Basic principles and concept design of a real-time clinical decision support system for managing medical emergencies on missions to Mars

Space agencies and private companies prepare the beginning of human space exploration for the 2030s with missions to put the first human on the Mars surface. The absence of gravity and radiation, along with distance, isolation and hostile environments, are expected to increase medical events where previously unseen manifestations may arise. The current healthcare strategy based on telemedicine and the possibility to stabilize and transport the injured crewmember to a terrestrial definitive medical facility is not applicable in exploration class missions. Therefore, the need for deploying the full autonomous capability to solve medical emergencies may guide the design of future onboard healthcare systems. We present ten basic principles and concept design of a software suite to bring onboard decision support to help the crew dealing with medical emergencies taking into consideration physiological disturbances in space and spaceflight restrictions. 1) give real-time support for emergency medical decision making, 2) give patient-specific advice for executive problem-solving, 3) take into account available information from life support and monitoring of crewmembers, 4) be fully autonomous from remote facilities, 5) continuously adapt predictions to physiological disturbance and changing conditions, 6) optimize emergency medical decision making in terms of mission fundamental priorities, 7) take into account medical supplies and equipment on board, 8) apply health standards for the level of care V, 9) implement ethics responsibilities for spaceflights, and 10) apply ethical standards for artificial intelligence. Based on these principles, we propose an autonomous clinical decision support system (CDSS) to provide real-time advice for emergency medical interventions on board of space exploration missions.