Imagine: You and five others are in a space ship of maybe 100 square feet, hurtling at 15,000 mph toward Mars, when the worst happens: a broken bone, a burst appendix, a gaping wound. Not only are you 20 million miles from the nearest hospital, but you are in the most extreme environment humans have endured, in zero gravity, with only the tools and resources you blasted off with.
What to do?
That’s what Dr. Danielle Carroll is working to answer as she develops protocols, practices and procedures for space medicine.
Carroll is part of the Dr. Aenor Sawyer's Space Health team at University of California, San Francisco, which in turn is supported by a grant from the Translational Research Institute for Space Health, the innovation arm of NASA's Human Research Program, based out of Baylor College of Medicine in Houston.
“Other folks when choosing what [medical] field to go into, they like to feel they are the expert, that they know front-to-back everything there is to know,” Carroll said in a phone interview earlier this month. “With space medicine, it’s not possible to do that right now, there’s so much that we don’t know. That would drive some crazy, but I love it. The opportunities are endless, every subject is its new mountain.”
Wyoming Stargazing will present Carroll in the next installment of its “World Above the Tetons” speaker series, set for 7:30 p.m. Friday.
Space and science geeks have been getting a small taste of the isolation astronauts experience as the nation self-isolates against the coronavirus, but Wyoming Stargazing accommodated the unusual circumstances by arranging for Carroll to deliver her presentation via a Zoom online meeting. Purchase a ticket at WyomingStargazing.org and the link to join in will be emailed to you.
Carroll was born in Newport Beach, California, but as a child moved to Charlottesville, Virginia, where she went to middle and high school and the University of Virginia, studying bioethics and Italian and signing up for the Air Force’s Reserve Officer Training Corps to help fund medical school.
“My family has had a lot of different people who served in the military over generations,” she said.
What’s more, her mother had a private pilot’s license, and Carroll served as her co-pilot before she was even out of grade school.
“In field training in college for ROTC ... I had the opportunity to go in a small airplane with a trainer, an instructor,” she said. “He’d do a maneuver and then I’d do it. It was monkey-see, monkey-do, nothing special, but after we landed [the instructor] looked at me and said, ‘You’re a natural at this,’” and he introduced her to the corps’ pilot training program.
After college, Carroll deferred medical school to fly high-performance T-34 and AT-38C jets for the Air Force from 2005 to 2010. She attained the rank of captain, played on the champion All-Air Force Women’s Soccer Team, assisted with Hurricane Katrina relief efforts as a part of a Special Operations helicopter unit and went to Italy for the Language and Area Studies Immersion Program.
After active duty she transferred to the Air Force reserves and returned to UVA for medical school. Her training included disaster relief, mass casualty incident management, wilderness medicine and trauma/emergency response in resource-limited settings, and she got involved in global health work, trauma and burn surgery research, and outreach in East Africa and Latin America.
Then, in April 2016, just before she was to graduate from medical school, she learned about a one-month intensive at the Johnson Space Center in Houston to learn about space health. As a friend said at the time, “This has you written all over it.”
“So I put in for it,” she said, “and I was selected and spent a month down there where I was exposed to all this stuff.”
It was then and there she “caught the bug” for space medicine. After three years at the University of California, San Diego, as a general surgery resident, last year she moved to UC San Francisco for a Space Health Innovation Fellowship. She is about eight months into a two-year stint there, researching the lingering questions of space health.
“There are so many questions,” she said, promising to go into detail about some of them in her talk Friday. “The primary questions now center on fluid shifts in body. From one g to zero gs, weightlessness, there’s a pretty massive shift that occurs in the first 36 to 48 hours from the legs to the head. ... That causes a whole bunch of issues,” including high blood pressure, retaining fluids or sudden evacuation of fluids, dehydration, kidney stones, weakening of the bones and higher calcium levels in the blood.
“Muscle atrophy is another concern, particularly in the neck and spine,” she said. “And there are teams across the country that are looking at changes that happen to the eyes.”
The eyeball can flatten out in microgravity, and vision can go from 20/20 to farsighted fairly quickly. There’s also the risk of the optic nerve swelling and “a whole boatload of other changes,” she said. “We don’t know enough about the path of physiology to intercept them early.”
Another risk is blood clotting. Female astronauts using oral contraceptives are particularly vulnerable. In one incident on the International Space Station, an astronaut was found to have an internal jugular vein clot, which could have been life threatening.
Carroll’s research has plenty of applications on terrestrial medicine, too, particularly in the realm of remote medicine in places like Antarctica, Africa and Central America.
“Some of these remote environments simulate the austerity of these deep space missions,” she said.
Such conditions require figuring out new ways of doing things that use fewer resources and require less medical skills. It doesn’t have to be surgery — “It can something as simple as placing an IV,” she said — but in the jungle or on the ISS, even simple things become more challenging.
“This field is really expanding,” Carroll said. “We’re in a real boom period right now,” especially as NASA begins to integrate with commercial space entities such as Space X and Virgin Galactic.
“We now know, or think we know, how to send someone into space who is healthy,” she said. “But to send someone who is not healthy into an environment that is inherently dangerous” — like the space tourist such private companies hope to cater to — “we need to know more, learn more.” ￼
— This story was edited to correct the relationship between the University of California, San Francisco, the Translational Research Institute for Space Health and the Baylor College of Medicine.