Bigelow Aerospace "Advanced Medical Facility" from a Military Doctor's POV

[BrighamUSAF]

Reviewing Bigelow's designs:

"Advanced Medical Facility (3000 m3) - Nine BA 330 modules, three propulsion buses with docking node, three crew capsules."

Image:
http://www.flickr.com/photos/sjipp/5417744391/

I can't find any documentation detailing the mission of such a facility and, thus, I have many questions regarding this particular idea.  Let me first say that this is coming from an Air Force Physician in Internal Medicine with plans to attend our Residency in Aerospace Medicine and continue research in space-based medicine practices.  I am not the expert in this field, but I will continue working towards advancing spaceflight and exploration through enabling our space-faring 'nauts by facing the medical challenges that come with spaceflight.

Here are the problems I have with such facilities:

1.  What is the mission of such a space-based "Advanced Medical Facility" (heretofor referred to as "AMF")?

Answer:  (1) Treat the sick/ailing (heretofor referred to as "patients") and (2) Serve as a platform with which to further research and advance our space-faring capabilities

My issues with this facility:

1a.  Who are our patients?  Conventional wisdom would propose the obvious - space-faring individuals (if I am incorrect in this assessment, please enlighten me).
1b.  Where are our patients coming from?  Other orbiting facilities?  One must assume this to be true.  Otherwise, are we to fly our patients from Terra Firma to an orbiting facility to... what... endure the hardships of spaceflight only to be admitted to an ICU bed?
1c.  If we assume our patients are coming from other orbiting facilities, we must then assume that a MedEvac must either (a) leave the AMF to pick up the individual from the other orbiting facility and return or (b) leave the other orbiting facility to transport our patient to the AMF.  In military medicine, MedEvac is performed by the receiving facility so as to not tie up the other commander's assets (unless the other commander allows his assets to be used, as in CasEvac [Casualty Evacuation]). 

Here is the ultimate problem:  In transporting a single patient (or small group of patients), massive amounts of resources would be used.  Therefore, any AMF must also serve a dual purpose:  Resupply Depot.  This is the lesson learned time and time again in military medicine.  When casualties are evacuated by either MedEvac or CasEvac, resources must be resupplied to the most forward deployed setting.

2.  The layout of this facility does NOT allow for safe patient transport.  If we assume a patient requires transportation to a higher level of medical care, we can likely be assured of either one of two things:  (a) The patient is otherwise stable, but requires some form of surgical intervention which could not be performed at their home station or (b) the individual is decompensated (but stable); in either situation, there must be a pressing reason why this individual cannot survive re-entry - either due to some orthopedic injury which changes the body's ability to absorb shock or cardiopulmonary subacute decompensation.  Any other surgical emergency would likely not survive transport to an AMF (if we assume several days to change orbit and match the AMF) and many medical emergencies would likely suffer the same sate.  Of these two patient populations that would require transport, the orthopedic injuries would likely be able to make the ~90 degree transition from Crew Vehicle to Medical Facility.  On the other hand, any fixed suppine position cannot make the 90 degree transition from crewed vehicle to Medical Facility.  Therefore, this facility would likely need rethinking.

An orbiting medical facility would likely be best built using the BA-2100 (Or BA-330 for less capability) module with an attached Sundancer Module attached to the fore position as a surgical suite to enable transport of suppine patients and separate clean from sterile environments.  Sterile processing could take place within the Sundancer Module.  Some form of transition from crewed craft to BA-2100/BA-330 requiring a straight shot to allow transport of Suppine patients would also be required, making any node attached to the BA-2100/BA-330's aft position requiring a straight pass through bypassing any 90-degree transitions.  Any crewed quarters would likely be attached to the port or starboard ports.  Any number of these configurations could be daisy chained side-to-side, but one must be sure to stock an abundant fuel supply, food stores, water, etc. to resupply any MedEvac or CasEvac, which might consist of a unspent upper rocket stage with other components.

3. Training/Makeup of the Medical Crew and per annum costs of just the orbiting personnel alone (I'll use equivalent military pay for these individuals and low-ball the surgeons' pay).  I'll have to assume rotations are 6-months.  This is more for speculation.  From my point of view the following would likely be required:

3a. Specifically trained Space Medicine Physician, likely an Internal Medicine Doc or Family Practitioner who has taken some fellowship in Space Medicine in order to understand the changes that space has on the body, specifically in micro- and zero-gravity.
$120,000/year

3b. Specifically trained Orthopedic Physician
$180,000/year

3c. Specifically trained General Surgeon
$150,000/year

3d. Anesthesiologist
$150,000/year

3e. Advanced Space Medical Technicians (2-3), who might serve dual purpose as pilots and lab technicians
$300,000/year total

3f. Flight Engineers (2-3)
$300,000

3g. Veterinarian.  Afterall, this facility is likely to serve a dual purpose as a research platform.
$120,000

~11 personnel on station at all times, not including ancillary staff/visiting personnel

Orbiting Personnel:
$1.32 million x 3 (2 6-month rotations per year, but with three phases [6 months train, 6 months orbit, 6 months recovery]).
~$4 million/year (super low ball), more likely ~$8 million/year, and this is without factoring in Earth-based monitoring, leasing, etc.  Just a little less cost effective than most modern hospitals!

Anyhow, I'm finished for now.

Stu

[Namechange User]

I get the impression this is a research facility not necissarily an in-space hospital/trauma center. 

[A_M_Swallow]

The time to Earth surface would also depend on where the facility is.  From lunar orbit or Lagrange points 1 or 2 allow 3 days.  From Mars orbit variable but likely to be in excess of 9 months.

[BrighamUSAF]

I get the impression this is a research facility not necissarily an in-space hospital/trauma center. 

True, nor would I expect a Level 3 Orbiting Trauma Center, but as an orbiting population approaches ~100, one can only be assured that any number of government sponsored individuals or their aging multi-millionaire civilian counterparts might suffer some form of medical emergency that would eliminate the possibility for Earth Re-entry.  I would estimate that someone in either an acute decompensated Congestive Heart Failure state or other form of cardiopulmonary arrest (either post-Acute Coronary Syndrome or massive PE for example) would have a much higher probability of survival in orbit, where the heart would not have to necessarily pump against gravity.  Of course, the lower atm may make pulmonary edema a nightmare to deal with. 

[neilh]

Actually, my initial instinct when I first saw the poster is that it's main intent would be to act as a sort of orbital retirement/nursing home.

[Pheogh]

Not sure this has been published yet or not but what is the cost to get one BA 330 module up and running on orbit?

[BrighamUSAF]

Actually, my initial instinct when I first saw the poster is that it's main intent would be to act as a sort of orbital retirement/nursing home.

http://www.flickr.com/photos/jedibfa/5147477002/in/set-72157625314521760/

Now, now... how many nursing homes have an enclosed ICU bed, let alone an "ICU2" bed which begs the question: Where's ICU bed 1?  Of course, this is an inside look at a concept BA-2100, which I personally think is much more suited for an orbiting hospital, with four decks.

I think in his grand scheme of things, Bigelow believes that we will ultimately become a space-faring civilization, likely with Retirement Homes, Hospitals, Research Platforms, etc....   However, we must examine the ultimate utility of these platforms, especially the earliest platforms.  I don't, for example, think a retirement/nursing home would be practical.  How many Alzheimer's patients would fare well in zero-g?  Could you imagine incontinent patients?  That would be a ... disaster; not to mention a huge risk of infection.

Just a thought.

[Robert Thompson]

Someone is designing and testing a small inflatable centrifuge. Perhaps they or someone else will study the concept of a centrifuge with plumbing.

[go4mars]

I remember hearing at some point that when people get too fat, and I mean really really fat, that surgery on their internal organs is often a waste of time because the weight of all their fat keeps the incisions from being able to close and heal properly.  Maybe the intention is to be a surgery center for very wealthy fat people as a zero gravity environment would prevent this. 

I did have a clip from one of my favourite characters from the Austin Powers movies, but decided to remove it.  As a clue:  He's Scottish.

[robertross]

Actually, my initial instinct when I first saw the poster is that it's main intent would be to act as a sort of orbital retirement/nursing home.

http://www.flickr.com/photos/jedibfa/5147477002/in/set-72157625314521760/

Now, now... how many nursing homes have an enclosed ICU bed, let alone an "ICU2" bed which begs the question: Where's ICU bed 1?  Of course, this is an inside look at a concept BA-2100, which I personally think is much more suited for an orbiting hospital, with four decks.

I think in his grand scheme of things, Bigelow believes that we will ultimately become a space-faring civilization, likely with Retirement Homes, Hospitals, Research Platforms, etc....   However, we must examine the ultimate utility of these platforms, especially the earliest platforms.  I don't, for example, think a retirement/nursing home would be practical.  How many Alzheimer's patients would fare well in zero-g?  Could you imagine incontinent patients?  That would be a ... disaster; not to mention a huge risk of infection.

Just a thought.

I've just done a cursory glance at this, since I'm still in 'vacation/travel mode', but wanted to say you have posed some excellent questions on this issue.

One of my quick thoughts on this, referencing the multi-millionairs/billionaires, is what THEY want out of this: a private & quiet escape in their final days, just a new challenge, or simply a vacation only a few could now afford.

I think there is a range of 'services' that could be provided, but your point on geriatric issues is a fundamental one (like incontinence, assuming it occurs in orbit as it does on the ground). The other being integrated services (dual purpose base), which is also excellent & wise.

So much I would like to discuss, but it will have to wait until (perhaps) the weekend.

[Cherokee43v6]

I'd hate to pull the thread off topic... or duplicate an existing thread on the subject if unnecessary, but can someone point me to a discussion of some of the other concepts depicted on the posters (on the Flickr site).


Something to consider in relation to one of the early points.

The mention of sending a vehicle to retreive the patient.  What say we revisit this concept from a different angle. 

Instead of sending 'an ambulance' Dragon, CST-100, etc... Why not detach and send a Sundancer with a Trauma Team?  That covers the supply situation and half the time delay, plus gives you the resources to handle any peripheral emergencies.  Once the emergency is handled (or if long-term care is required) the Sundancer returns to the 'Hospital Station'.

Hospitals don't go to the patients because they are buildings anchored in one spot.  Space stations are ships.  Yes there are fuel requirements associated with such translations, but the concept of designing a propulsion module that can rapidly move a Sundancer as a 'Medical Cutter' (to merge Hospital and Coast Guard concepts) to a different orbit as a 'first responder' sounds like a reasonable leap from the poster concept.

"Welcome to L1 General, please have a seat.  Filling out the insurance forms should only take three orbits."

[MP99]

3a. Specifically trained Space Medicine Physician, likely an Internal Medicine Doc or Family Practitioner who has taken some fellowship in Space Medicine in order to understand the changes that space has on the body, specifically in micro- and zero-gravity.
$120,000/year

3b. Specifically trained Orthopedic Physician
$180,000/year

3c. Specifically trained General Surgeon
$150,000/year

3d. Anesthesiologist
$150,000/year

3e. Advanced Space Medical Technicians (2-3), who might serve dual purpose as pilots and lab technicians
$300,000/year total

3f. Flight Engineers (2-3)
$300,000

3g. Veterinarian.  Afterall, this facility is likely to serve a dual purpose as a research platform.
$120,000

~11 personnel on station at all times, not including ancillary staff/visiting personnel

Orbiting Personnel:
$1.32 million x 3 (2 6-month rotations per year, but with three phases [6 months train, 6 months orbit, 6 months recovery]).
~$4 million/year (super low ball), more likely ~$8 million/year, and this is without factoring in Earth-based monitoring, leasing, etc.  Just a little less cost effective than most modern hospitals!

If orbital tourism (or medical stay) remains in the millions-of-dollars-per-seat, then perhaps you would find volunteers to undertake the earlier tours of duty without being paid.

This may be a way to kick-start such a facility.

I get the impression this is a research facility not necissarily an in-space hospital/trauma center. 

However, I'd agree that medical research seems a more likely guess at the intention here.

cheers, Martin

[mrmandias]

A zero-G environment induces its own stresses.  I can't imagine the very aged would be immune.
A low-g environment, on the other hand, would probably be ideal for folks with creaky joints, lower muscle mass, and weak bones.
So the trade space would be between the costs and space limitations of centrifugal space habitats and the extra costs/risks of getting to the moon.

[rusty]

Reviewing Bigelow's designs:

"Advanced Medical Facility (3000 m3) - Nine BA 330 modules, three propulsion buses with docking node, three crew capsules."

Image:
http://www.flickr.com/photos/sjipp/5417744391/

I can't find any documentation detailing the mission of such a facility and, thus, I have many questions regarding this particular idea.  Let me first say that this is coming from an Air Force Physician in Internal Medicine with plans to attend our Residency in Aerospace Medicine and continue research in space-based medicine practices.  I am not the expert in this field, but I will continue working towards advancing spaceflight and exploration through enabling our space-faring 'nauts by facing the medical challenges that come with spaceflight. ...

IMO, a stand-alone medical facility would never be nessisary, as populations large enough to require one would have their own, but a vehicle akin to a space ambulance might be eventually. An important feature would have to be some centrifugal gravity. Could you imagine surgury or draining a punctured lung without it?

[tnphysics]

I think this is more likely for patients who cannot fit (because of everything that must be around them for their care) into a return capsule, or for a situation too far from Earth for quick enough return.

[ChefPat]

We could call it Mercy Point.

(sorry, I couldn't resist  )