Author: Christos Tsagkaris
Telemedicine has been defined as the “delivery of health care services, where distance is a critical factor…in the interests of advancing the health of individuals and their communities”. It pertains to medicine that is practiced from a distance, or remotely. Similarly, distance is a crucial factor in the field of global health, which often aims to tackle health challenges that occur across continents and to provide health services to remote communities. Currently being adopted by the World Health Organization, Medecins sans Frontiers and other prestigious players in the field of healthcare, telemedical technologies are expected to play a crucial role in global health in the near future.
Telemedicine encompasses a wide variety of modalities. Having a patient living in a remote area assessed by a specialist physician from a tertiary hospital, or having an astronaut in the International Space Station (ISS) examined by a flight surgeon in the European Space Agency (ESA) premises are just two examples of current applications within telemedicine. In the future, physicians will be also able to control surgical robots conducting interventional procedures or surgery remotely.
Meanwhile, distance is also a key component of space medicine. A patient living on a remote island can usually be transferred to a proper healthcare facility, but it is almost impossible for an acutely unwell astronaut to return to Earth. A spacecraft heading to Mars is not able to wait for an ambulance. Space exploration has been described as a constant fight against distance that ought to be covered in a safe and fast way. Such distance undermines traditional medical practice and urges for solutions derived from the field of telemedicine. Telemedicine has thus greatly advanced as a result of meticulous research by scientists from diverse backgrounds, committed to maintaining the safety and well-being of those performing space exploration. However, space medicine has been criticized for allocating enormous funding to medical applications that serve few people instead of working on the amelioration of healthcare on a global level.
In this sense, the fields of space medicine and global health appear contradictory. However, telemedicine holds the potential to bridge the gap and create a fruitful interaction between them.
Telemedicine in space must still overcome many challenges to provide astronauts with exceptional healthcare, and several researchers have suggested that these advances in space medicine may also be implementable on Earth. This appears to be a promising framework for future research. What do the International Space Station and a remote village in Nepal, for example, have in common? They share isolation, remoteness from tertiary care centers, resource scarcity, challenging (and expensive) emergency transfers, limited access to specialists, and limited opportunities for training of medical staff.
Space telemedicine is based on communication systems that allow synchronous and asynchronous transmission of information. Flight surgeons are thus able to provide guidance for various procedures such as Cardiopulmonary Resuscitation (CPR) and microoperations. In terrestrial settings this feature may be possible through 5G internet applications. The advantages and disadvantages of using 5G in healthcare on Earth is already being widely discussed, and its use in space is likely to add even more controversy. However, addressing the matter of 5G in both terrestrial and extraterrestrial contexts will possibly facilitate solutions or indeed alternatives.
During space missions an astronaut is usually appointed as Crew Medical Officer (CMO). CMOs receive practical training in key medical concepts using the model of Advanced Trauma Life Support (ATLS). In terrestrial remote communities, it is common that a medic, usually a general practitioner, is expected to take care of all the patients with the remote support of specialists. The concept of a CMO could be further explored in such communities by training individuals to detect life threatening conditions and assist in a wide range of medical procedures. Telemedicine could also provide an educational dimension in such settings, via remotely delivered training courses. Hence, lifelong learning appears as an achievable goal for both extraterrestrial and terrestrial CMOs. Making this training as interactive as possible and assessing the level of practical skill acquisition would be key to its success.
Although many new skills can be taught and obtained, other skills such as conducting an echocardiogram or performing a needle aspiration of an abscess or pleural effusion require more intensive training and specialization. It is a challenge for space and terrestrial telemedicine to develop technology that will enable remote specialists to conduct such procedures themselves. A skilled radiologist could therefore move the transducer of an ultrasound device from thousands of miles away, rather than verbally guiding an inexperienced user. Time, and even lives, could be saved this way.
All in all, telemedicine appears to be a point of synergy between space medicine and global health. Echoes from space and urgent calls from Earth shape a list of needs that ought to be addressed in the near future. Space telemedicine is supported by generous funding but has minor chances of being evaluated on a wide scale due to the small sample size of astronauts that are served by it. On the other hand, millions of isolated or remote communities worldwide would benefit greatly from receiving novel telemedicine approaches and could provide robust data on their efficacy. Last but not least, telemedicine has the privilege of being served by a multidisciplinary workforce, comprising scientists eager to combine advanced technology and state of the art medical knowledge. In future, space missions may be able to bring back more than just rocks and observational data; they could provide vital insights that help us to ameliorate or even revolutionize health on a global level.
Eye on Global Health 