ISOPTWPO Today

O CTOBER 2014, N O 12

ISOPTWPO Today

EILEEN MARIE COLLINS (COLONEL, USAF, RET.) NASA ASTRONAUT (FORMER) Collins graduated in 1979 from Air Force Undergraduate Pilot Training at Vance AFB, Oklahoma, where she was a T-38 instructor pilot until 1982. From 1983 to 1985, she was a C-141 aircraft commander and instructor pilot at Travis AFB, California. She spent the following year as a student with the Air Force Institute of Technology. From 1986 to 1989, she was assigned to the U.S. Air Force Academy in Colorado, where she was an assistant professor in mathematics and a T-41 instructor pilot. She was selected for the astronaut program while attending the Air Force Test Pilot School at Edwards AFB, California, from which she graduated in 1990. She has logged over 6,751 hours in 30 different types of aircraft. Collins retired from the Air Force in January 2005.

Selected by NASA in January 1990, Collins became an astronaut in July 1991. Initially assigned to Orbiter engineering support, Collins has also served on the astronaut support team responsible for Orbiter prelaunch checkout, final launch configuration, crew ingress/egress, landing/recovery, worked in Mission Control as a spacecraft communicator (CAPCOM), served as the Astronaut Office Spacecraft Systems Branch Chief, Chief Information Officer, Shuttle Branch Chief, and Astronaut Safety Branch Chief. Collins served as pilot on STS-63 (February 3-11, 1995) and STS-84 (May 15-24, 1997), and was the commander on STS-93 (July 22-27, 1999) and STS-114 (July 26 to August 9, 2005). A veteran of four space flights, Collins has logged over 872 hours in space. Collins retired from NASA in May 2006. — Image Credit:NASA

Human Space Flight Edition

Risk of Injury and Compromised Performance due to EVA Operations First EVA was conducted by USSR/Alexi Leonov on March 18, 1965.

U.S. EVA Experience • Gemini EVA Experience 1. Astronaut Edward White II performed first U.S. EVA during Gemini IV June 3, 1965.

2. Problems encountered: helmet fogging, overheating due to high metabolic activity (primarily due to suit constraints and lack of training).

3. Gemini Extravehicular Spacesuit and Life Support – 5-layer Gemini spacesuit was intended primarily for Intravehicular Activity (IVA).

– 2 additional layers were added for EVA (making 7 layers total).

– An umbilical was used to tether the EVA crewmember to the spacecraft and to supply breathing oxygen.

4. 5 Gemini missions involved nine EVAs for a total of 12 hours and 22 minutes of EVA. • Apollo EVA Experience – Spacesuit was redesigned to allow greater mobility.

– Suit used for lunar and in-space EVAs. – Suit was configured with its own portable life support system providing: ∗ ∗ ∗ ∗ ∗

Pressurization & Atmosphere Communication Ventilation Cooling Waste management system

– 7 EVA missions totaling 170 hours of EVA (15 on lunar surface, 5 outside Crew Module) – Last 3 Apollo missions (15, 16,& 17) utilized the lunar rover vehicle for greater range in lunar exploration.

• Skylab EVA Experience – Apollo-style suit used.

– Umbilical replaced portable life support system and provided breathing oxygen, cooling, and served as a tethering device.

– 10 EVAs were performed during the 3 Skylab missions totaling 82.5 hours.

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Human Space Flight Edition

• Space Shuttle EVA Experience – New space suit design for additional mobility and modularity.

– Portable life support system designed for microgravity operation.

– Increased operational capability from orbiter.

– Accumulated 1000s of hours of EVA experience over 200+ EVAs.

Injury Rate of Shuttle Astronauts Medical records of astronauts with Shuttle exposure were examined for ICD-9 codes of injuries (which includes fractures, sprains, strains, and open wounds), joint derangements, or disorders of ligaments and muscular attachments.

Mission period analyses encompassed only those who flew between the April 1981 STS-1 and January 1998 STS-89 missions. The mission period was defined as the 1 year preflight and 1 year postflight periods, or a total of 2 years surrounding a mission. The medical data were obtained from periodic clinic visits, annual examinations, preflight and postflight examinations and consultant reports between January 1978 to March 1999.

For comparison purposes, medical records of the comparison participants were also examined for similar events.

The overall injury rate for the shuttle astronauts was markedly greater than the rate for the comparison participants(Table 1). The astronaut injury rate within the mission period was almost three times that of the overall astronaut injury rate, while outside the mission period their injury rate was about half the overall rate.The difference between the injury rates inside and outside the mission period was statistically significant . This trend fits the previous expectation of increased injury rates due to more physical activity in the preflight training period as well as the deconditioning of bones and muscles in microgravity. Shuttle astronauts sustained injuries at a much higher rate than those sustained by the comparison participants. A higher injury rate is to be expected because astronauts, as compared to the comparisons as well as the population as whole, tend to be physically more active, and many participate in regular vigorous exercise.

There was no difference in the injury rate between the preflight and postflight periods. However, in examining specific musculoskeletal injuries (excluding open wounds and all injuries at other sites), more neck and ankle injuries were sustained in the preflight period and more back injuries were reported postflight. The increased number of postflight back injuries is noteworthy and may be attributable to several factors, including deconditioning, failure of the musculoskeletal system to return to its preflight.

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Human Space Flight Edition

Spacesuit Leak in Shuttle Discovery Astronaut Steve Bowen (STS-133) The leak was discovered in the spacesuit worn by shuttle Discovery astronaut Steve Bowen during a routine check before the start of spacewalk. Bowen and his crewmate Alvin Drew are taking the mission’s second spacewalk to perform a variety of tasks to upkeep the station.

Shuttle astronaut Mike Barratt and space station astronaut Paolo Nespoli were helping Bowen into his suit inside the station’s Quest airlock when they noticed the issue. They traced the leak to a faulty seal on the air-scrubbing lithium hydroxide canister in Bowen’s suit. The canister helps remove carbon dioxide from the air inside spacewalkers’ suits.

Barratt and Nespoli retrieved a replacement seal inside the Quest airlock and inserted the new one in the lithium hydroxide canister. The substitute seal passed all subsequent leak checks.

NASA selected Bowen to replace mission specialist Tim Kopra, who was injured in a bicycle accident. Bowen will perform two spacewalks on this mission. He is the first U.S. astronaut to fly on back-to-back missions. He was a mission specialist on STS-132, which flew in May 2010.

NASA-Mir Program There were 7 U.S. astronauts who were part of 6 primary space crews on the Mir station and worked jointly with 12 Russian cosmonauts over a period of 977 d of spaceflight (March 14, 1995, to June 4, 1998).

Between May 1995 and September 1998 during joint activities, crewmembers performed 25 EVAs ranging from 21 min to 6 h 38 min. Most EVAs were for installation, maintenance, or repair of hardware.

Crewmembers performing operations outside the station frequently noted pain, fatigue (possibly from overuse), and small traumatic injuries to the skin, mainly on the arms and hands associated with hard physical work in a spacesuit.

The U.S. and Russian space programs used different EVA space suits and employed both different and similar EVA techniques. The Russian spacesuit used for EVAs on Mir, the Orlan-DMA, is a semi-rigid suit, adjustable for size with a metal upper torso and fabric arms and legs.

Crewmembers reported most findings after the completion of an EVA. The skin injuries most often seen were: friction-induced sores in the areas of the fingers, hands, forearms, and shoulders; eroded fingernails; and, less often, friction abrasions on the ribcage. These findings are consistent with the types of problems encountered during EVA training in NASA’s underwater facility for simulating EVA in microgravity.

The recommended therapy for abrasions and other superficial trauma included application of ointments such as Lincomycin (lincomycini hydrochloridi) and Methyluracil (2,4-dioxo-6-methyl-1,2,3,4-tetrahydropyrimidine) where friction sores formed, and antiseptics ointments such as Solutio Sulfacyli-natrii (para-aminobenzenesulfacetamidesodium) where the skin surface was excoriated.Recommended therapy for pain included analgesic medication such as Analgin (1-phenyl-2, 3-dimethyl-4-methylaminopyrazolone-5-N-methane sodium sulfonate), Tylenol (acetaminophen), and aspirin (acetylsalicylic acid)

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Human Space Flight Edition

NASA Astronaut Norman Thagard

Shannon Lucid

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John Blaha

Jerry Linenger

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Michael Foale

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David Wolf

Andrew Thomas

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Shuttle-Mir - EVAs Mir Expedition Russian Crew Mir-18 V. N. Dezhurov G. M. Stekalov Mir-21 Y. N. Onufriyenko Y. V. Usachev Mir-22 V. G. Korzun A. Y. Kaleri Mir-22 V. G. Korzun A. Y. Kaleri Mir-22 V. G. Korzun A. Y. Kaleri Mir-23 V. V. Tsibliev A. I. Lazutkin Mir-23 V. V. Tsibliev A. I. Lazutkin Mir-24 A. Y. Solovyev P. V. Vinogradov Mir-24 A. Y. Solovyev P. V. Vinogradov Mir-24 A. Y. Solovyev P. V. Vinogradov Mir-25 T. A. Musabaev N. M. Budarin

Dates of Joint Residency 03/16/95 - 07/04/95

03/24/96- 08/19/96

08/19/96- 09/19/96

09/19/96- 01/15/97

01/15/97- 02/12/97

02/12/97- 05/17/97

05/17/97- 08/07/97

08/07/97- 09/27/97

09/27/97- 01/24/98

01/24/98-01/31/98

01/31/98-08/25/98

ISS EVA-23 Space Suit Water Intrusion Mishap (July 16, 2013) On July 16, 2013, two US crew members (referred to here as EV1(Christopher J. Cassidy (CAPTAIN, U.S. NAVY)) and EV2(Luca Parmitano)) exited the International Space Station (ISS) US Airlock to begin U.S. Extravehicular Activity (EVA) 23. Roughly 44 minutes (Phase Elapsed Time) into EVA 23, EV2 reported water inside his helmet on the back of his head. The EVA ground team and EV2 were unable to identify the water’s source. As EV2 continued to work, the amount of water in the helmet increased and eventually migrated from the back of his head onto his face. EVA 23 was terminated early and the crew safely ingressed the airlock. The nominal rate was used to repressurize the airlock followed by an expedited suit doffing. The water quantity introduced into the helmet was estimated at 1 to 1.5 liters.

During the post-EVA debrief, EV2 reported impaired visibility and breathing with water covering his eyes, nose, and ears. In addition, EV2 had audio communication issues because of the water. When returning to the airlock, EV2 had to rely on manual feel of his safety tether’s cable for pathway directions.The event was classified as a High Visibility Close Call and entered into the NASA Incident Reporting Information System (IRIS) as record number S2013-199-00005.

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Human Space Flight Edition

A related concern occurred during a post-EVA 23 suit dry-out procedure. A vacuum cleaner was used and unexpectedly suctioned O2 from the suit’s secondary high pressure oxygen tank, causing a potentially hazardous mix of electricity and pure O2 , which could have ignited flammable materials in and around the vacuum cleaner. Fortunately, no incident of this nature was detected.

The International Space Station (ISS) Extravehicular Activity (EVA) 23 Suit Water Intrusion High Visibility Close Call (HVCC) Mishap Investigation Board (MIB) was appointed on July 22, 2013 to gather information, analyze facts, identify the proximate cause(s), intermediate cause(s), and root causes that resulted in the mishap.

In summary, the causes for this mishap evolved from (1) inorganic materials causing blockage of the drum holes in the EMU water separator resulting in water spilling into the vent loop; (2) the NASA team’s lack of knowledge ISOPTWPO Today c International Space Agency(ISA)

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Human Space Flight Edition regarding this particular failure mode; and (3) misdiagnosis of this suit failure when it initially occurred on EVA 22.

The source of the inorganic materials blocking the water separator drum holes had not been experienced during an EVA before and is still undergoing a concurrent investigation. The results of this investigation will ultimately lead to resolution of this issue; however, since the concurrent investigation into the source of the debris is expected to continue for many months, the MIB does not yet have the required data to determine the root causes of the contamination source, which must ultimately be determined to prevent future mishaps. Because the hardware investigation must continue, this report is divided into two unique areas of focus. First, the report focuses on the hardware failure investigation and understanding of the hardware involved, work completed to date, preliminary results, and future work needed to determine root causes. Second, the report focuses on real-time operation activities that can be improved to help the ground control teams and crew quickly recognize and react rapidly to emergencies of this type.

The MIB identified the following five Root Causes: 1. Program emphasis was to maximize crew time on orbit for utilization The ISS Program must place a strong emphasis on performing utilization with the ISS; it is in fact the very reason ISS exists. However, the strong emphasis on utilization was leading team members to feel that requesting on-orbit time for anything non-science related was likely to be denied and therefore tended to assume their next course of action could not include on-orbit time. The danger with that thought process is that lower level team members were in effect making risk decisions for the Program, without necessarily having a Program wide viewpoint or understanding of the risk trades actually being made at a Program level.

2. ISS Community perception was that drink bags leak The MIB could not identify a clear reason why the EVA community at large had the perception that the EVA drink bags leaked. When presented with the suggestion that the crew member’s drink bag leaked out the large amount of water that was found in EV2’s helmet after EVA 22, no one in the EVA community (which includes team members from Operations, Engineering, Safety, and Crew) challenged this determination and investigated further. Had that conclusion been challenged, the issue would likely have been discovered prior to EVA 23 and the mishap would have been avoided.

3. Flight Control Team’s perception of the anomaly report process as being resource intensive made them reluctant to invoke it Based on interviews and MIB investigation, it was clear that several ground team members were concerned that if the assumed drink bag anomaly experienced at the end of EVA 22 were to be investigated further, it would likely lead to a long, intensive process that would interfere with necessary work needed to prepare for the upcoming EVA 23, and that this issue would likely not uncover anything significant enough to justify the resources which would have to be spent.

4. No one applied knowledge of the physics of water behavior in zero-g to water coming from the PLSS vent loop The MIB learned that while there is a significant amount of knowledge about the way water behaves in zerogravity, the ground teams did not properly understand how the physics of water behavior inside the complex environment of the EMU helmet would manifest itself. The teams believed that if significant water entered the helmet through the vent loop that it would cling to the inner surface of the helmet rather than cling to the crew member;s head. They also believed that if a significant amount of water entered the vent loop, the Fan/Pump/Separator would likely stall, as it had in 1-G when significant water entered the vent loop. Therefore, the significant hazard it presented was not anticipated.

5. The occurrence of minor amounts of water in the helmet was normalized Through interviews with ground personnel and review of data from previous EMU performance, it was clear that some water entering the helmet was considered normal by the ground teams. Despite the fact that water carryover into the helmet presented a known hazard of creating eye irritation due to its interaction with antifog agents, and also presented a potential fogging hazard, the ground teams grew to accept this as normal EMU behavior. Since these smaller amounts of water carryover had never caused a significant close call, it was perceived to not be a hazardous condition. When water began entering EV2’s helmet, the ground team discussed anti-fog/eye irritation concerns and visibility concerns; however, a more hazardous condition was not expected because the presence of water in the helmet had been normalized.

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Human Space Flight Edition Proximate Causes A Proximate Cause is the event(s) that occurred, including any condition(s) that existed immediately before the undesired outcome, directly resulted in the occurrence of the undesired outcome and, if eliminated or modified, would have prevented the undesired outcome. Three proximate causes were identified.

1. The ISS Program conducted EVA 23 without recognizing the EMU failure which occurred on EVA 22 The MIB learned that on EVA 22, EV2 in suit 3011 experienced water in the helmet during repress. This failure was misdiagnosed and not determined to be a constraint to EVA 23. The MIB has determined that had the source of the water at the end of EVA 22 been investigated thoroughly, EVA 23 and the subsequent mishap would not have occurred.

2. EMU 3011 Helmet had a large quantity of water during EVA 23 During EVA 23, EV2 (wearing SEMU 3011) experienced a large amount of water inside the helmet area, originating somewhere behind the crewmember’s head near the neck/lower head area. The presence of this water created a condition that was life threatening.

3. Flight Control Team/Crew did not terminate EVA 23 as soon as water was reported in the helmet The MIB determined that the time between first mention of water in EV2’s helmet and the call to terminate the EVA was roughly 23 minutes. The fact that no one on the ground or the EVA Crew immediately recognized the severity of the hazard and terminated the EVA resulted in the crewmember being exposed to an increased level of risk.

Musculoskeletal Injuries and Minor Trauma in Space A total of 219 in-flight musculoskeletal injuries were identified, 198 occurring in men and 21 in women.

Astronauts sustain injuries during the preflight period, especially during training sessions in the Neutral Buoyancy Laboratory (NBL). Viegas et al. identified 83 astronauts who participated in training at the NBL between July 19, 2002, and July 18, 2003.

Out of the 83 astronauts, 28 experienced hand symptoms, 19 experienced shoulder symptoms, while 9 had problems with the elbow.

It seems likely that injuries seen both in flight and postflight may be the result of exacerbations of old training injuries rather than new injuries associated with the mission. However, up to now training injuries and the relationship to inflight events have not been clearly identified.

Data on musculoskeletal injuries was obtained from postflight medical debriefs, the LSAH medical record database, the Johnson Space Center (JSC) electronic medical record system, including ASCR specialist assessment and treatment logs, and the JSC Flight Medicine Clinic vault records.

A total of 369 in-flight musculoskeletal conditions were found, from which 219 in-flight musculoskeletal injuries were identified, along with a detailed mechanism for each injury. There were 198 injuries in male astronauts and 21 injuries among female crewmembers. Exercise, previous injury, treatment, and postflight outcome data were included if found within the postflight medical debriefs or in-flight ISS private medical conferences. U.S. astronauts have operated in space a total of 231,724.7 h as of December 2006, with 198,275.5 of those hours by male crewmembers and 33,449.4 by female crewmembers.

The incidence of in-flight musculoskeletal injuries was found to be to 0.021 injuries per day for male crewmembers and 0.015 injuries per day for female crewmembers.

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Human Space Flight Edition

Fig. 1 represents the total injuries separated by anatomical location. Hand injuries dominate throughout the space program, with shoulder and back injuries also notable in the data. The general category included injuries to multiple locations, such as multiple abrasions to the arms and shins, or injuries in which a definite location could not be ascertained from the mission debriefs.

Fig. 2 breaks down the injuries by type, with abrasions and contusions representing the most prevalent, followed by strains. Fortunately, in-flight cases of significant soft tissue injury such as sprains and dislocations have been uncommon. To date there have also been no cases of in-flight skeletal fractures.

Fig. 3 illustrates total injuries in the space program by mission activity. Injuries while transferring equipment accounted for the majority observed. The exercise category included injuries caused by exercise equipment or exercise activity. The launch and entry suit (LES) category included injuries caused by the older LES or the new advanced crew escape suit (ACES) or during launch and entry operations while wearing the suit. The experiment category involved injuries occurring during scientific experiments and the egress category included injuries sustained while exiting the spacecraft.

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A breakdown of the specific types of crew activity that caused in-flight musculoskeletal injuries is illustrated in Fig. 4 . Generic crew activities were the leading category of injury, although a large number of those injury etiologies are unknown. Impacting structures, especially while stowing hardware and translating through the vehicle, was a leading cause of injury. Wearing the extravehicular activity (EVA) suit and performance of exercise were the second and third leading causes of in-flight injuries, respectively. Cases listed as unknown in Fig. 4 represent injuries in which " crew activity " was the identified mechanism, but no further information was available.

Further examination of the 50 injuries that occurred due to the EVA suit is depicted in Fig. 5 . In this analysis,the hand represented the most commonly injured area of the body during EVA, followed by the foot.

Five other injuries occurred during EVA that were not due to interaction with the suit components (see Fig. 3 ). Four of these injuries involved muscular strains while performing EVA activities, and the fourth a hand abrasion immediately following the EVA. EVA-related injury incidence from all sources was 0.05 per hour in 1087.8 h of EVA activity during the space program to date. This equates to an in-flight musculoskeletal injury incidence of 1.21 per day or 0.26 per EVA. Use of the aerobic and/or resistive exercise equipment accounted for 12 of the 14 musculoskeletal injuries occurring on the ISS. The treadmill with vibration and isolation system was associated with two injuries, the interim resistive exercise device accounted for seven injuries, while use of both devices was blamed for the remaining three injuries.

Through the entire space program, exercise activity or use of exercise equipment was associated with an injury rate of 0.003 injuries per day.Only one in-flight musculoskeletal injury among female astronauts due to exercise, which involved a strained back muscle due to use of a resistive exercise device. Two other musculoskeletal conditions were identified in women due to exercise: one in which a pre-existing osteoarthritis of the knee was felt to have been a predisposing factor and the other was an aggravation of an underlying lateral epicondylitis.

Table I shows the anatomical location of injuries due to exercise and also separates injuries based on which NASA spaceflight vehicle the crew occupied. Noteworthy in this table are a substantial number of back injuries occurring ISOPTWPO Today c International Space Agency(ISA)

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Human Space Flight Edition on ISS.

Table II summarizes the different types of in-flight musculoskeletal injuries by mission activity taking place at the time of injury. Soft tissue injuries in the form of abrasions and contusions dominate the injury log, with the notable exception of strains that occurred mainly during crew translation and exercise.

Table III illustrates the injury incidence separated by specific NASA spacefl ight program. The rates in general are quite low, with the highest rate per flight hour occurring early in spaceflight history.

Nine musculoskeletal events or minor trauma related to EVA occurred on the lunar surface. Five events occurred in the hand, ranging from finger soreness and muscle fatigue (attributed to the high workload and constraints of working in a pressurized glove) to pain, swelling, and abrasions over the metacarpophalangeal(MCP) joints and distal phalanx. In the wrist, a laceration occurred due to the suit wrist ring cutting into the skin. Extensor wrist pain and soreness where the suit ring and sleeve repetitively rubbed over the joint was reported.

One event resulted in a significant shoulder strain during a surface core drilling experiment on the second of three EVA. One report of significant muscle fatigue occurred in the lower extremities while covering large distances on the ISOPTWPO Today c International Space Agency(ISA)

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Human Space Flight Edition lunar surface or ambulating up sloped terrain.

Apollo crewmembers who performed EVA on the Moon noted problems with their hands. For example, one astronaut remarked, " EVA 1 was clearly the hardest... particularly in the hands. Our fingers were very sore. " Another commented that his hands were " very sore after each EVA. " One Apollo astronaut even suffered a significant laceration to his wrist during lunar EVA while working with drilling equipment.

Another Apollo astronaut injured his shoulder as a result of the tight mission timeline for completing multiple surface activities, and unbeknownst to his flight surgeon, took large doses of aspirin to treat the pain over the course of the next 24 h. In another instance, an Apollo lunar crewmember stated that following the third lunar EVA, his metacarpophalangeal and proximal interphalangeal joints were so swollen and abraded from a poor-fitting glove and/or lack of inner liner or comfort glove, he is certain further EVA would have been very difficult if not impossible. This data is useful to suit engineers as they not only seek to improve existing EVA suits but also design next-generation suits for missions to the Moon and Mars.

The overall incidence of in-flight musculoskeletal injuries due to exercise was low, a relatively high number of minor back injuries occurred while using the exercise equipment.The large number of back injuries that have occurred on ISS relative to other NASA programs. Most of these injuries involved muscle strains while using the interim resistive exercise device. Two crewmembers, injured their hip from a poorly fitting treadmill system harness. Interestingly, there had been five separate incidences of similar injuries on shuttle missions involving a treadmill harness.A treadmill harness on the Mir broke while in use, causing the astronaut to impact a panel on the device, causing bruising and swelling over the right shoulder and clavicle.

Several injuries occurred while astronauts performed scientific experiments. Two astronauts experienced contusions due to a blood pressure cuff and hose, while other astronauts suffered contusions to their shoulders after performing repetitive tasks in a glove box.

The three egress injuries occurred only during the Mercury Program and involved an abrasion to the leg and two lacerations to the hand.

In-flight problems such as back pain related to off-loading of the axial skeleton in microgravity or fingertip injuries due to stiff gloves or suit compliance could be mitigated or prevented with proper adjustments or countermeasure.

Medical events on U.S. Navy submarines between 1997 and 2000. Among officers, injuries such as open wounds and musculoskeletal conditions such as disorders of ligaments, tendons, and muscles accounted for the second and third most common medical events, respectively. Among enlistees, injuries accounted for the highest rate of events.

The Thomas et al. specifically compared the submarine environment to those encountered by astronauts, noting similarities in "isolation, closed environment with artifi cial atmosphere, working and living in crowded quarters, limited space for medical supplies, non-physician health care providers, pre-mission health screening, and the precedence of the mission over individual needs. " Differences vs. astronauts include: crewmember education, communication outside the vehicle, and a lack of microgravity. Overall, they found limited potential for mission impact. Using their data, assuming a crew of seven Naval officers, only one medical event would occur during a 6-mo mission, and result in 3/4 d or less of limited or no duty.

Symptoms and injuries experienced by NASA astronauts during their extravehicular activity spacesuit training at the Neutral Buoyancy Laboratory NASA astronaut and International Partners neutral buoyancy EVA EMU training is conducted at the JSC NBL. EVA mission training is provided for assigned missions scheduled on orbit from the Space Shuttle and ISS. The trainingto-flight ratio is approximately 10-12 hours of training for each hour of EVA planned on orbit. Therefore, a flight in which three EVAs consisting of seven hours each are planned would typically require 210-250 hours of in-water, missionspecific training. Mission training flows usually start approximately one year before the scheduled space flight.

The primary source of EMU EVA training is from designated materials and instructors of the EVA Robotics and Crew and Thermal Systems Division of the Mission Operations Directorate.

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Astronaut EMU training is provided during astronaut candidate (ASCAN) training using equipment familiarization in the classroom, a workbook, computer-based training, and equipment demonstrations. Initial EMU operations training is conducted at the Systems Integration Facility. This includes suit-up, pressurization, and display and controls module (DCM) demonstrations. Didactic and demonstration training for EVA tools precedes NBL in-water training for ASCAN and EVA skills training flows. Tasks, airlock, EVA procedures, mock up, and translation path training are provided informally in a briefing/debriefing format associated with NBL training test events.

In-water EMU evaluation and training phases at the NBL consist of four training flow types: • ASCAN suit qualification/task familiarization and evaluation: This usually consists of four training test events of three to four hours each.

• EVA skills training: These test events usually consist of eight to 12 sessions consisting of four to six hours each.

• Contingency EVA training: EVA astronauts receive NBL EMU training in contingency operations including the payload bay door, Remote Manipulator System, airlock hatch, Ku- band antenna system, payload retention latches, orbital docking system, and the Thermal Protection System.

• Mission training for assigned crew: Total NBL training time depends on the number of planned EVAs, and the complexity of development and training required. To date, the number of ISS/Hubble EVAs have ranged from one to five per mission, with an average training ratio of 11.6:1 (hours of EMU training in the NBL per hour of EVA).

The Severity Scale was characterized as follows: • 0 - No pain • 1 - Very mild pain • 2 - Mild pain • 3 - Moderate pain • 4 - Moderately severe pain • 5 - Severe pain

At the completion of 18 months’ study, 770 suited test events were evaluated. This represented 86 astronaut-suited subjects from July 19, 2002, through January 18, 2004. The following is a summary of findings: • Study population = 86 • Total test events = 770 • Number of reported symptoms = 352

Frequency of Symptoms by Location

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Incidence Rates - Subjects by Location

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Characteristics, Average Severity, and Attributed Causes Hands Frequency 47.16% These primarily involve fingernail delamination (onycholysis) attributed to axial loading and moisture in comfort gloves. Fingertip pain was attributed to hard contact to the fingertips with extended reaching and forceful grasping.

Other assorted complaints included superficial abrasions, contusions, and two peripheral nerve impingements that were attributed to glove fit and unprotected contacts. Some of the astronauts complained of generalized hand fatigue following several hours of repeated and forceful grasping.

Average Severity 1.13/5 (Scale of 0 - 5) Causes (distribution by specific location) of hand complaints, including fingernail delamination, are: • Fingertips / nails contact - 55% • Other glove contact - 35% • Fatigue - 8% During this study period 18 astronauts were followed for hand complaints. Thirteen of these were for fingernail delamination.

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Shoulders Frequency 20.73% Half of these were comments attributed to hard contact between the shoulders and the HUT.They were worse with heads down and shoulders/arms abducted. The most common symptoms were attributed to unprotected contact with the planar HUT, especially at the scye joint.

Shoulder rotator cuff stress and strain injuries were also reported, particularly after the shoulder joints were used in compromised positions exacerbated by the inherent design of the planar HUT. Compromised body positions included heads down and rotation laterally and supine especially associated with reaching into extension such as to deploy a swing arm or body restraint tether (BRT). In the planar HUT, shoulders are forced into internal rotation, there is often a mismatch between the HUT opening and the functional range of motion of the shoulders, and there is a limited safe work envelope.

Average Severity 1.86/5 (Scale of 0 - 5) Causes of shoulder complaint are: • HUT contact - 47% • Strain, sprain, tear, overuse, and impingement injuries - 46% • Harness contact - 7% During this study period 13 astronauts were referred and followed for shoulder complaints. Two were referred for surgical intervention.

Feet Frequency 11.37% Most of the problems with feet were compression complaints on the tops of the feet andvdistal toes associated with problems with the boot fit. A common comment was that boot sizing inserts (BSIs) and other inserts were not comfortable or became displaced during the test event .It was noted that key areas of the foot were not protected, and that there is no foot arch support built into the current BSI design. BSIs did not adequately protect the feet from hard contacts including from the 1g effect on the front of toes, hard contact on the tops of feet while in the portable foot restraints (PFRs)/articulating portable foot restraints (APFRs), and bladder folds.

Average Severity 1.66/5 (Scale of 0 - 5) Causes of foot complaint are: • Boot contact causing dorsal foot pain - 60% • Hard contact with the front of the boot causing toe pain - 28% • Poor protection and lack of support causing heel and arch pain - 12%

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Arms Frequency 5.97% Most of the problems with arms were attributed to hard contact and rubbing by the soft goods to the elbows. Strains were due to elbow overuse mechanisms, manifest mostly as lateral or medial epicondylitis.

Average Severity 1.65/5 (Scale of 0 - 5) Causes of arm complaint are: • Contact causing abrasions and contusions - 65% • Strains - 35% During this study period three astronauts were referred and followed for elbow strain complaints.

Legs Frequency 5.68% Problems with the legs were attributed to contact in the knees, especially while flexed and bearing most of the body weight. One ankle complaint was due to hard contact at the dorsal ankle from the boot.

Average Severity 1.56/5 (Scale of 0 - 5) Causes of leg complaint are: • Knee contact - 95% • Ankle contact - 5%

Neck Frequency 5.68% Problems with the neck were mostly attributed to the Teflon shoulder inserts when not shaped or placed properly, and was worse with donning/doffing and with shoulders abducted. There was one complaint of cervical strain due to uncomfortable head and neck positions.

Average Severity 0.8/5 (Scale of 0 - 5) Causes of neck complaint are: • Contact with Teflon inserts - 95% • Strains - 5%

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Human Space Flight Edition

Trunk Frequency 2.84% Problems with the trunk were all attributed to contact between components of the EMU and the affected body part.

Back irritations and contusions were mostly due to hard contact with the vent tubes and plenum in the LCVGs during supine body positions. Chest and abdomen symptoms were mostly attributed to contact with the HUT, including scye joints, depending on exposure to the gravitational forces in various body positions.

Average Severity 0.4/5 (Scale of 0 - 5) Causes of trunk complaint are: • Back contact - 54% • Chest contact - 46%

Groin Frequency = 0.28% Average Severity 4/5 (Scale of 0 - 5) The cause of groin complaint is soft goods suit contact due to fit.

Head Frequency = 0.28%

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Human Space Flight Edition Reference: 1.Human Research Program Requirements Document, HRP-47052, Rev. C, dated Jan 2009.

2.International Space Station (ISS) EVA Suit Water Intrusion Report,IRIS Case Number: S-2013-199-00005,NASA. 3.STS-133 MCC STATUS REPORT 13,NASA. 4.THE LONGITUDINAL STUDY OF ASTRONAUT HEALTH ,Newsletter,Volume 8,Issue 2,NASA. 5.Viegas SF , Williams D , Jones J , Strauss S , Clark J. Physical demands and injuries to the upper extremity associated with the space program. J Hand Surg [Am] 2004; 29 : 359 - 66.

6.GONTCHAROV IB, KOVACHEVICH IV, POOL SL, NAVINKOV OL, BARRATT MR, BOGOMOLOV VV, HOUSE N. In-flight medical incidents in the NASA-Mir program. Aviat Space Environ Med 2005; 76:692-6.

7.SCHEURING RA, MATHERS CH, JONES JA, WEAR ML. Musculoskeletal injuries and minor trauma in space: incidence and injury mechanisms in U.S. astronauts. Aviat Space Environ Med 2009; 80:117 - 24.

8.Thomas TL , Garland FC , MolĂŠ D , Cohen BA , Gudewicz TM , Spiro RT , Zahm SH. Health of U.S. Navy submarine crews during periods of isolation. Aviat Space Environ Med 2003; 74 : 260 - 5.

9.Samuel Strauss, DO, MPH,Extravehicular Mobility Unit Training Suit Symptom Report Study,NASA/TP-2004-212075.

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ISOPTWPO The ISOPTWPO is International Space Flight & Operations - Personnel Recruitment, Training, Welfare, Protocol Programs Office (International Space Academy). It is a division of the ISA organization.

Mr. Martin Cabaniss is director and Mr. Abhishek Kumar Sinha is Assistant Director of ISOPTWPO. Ad Astra ! To The Stars! In Peace For All Mankind !

Mr. Rick R. Dobson, Jr.(Veteran U.S Navy) — International Space Agency (ISA)

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