Abstract
As this editorial is being penned, the U.S. Space Shuttle Atlantis and the International Space Station are circling the earth at 17,500 miles per hour. This current Shuttle mission is the last in the 30-year Shuttle Program. The remaining orbiters, Endeavour, Discovery, Atlantis, and Enterprise, will all become museum pieces and serve as a testament to a nation's legacy in space exploration. Each Orbiter was named after a maritime research vessel. The Enterprise, originally named Constitution, was named after Captain Kirk's Starship Enterprise in the television series Star Trek. Challenger and Columbia and their crews were tragically lost. The Space Shuttle System is the most complex machine or systems of machine ever built. It has provided all of us inspiration as a nation and as inhabitants of this Blue Planet we call home. The thunderous roar of a launch, seeing the Orbiter streak into the sky, we watch with awe the men and women who travel into space. We wonder in amazement how they live and work with a window watching over a spinning world.
Space exploration has been part of the human condition for over six decades. Beginning in earnest in the late 1950s, getting into space was seen as a national need. The launch of Sputnik by the Soviets in October 1957 shocked the world, especially the United States. This initiated the Space Race, which culminated with the moon landing in July 1969. The Space Race ushered in a period of unparalleled growth and discovery in technology that has touched almost everything we do. Today, the U.S. leadership will continue in both commercial space flight and exploration missions to an asteroid and eventually Mars. Other nations, including Russia, China, and India, are all aggressively moving forward with various plans for moon landings and exploration.
You might ask, “What does this all have to do with telemedicine?” Well, the answer is everything! The dawn of human spaceflight began with limited understanding of what would happen to the human body once it was beyond the Earth's grasp. Initially, work was done on animals, and in 1957 aboard Sputnik 2, the Soviets wirelessly monitored the physiological condition of Laika, a dog. This information was downlinked to the ground. Sound familiar? The use of telemedicine in the space program was ushered in. As aerospace medicine specialist in the United States began to develop spacecraft systems for monitoring astronaut health, the concepts of telemedicine began to take hold. Biomedical information needed to be transmitted to the physicians on the ground so that they could assess crew health. The astronauts in the Mercury and Gemini programs paved the way to the first moon landing and those men who stepped foot on the moon were monitored by their physicians 240,000 miles away.
Eventually, the Apollo program led to America's first space station, Skylab, and a joint mission with the Soviets, the Apollo–Soyuz Test Project. Although not called telemedicine at the time, it was clearly being practiced regularly. As America began to develop the Skylab program, a group of individuals, companies, and government officials worked with NASA to develop a ground-based testbed, which was deployed and evaluated in Sells, Arizona. This was called the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC). The instrumentation, communication systems, and clinical protocols would prove invaluable to those involved and would lead to development of further telemedicine capabilities.
By the late 1970s the Space Shuttle Program was nearing its maiden voyage. While Enterprise was a test article, it was Columbia that made the first flight into space in 1981. Over the next 30 years, astronauts would live and work in a shirt sleeve environment, with communications with the ground to support mission critical functions and mission planning, family conferences, and of course telemedicine. The Shuttle has a pretty comprehensive medical capability on board, and often there is a physician. Nevertheless, the onboard capability is aptly complemented by expertise on the ground.
The work conducted aboard the Shuttle and a wide variety of ground-based research activities and testbeds have paved the way for the systems and capabilities on the International Space Station. This facility will serve the community well as a testbed for future systems.
As we embark on the next chapter of exploration, we will require more advanced and autonomous systems to support individuals who are some distance from the Earth. Their real-time needs will be supported by intelligence that they have on board. Linkage back to Earth will be delayed, thereby making synchronous telemedicine not possible.
The lessons from the Shuttle Program and its impact on the field of telemedicine will influence how crewmembers and commercial paying customers will be supported during their sojourn in space.
We have both been intimately involved in the space program and congratulate all of these true pioneers for their unwavering efforts in moving human spaceflight forward and its direct impact on the development of telemedicine. We should all continue to look forward, seeking guidance from our past, reflecting on both accomplishment and failure, and marshalling the talent and resources to forge ahead. The future of human exploration will have a tremendous impact on healthcare in terms or delivery and research. The systems we will see in our physician's office in 2025 or 2050 will have a direct link back to those technologies that are developed to support a human mission to Mars or any other destination.
We look for a safe landing and await the next launch. Telemedicine has been highly influenced by the space program. Telemedicine will continue to grow in capability and application. When those select few human beings look out their window while they orbit the Earth every 90 minutes or so, they know the future is bright!