University Medical Center Mainz goes to Mars

(Mainz, 20 April 2010, tr) Mars is some 50,000,000 kilometers from Earth and experts believe that it will only be in several decades‘ time that humans are actually in a position to get there. Despite this, the European Space Agency (ESA) and the Institute of Biomedical Problems (IBMP) of the Russian Academy of Sciences have already begun putting in place detailed preparations for this new challenge to manned spaceflight. This coming summer, they will be initiating a simulated mission to the red planet: the Mars500 mission. It is their intention to find out whether humans can withstand the pressures placed on their physical and psychological health which they will face under the extreme conditions of a flight to Mars. For this purpose, the crew members will perform various tasks and a number of experiments. One aspect to be looked at is the problem of how to manage medical emergencies without help from outside. Potential solutions and a relevant concept have been developed by experts of the Mainz University Medical Center: A team headed by Professor Wolf Mann, M.D., Director of the Department of Otolaryngology, Head, and Neck Surgery – Plastic Surgery, and Professor Christian Werner, M.D., Director of the Department of Anesthesiology, is the only German group specializing in emergency medicine that has been asked to participate in the Mars500 project. Financial support for the project to the amount of EUR 257,000 is being provided by the German Aerospace Center (DLR).

"Around 250 days for the outward trip, 30 days sojourn on the surface of the planet Mars, and 240 days for the return flight – experts assume that a long-term mission to Mars will probably take all of 520 days. The crew will be exposed to extreme physical and psychological stresses during this period. Six persons will need to be prepared to co-exist in extremely cramped confines and conditions for nearly 18 months. Food will be rationed, and illnesses and injuries will need to be treated. Only little help from Earth is to be expected when it comes to providing emergency aid to sick or injured colleagues as there will be major delays of up to 20 minutes in communication each way," explains Professor Wolf Mann, M.D., head of the Mars500 project team at Mainz University Medical Center.

"This means that the crew will have to learn to be fully self-sufficient, particularly in view of the fact that absolutely anything can happen. They may even have to be capable of resuscitating a crew member if the worst comes to the worst. The astronauts will require a form of medical training specially adapted to the needs of long-term missions if they are to survive," adds Professor Christian Werner, M.D., Director of the Department of Anesthesiology.

The experts based at the University Medical Center of the Johannes Gutenberg University Mainz have thus developed a training concept for the IBMP / ESA simulation research project that can be used to provide non-professionals with the knowledge and skills needed to master emergency medical situations. Before the future test astronauts move into their shared "Mars residence," the Mainz team will provide them with initial training on-site in a three-day course in Moscow. "The focus will be on the practical rehearsal of an emergency medical procedure checklist adapted specifically to the conditions of weightlessness. We will also be monitoring to what extent the participants lose the skills acquired during the on-going project. This means that we will be subsequently able to develop telemedial measures and assess their effectiveness," states Matthias Schäfer, M.D., Managing Senior Consultant of the Department of Anesthesiology, who is also involved in the Mars500 project at the Mainz University Medical Center. The training concept to be used is based on the results of a pilot study involving medical students at Mainz and the data gathered by Professor Mann and Professor Werner and their team during a study of the crew working at the Concordia station in the Antarctic.

In the initial three-day training session in the container complex in Moscow, the Mars500 participants will be instructed in the basic skills they need to be able to provide emergency medical treatment. A total of 12 members of the Mars500 team – six of them will later be selected to actually move into the simulation container – will be taught a modified form of advanced life support (ALS) measures and the use of checklists (ERC algorithms) covering emergency procedures such as those required to treat cardiac arrest. Among other things, the Mainz team has adapted the guidelines followed by accident and emergency doctors to the capacities of non-professionals, and they have put together a set of medical equipment that is easier to use. This includes, for example, a special tube that can be used to maintain patency of the respiratory system. This can be inserted without visualization aids and will automatically position and hold itself in place. Similarly, the automated external defibrillator (AED) commonly employed at airports, railroad stations, and in public buildings will be provided instead of the manual defibrillator used by trained professionals. Devices of this kind already form part of the standard equipment of the International Space Station ISS. Rather than use a venous access, emergency administration of medication or infusions will be effected with the help of so-called intraosseous access, in other words, by infusion or injection directly into the bone marrow – at a site on the upper part of the tibia, for example. The advantage is that this procedure is quicker, and it is associated with a high success rate and a lower risk of complications.

To ensure that the participants retain the imparted skills and knowledge in the long term, the team of trainers from the Mainz Department of Anesthesiology and the Department of Otolaryngology, Head, and Neck Surgery will be concentrating on the trainees‘ exercise of the procedures learned in theory. A total of ten test days are planned for the crew of the Mars500 project during the isolation phase during which they will perform various practical and theoretical tests. In the end, a simulation mannequin will be used to evaluate their practical competence in emergency medical situations while their theoretical knowledge will be assessed using multiple choice questionnaires. One of the two test groups will also be provided with two refresher courses. Film recordings and stored sensor data from the simulation mannequin and the AED will be subsequently evaluated to determine how well the participants perform and to what extent they lose their acquired knowledge with and without the refresher courses.

More information on the Mars500 mission
The Russian Institute of Biomedical Problems (IBMP) and the European Space Agency (ESA) collaborate in simulating the conditions of a manned space flight to Mars. In "Mars500," the name of the project, researchers will be studying the effects of isolation for a period of 520 days on the endurance of a group of participants. The "Mars500" crew will consist of six individuals – two from Europe, three Russians, and one Chinese. The standards that these volunteers will have to meet will be roughly the same as those that the IBMP and ESA would require of astronauts participating in a genuine Mars mission.

The isolation study is to be conducted in a specially designed Mars500 container located in the Institute of Biomedical Problems in Moscow. This is a tubular module system with a living and working area of 180 square meters. There are also cold storage facilities for the food and a quarantine unit. Each of the test astronauts will be provided with a personal cabin with a floor space of three square meters – including a narrow bed.

A manned mission to Mars not only represents a massive technological challenge, but would also subject the astronauts involved to extensive stresses: The crew would need to be able to coexist amicably for some 18 months in the tiny space available and work together to resolve any problems that arise. The IBMP and the ESA also want to analyze these interpersonal factors in greater detail during the simulated mission to Mars. The crew will be expected to carry out a wide range of experiments and will even be confronted with "unexpected problems" in their containerized world that the external project supervisors will contrive for them. They will also have to cope with delays of up to 40 minutes in communications with "mission control".

Contact
Professor Wolf Mann, M.D.
Director of the Department of Otolaryngology, Head, and Neck Surgery – Plastic Surgery
University Medical Center
Johannes Gutenberg University Mainz
tel. +49 6131 17-7361
fax +49 6131 17-6637
e-mail: konhaeuser@hno.klinik.uni-mainz.de

Professor Christian Werner, M.D.
Director of the Department of Anesthesiology
University Medical Center
Johannes Gutenberg University Mainz
tel. +49 6131 17-7117
fax +49 6131 17-6649
e-mail: wernerc@uni-mainz.de

Press contact
Tanja Rolletter
Communications and Media Relations
University Medical Center
Johannes Gutenberg University Mainz
tel. +49 6131 17-7424
fax +49 6131 17-3496
e-mail: pr@unimedizin-mainz.de

About University Medical Center of the Johannes Gutenberg University Mainz
The ‚University Medical Center Mainz‘ consists of more than 50 specialist clinics, institutes and departments as well as two central health-care facilities, a pharmacy and a transfusion center. All of these clinics and institutes work together on an interdisciplinary basis. The hospital has over 1,600 beds and treats more than 61,000 in-patients every year. It also serves an additional 217,000 people per year on an out-patient basis. We define ourselves as the patients‘ best source for optimum patient care. In our work, we use state-of-the-art diagnostic and therapeutic procedures based on recent medical research. It is our goal to serve as optimally as possible by integrating our knowledge and experience into the excellent services we provide. We offer nearly every kind of clinical facility you might need. The University Medical Center offers health care to the highest university standard. In addition, we are not only a health-care center, but also a research and teaching hospital. These three pillars of medicine – clinical health care, medical education, and research – are inseparable aspects of integrated health care. For more information, please visit: <www.unimedizin-mainz.de>
(idw, 04/2010)

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