That's just one of the reasons why critical-care medicine in space requires thinking forward, said Scott Dulchavsky, associate professor of surgery at Wayne State University in Detroit, who consults to the National Aviation and Space Administration on how to care for astronauts far from earth.

"It is my passion," he said, "to develop methods of treating people in space," noting that the methods developed by NASA can then be applied to earth-bound medicine to improve care in remote areas, on the battlefield and in underserved regions.

Through discussions with crew members on space shuttles and the International Space Station as well as numerous rides on the NASA model of weightlessness -- the infamous "vomit comet" excursions into the stratosphere on winged aircraft -- Dulchavsky said he has learned lessons of bringing emergency medicine to extreme environments.

To give CPR, he said, a person has to hold onto a strap to avoid floating away from the patient, which makes performing the life-saving maneuver quickly exhausting.

A better way to do it: Upside down. By putting your feet on the ceiling you stay in position over the victim's chest. "I could do CPR forever that way," Dulchavsky told doctors at this week's 35th annual meeting of the Society of Critical Care Medicine in San Francisco.

However, he added that weightlessness doesn't always create problems for medical personnel. He showed film clips that demonstrated how easily a patient can be transferred from one bed to another to prepare for surgery. A simple tug on the pants and the patient tumbles right into the surgical platform.

"We can use the floor, the ceiling, the wall, virtually any flat surface for surgery," he said, because in space there is no up or down."

Of course, he said that is why one absolute is that when you do surgery in space you need duct tape. "I put my scalpel 'down' once (while on the weightlessness flights) and the next time I saw it was about four flights later when the pilot found it in the cockpit," he said. "Without duct taping everything, lots of things get lost in space."

Telemedicine is one of those aspects of care delivery that is already making its mark on the ground, but in space, telemedicine still has its limits, Dulchavsky noted.

"I can walk untrained crew members through some surgical procedures when the time gap is only a second or two," he said, but what happens in a mission to a distant planet? If I say, 'Oh, my gosh, don't do that,' it may take 28 minutes before that transmission reaches the crew member."

He said he is working now with NASA to figure out ways of rehabilitating crew members who travel to Mars. He explained that in space, a person's heart becomes used to less work. "We don't know what is going to happen after 18 months when that person has to do work in a gravity field," he said. "We have to develop cariac rehabilitation programs that work 50 million miles from home."

Donald Maxwell, medical director of the medical/surgical intensive care unit and stroke center at Banner Desert Medical Center in Mesa, Ariz., told United Press International, "We have seen greater use of ultrasound for diagnosis that was pioneered in space. The progress being made in developing these devices and techniques by NASA for use by astronauts always comes to benefit those of us who stay at home."

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