Medical Toxicology Considerations for Space Exploration.

Spaceflight poses many risks to human health. Toxic exposures from inadvertent release of vehicle or payload chemicals and materials used in the operations of spaceflight are unique among them. There is a need for identification and development of clinical protocols for the management of toxic exposures before, during, and after spaceflight, particularly for acute exposures, because these events are likely to occur in austere environments with limited resources. The need for publicly available protocols is gaining importance as commercial spaceflight operations advance, and future spaceflight missions will require independence from Earth. This paper reviews the publicly available literature on toxic exposures in spaceflight to inform the development of relevant clinical practice guidelines. We performed a focused literature review and identified significant aerospace toxicologic incidents, including fatalities, injuries, and near-miss events. Sources included NASA-published literature, NASA safety reviews, published case reports, and published review articles. Searches were performed using the NASA Technical Reports Server, Google Scholar, and PubMed, and we included all cases involving exposure or potential exposure to an agent that could cause acute toxicity in spaceflight missions. Thirty-four cases were identified involving agents that can cause acute toxic effects. The two most common agents identified in acute toxicologic exposures in spaceflight operations were hydrazine and ammonia. These incidents can help us identify high-risk exposures so that we can develop protocols for the detection and management of future toxic exposures.