) for this document is Artemis Campaign Development (ACD) Mission Definition and Utilization (MD&U) office.

Proposed changes to this document shall be via change request (CR) to the ACD Control Board (ACB) for consideration and disposition. All such requests adhere to the ACD Configuration Management Process defined in ACD Configuration and Data Management Plan (CDMP)

(ACD-50005).

1.4 DOCUMENTS

(TBR-52105-003)

Applicable Documents

The following documents include specifications, models, standards, guidelines, handbooks, and other special publications. The documents listed in this paragraph are applicable to the extent specified herein. Inclusion of applicable documents does not in any way supersede the order of precedence identified in section 1.2 of this document.

TABLE 1.4.1-1 APPLICABLE DOCUMENTS

Document Number Title Privacy Act of 1974, as amended ACD-50001 Artemis Campaign Development Implementation Plan ACD-50004 Artemis Campaign Development Risk Management Plan ACD-50007 Artemis Integrated Concept of Operations ACD-50013 Artemis Campaign Development Modeling and Simulation Plan

ACD-511XX-ANX01

(“XX” is the Artemis mission designation)

Artemis Mission Definition Baseline (MDB), Annex 1: Cross Program Operational Ground Rules and Constraints

EP-18-113 Safety Requirements for Use of Electrolytic Capacitors in ISS End Items

ESD 10003 Exploration Systems Development (ESD) Risk Management Plan ESD 10004 Exploration Systems Development Mishap Preparedness and

Contingency Plan ESD 10012 ESD Concept of Operations ESD 10033 Exploration Systems Development Mission Management Team

Operations Plan ESD 10044 Exploration Systems Division Cross-Program Modeling and

Simulation Integration Plan FPS-149 Standard for Food Facility Preparation for Processing Aerospace

Food

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Document Number Title HLS-PLAN-011 Human Landing System (HLS) Program Mishap Preparedness and Contingency Action Plan JPD 1830.1 Medical Examination of Flight Control Team Members JSC 12820 Generic Artemis Operational Flight Rules JSC 20584 Spacecraft Maximum Allowable Concentrations for Airborne

Contaminants JSC 22538 Flight Crew Health Stabilization Program JSC 27050 Postflight Rehabilitation Plan JSC 27472 Requirements for Submission of Data Needed for Toxicological

Assessment of Chemicals and Biological to be Flown on Manned Spacecraft

JSC 67608 Artemis Food Provisioning Plan NASA-STD-3001 NASA Space Flight Human-System Standard (SFHSS), Volume1, Rev B: Crew Health Volume 2, Rev C: Human Factors, Habitability & Environmental Health

NASA-STD-6001 Flammability, Offgassing, and Compatibility Requirements and Test Procedures

NASA-STD-6016 Standard Materials and Processes Requirements for Spacecraft NPD 1800.2 NASA Occupational Health Program NPD 8900.1 Medical Operations Responsibilities in Support of Human Space

Flight Programs NPD 8900.3 Astronaut Medical and Dental Observation Study and Care

Program NPR 7120.11 NASA Health and Medical Technical Authority (HMTA)

Implementation SD-T-0251 Microbiological Specifications and Testing Procedures for Foods

Which are Not Commercially Sterile SD-T-0252 Microbiological Specifications and Testing Procedure for

Commercially Sterile Foods (TBD-52105-004) Artemis Mission Medical Evaluation Requirements Document

(AMMERD)

(TBD-52105-005) Artemis Phase 1 Missions: Functional Medical Concept of

Operations (TBD-52105-019) Artemis equivalent to the Exploration Crew Scheduling

Constraints

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Reference Documents

The following documents contain supplemental information regarding the Artemis missions and can be used to guide the reader in the application of the Medical Operations Requirements Document. These documents may or may not be specifically cited within the text of this document.

TABLE 1.4.2-1 REFERENCE DOCUMENTS

Document Number Title

ACD-51103, 51104,

51105

Artemis Mission Definition Baseline (Artemis III, IV, V)

ANSI S12.2-2008 Criteria for Evaluating Room Noise CA-WI-16 Space Flight Personnel Certification Plan CEV-T-001001 Project Orion Integrated Models, Simulations and Support Plan:

Modeling and Simulation Technical Analysis Plan ESD 10001 Exploration Systems Development Implementation Plan ESD 10007 ESD Systems Engineering Management Plan ESD 10018 Mission Integration Implementation Plan (MIIP) ESD 10020 Exploration Systems Development Certification of Flight Readiness

(CoFR) Plan ESD 10110 Exploration Crew Scheduling Constraints (ECSC) GP 10000 Gateway Program System Requirements GP 10004 Gateway Subsystem Specification for the Environmental Control and

Life Support System (ECLSS) GP 10007 Gateway Subsystem Specification Computer Human Interface (CHI) GP 10110 Gateway Program Implementation Plan (GPIP) GP 10016 Gateway Program Subsystem Specification for Crew Health and

Performance (CHP) GP 10017 Gateway Program Human System Requirements (HSR) GP 10071 Gateway Program Mishap Plan GP 11009 Gateway Program Modeling and Simulation Plan HLS-PLAN-030 Human Landing System Program Modeling and Simulation Plan HLS-RQMT-001 Human Landing System (HLS) Program System Requirements

Document HLS-RQMT-006 Sustained Phase Human Landing System (HLS) Program System

Requirements Document JPR 1700.1 JSC Safety and Health Handbook JPR-1800.5 Biosafety Review Board Operations and Requirements Document JSC 13956 Medical Operations Requirements Document for Shuttle Missions

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JSC 26895 Guidelines for Assessing the Toxic Hazard of Spacecraft Chemicals and Test Materials JSC 27579 Astronaut Exercise Program JSC 28566 Nutritional Status Assessment for Extended Duration Space flight JSC 28913 Medical Requirements Integration Documents JSC 29365 Human Health and Performance Directorate Contingency Action

Plan for Space Flight Programs JSC 63414 Spacecraft Water Exposure Guidelines JSC 63557 Net Habitable Volume Verification Method JSC 67272 Project Technical Requirements Specification for the Orion Flywheel JSC 67409 Project Requirements &Verification Documents KSC-PLN-1914 Medical Operations Support Implementation Plan, Kennedy Space

Center MIL-STD-1474D Department of Defense Design Criteria Standard, Noise Limits MPCV 70024 Orion Multi-Purpose Crew Vehicle (MPCV) Human System

Integration Requirements (HSIR) NASA-FPS-149 Standards for Food Facility Preparation for Processing Aerospace

Food NASA-STD-6001 Flammability, Off-gassing, and Compatibility Requirements and Test

Procedures NPD 7100.8 Protection of Human Research Subjects NPD 8900.5 NASA Health and Medical Policy for Human Space Exploration NPR 1800.1 NASA Occupational Health Program Procedures NPR 7100.1 Protection of Human Research Subjects NPR 7120.5 NASA Space Flight Program and Project Management

Requirements NPR 7123.1 NASA Systems Engineering Processes and Requirements OCHMO-STD-100.1 NASA Astronaut Medical Standards Selection and Annual

Recertification OPM GS-2152 Air Traffic Control Series 2152 SAE 2009-01-2592 A Design Basis for Spacecraft Cabin Trace Contaminant Control SD-WI-385 Space Radiation Analysis Group Training Plan SOP-SFSL-00 Space Food Systems Laboratory Standard Operating Procedure

Manual SSP 41172 Qualification and Acceptance Environmental Test Requirements (TBD-52105-002) Microbiology Operations Plan for Space Flight (TBD-52105-003) Document numbers and titles of the Crew Health System

Government Furnished Equipment (GFE) Specification Documents

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(TBD-52105-013) Document that establishes the conditions of access to other medical specialists. (Similar to Multilateral Medical Policy Board Policy Directive 03, Medical Data Security Policy, May 2007)

1.5 FLIGHT CERTIFICATION

For all crewed missions, the medical operations requirements compliance for each mission will be assessed and reported via Artemis Certification of Flight Readiness (CoFR) milestones. The CoFR requirements establish a CoFR Implementation Plan, which enables the assessment and validation of applicable endorsement statements, as well as what objective evidence was used to satisfy the endorsement. Signed CoFR endorsement statements by the Human Health and Performance Control Board (HHPCB), the Health and Medical Technical Authority (HMTA) management representatives, and the JSC CMO will attest to the flight readiness of HH&P systems. The endorsed certification statements will be provided by the JSC CMO to the NASA Chief Health and Medical Officer (CHMO) who is a voting member of the NASA Flight Readiness Review (FRR) Board.

(TBR-52105-003)

2.0 AUTHORITY

The provision of medical services is authorized by NPD 8900.1, Medical Operations Responsibilities in Support of Human Space Flight Programs; NPD 8900.3, Astronaut Medical and Dental Observation, Study, and Care Program; NPD 1800.2, NASA Occupational Health Program; JSC Policy Directive (JPD) 1830.1, Medical Examination of Flight Control Team Members; and the ACD-50001, ACD Implementation Plan.

2.1 PRIVACY OF MEDICAL INFORMATION

Provisions of the Privacy Act of 1974, as amended, will be strictly followed regarding the control of records, information exchange, and release of crewmember health information to the public.

Communications pertaining to an individual’s health care will be private as regulated by the controls, regulations, provisions, and penalties of the Privacy Act of 1974, as amended.

(TBR-52105-003)

2.2 HANDLING AND RELEASE OF MEDICAL DATA

Requests for crewmember medical data from outside of the nominal working level medical support or management chain is coordinated through the office of Lifetime Surveillance of Astronaut Health process. Public release of biomedical information or data concerning any flight crewmember will only be made with the prior approval of the crewmember in accordance with the provisions of the Privacy Act of 1974, as amended Conditions of data sharing are specified in the individual astronaut’s Data Sharing Plan with the consent from the astronaut.

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3.0 MISSION MEDICAL OPERATIONS PERSONNEL

Medical operations personnel are assigned to support the crew assigned to an Artemis mission.

These personnel include the Crew Surgeon (CS), Deputy Crew Surgeon (DCS), additional FSs, psychologists and/or psychiatrists, Astronaut Strength Conditioning and Rehabilitation Specialists (ASCRS), Behavioral Health and Performance (BHP), Biomedical Engineer (BME) Flight Controllers, a Radiation Health Officer (RHO), the Space Radiation Analysis Group (SRAG) Space Environment Officers (SEO), Pharmacists, and training instructors.

The lead Flight Surgeon, referred to as the Crew Surgeon, and a Deputy Crew Surgeon are primarily responsible for crew health operations for the assigned crew. The term Crew Surgeon (or CS) in this document refers to the CS, DCS, or designee, unless otherwise specified. Other members of the team perform specific roles and have responsibilities that support the CS and

DCS.

(TBR-52105-003)

Certification and training requirements of key medical operations personnel are defined in Section 10, Training and Certification.

[MO-1] Flight Surgeon

The Artemis Campaign Development shall provide a cadre of Artemis certified Flight Surgeons to support each Artemis mission.

Rationale: Human health is a significant risk during Artemis missions. The ACD must provide a cadre of skilled aerospace medicine practitioners to support the Artemis crews during training, preflight, in-flight, EVAs, and postflight recovery to mitigate the health risks of space flight and space flight related training.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

3.1 CREW SURGEON AND DEPUTY CREW SURGEON OPERATIONS

[MO-2] Crew Surgeon and Deputy Crew Surgeon

The Artemis Campaign Development shall designate a Crew Surgeon and at least one Deputy Crew Surgeon from the cadre of certified Flight Surgeons to have primary responsibility for the medical care of NASA crewmembers for each Artemis mission.

Rationale: For a given mission, a single focal point for medical issues involving the crew is required. The CS and DCS have the primary responsibility for the health and well-being of the entire crew and are the designated points of contact for all medical issues and time lined medical activities for that crew during all mission phases.

Effectivity: Artemis III and subsequent

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[MO-3] Crew Surgeon Authority

The Artemis Campaign Development shall authorize the assigned Crew Surgeon and designees as the Flight Control Team (FCT) medical authority to intervene in any in-flight situation that may be deleterious to a crewmember’s health.

Rationale: Clear lines of authority must be established for a rapid response to a (potential or current) medical contingency. In the absence of CS or DCS, this authority may only be delegated to another certified FS.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-5] Crew Surgeon Medical Intervention and Care Coordination

The Artemis Campaign Development shall authorize the Crew Surgeon to coordinate medical intervention and care activities for Artemis crewmembers as follows:

A. Preflight: through the Johnson Space Center Flight Medicine Clinic (FMC) or other medical care facility as needed

B. In-flight: through the Mission Control Center (MCC) coordination of use of Artemis medical resources

C. Postflight: through the Johnson Space Center Flight Medicine Clinic or other medical care facility as specified in the Medical Operations Support Integration Plan(s), Emergency Medical Services, and other support plan(s)

Rationale: The CS has medical responsibility for all situations for crew health. In the event of a preflight or postflight medical contingency, medical intervention and care are coordinated by the CS. During the mission, the CS acts on behalf of medical management and with the support of specialist groups, provides a point of contact for coordinated communication to the Flight Director on issues concerning crew health and safety. The CS will advise Flight Operations personnel on the medical aspects of the contingency, including potential risk(s) to the crewmember(s). Care given in any of these settings with impacts to crew training, operations, rehabilitation, or data collection will be disseminated to the appropriate personnel. The JSC FMC maintains crewmember health records regardless of where medical intervention and care is provided.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-6] Crew Surgeon Medical Monitoring of Hazardous Training, Testing, and Human Subject Research on Crewmembers

The Artemis Campaign Development shall grant the Crew Surgeon the authority to:

A. Monitor developmental, verification, and validation testing (i.e., Human in the Loop);

hazardous training; and human subject research on crewmembers

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B. Terminate any of these activities in the interest of crew health and safety

Rationale: The CS must assess the risks to crewmember safety and health prior to any tests, training, and human subject research involving crewmembers and monitor during these tests, etc. to mitigate risk or to treat any injury sustained by a crewmember. The CS determines the readiness of the crewmember to participate in the testing and has the authority to terminate any test based on an assessment of crewmember health and safety.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-7] Crew Surgeon Access

The Artemis Campaign Development shall provide the ability for the Crew Surgeon, as part of the Flight Control Team (FCT), to always be able to communicate with the Mission Control Center and the crew during the mission.

Rationale: Due to the hazardous nature of space operations, prompt access to a CS is always needed (24/7) during a mission, to provide emergency response, medical intervention and care to the crew in-flight.

This need is recognized by the NASA JSC Flight Operations Directorate (FOD) and the ACD by the inclusion of the Flight Control Room (FCR) position of “Surgeon” as a member of the FCT.

Biomedical Engineers are not trained to offer clinical medical support. A means of communication (video, voice, etc.) to CS must be provided for times when the CS is physically absent from the FCR.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

3.2 BIOMEDICAL ENGINEER OPERATIONS

[MO-8] Biomedical Engineer

The Artemis Campaign Development shall provide a team of Biomedical Engineers that is composed of Flight Director certified Flight Controllers and off-console mission support, as required, to support each Artemis mission.

Rationale: Biomedical Flight Controllers staff console in the MCC 24 hours per day/7 days per week during a mission. Additional off-console mission support and/or real-time support may be required by the designated Biomedical Engineers for tasks that include but are not limited to real-time contingency response, procedure authoring, hardware owner interfacing, data management, and mission management.

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3.3 ASTRONAUT STRENGTH CONDITIONING AND REHABILITATION SPECIALISTS

[MO-162] Astronaut Strength Conditioning and Rehabilitation Specialists Personnel

The Artemis Campaign Development shall provide a team of Astronaut Strength Conditioning and Rehabilitation Specialists to direct physical training regimens and instruct astronauts assigned to flights.

Rationale: Physical exercise is a major preflight, in-flight, and postflight training need to maintain crew health and performance. The targets for maintenance of operational performance include training for aerobic and anaerobic capacity, muscular strength and endurance, preservation of bone mineral density and morphology, behavioral health, and sensorimotor coordination.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

3.4 BEHAVIORAL HEALTH AND PERFORMANCE OPERATIONS

[MO-10] Behavioral Health and Performance Provider

The Artemis Campaign Development shall assign a Behavioral Health and Performance provider to offer operational psychology or psychiatry expertise to each mission for preflight crew and family preparation; in-flight monitoring and support; intervention and countermeasures as needed; and postflight re-adaptation.

Rationale: The maintenance of sound behavioral and emotional health, as well as the readiness to perform optimally, are essential for crewmembers in high-risk, high-stress environments. The assigned provider will be present at launch to provide professional and consultative services to the CS, family members, crew, and management. The assigned BHP provider will possess licensure in psychology or psychiatry, as well as extensive training and operational experience in the areas of aerospace psychology or aerospace psychiatry.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-163] Behavioral Health and Performance Support Coordinators

The Artemis Campaign Development shall provide Behavioral Health and Performance support coordinators for each mission to assist the Behavioral Health and Performance provider through preparing and implementing crew and family countermeasures preflight, in-flight, and postflight.

Rationale: BHP support coordinators are necessary to assist in the provision of preventative behavioral countermeasures for the individual crewmembers and their families.

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[MO-164] Behavioral Health and Performance Family Support Personnel

The Artemis Campaign Development shall provide Behavioral Health and Performance family support personnel for each mission to provide specific information and logistical insight in preparation for launch and landing, and to accompany crewmember families during launch and, if needed, landings.

Rationale: Specific launch and landing family preparations and activities are provided in close coordination with the crew office. Family support personnel will be present at launch to assist the BHP provider and to accompany and support family members during pre-launch activities.

Family support personnel will be present at landings only if the families are at the landing site.

This is the first line of education and support for family members.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

3.5 RADIATION HEALTH OFFICER OPERATIONS

[MO-12] Radiation Health Officer

The Artemis Campaign Development shall provide a certified Radiation Health professional as a Radiation Health Officer to each Artemis mission to ensure crew health and safety with regards to radiation exposure during the mission.

Rationale: The RHO is a certified Radiation Health professional responsible for assessing crew risk from radiation exposure and providing that information to crew and to Flight Surgeon personnel. Certification for the RHO is provided by the American Board of Health Physics or equivalent.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

3.6 SPACE RADIATION ANALYSIS GROUP OPERATIONS

[MO-14] Space Radiation Analysis Group Space Environment Officers

The Artemis Campaign Development shall provide a team of independently certified Space Radiation Analysis Group- Space Environment Officers as part of the Mission Control Center Operational Flight Control Team to support each Artemis mission.

Rationale: Real-time monitoring of the space radiation environment and space weather events/conditions that could potentially impact crew, vehicle, and/or hardware components that are radiation sensitive is essential for crew health and safety and mission success during all mission phases.

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3.7 CREW MEDICAL OFFICER (CMO)

[MO-16] Crew Medical Officer

The Artemis Campaign Development shall designate and train a minimum of two crewmembers per crewed vehicle as Crew Medical Officers within each prime and backup mission crew.

Rationale: CMOs are required to assure the presence of persons with the appropriate training and skills to administer emergency medical care should it be necessary. Designating and training a minimum of two crewmembers per crewed vehicle as CMOs is required to provide depth of training and redundancy in skills during the mission should one of the CMOs become incapacitated. Depending on DRM (e.g., separate vehicle ops or longer duration missions), it may be necessary to train more than two CMOs. Non-CMOs may not possess the proper skills and training to a level of proficiency to deliver the entire range of medical care offered by the Artemis Medical System. Should communications with the MCC become unavailable, the CMOs must be able to act independently.

Effectivity: Artemis III and subsequent

[MO-18] Physician Crewmembers as Crew Medical Officer

The Artemis Campaign Development shall assign the role of Crew Medical Officer to each physician crewmember assigned to an Artemis mission.

Rationale: The crew benefits from having a physician crewmember with clinical experience onboard. A physician CMO provides advanced clinical expertise, judgment, decision making, and medical procedure expertise. This expertise may minimize the mission impacts of a medical contingency. In addition, these skills enable precise and efficient communication between the CMO and the CS. The physician CMO and the CS will mutually decide on a course of action for a given medical situation that the CMO will implement in flight.

Effectivity: Artemis III and subsequent

3.8 KENNEDY SPACE CENTER SUPPORT OPERATIONS

[MO-19] Kennedy Space Center Support

The Artemis Campaign Development shall provide at the Kennedy Space Center, with capability and sizing per Program Requirements Documents; Medical Operations Support Implementation Plan; and Emergency Medical Services plans, the following:

A. Facilities (i.e., office space, medical examination suite, etc.) for the use of the Crew Surgeon and Deputy Crew Surgeon, equipment, and access to support crew medical care within the Astronaut Crew Quarters

B. Ancillary medical support personnel to support crew medical care (e.g., nurses, physicians, Astronaut Strength Conditioning and Rehabilitation Specialists, etc.)

C. Ability to collect medical specimens and coordinate processing to assist Crew Surgeon in crew medical care at the launch site or to support preflight biomedical data collection

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D. Ability to incorporate the Crew Surgeon and Deputy Crew Surgeon into contingency operations and triage operations

E. Transport, as required, of Crew Surgeon and Deputy Crew Surgeon to medical care facilities where crewmembers are treated in case of a contingency

Rationale: The CS and DCS need to be located among crew to conduct preflight medical duties.

A co-located medical suite provides immediate care to crew, preserving crew time for mission needs. CS and DCS will require additional medical support at the launch site due to quarantine and public access restrictions to comply with the Health Stabilization Program. Access to timely and secure laboratory services will be needed to perform any preflight testing or crew health matters such as injury, illness, or infectious disease. The CS and DCS assigned to the crew know the medical histories of the crew the best and can provide consultative information regarding crewmember health. Crew medical care could be hampered if the CS do not assist.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-20] Aerospace Medicine and Occupational Health at Kennedy Space Center

The Artemis Campaign Development shall provide at the launch site in the Kennedy Space Center, with capability and sizing per Program Requirements Documents and Medical Operations Support Implementation Plan, the following resources:

A. A health stabilization program in accordance with the latest revision of JSC 22538, Flight Crew Health Stabilization Program (HSP)

B. Emergency medical services dedicated to crew for hazardous operations involving crewmembers

C. Occupational medicine and environmental health support

Rationale: KSC personnel who will interact with crew, maintain quarantine facilities, and support the launch site, directly or indirectly, require participation in HSP. The crew might perform hazardous operations during the quarantine period as “just in time” training or in vehicle check-out, as well as in actual launch procedures and require dedicated emergency medical care and Medical Evacuation (MEDEVAC) due to a launch day accident or actual launch contingency.

Launch contingencies also require downwind monitoring and crew decontamination assessment by launch site environmental health support.

Effectivity: Artemis III and subsequent

3.9 MISSION INTEGRATION COORDINATOR (MIC) OPERATIONS

[MO-21] Mission Integration Coordinator Support

The Artemis Campaign Development shall provide Mission Integration Coordinator support for Artemis missions.

Rationale: It is necessary to have a single point of contact designated to track and schedule medical evaluations required to certify crewmembers for flight, as well as to coordinate and

Release Date: June 16, 2022 Page: 20 of 163 schedule all preflight and postflight medical testing. In the immediate postflight period, there are multiple groups that have activities that are scheduled, and the MIC is responsible for integrating all activities into one consolidated schedule.

(TBR-52105-003)

4.0 CREWMEMBER MEDICAL EVALUATION, CERTIFICATION, AND

MONITORING

This section establishes the requirements for medical evaluation, certification, and monitoring of the state of health and level of physical fitness of the crewmembers. These requirements apply to all mission phases: preflight, in-flight, and postflight.

Artemis crewmembers are medically evaluated and medically certified for flight based on documented standards. Medical evaluation results are presented to the Aerospace Medicine Board (AMB) by the CS. The AMB determines the medical certification of a crewmember and reports the status to the crewmember and the Chief, Astronaut Office. The AMB may require the crewmember to provide additional medical information or to undergo additional medical evaluations.

The Chief Health and Medical Officer has responsibility and authority for oversight of the development, review, waiver, and maintenance of medical policies and standards. The AMB is established as part of this authority and is primarily a clinical and implementation body for addressing crew medical certification. The AMB also addresses establishment of, or modification of, health and medical policies and standards, and oversees surveillance of crew health including evaluating and recommending approval or disapproval of waivers related to medical standards for atmospheric and space flight.

During the mission, the crewmembers are monitored via in-flight medical evaluations, evaluations, and conferences with the CS in the MCC to assure continued nominal health and performance. Crewmembers are also monitored in-flight via biomedical monitoring during dynamic flight events, such as EVA. Issues that threaten crew health and performance (both near and long term) may also impact mission and programmatic success, so it is important to recognize problems as early as possible to mitigate or eliminate impacts.

The Artemis Campaign Development will coordinate the collection and documentation of health risk information pertaining to crewmembers during in-flight and ground-based medical evaluations. Medical risks are identified, quantified, and tracked using medical evaluation data.

In addition, the risk data is used to recommend selection and certification standards, medical capabilities for space flight, and research areas.

(TBR-52105-003)

4.1 ARTEMIS CREWMEMBER MEDICAL CERTIFICATION

[MO-23] Artemis Crewmember Medical Certification

The Artemis Campaign Development shall authorize the Aerospace Medicine Board, as chartered, to determine and grant medical certification of all Artemis crewmembers.

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Rationale: The AMB has the final authority for the medical certification of all Artemis crewmembers. This includes initial certification of astronaut candidates, annual certification of crewmembers in training, preflight medical certification for flight, and recommendations on any waivers to medical certification requirements. The NASA Chief Health and Medical Officer reviews all waivers.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-24] Crewmember Medical Evaluations and Certification Criteria

The Artemis Campaign Development shall authorize the Aerospace Medicine Board to establish the medical evaluation and certification requirements for Artemis crewmembers.

Rationale: A standard set of medical evaluation and certification requirements for all Artemis crewmembers needs to be followed.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-25] Medical Certification Criteria for Artemis Crewmember Selection

The Artemis Campaign Development shall conduct evaluation and certification of Artemis crewmembers in accordance with documented Aerospace Medicine Board evaluation and certification requirements.

Rationale: Documented standards constitute the “core” clinical medical standards required for crewmembers to be medically fit for duty on Artemis missions and serve as a basis for crew health certification and monitoring.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

4.2 MEDICAL EVALUATIONS FOR CREWMEMBERS (PREFLIGHT, IN-FLIGHT,

POSTFLIGHT)

[MO-26] Medical Evaluations for Crewmembers

The Artemis Campaign Development shall document the requirements for medical evaluations and crew health certification and monitoring for Artemis missions (TBD-52105-004), Artemis Mission Medical Evaluation Requirements Document (AMMERD).

Rationale: To provide consistent crew health requirements and evaluations for crewmembers on Artemis flights and as indicated in the (TBD-52105-004) Artemis Mission Medical Evaluation Requirements Document. Additional medical evaluations may be completed as clinically indicated.

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Preflight Evaluations

[MO-165] Preflight Medical Evaluations

The Artemis Campaign Development shall plan and implement required preflight medical and behavioral evaluations of Artemis crewmembers.

Rationale: To ensure medical and behavioral readiness of crewmembers to successfully perform mission objectives and as indicated in the (TBD-52105-004) Artemis Mission Medical Evaluation Requirements Document.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-27] Preflight Research Baseline Data Collections (BDC)

The Artemis Campaign Development shall integrate and implement preflight research baseline data collections for investigations baselined in the Mission Definition Baseline.

Rationale: This requirement is to ensure that the crews participating in human research experiments are available for an Informed Consent Briefing and BDC prior to launch and that crew scheduling recognizes the need to provide access for science teams to those NASA crewmembers. BDC is the collection of biological samples as well as physiological and psychological data from the crewmembers participating in research activities. When possible, these activities will be integrated with required medical evaluation testing. Laboratory and office space will provide the capability for the collection, processing, and preservation of biological samples in support of the medical and research activities.

(TBR-52105-003)

Effectivity: Artemis III and subsequent

In-flight Medical Evaluations

[MO-28] In-flight Medical Evaluations

The Artemis Campaign Development shall plan and implement periodic in-flight medical and behavioral evaluations via the established flight planning and timelining process.

Rationale: In-flight assessments of crewmember health and wellness are required to assure mission success, to assess the potential impact(s) of a crewmember medical condition for current and upcoming mission activities, and to prescribe medical interventions as required and as indicated in the (TBD-52105-004) Artemis Mission Medical Evaluation Requirements Document. Additional medical evaluations may be completed as clinically indicated.

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[MO-29] Evaluation of In-flight Medical Evaluations

The Artemis Campaign Development shall ensure that the Crew Surgeon, Deputy Crew Surgeon, and experts analyze the results of in-flight evaluations and private conferences.

Rationale: In-flight assessments of crewmember health and wellness are required to assure mission success, to assess the potential impact(s) of a crewmember medical condition on mission activities, and to prescribe medical interventions as required. The objectives for the analysis and evaluation of the in-flight medical evaluations and private conferences include but are not limited to:

A. Assess the health and fitness of the crew, including behavioral health and performance and team functioning

B. Assess the workload and work/rest schedules of the crew

C. Evaluate and prescribe countermeasures and treatment

D. Predict and enhance tolerance for physical challenges such as Extravehicular Activity and the dynamic forces experienced during entry and landing

E. Provide a basis for in-flight medical certification

F. Report issues that may impact mission activity to the Flight Director and the Mission Development Manager (MDM)/Mission Management Team (MMT) Chair

(TBR-52105-003)

Effectivity: Artemis III and subsequent

[MO-30] Medical Impacts on Mission Operations

The Artemis Campaign Development shall ensure the Crew Surgeon informs the Commander and the Flight Director in the Mission Control Center if any crewmember’s medical condition will, or potentially will, impact mission operations.

Rationale: Communication between the CS, Commander, and Flight Director regarding mission impacts allows for appropriate dissemination of the potential impact of a crewmember medical condition on mission activities, flight planning, early mission termination, flight operations, etc.

PMCs resulting in possible mission impacts or mission impacts must be communicated by the Flight Surgeon to the Commander, and then the Flight Director. MDM/MMT communication will follow procedures delineated in ESD 10033, Exploration Systems Development Mission Management Team Operations Plan.

The CS reports results of all in-flight medical…