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THE COMPANY INTEGRATED MEDICAL AND BEHAVIORAL LABORATORY MEASUREMENT SYSTEM ENGINEERING ANALYSIS AND LABORATORYVERIFICATION CONTRACT NAS 9-11756 COPY REPORT FINAL REPORT JUNE 30, 1973 HOUSTON, TEXAS https://ntrs.nasa.gov/search.jsp?R=19730018167 2020-06-22T06:37:57+00:00Z

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Page 1: COPY - NASA€¦ · 1.3 (Cont'd) 2. Weekly Progress Reports. 3. Monthly Progress Reports. The medium of technical information transfer utilized was the NASA 2-Way Memo (Form 5027-102

THE COMPANY

INTEGRATED MEDICAL AND BEHAVIORAL LABORATORY

MEASUREMENT SYSTEM

ENGINEERING ANALYSIS AND LABORATORY VERIFICATION

CONTRACT NAS 9-11756

COPYREPORT

FINAL REPORT

JUNE 30, 1973

HOUSTON, TEXAS

https://ntrs.nasa.gov/search.jsp?R=19730018167 2020-06-22T06:37:57+00:00Z

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FINAL REPORT

INTEGRATED MEDICAL AND BEHAVIORAL LABORATORY

MEASUREMENT SYSTEM

ENGINEERING ANALYSIS AND LABORATORY VERIFICATION

CONTRACT NAS 9-11756

PREPARED BY 6W^rt^Boeing fMBLMS Team

APPROVED BY //2/J , M^/VlfrT B. LeysHa, IMBCMS Program Manager

f-L#_3^APPROVED BY ixO^

"(a.~-fSBowling, Jt>T, Life Sciaticas Manager

APPROVED BYNorman Belasco, Chief, IMBLMS Program Office

Submitted to:

IMBLMS PROGRAM OFFICEBIOENGINEERING SYSTEMS DIVISION

LIFE SCIENCES DIRECTORATEJOHNSON SPACE CENTER

NATIONAL AERONAUTICS AND-SPACE-ADMINISTRATION

THE BOEING COMPANY

June 30, 1973

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TABLE OF CONTENTS

Section

TITLE PAGE

TABLE OF CONTENTS

ABBREVIATIONS AND ACRONYMS

FOREWORD

SUMMARY

REFERENCES

Page

i

ii

v

vi

vii

1.0

1.1

1.2

1.3

INTRODUCTION, OBJECTIVES, AND REPORTS

INTRODUCTION

OBJECTIVES

REPORTS

2.0

2.1

2.2

2.3

2.4

SUMMARY OF ACCOMPLISHMENTS 3

TASK 1.1 - COMPILE AND ANALYZE TECHNICAL DATA 3

TASK 1.2 - SPACE-ORIENTED BIOTECHNOLOGY 5

TASK 1.3 - LIFE SCIENCES PAYLOAD DEFINITION 7

TASK 1.4 - PROGRAM INFORMATION TRANSFER 8

ATTACHMENT I EXHIBIT C, STATEMENT OF WORK 1-1

ATTACHMENT II TASK 1.1 PRODUCTS - Table of Contents II-2

-TASK-1-.2 PRODUCTS —-Table-of-Contents : H-3-

TASK 1.3 PRODUCTS - Table of Contents II-3

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ABBREVIATIONS AND ACRONYMS

ADP Automated Data Processing

AHSFU Area Health Services Field Unit

AMA American Medical Association

ARC Ames Research Center

CDR Critical Design Review

CHM Community Health Medic

CVT Concept Verification Testing

DVTU Design Verification Test Unit

EC/LSPS Environmental Control/Life Support Protective System

EC/LSS Environmental Control/Life Support System

ECS Environmental Control System

EVA Extravehicular Activity

FBB Functional Breadboard

FCC Federal Communications Commission

FET Field Effects Transistor

FPE Functional Program Element

FY Fiscal Year

GD/C General Dynamics/Convair

GFE Government Furnished Equipment

HEW U.S. Department of Health, Education, and Welfare

HIS Health Information System

JHSJHA Heal th Services.jmd^Men tal Heal th Administration

HSSCC Health Services Support Control Center

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ABBREVIATIONS AND ACRONYMS - (Cont'd)

ICP Interface Coordination and Planning

IECS Internal Environmental Control System

IMS Indian Health Service

IMBLMS Integrated Medical and Behavioral Laboratory Measurement System

IPO IMBLMS Program Office

I.V. Intravenous

JND Just Noticeable Difference

KFI Kaiser Foundation International

LEC Lockheed Electronics Corporation

LHSC Local Health Services Center

LMSC Lockheed Missiles and Space Company

LP Low Pressure

LPN Licensed Practical Nurse

LSP Life Sciences Payloads

LS/PS°r Life SuPP°rt & Protective System

LSS Life Support System

MHSF Mobile Health Services Facility

MHU Mobile Health Unit

MSFC Marshall Space Flight Center

MSS Modular Space Station

NASA National Aeronautics and Space Administration

NEC . National-Electr-ic-Code - - --- — -

ORD Office of Research and Development

iii

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ABBREVIATIONS AND ACRONYMS -.(Cont'd)

PA Physician's Assistant

PAM Portable Ambulance Module

PCS Principal Coordinating Scientist

PHN Public Health Nurse

PI Principal Investigator

PLSS Portable Life Support System

PM Project Manager

PRL Program Requirements Listing

RAM Research and Applications Module

RFP Request for Proposal

RN Registered Nurse

SCC Support Control Center

SCI SCI Electronics Incorporated

SOW Statement of Work

TIRR Texas Institute for Rehabilitation and Research

UHF Ultra High Frequency

V Volts

VHF Very High Frequency

WBS Work Breakdown Structure

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FOREWORD

The activities reported herein were accomplished in accordance withContract NAS 9-11756, Amendment 5S, and represent a continuation ofthe IMBLMS Program accomplishments initiated under Contract NAS 9-9456(IMBLMS FBB Assessment) and NAS 9-10771 (IMBLMS FBB Applications).

The results of the previous contract phases were submitted to NASAby Interim and Final Reports, in accordance with contract requirements/A listing of these submittals is provided under the Reference Section.

Throughout the period of all contract activities excellent professionaland technical cooperation has been realized between the IMBLMS ProgramOffice (IPO) and Boeing. The individuals in NASA responsible for theseexcellent working relationships included Mr. Norman Belasco, Chief,IMBLMS Program Office (Technical Monitor); Sam L. Pool, M.D., IMBLMSMedical Officer; Edward C. Moseley, Ph.D., IMBLMS Information ProcessingOfficer; and Mr. Charley D. Stamps, IMBLMS Contracting Officer.

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SUMMARY

The contents of this report and attachments present significant resultsof the effort of The Boeing Company in accomplishing the tasks ofContract MAS 9-11756, Amendment 5S, (see Work Statement, Attachment Iof this report).

The tasks reported herein provided the IPO with engineering, analyses,and health systems technical data of particular value during the IMBLMS(Area Health Services Field Unit [AHSFU]) Program Definition phase. Theresults of these tasks were used in technical program planning, includingtest site selection and system configuration definition.

This Final Report summarizes the task products associated with this con-tract phase and provides an overview of the entire effort. The materialis organized to present the specific contract tasks and provide an orderlysummary of the results associated with the accomplishment of those tasks.

The studies and analyses conducted indicate that the IMBLMS AHSFU conceptwill provide a unique contribution to the delivery of health services inremote areas.

vi

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REFERENCES

Listed here are significant reports from this contractor's previousperiods of performance on this contract (NAS 9-11756) and previousIMBLMS contracts (NAS 9-9456 and NAS 9-10771, IMBLMS FBB Assessmentand IMBLMS FBB Applications, respectively) to provide a consolidatedrecord of Boeing work on the IMBLMS Program:

Contract No. Report Name Report Date

NAS 9-9456 Interim Report No. 1 April 17, 1970Interim Report No. 2 Sept. 30, 1970Final Report Dec. 31, 1970Final Report - First Feb. 28, 1971

SupplementFinal Report - Second May 31, 1971

Supplement

NAS 9-10771 Phase Progress Report No. 1 Jan. 26, 1972Phase Progress Report No. 2 April 15, 1972Phase Progress Report No. 3 April 15, 1972Phase Progress Report No. 4 April 12, 1972Final Report April 15, 1972

NAS 9-11756 Interim Summary Report Aug. 29, 1972Final Report Nov. 30, 1972

vn

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1.0 INTRODUCTION. OBJECTIVES. AND REPORTS

1.1 INTRODUCTION

This Final Report covers the Boeing accomplishments on the IMBLMS Engineer-ing Analysis and Verification Contract No. NAS 9-11756, Amendment 5S,during the period from January 1 through June 30, 1973.

During this contract phase, hardware operations were at a minimum andBoeing efforts were mainly directed to supporting the IMBLMS Programactivities associated with Phase C, including Operational Test SiteInvestigations in preparation for site selection, Program Definition,Preliminary Systems Requirements Definition, cost and Preliminary Designstudies of the AHSFU System on the selected site. On May 17, 1973,NASA/HEW jointly announced the selection of the Papago Reservation insouthern Arizona as the operational test site. The details of theBoeing activities and associated accomplishments have been previouslysubmitted to the IMBLMS Program Office. This report summarizes theactivities performed during this phase of the contract. Significantresults have been included herein as Attachment II.

1.2 OBJECTIVES

The main objective of the Boeing activities during this program phasewas to research and compile technical information to be used by the IPOin test site screening, program planning, and technical decision-makingduring the site selection and systems definition period. Activitiesincluded studies and analyses of site candidates, review of systemsrequirements, identification of critical design factors, and analysesof various system configurations to assist the IPO during this criticalphase of IMBLMS Program Planning.

1.3 REPORTS

During the contract period, Boeing.provided the following reports to IPO:

1. Review, study, and analysis reports in the form of engineeringand scientific memoranda.

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1.3 (Cont'd)

2. Weekly Progress Reports.

3. Monthly Progress Reports.

The medium of technical information transfer utilized was the NASA2-Way Memo (Form 5027-102 Optional Form 27). Summarized results ofreviews, studies, and analyses were attached to the 2-Way Memos toprovide correspondence control and tracking/retrieval of technicaldata. Research material gathered to support these efforts was placedin the IMBLMS Working File upon completion of the task. Twenty-sevensuch studies, analyses, or technical compilations were provided toIPO during the contract period. The most significant results of thesetasks are summarized in this report and are included in Attachment II.Additional technical data sources and references are contained in theIMBLMS Technical File located adjacent to the IMBLMS Program Office.

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2.0 SUMMARY OF ACCOMPLISHMENTS

2.1 TASK 1.1 - COMPILE AND ANALYZE TECHNICAL DATAStatement of Work requirements, paragraph 1.1 - Compile and analyze

r

available technical information and data relating to the IMBLMS Pro-gram and make recommendations as to potential problem areas during thedesign and development of the IMBLMS (Phase C), by:

A. Preparing a technical summary of each subsystem whichhighlights design features or potential developmentproblems demanding critical assessment.

B. Reviewing details of design changes or deviations.

C. Reviewing IMBLMS Program requirements for areas oftechnical concern.

D. Reviewing critical program documentation for adequacy andcompleteness.

E. Identifying critical site selection factors and compilingreview comments.

F. Reviewing and evaluating long lead time items relating toidentifying, selection, and procurement rationale.

Results/Discussion1. An analysis was performed on "The Responses to Site Selection

Criteria" to identify key factors for use by IPO in the AHSFUsite selection process. Submittals were reviewed from the fol-lowing areas:

a. The Papago Tribe/Office of Research and Developmentof the Indian Health Service (IHS).

b. The Memorial General Hospital (Las Cruces, N.M.).

c.. The .Williams port Hospital (Williamsport, Pa.).

This study revealed that many advantages were to be gained by theselection of the Papago Reservation as the AHSFU test site. Themajor advantages included:

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2.1 (Cont'd)

a. A patient population wherein health care delivery by Physician'sAssistant (PA) is a legally and ethically accepted fact.

b. An existing patient data base which utilizes automated dataprocessing.

c. The Papago Reservation,''which has a total population of approx-imately 10,000, provides a discrete entity of patient population,local/Federal Government cooperation, geographic, climatic,and technical factors which tend to insure a valid AHSFU andfield test demonstration. Reference Attachment II, Item 1(HA-60-104, 111, 112, 113, and 114).

2. A cost analysis of the IMBIMS AHSFU system was performed to identifymethods of reducing IMBLMS Program costs. IPO provided a list ofacceptable possibilities. Of these, three cost reduction optionswere identified and subsequently implemented in the IMBLMS Program.The options identified included:

a. Selection of a less sophisticated Mobile Health Unit (MHU)to replace the much larger and more complicated MobileHealth Service Facility.

b. Utilization of IHS medical personnel in place of KaiserFoundation International (KFI) personnel during Part 3operations.

c. Elimination of redundant and hot standby from the commun-ications system.

Comparative analyses of these and other proposed options were pro-vided to IPO to assist in establishing the technical impact of amodified AHSFU system configuration. Reference Attachment II,Item 2 (HA-60-115 and 118).

3. The Boeing IMBLMS Team participated in several program meetings andreviews including the Contract Kick-off Meeting (Dec. 20, 1972),Preliminary Requirements Review (May 9-10, 1973), and the Prelim-inary Design Review (June 27-29. 1973). These efforts involved

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2.1 (Cont'd)

providing IPO with meeting preparation recommendations, partici-pation in detailed working groups, and the performance of specificaction items resulting from these meetings.

An open action item and problem resolution listing was evolved andmaintained on a weekly basis to provide IPO with technical trackingand status information.

A significant effort was provided in gathering technical informationand data and generating a "checklist" to support the Program Inter-face and Coordination Meeting held in Tucson (April 26 and 27, 1973)between HEW-IHS/NASA/LMSC. Reference Attachment II, Item 3 (HA-60-103, 129, and 123).

4. During the contract period, Boeing personnel performed many technicalreviews and analyses of IMBLMS program documentation. The principalproduct of this task was a detailed critical review of the draftand preliminary versions of the Systems Requirements .and the ProgramDefinition Reports, including System Block Diagrams, Flow Charts,Schedules, and Plans. During these reviews, particular .emphasiswas placed on critical areas including Program Planning and Schedules,Lead Times and Impact, Communications and Data Management, MedicalSystems and Equipment. The results of these analyses and reviewswere used to help establish an IPO position on acceptance/approvalof the associated documentation. Reference Attachment II, Item 4(HA-60-108, 109, 120,~and 122). ".

2.2 TASK 1.2 - SPACE-ORIENTED BIOTECHNOLOGY

Statement of Work requirements, paragraph 1.2 - Define, analyze, andparticipate in future development of space-oriented concepts of biomedicaltechniques and biomedical hardware systems for ground-based and airbornemedical applications.

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2.2 (Cont'd)

A. Identify, investigate, and analyze information pertinentto applications projects and studies, to derive specificinformation for use in direction and conduct of the project.

B. Review schedules, documentation, reports, design drawings,specifications, test plans and procedures, and participatein development of acceptance testing.

C. Interface with Principal Coordinating Scientists (PCS's)as coordinated with the Medical Applications Officer.

D. Participate in activities to resolve unanticipated contractortechnical problems on applications projects.

E. Develop scheduling requirements and track progress and statusof applications projects.

Results/DiscussionAn extensive investigation, study, and analysis was performed to identifyspace-oriented concepts or equipment of the high technology classificationwhich would have potential application to the IMBLMS AHSFU. Thirty-onesuch items were identified and detailed analysis of available technicaldata was performed to define unique interface requirements, includingpower, isolation, space requirements, and read-out/analysis provisions.A schedule of availability to IMBLMS for sixteen of these items hasbeen tentatively established, ranging in date from currently availablethrough FY 76. Reference Attachment II, Item 5, (HA-60-140).

Another example of this type of activity concerned definition of componentsources and recommendation for equipment selections which were providedfor the Portable Display Entry Device currently being considered fordevelopment by NASA. .Additionally, many equipment recommendations wereprovided to IPO on the systems associated with the IMBLMS AHSFU.

A technical review of a U. S. Army "Proposal for a Medical ResearchSemi-trailer" was accomplished at IPO request to evaluate selected

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2.2 (Cont'd)

technical aspects of this paper for application to the IMBLMS MHUspecifications. Several recommended areas were defined which would assistin this definition of MHU specifications. Reference Attachment II,Item 5, (HA-60-131).

2.3 TASK 1.3 - LIFE SCIENCES PAYLOAD DEFINITIONStatement of Work requirements, paragraph 1.3 - Conduct studies andanalyses of the IMBLMS activities associated with the Space ShuttlePayload Advance Planning and Preparation for Concept Verification Testing(CVT) for technical planning and coordination. This will necessitateparticipation in reviews, meetings, and critique of study reports,developing recommendations for upgrading on-going related studies andfor incorporating IMBLMS concepts and approaches and generating systemconcept requirements for CVT mockup.

Results/Discussion1. A detailed analysis and review was performed on a NASA Headquarters-

originated document entitled "Life Sciences Flight Research ProgramDocument". This document, which was distributed to all the NASA

. centers for review and comment, was.intended to provide a workingpaper for development of specific payload planning guides and wasto serve as a basis for the development of a management approachfor the Space Shuttle Research Program.

The review indicated that the document was vague about the assignmentof center roles and responsibilities. In addition, the report lackedorganization and failed to mention such features as the use ofPrincipal Investigators (Pi's) and PCS's, or make any comment orrequest on methods of data/information transfer between participants.

- Reference Attachment II, Item 6, (HA-60-121).

2. Results of an inspection of mockups of a Modular Space Stationapplicable to the Space Shuttle were transmitted to IPO. This memoalso reported on a Payload Committee meeting which dealt with

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2.3 (Cont'd)

utilization of the mockups in Block 2 Concept Verification Testingat JSC. Reference Attachment II, Item 6, (HA-60-106).

3. A proposed Program Plan for Life Sciences Payload Experiment Iden-tification and Selection and PI involvement was requested by IPO.The draft of the plan that was generated under IPO guidance offersa groundwork for achieving participation by PI applicants and foracquiring experiments. Reference Attachment II, Item 6, (HA-60-132).

4. Materials comparing the IMBLMS and General Dynamics/Convair (GD/C)approaches for providing biochemical, cytological, and physiologicalmeasurements and support to Space Shuttle Sortie Laboratory develop-ment were transmitted to IPO and to J. Mason (Life Sciences PayloadPlanning). It was found that use of four items from developmentalprograms including the cell counter, slide stainer, mass spectrometer,and G0 analyzer from IMBLMS and Skylab, could save $2 million inestimated developmental costs for payload measurement devices. Itis suggested that a more detailed study which includes the man/systemintegration Functional Program Element (FPE) would show still moresignificant savings by transfers from current and recently completeddevelopmental programs. Reference Attachment II, Item 6, (HA-60-136).

5. An analysis was made of the GD/C Final Report entitled "Life SciencesPayioad Definition and Integration Study". Comments were providedto IPO concerning the Study's format and organization in additionto content and rationale. Reference Attachment II, Item 6, (HA-60-138)

2.4 Task 1.4 - PROGRAM INFORMATION TRANSFER

Statement of Work requirements,'paragraph 1.4 - Perform a transferof program information to designated Government and/or another contractor'spersonnel to effect an orderly transition.

A. During the final months of these efforts and at the directionof IPO, the contractor shall prepare an inventory and transferto the designated personnel the files, program records, design

8

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2.4 (Cont'd)

data, and other pertinent information that has been collectedand developed while performing this contract addition andprevious related contracts (NAS 9-9456 and NAS 9-11756).

B. During the final month of this effort, the contractor shallwork with and generally orient the personnel designated tosucceed him for the purposes of effecting an orderly transition,

Results/DiscussionDuring the accomplishment of the tasks associated with this contract,data gathered in performance of specific tasks was placed in identifiedfolders in the Boeing/IMBLMS working file. This material, in additionto the source material remaining from previous Boeing/IMBLMS activities,will be inventoried and tendered to IPO or an IPO-designated receiverat the close of this contract.

A file containing all of the formal products resulting from Boeing/IMBLMS activities associated with Contracts NAS 9-9456, NAS 9-11756,and NAS 9-10771, has been established adjacent to the IMBLMS ProgramOffice. Listing of the contents of this file is contained in theReference Section of this report (page vii). A copy of this report willbe placed in that file upon receipt of IPO approval.

Several times during the contract period transfer of selected materialsto LMSC was accomplished as directed by IPO. Typical of these transferswas a packet of information peculiar to the.P.apago site, which was pro-vided to LMSC to assist in early systems requirements definition. Thesetransfers, although accomplished informally, were always individuallyapproved by IPO. In addition, a record of all individual technicalcontacts involving IMBLMS activities between Boeing personnel and out-side organizations was provided to IPO on a weekly basis.

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ATTACHMENT I TO FINAL REPORT - IMBLMS

EXHIBIT C

STATEMENT OF WORK

1-1

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EXHIBIT C

STATEMENT OF WORK

TASK 1.1

Compile and analyze available technical information and datarelating to the IMBLMS Program and make recommendations as topotential problem areas during the design and development ofthe IMBLMS (Phase C) by:

;a. Preparing technical summary for each subsystem whichhighlight design features or potential development problemsdemanding critical assessment.

b. Reviewing details of design changes or deviations.

c. Reviev/ing IMBLMS-program requirements for areas oftechnical concern.

' d. Reviev/ing critical program documentation for adequacyand completeness.

e. Identifying critical site selection factors and compilereview comments.

f. Reviewing and evaluating long lead time.items relatingto identification, selection, and procurement rationale.

TASK 1.2 .

Define, analyze, and participate in further development of spaceoriented concepts of biomedical techniques and biomedicalhardware systems for ground-based and airborne medical applications.

a. Identify, investigate, and analyze information pertinentto applications projects and studies, to derive specific informationfor use in direction and conduct of the project.

b. Review schedules, documentation, reports, design drawings,specifications, test plans and procedures, and participate indevelopment of acceptance testing.

c. Interface with Principal Coordinating Scientists (PCS's)as coordinated with the Medical Applications Officer.

PAGE 1 of 2 ,

1-2

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x

d. Participate in activities to resolve unanticipatedcontractor technical problems on applications projects.

e.' Develop scheduling requirements and track progress.and status of applications projects.

TASK 1.3 . A

Conduct studies and analysis of the IMBLMS activities associatedwith the Space Shuttle Payload advanced planning and preparationfor Concept Verification Testing (CVT) for technical planning andcoordination. This will necessitate participation in reviews,meetings and critique permanent study reports. Developrecommendations for upgrading on-going related studies and forincorporating IMBLMS concept and approaches, and generate systemconcepts requirements for a CTV mockup.

TASK 1.4

Perform a transfer of program information to designated Governmentand/ or another contractor's personnel to effect an orderly'transition.

a. During the final months of these efforts, and at thedirection of IPO, the contractor .shall prepare an inventory andtransfer to the designated personnel the files, program records,design data and other pertinent information that has been collectedand developed while performing this contract addition and previousrelated contracts (MAS 9-9456, NAS 9-11756).

b. During the final month of this effort, the contractorshall wcrk with and generally orient the personnel designated tosucceed him for the purpose of effecting an orderly transition.

PAGE 2 of 2

1-3

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ATTACHMENT II TO FINAL REPORT - IMBLMS

TABLE OF CONTENTS

OF SIGNIFICANT TRANSMITTAL MEMOS

II-l

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TABLE OF CONTENTS

PageA. PRODUCTS ASSOCIATED WITH TASK 1.1

ITEM 1

HA-60-104 Site Application Analyses II-4HA-60-111 Information on Legislation on 11-31

Physician's Assistants in New MexicoHA-60-112 Update of Information on 11-32

Utilization of ParamedsHA-60-113 Pennsylvania Physician 11-34

Assistant LegislationHA-60-114 New Mexico Physician 11-35

Assistant Legislation

ITEM 2

HA-60-115 IMBLMS AHSFU Cost Reduction Options 11-40

HA-60-118 Advantages of Conserving the Mobile 11-44Unit Concept

ITEM 3

HA-60-103 Review Comments on IMBLMS Phase C 11-47Kick-off Meeting of Dec. 20, 1972

HA-60-129 Interface Coordination & Planning 11-51Meeting

HA-60-123 Working Material for Consideration in 11-67Arriving at Agreements between HEW,IHS, NASA, and LMSC as a Result ofIMBLMS Program Redefinition

ITEM 4

HA-60-108 Engineering Review of the IMBLMS 11-78AHSFU Updated System Block Diagram,Revision B, Figure A-2

HA-60-109 Transmittal of Comments on KFI 11-79Work Statement

HA-60-120 KFI Role in AHSFU, Parts I, II, 11-82- . and III - - -

HA-60-122 Role of KFI in AHSFU 11-86

II-2

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TABLE OF CONTENTS - (Cont'd)

B. PRODUCTS ASSOCIATED WITH TASK 1.2

ITEM 5

HA-60-140 Transmittal of High Technology Items 11-89for GFE to IMBLMS - Revision B

HA-60-131 Comments on "A Proposal for a Medical II-120Research Semi-trailer Van" by Capt. G. R.McCahan, Jr., DVM, U.S. Army AeromedicalResearch Laboratory

C. PRODUCTS ASSOCIATED WITH TASK 1.3

ITEM 6

HA-60-121 A Review of Life Sciences Flight Research 11-126Program for the Space Shuttle Program -Preliminary Study

HA-60-106 Results of Life Sciences Payload Develop- 11-139ment Committee Meeting Jan. 8-12, 1973

HA-60-132 LSP Experiments Program Plan 11-141

HA-60-136 Transmittal of Work Packages 11-149HA-60-138 Comments on Analysis of General Dynamics 11-174

Final Report "Life Sciences PayloadDefinition and Integration Study"

II-3

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UNITED STATES GO\'E/?.1W.!E/7T

2- Wai / a

Subject: sitc Application Analyses

To:r,Norm Belasco, Chief, DE2

L

~]

_l

HA-60-104

DATE OF MCSi'.GE •

January 5, 1973DATE OF~RC?LY

INSTRUCT!C.V;SU« rou t ing symbols ^ . u - r . . r tslblc.SENDEK:

KorwarJ or ig ina l jr i^ cr.eConsirve space.

R K C E I V T K :Reply below the r-. .-j-.s^e,ont copy, r e t u r n on-, copy .

—FOLD-USE BfclEr.INrORV.AL LA.NGUACE

• Attached herewi th are three copies of the Site A p p l i c a t i o n Analysesperformed by D o s i n g on the W i l l i a m s p o r t , Papago, and Hatch cand ida tesites, at the request of IPO.

W. B. Lewis

From:

r W. B. LewisThe Boeing Coir.osny5-2720 HA-60 "

~i

L

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January 3, 1973

SITE APPLICATION ANALYSIS - HATCH. NEW MEXICO

The results of an analysis by Boeing of the subject site for the IMBLMSArea Health Services Field Unit are presented below.

I. STRENGTHS

The site is excellent in every respect except for the weaknessesdescribed in paragraph II. below.

II. WEAKNESSES

A. The basic weakness is that the State of New Mexico does nothave laws which allow paramedical operations like thoserequired for the IMBLMS project. Responses given to questionsstate that a paramedical ACT is now in draft form and willbe voted on by the New Mexico legislature during the comingsession. However, the data furnished indicate that the ACT,if passed, will be significantly restrictive in nature and willnot be suitable for IMBLMS. The New Mexico concept is basedon having very close coordination between doctors and paramedicalpersonnel on all functions, and sending doctors to the remotesite on a scheduled basis for patient treatment, e.g., thisis the paramedical approach used for the Estancia area fromwhich data are being collected for the proposed paramedicalACT.

B. There is inadequate recognition in the site data regardinghow the IMBLMS project will relate to future space missions.This is reflected in the weakness described in paragraph A.above, e.g., it is not practical to shuttle doctors back andforth to a space vehicle.

III. SITE ORIENTED QUESTIONS NEEDING FURTHER EVALUATION

The question of legality of paramedical operations in New Mexicocauses significant concern for the adequacy of the Hatch site.Further, it appears from studying available data that this questioncannot be resolved in the near future. The risks involved intrying to hurry a new Act through a legislature are significant.An overview of paramedical laws in the U.S. provides good evidencethat similar legislation has a long history of suppression.

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January

Site Application Ana TVS is - Papago Reservation

An analysis of the site candidacy of the Papago Indian Reservation for theDHEW/I.'ASA IMBLMS Area Health Services Field Unit test project was performedby Booing with the following results.

I. STRENGTHS

A. This is a joint application from:

E. S. Rabeau, M.D.Director, Office of Re-search and Development (ORD)Indian Health Service (Tucson)

and

Augustine LopezChairman, Papago Tribe

s

B. The ORD is specifically assigned the task of developing improved'methods and systems for health service delivery and has presentlydeveloped a reservation-wide, patient-oriented computer-basedHealth Information System which could be of considerable valuein the assessment of the IM3LMS demonstration and field testactivities.

•C. The Papago Reservation (approximately 100 x 100 miles) has apopulation of about 10,000 people. This system provides adiscrete entity of patient population, local and fedora! govern-ment, geographical, climatic, and technical features which tendto assure valid IK3LMS field test and demonstration.

D. The tribe through the Executive Health Staff presently operatessix reservation-wide health/education oriented programs. Theseprograms provide a natural information base for IKBLKS operations.

E. The Papago tribe has an incorporated governmental form and pro-vides for annual election of the Chairman and Vice Chairman whooversee the daily operations.

F. The Indian Health Service was organized in 1955 and is responsiblefor Anerican Indian and Alaskan Native health services. The SellsService Unit is a component of the Office of Research and Develop-ment (ORD) Headquarters, IHS.

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-?-

t

G. Cost cffectivcnes'.; considerations are favorable, in that a reserva-tion-wide information system with supporting computer facilitiesand software are in existence to provide a wide data base forIMDLI-'.S operations. In addition, PHM cars are equipped with..Kleinschrnitt printers to permit Health Information System re-trievals at remote locations without power or telephone service.

H. Staff housing availability can be accomplished through a tribalcooperation in housing, mobile homes, or private housing in thesurrounding communities or cities.

I. Provider and consumer acceptance - both have had favorable interestindicated and a willingness to participate.

J. While; the IRS has been able to improve the Indian and AlaskanNative health indices, these people still do not enjoy the healthstatistics of the general U. S. population. Dispersed populationssuch as the Papagos make health care delivery by existing systemsdifficult, and innovative programs such as HIS and the CHM (and1MBLMS) must be developed to meet this need.

II. WEAKNESSES..

A. Area co:nmuni cations such as telephone and mail/parcel post servicesare more difficult (here, due to low population density) than areusually experienced in the northeastern section of the U. S.

B. Road and transportation services - main roads are all-weather orimproved in the reservation and, therefore, do not represent aproblem. However, like any low population density area, theremote ccmn'.ur.ities are usually linked by dirt or gravel roadsv/hich can become difficult to traverse in bad weather. Annualrainfall is very low, so dust end stones constitute the mainhazards to transportation equipment and operations.

"III. SITE ORIENTED QUESTIONS NEEDING FURTHER ELABORATION

Papago Site -

1. Conmuni cations:

.. ' A. More information is needed on existing communications

(1) What systems are available on the reservation

VHP- - . . . . . . . . . . UHF

.' ' Microwave - - _Citizens Band RadioReservation Police,

(2) Frequency allocations presently available

II-7

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-3-

(3) Existing tov;crs, sites and communications facilities?

Specifics on pov.-er/utilities

B. No statement v/as included on telephone services presentlyavailable.

C. Question - Hov/ v.-ould the AUSFU system be notified of anaccident or medical need in the remote areas?

• •

2. Staff Impact Items

A. Staff housing is available at San Xavier, Santa Rosa andSells. Report mentioned mobile homes in remote areas --who provides this housing?

B. Item F, page 4, mentions a professional staff availability

(1) Would these people man the system?• • •

(2) Would Lf-iSC physicians be accepted?

II-8

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January <\,

'SITE APPLICATION ANALYSIS - WILLIAMSPORT, PENNSYLVANIA

STRENGTHS ' ••i

The site is a well-established, stable community without importantlinguistic barriers. The populace is progressive with respect toeducation, community interest, etc., hence the test experience wouldbe relevant to the majority of progressive American communities.

II. WEAKNESSES

roles

Medical staffing is already at a nearly national par, although thedistribution exhibits the national trend in rural non-availabilityarid urban surfeit.

The area is not shown to be progressive v/ith respect to con-.nuni cationssystems and computerization for business or medical management.

The legal prerogatives of all ied^health professionals in primaryin remote health care delivery are apparently very limited.

The ten specialties of allied health professionals produced by theWill isms port Hospital are oriented toward hospital service rather thanprimary health care delivery, as is generally needed by AliSFU.

No data were offered on the incidence of disease among the populationcr the likelihood that individuals would seek health -care.

III. SITE ORIENTED QUESTIONS NEEDING FURTHER ELABORATION

A. Legal aspects of AHSFU operation at Will iamsport, Pennsylvania. .

Upon review of the Vlilliarnsport proposal from a patient carestandpoint, it was noted that the candidate proposes to use

. nurse practitioners for primary patient contacts. Review ofthe Pennsylvania statutes which were furnished by the common-wealth Department of Health in Kay 1972 did not reveal a legalstatus for nurse practitioners (see Section 4, lines 9-14, and

• Section 3, lines 11-24, S3 1394). Physicians' assistants canbe used but they cannot exercise independent judgment in determiningand prescribing treatment (see Section 2 (c), lines 7-10, SB 1194).This stipulation is construed to require that a physician be in-volved in each patient contact, except in emergencies.

Since the proposal does not' address itself specifically to themode of operation intended by NASA-HEW, it is suggested thatthe proposer be asked to furnish competent information on thefollowing points:

II-9

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SITE PRINTED_QL'ESTIO?.'S f!EED FURTHER ELABORATION (Cent.)

Legal status of the nurse practitioner to provide primarypatient contact and treat the majority of patients withrecourse to the services of a physician only when she feltthat consultation was necessary, provided also that shemaintained records for periodic review of a licensedphysician.

Currency of the stipulation in Pennsylvania Senate BillNumber 1194 that prohibits the exercise of independentjudgment end independent action by physicians' assistantsexcept in life threatening emergencies.

Referenced legislation - Senate Bill No. 1394 Session of1972 (The Medical Practice Actof 1972)

Senate' Bill No. 1194 Session of1971 (Practice of Medicine byPhysicians' Assistants)

B. The "data base" should be described in detail (referenceproposal page 9) with respect to the existence of communityhealth data, number of visits to a medical installation perperson per year, also probable availability to IMBLMS ofindividual medical data and population data.

C. The existence of fixed computer facilities and the possibleinterface of the IMBLMS system with them'should be explored.

11-10.

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o oPnniorV, f\!o.

-i—n r-i i«nrTTrrirr»«r»]itjfDrjULi j tr-irpr i tnri- iTnr-1 "vrr--«—r —*'! "T"" "^ ——*-

THE G E N E R A L ASSEMBLY OF PENNSYLVANIA

Scssion of1971

^ i

C INTRODUCED BY'MHSSINGER, MAZZEI, MELLOW, MILL, COPPERSMITH ANDAVuV.ERMAN, DECcME'ER 8, 1971

y*«*^'^^^g:j^^~f7r*^

REFERRED TO STATE GOVERNMENT, DECE//.3ER 8, 1971rfKSB •o^aw«Ki -T^T^«?yAf e55jco»zt sr V'i cr /j«Wi £i! ' ^

AM ACTi

1 Relating to the practice of Eedicine by physicians' assistants2 and providing penalties.

3 ". The General /issenbly of the Coiinonvealth of Pennsylvania

U hereby enacts as follovs:

5 Section 1., 1.3 D.c;ed.in t.hlc act.:

.6 (1) "Board" aeans ths Board of Medical Education. and

7 Licensure of the Cor.aonwealth of Pennsylvania.

8 (2) "Physician1 s assistant" r.eans a person who is registered

9 as a physician's assistant in accordance vith the provisions of

10 this act.

11 Section 2. (a) This act does not prohibit a person fron

12 render ing nodical services:

13 (1) If the person has satisfactorily conpleted a t ra in ing

1U prograa, approved by the board, for physicians ' assistants;

• 15 (2) If the services are rendered u n d e r the j;npervision and

16 control of a person licensc.-d. u n d e r this act to practice ncd ic ine

17 and the use of the assis tant 's services has been approved by the

18 board as provided by this act; and

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1 (3) If the i .'.i is registers;] as a physician's assistant

2 as provided by t? : - -7t.

3 (b) The act o • -.c. t. prohibit a student enrolled in an

t» approved progran for training physicians' assistants froa

5 rendering nodical services if the services are rendered in the!

G course of the proc*•*?. . i. ' i. . j

7 (c) h'otvithsta:. '/ subsections (a) and (b) of this section,

8 n physician's assi\- .. shall not exercise independent judgment

9 in deternining and'"., -' ribing treataent except in

10 life-threatening emergencies.

11 Section 3. The provisions of this act do not require an

12 enploye of a person licensed to practice cedicine under this

13 act, or of a niefiical' clinic or hospital to be registered under

10 this act, cnless the employe is employed as a physician's

15 assistant in which case the enploye shall be registered under

1C this act.

17 Section 0. The board aay adopt regulations regarding the

.18 registration of physicians' assistants and the ncdical services

19 that assistants nay perform, including but not limited to:

20 (1) The educational and other qualifications of such

21 assistants; ,

22 (2) 7i reguired training program for applicants;

23 (3) Procedure applicable to applications for examination and

20 registration;

25 (0) Tests or exaninations given applicants by the board;

26 (5) Registration of qualified applicants, tenporary

27 registration and renewal of registration,;

2C (6) Medical cervices registrants ::ay be authorized to

29 p e r f o r m ; '

30 (7) Supervis ion of services of rcgir. trantr, ; and

- 2 -

11-12

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1 (0) Ter i.-nc.tio:\ of registration of rcc,_..trants.

2 Section 5. Performance of any r.odical cervices by a

3 physician's assistant after the termination of registration by

H the board, after expiration of temporary registration or in the

5 absence of renewal of annual registration constitutes the

6 unauthorized practice of nedicine and subjects the assistant to

., 1 the penalties provided by law.

.8 Section 6. (a) A person licensed to practice ncdicine under

9 the law of this State shall not use the services of a

10 physician's assistant without the prior approval of the board.

11 The application shall state the nane of the physician's

12 assistant, describe the Banner and extent to which his services

13 vould be used and supervised, state the education, training and

14 experience of the physician's assistant and provide such other

15 information in such a form as the boaird nay require.

16 (b) The board nay approve or reject an application, or it

1V nay r.odify the proposed use of the services of the assistant and

18 approve the application as modified. Approval shall be valid for

1.9 no more than one year but Day be renewed annually. When it

20 appears to the boerd that the cervices of a physician's

21 assistant are being used ia a manner inconsistent with the

22 approval granted, the board nay withdraw its approval. If a

23 hearing is reguested by the physician or the physician's

." 24 assistant upon the rejection- of an application, or upon the

25 withdrawal of an approval, a hearing shall be conducted and

26 find.ings issued.

27 Section 7. (a) Every physician's assistant shall pay to the

28 board: • .

29 (1) Kith an' application for registration as a physician's

30 assistant,, fifty dollars (S50) . ;

• . • - 3 - '

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O •.1 (2) For registration .or renewal of registration for one yoar

2 to engage in active practice as & physician's assi.stant, twenty

3 dollars ( $ 2 0 ) . - ',i

(I (3) For registration or renewal of 'registration for one yeari

5 if the registrant is not engaged in active practice as a

6 physician's assistant, five dollars (S5) .i

•7 Section 0. The board shall subnit annually to the .

8 Legislature a report detailing the number of physicians'

9 assistants registered with the board; the location of all

10 physicians':" assistants employed or in training in this State; a

11 copy of all regulations adopted by the board pursuant to section

12 4 of this act; and all pertinent- data collected by the board

13 pursuant to subsection (a) of section 6 of this act.

K23I.S0.1V:/1971DG)I|GG5

11-14

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Printer's Mo. 1733

THE G E N E R A L ASSEMBLY OF P E N N S Y L V A N I A

3 r-\

JlLfl £•

/] Session ofJ 1972

CC..J v;. ./> i.: L J I L.

f^J«^*-gr^^J ^-n>C^

INTRODUCED BY COPPERSMITH, STAUFFEP., MURPHY, P.OVNER, MESSINGER, HILL,SESLER AND. FRAME, MAY 2, 1972

REFERRED TO PUBLIC HEALTH AND WELFARE, MAY 2, 1972>

AU ACT

1 Eclating to tho right "to practice medicine and surgery in the2 Co an on veal th of Pennsylvania; and establishing Moans and3 nothods whereby the right to practice medicine and surgery1 . and any of its branches and limited right to practice5 uedically related acts r.ay be obtained, and exemptions6 therefrom; imposing covers and duties on the State Board of7 Kedical Education and Licensure; providing for appropriation•8 . of board fees to carry ov:t the provisions thereof, and for9 the granting, revocation and suspension of licenses;

•10 providing penalties for violations; and taking repeals.

11 The General J.ssesbly of the Condon veal th of Pennsylvania

12 hereby enacts as follows:

. 13 Section 1. Short Title. — This act shall be known and may be

11 cited as "The Medical Practice Act of 1972."

15 Section 2. Dof ini tion s. -- As used in this act, the following

' 16 terns shall have the following neanings ascribed to then in this

^ 17 section unless the context clearly determines otherwise:

18 (1) "Board. l! The State Board of Medical Education and

19 Licensviro, established by section 11?. of the ect of April 9,

20 192S ('.'.L.177), knovn as "The Administrative Co3e of 1929, |: and

21 its ancndhents.

22-' (2) "f ' .edicul college. " An ins t i tu t ion of h ighe r l ea rn ing

11-15

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1 'vhich has been fully accredited by the Association of American

2 Medical Colleger;, its successors or assigns, or the American") al

3 Medical Association, either airectly or through their respective

i» accrediting bo3ios, as ln e-;ency to provide courses in the arts

5 and sciences of ucdicine and related subjects and eppot/ercd by

6 the Connonvealth to grant Acadcnic Degrees in Medicine.

7 h;

7 '(3) "Medicine and 'surgery." The art and science having for

8 its object the cure of the diseases of and the preservation ofQ a •

9 the health of nan including all practice of the healing art. with

9 e '10 or without drugs, except hoaling by spiritual ncans or prayer.

11. (*J) "Physician." A person who has received fornal and

12 recognized .training in the art and science of medicine and is .

1 2 u 'r 13 qualified to seek or has acquired a license to practice medicine

13 P '. 14 and surgery.

15 (5) "Healing art." The science and skill of diagnosis and

1 5 1 "16 treatment in any man-ncr' vhatsoever of disease or any ailment of

17 the human body. _ • •

•18 (6) "Intern" or "resident." A physician who is receiving

•• 19 supervised graduate nedical training at an approved hospital or

19 ' 20 its l&gal affiliate. • •

20 •21 (7) "Clinical clerk." An undergraduate student in a medical

21 22 college, who is assigned under the auspices of the school in22

. 23 which he is currently enrolled to make notes upon patient

23 2U histories and physical exaninat ions and to p o r f o r n -cer ta in2/i

25 .procedures and laboratory tests for the sole purpose of

26 instruction and experience oc who nay r.ake notes which becone? ft

•27 o f f i c i a l on ly w h e n edited and counters igned by a c-ercber of the

27 •28. hospital staff, nothing contained in this act shall be construed•

? ft29 to ent i t le a clinical clerk to practice nedicine and surgery or

29 •- 30 to prescribe drugs.

- 2 -

C15_. . / ' : ..... ..... ... . ..

' -•' ' ......... "•" 11-16

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'J1 (8). "Hospital." ' An institution fully accredited by the

2 Joint Commission on Accreditation of Hospitals or licenced by

3 the Connonvealth of. Pennsylvania to render health care,

4 (9) "Approved hospital." A hosp.ltal which has been approved

5 by the board for providing supervised graduate medical training.

6 (10} ";»ffiliate." A nenbor of a group of tvo or core fully

7 accredited health care, institutions legally united by an

8 agreement of affiliation, conceived to enhance the potential of

9 all participants in the provision of health care and nodical

10 education.

11 Section 3. Practice of Medicine and Surgery without License

12 Prohibited; Penalties.--It shall be unlawful for any person"in

13 the Connonvealth to engage in the practice of medicine and

11 surgery, or protend to a knovledge of any branch or branches of

15 medicine and surgery, or to hold himself or herself forth as ~

16 practitioner in ucdicinc and surgery, or to assur.e the title of

17, doctor of ncdicino and surgery or doctor of any specific

'10 disease, or to diagnose diseases, or to treat diseases by ths

19 use of medicines and surgery as defined in clause (3) of section

20 2 of this act or by any other means, or to si.cn any death

21 certificate, or to hold hinself or herself forth as able to do

22 so, excepting those hereinafter excnnted, unless he or she has

23 first fulfilled the reguirenents of this act and has received a

?.*\ certificate of licensure fror. the board, which license shall be

25 properly recorded in the office of the board. On first offense

26 any person vilfully violating the provisions of this section of

27 this act shall, upon conviction, be guilty of a nisdetieanor and

28 shall be subject to a fine of not nore than one thousand dollars

29 (f.1,000) or inpri'sonaent- for not nore than six r.onths in thet

30 county prison,, or both, at the discretion of the court; on

11-17

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o J

12 a."

3 a)

"t> D'

6 c

7 h

8 a

. 9 e

10 b

11

.12 F

13 F

•11 1

15 1

16

17 !

.18 '

19 •

20

21

22

23 .

25

26

27

28.

29

1

2

3.-••—

5

6

7

8

9

10

11

12

13

14

15

16

17

-18

19

20

21

22

23

2H

25

26

27

28

29

30

so-cone! offence shall he subject to a Cine of not loss than tvo

thousand dollars (?2,000) and imprisonment of not loss than six

r.onths or nore than one year, at the discretion of the court.

Section 1. Acts and Services Pcrforr.-.ed by an Assistant to a

Physician.—Tho board shall have the pover to adopt and revise

regulations governing allied nodical personnel i/ho assist

physicians if such allied nodical personnel are not at the

effective date of this act otherwise controlled by law or

regulation. In the absence of .standards established by the

board, nothing in this act shall be construed as to prohibit

services and acts rendered by a physician's technician,

assistant and/oj: other alliod medical person if such services

and acts are rendered under the supervision, direction and/or

control of a licensed physician.

Section 5. The Board's Pover to Grant License.--The board

tuiy grant the follov:ing licenses:

(1) License. License for the practice of medicine and

surgery vrithout restriction.

(2) Temporary License. A graduate of a nodical school vho

qualifies under section 7 of this act, nay, on receiving his;

medical degree, apply to. the board for a temporary license- upon

presenting a coupleted application forn issued by the board and

paying a reasonable registration foe in an ar.ount as determined

froQ tine to tine by the board.

A temporary license shall be valid for tvelvc consecutive

contliS and shall be recognized only as conferring upon the

licer.see the rrght to participate-in approved graduate medical

training within the complex of the hospital to which he is

assigned. Temporary licenses -5ill become null and void after

twelve r.oriths, at which tir.e they shall be surtc-ndcrr-d to the

C15:

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1 board. The board nny extend the validity of a temporary license

2 when such action is warranted.

3 (3) Linitcd License. A linitcd license nay be granted by

1 the board to graduates of foreign r.edical schools who have

5 attained through professional growth and teaching experience the

6 true status of teacher, or its equivalent, for the purpose of•

7 teaching and/or practicing ncdicine and surgery in one of the

8 nodical schools or in any of its affiliates within the

9 Commonwealth. Persons granted linited licenses vho subsequently

10 desire to obtain a license for the practice of tiedicine and

11 surgery without restriction shall- bo required to ceet all'of the

12 standard requirements for such license as set forth in this act.

13 ' (4) Midwifery, Physical Therapy and Drugless Therapy.

1*1 Kothing in this act shall be construed to preclude the board

15 fron continuing to license, register and regulate persons

1C engaged in the practice of tvidwi-f.ery-and/or physical therapy or

17 to register or regulate persons engaged in the practice of

18 drugless therapy in accordance with existing rules and

19 regulations lawfully pronulgate.d by said board prior to the

20 effective date of this act.

21 Section 6. Standards for Medical Training and -

. 22 Facilities.--{a) The educational qualifications for acceptance

23 as a matriculant in a Dedical college incorporated within the

2tt Commonwealth and the curricula and training to be offered by

25 such nedical colleges shall ccet the requirements set by the

26 Liaison Conmitteo on ftedical Education of the Anerican Medical

27 Association and the Association of An or lean Medical Colleges, or

20 any other accrediting body which fron tine to ticse nay be

29 recognized by the board. /.

30 (b) It shall be the duty of the board, in its discretion,

— 5 —

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o o1 1 periodically to ascertain the character of the instruction-and

2 a" 2 tho facilities possessed by each of the nodical colleges and

3 al 3 hospitals offering or desiring to offer nodical training in\

1} H accordance with the requirements of this act. It shall furtherI

5 ta; 5 be the duty of the board, by inspection and otherwise, toI

6 c 6 ascertain the facilities and gualificationrj of nodical. i

7 h 7 institutions, colleges, or hospitals, outside this Cordonvoalth,

8 a 8 whose graduates or trainees desire to obtain raedical licensure

9 e 9 or. graduate nedical training in this Commonwealth.:

* , ,

*vO b 10 (c) Any nedical institutions eupovered by the Commonwealth

11 11 'to confer acadenic degrees in nedicine which in the judgment of

12 F 1 2 t h e board fail to provide proper facilities, or to maintain the

13 J 13 minimum reguircnents for accreditation shall be duly notified of

11} t Hi such failure. Until such deficiencies are corrected, graduates

15 1 ' 15 of such institutions shall be ineligible for licensure and/or

16 16 graduate.medical training.

17 ) - 17 Section 7. Qualifications for License.—(a) A graduate of a

.18 « 18 United States or Canadian sedical college who seeks licensure by

19 « 19 the board shall furnish the board vith evidence, prior to any

20 20 examination, that he is a citizen of the United States or the

21 ' 21 Dominion of Canada, or has declared his intention of becouing a

22 22 citizen of the United States, that he is of legal age, is of

23 . '23 good coral character, and is not addicted to the inteapcrate use

2'l 24 of alcohol or the habitual use of narcotics or other

25 25 habit-forming drugs, and that he has completed the educational

26 26 rcguircncnts prescribed by the board.

27 27 (b) Foreign nedical school graduates, except graduates of

28 20 Canadian nedical colleges, who seek licensure by the board,

29 -29 shall in addition to the foregoing reguire.-ients present evidence

30 of certification by tho Educ.ttion.il Council for Foreign Medical

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. o1 Graduates, its successors or assigns.

2 (c) ' A licensee who fulfills the reguironcnts of this act•>

3 relating to citizenship by presenting a declaration of intention• \

<l of becoming a citi2en, shall have his license automatically

5 revoked by the board if such licensee does not present a

6 certificate of United States citizenship to the board withini •

7 seven years after original licensure.

8 (d) Each application to the board shall have attached

9 thereto the affidavit or affirmation of the applicant as to its

10 verity. Any applicant who .kr.ovingly or wilfully nakes a false• /

11 s ta tement of fact in his applicrttion shall be subject to

12 prosecution.

13 -Section 8. Certification of Licenses.—The fc.ct of licensure

14 to practice medicine and surgery in the Connonvealth shall be

15 certified to by the board to other jurisdictions upon fornal

16 application and by payment by the licensee of a reasonable fee

17 in an anount as determined from tine to time by the board •

'18 providing that the licensee at such tine is in good standing,

19 Section 9. Meetings of the Board; Examinations.— (a) The

20 board shall hold tvo stated meetings each year at a place within

21 the Cor.KOiwealth as determined by the board for the transaction

22 of its business, and nay hold special Eeotingr, upon giving due

23 notice thereof. The board shall hold at j.east tvo examinations

.2'! for applicants for licensure under clause (1) of section 5 of

25 this act each year.

26 (b) Such examinations conducted by the board shall he in the

27 English language. Special examinations^ can' be designated by the

28 board. The cxaninationr. shall be held at such tir.es and places

29 as designated by the board.

30 (c) In C2.':e of failure at any such examination the applicant

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1 shall have, after the expiration of six tnonths and within two

. 2 years, the privilege of a second cxanination by the hoard. In

, 3 case of failure in a second examination the applicant nust enter

1 de novo and only after a year of graduate study approved by the

5 board, and qualify under the conditions obtaining at the tine of5 D

6 his application.6 C .

' 7 (fi) Applicants for a license to practice nedicine and

8 surgery who have been successfully examined by any agency8 a

9 considered competent by the board and who can, in addition,

. 10 present to the board satisfactory evidence of having in every

11 vay fulfilled all the scholastic and other requirements of this

12 act and applicable regulations of the board, nay, without

13 further examination, receive froa the board, in its discretion,

1U a license conferring ail the rights accorded by this act,

. 15 provided the applicant has paid a reasonable fee in an anount as

16 determined fron tine to time by the hoard, and further provided1 6 .

17 that such applicant has not previously failed a licensing

-18 exanination given by the board..18

19 (e) For the purpose of conducting all examinations the board

20 shall have the privilege of calling to its aid oedical

21 consultants, vho shall be conpensated for their services at a

22 reasonable rate in an araount as deternined frou time to time by

23 the board in addition to all incurred expenses.

.2*4 Section 10. Reciprocity or Endorsement. --Kcciprocity or

25 endorsement may be established at the discretion of tho board.

26 ' Section 11. Licenses; Exemptions, ilon-residcnt

27 Practitioners- Graduate Students; Biennial Registration.--- (a)

28 All physicians who have complied with the requirements of ther

'29 board, and who shall have passed a final examination, and vho

30 have otlierwir;e complied with the provisicnr. of thic- act, shall

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1 receive fron the Conair.cionor of Professional and Occupational

2 Affairs in the Dcpartnent of State, acting for the board, a

3 license entitling thcra to tho right to practice medicine and

I t\ surgery vithout restriction in this Connonwealth. Each such

5 license shall be duly recorded in the office of the board, in a

6 record to be properly kept for that purposo which shall be open. |->5Frt t

•- | 7 to public inspection; and a certified copy of said record shall

.8 be received as evidence in all courts in this Commonwealth in

9 the trial of any case: Provided, That this section relating to

10 licenses to practice nedicine and surgery shall not apply to

11 nodical officers in the nedical service of the Arr.ed Forces of

12 the United States, or the United States Public Health Service,

13 or Veterans Administration, or' physicians cnploycd within

11 Federal services, while -in discharge of their official duties;

15 or to any one who may be a duly licensed practitioner of

16 tiiedicine in any state or cosnonvealth v;ho nay be called upon by

17 a licensed physician of this CoKnonwealth to consult with him in

•18 a case under treatment; or to physicians of other jurisdictions

19 uho are training for certification in special departments of

20 nedicine and surgery under subsection (b) .of this section; or

21 anyone while actually serving as a clinical clerk unclor the

22 supervision of the nedical or surgical staff in any hospital.

23 nothing contained in this section shall bo construed to entitle

'-• s 2') a clinical clerk to practice nedicino and surgery or to

• 25 prescribe drugs: f-.nd provided further, That any duly licensed

26 physician residing in or r.aintaini.ng his office of practice in

27 any state near the boundary line between' said state and this

28 Coanonucalth whose practice extends into this Conaonvealth shall

-29 have the right to practice in this COD:-, on veal th, at the

30 discretion of the board, provided ho files with the secretary oC

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J v^1 1 the bo !.cl a certified copy of hie license in the state where he

2 a 2 reside:-, and provided that the board of exaninors of the

3 a- 3 adjoin: "j r.tate reciprocates by extending the sane privilege to

1 1 physicians in this Conmohvcal th vhcn he shall receive fror. the

5 ° 5 secretary of the board a license which shall be automatically

6 c 6 revoked if ho changes his said residence or office of practice.

7 h 7 A record ".ill persons so licensed shall be kept in the office

8 a 8 of the bo..:." and shall havo the standing before the law of any* •

9 e 9 other li •' . issued by the board.

10 t 10 (b) Physicians who are legally authorized to practice

11 11 nedicine and surgery in other states or territories of the

12 I 12 United States and the Dominion of Canada, and who apply for

13 I 13 training and certification in special departments of medicine

11 ^ 11 and surgery in institutions in this Connonwoalth recognizer.

15 1 15 either by the board or the various examining boards in ncdica1

16 1.6 .specialties .approved by tho Council on Medical Education of the

17 ) :• ]7 American Medical Association as proper for such training, .shall

.18 • • "18 receive a graduate certificate that is limited to said training

19 • 19 within the cor.plex of the hospital and its affiliates where he

.20 20 is engaged in such training. This training experience shall not

21 21 be converted into a staff service. It shall be valid for one

22 22 year but nay be renev/ed fron year to year. Any person who has

23 . 23 b3cn certified in a specialty discipline recognized by the

2'l 21 American Medical Association and the board, and vho r.akes an

25 25 application for licensurc to practice medicine and surgery

26 26 v,'ithout restriction i.n the Commonwealth, upon the payment of a

27 27 reasonable fee as determined frcra tine to tine by the hoard and

28 28 at the discretion of the board may be given a qualifying

29 . 29 examination. Ccch examination- shall enohasizo tho'subject natter

' 30 of the specially discipline- for which the applicant has beep.

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Cf

( I

1 t rained but may also inc lude n ia tc r ia i f r o n the genera l f io ld of

2 medical.science. ii

3 (c) It shall be the duty of all persons nov licensed'to% I

U practice nedicino a:id surgery without restriction, or who shall

5 hereafter be so licensed by the beard to engage in such practice

6 in the Con-aonvealth to be registered vith the board, andi

7 thereafter to register in like manner biennially on or before

8 the first day of January of each succeeding bienniuai. The form

9 and aethod of such registration shall be provided for by the

10 board in such nanner as will enable the board to carry into

11 effect t-.he -purposes of this act.

12 ' (d) Each person so registering vith the board shall pay, for

13 rlach biennial registration, a' reasonable fee as determined fron

11 tine to time by the board which fee shall accompany the

15 application for such registration.

16 (e) Upon receiving a proper application for such

17 registration accompanied by the fee above provided for, the

-10 board shall issue its certificate of registration to the

19 applicant. Said certificate together with its renewals shall be

20 good and sufficient evidence of registration under the

21 provisions of this act.

22 Section 12. Violation of Act.—Any person, or the •

23 responsible officer or employe, of any corporation or .

2W partnership, institution or association, violating any of the

25 provisions of this act shall upon suasary conviction bo

26 sentenced to pay a fine of not less than one hundred dollars

27 (£100). nnd-not .Eiore than five hundred dol lars (S500) .

28 Section 13. Examination Fees.—The board shall have the

29 power to charge a reasonable fee for all cxanir.at ions, as

30 dotcrninod frocs tine to. tine by the board.

- 11 -

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'J1 1 Section 1U. Fees and Fines for Hoard.—Ml fees and fines

2 a! 2 collected under the provisions of this act arc hereby

3 a! 3 specifically appropriated for exclusive use by the board in

1 1 carrying out tho provisions of this act.

5 o 5 Section 15. Automatic Suspension.--A license issued under

6 c 6 this act shall autonatic-ally be suspended upon the legal

7. h 7 conr.itr.ent to an institution of a licensee because of mental

8 a 0 inconpetency from any cause upon filing vith the board a

9 e 9 certified copy of such con^itmcnt. Restoration of such license

10 I 10 shall be made as hereinafter provided as in the case of

11 11 revocation or suspension of such license.

12 j 12 Section 16, Reasons for Refusal; Revocation or Suspension of» ,

13 i 13 License.--(a) The board shall have authority to refuse, revoke

1'l 1 11 or suspend the license of a physician for any or all of the

15 ' 15 following reasons:

16 16 (1) Failing to^denonstirate the qualifications or standards

17 s 17 for a license" contained in this act or regulations of the board,

.18 . 18 in which proceeding the burden-of proof shall be upon the

19 19 applicant. - .

20 20 (2) Making misleading, deceptive, untruo or fraudulent

21 21 representations in the practice of p.edicir.e; practicing fraud or

22 22 deceit in obtaining a license to practice nedicinc and surgery;

23 . 23 or naming a false or deceptive- biennial registration with thi2

2'l 21 board.

25 25 (3) Being convicted of a felony in the courts of this

26 26 Conr.onvr;alth or any other state, territory or country.

27 27 Conviction as used in this paragraph shall include a critiinal

20 28 proceeding in which a finding or verdict of guilt is nade or

29 29 returned but the adjudication of guilt is either withheld or not

30 entered thereon.

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f

*

•1 ('I) Having his licence to practice medicine and surgery

2 revoked or suspended or having other disciplinary actiort taken,

3 or his application for a license refused/ revoked or suspended

H by the proper licensing authority of another .:tatc, territory or

5 country.

6 . (5) Being unable to practice nedicine with reasonable skill

7 and safety to patients by reason of illness, drunkenness,

8 excessive use of drugs, narcotics, chemicals, or any other typo

9 of natetial, or as a result of any tnental or physical condition.

10 In enforcing this clause (5), the board shall, upon probable

11 cause, have authority to compel a. 'physician to submit to a

12 rental or physical examination by physicians designated by it.

13 Failure of a physician to subnit to such examination when

14 directed shall constitute an admission of the allegations

15 against him unless failure is due to circumstances beyond h:'.s

16 control, conseguent upon i.'hich a default and final order nay be

17 entered without the taking of testinony or presentation of

"18 evidence. A physician affected under this paragraph shall at

19 reasonable intervals be afforded an opportunity to demonstrate

20 that he can resune a competent practice of medicine with

21 reasonable skill and safety to patients.

22 (6) Violating a lavful regulation promulgated by the board

23 or violating, a lawful order of the board, previously entered by

24 the board in a disciplinary proceeding.

25 (7) Knowingly maintaining a professional connection or

26 association vitli any person who is in violcition of this act or

27 regulations of the board or knowingly aiding, assisting,

28 procuring or advising any unlicc.-p.sed person to practice nodicine

29 contrary to this act, or regulations of the board.

30 (8) Seing guilty of innorfil or unprofcssj.onal conduct.

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1 Unprofessional conduct shall include any departure fron, or the

2 failure to conform to, the siinical standards of acceptable and£, cL.

3 prevailing Radical practice, in which proceeding actual injury3 a! \

1 to a patient need not be established.I

5 (b) When the board'finds any person unqualified or guilty of5 m - j .

6 any of the grounds set forth above, it raay enter its order,6 ' c .. j

7 imposing one or more of the folloving to:7 h -

8 (1) D e n y the appl ica t ion for a license.8 a

9 . (2) Permanently withhold issuance of a license.9 e '

10 (3) Administer a public or private, reprinand.

11' (U) Suspend or limit or restrict a license.as deternined by

12 the board.12 I

13 . (5) Revoke a license. •• . . .

1H (6) Require a licensee to submit to the care, counseling, or

15 treatment of a physician or physicians designated by the board.

16 (7) . Inpose a judgment and penalty but suspend enforcement16 '" .

17 thereof and place a licensee on probation vith the right to

•1C vacate the probationary order for noncompliance.

19 (8) Restore or reissue,, in its discretion, a license to

20 practice medicine and surgery, and nay inposa any disciplinary

21 or corrective measure which it Bight originally have inposed.

22 (c) All actions of the board shall be taken subject to the

23 right of notice, hearing and adjudication and the right of

2ft appeal therefrom in accordance w5.th the provisions of the act of

25 June i), 19!|5 (P.L.1338), known as the "Administrative Agency

26 Law." . - • ' .26 . .

27 Section 17. Regulatory Powers of the Board.--The board in

28 the exercise .of its duties under this act shall have the power20

• 29 to adopt and revise such regulations as are reasonably necessary

'30 to carry out the pur pone;; of this acl in conformity vith the

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'Jprovis ions of the act of J u l y 31, 196B ( A c t No. 2 '»0) , k n o w n as

t!:c "Cor . inonwea3. th D o c u m e n t s L a w . "

Section 18. . a p p l i c a b i l i t y of A c t . - - ( a ) The provisions of

t} this r.ct shall not app ly eith.ec d i r e c t l y or ind i rec t ly , by

5 in ten t or purpose, to a f f e c t the pract ice of:

6 (1) P h a r m a c y as a u t h o r i z e d by the acts approved Sep tember

7 26, 1951 ( P . L . 1 C 6 U ) , k n o w n .as "The D r u g , Device and Cosinetic

8 Act ," and September 27, 1961 ( P . L . 1 7 0 0 ) , knovn as the " P h a r m a c y

9 Act."

10 (2) Dentistry as authorized by the act approved Kay 1, 1033

11 (P.L.216), knovn as "The Dental Law."

12 (3) Optometry, as authorized by the act approved March 30,

13 1917 (?,L.21), entitled, "An act defining optonetry; and

11 relating to the right to practice optonetry in the Coaaonwealth

15 of Pennsylvania, and making certain exceptions; and providing a

16 Board of Optonetrical Education, Examination, and Liconsure, and

17 p.eans and methods whereby the. right to practice optonetry aay be

-18 obtained; and providing for the means to carry out the

19 provisions of this act; and providing for revocation or

20 suspension of licenses given by said board, and providing

21 penalties for violations thereof; and repealing all acts or

22 parts of acts inconsistent therewith."

23 (1) Chiropractic, as authorized by the act of August 10,

21 1951 (P.L.1192), known as the "Chiropractic Registration Act of

25 1951."

26 (5) Podiatry, as au thor ized by the act of M a r c h 2, 1956

27 ( P . L . 1 2 0 6 ) , k n o w n as the "Pod ia t ry Act of 1956,"

20 (b) This act shall not be cons t rued so as to give the Board

29 of Medica l Educa t ion and Licensure any ju r i sd ic t ion over any of

30 the schools or colleger, of the n c t h o d s cxeuptecl in th is section.

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o1 Section 19. Specific Kepoa l s . - - ( a ) The f o l l o w i n g acts and

2 al l n n c n d ^ e n t s t he reo f and s u p p l e m e n t s thereto are repealed

3 absolutely:«

li (1) The act of July 9, 1897 (?.!,.21G), entitled "An act

5 taking valid the diplomas of physicians, issued by any reputable

6 college or university in another state or foreign country, which

7 have been improperly registered under the act of Assembly

8 approved June eighth, Anno Donini one thousand eight hundred and

9 eighty-one," and v:ith the sane effect as if said diplomas had

10 been legally registered under the provisions of said act."

11 (2) The act of May 31, 1919 (P. L. 358), entitled "An act

12 providing for the granting of certificates of licensure to

13 practice r.edicine and surgery to certain persons vho served in

1'» the Amy or .Navy of the United States or any branch or unit

15. thereof."

16 (3) The act of August 10, 1951 (P.L. 1154), entitled "An act

17 providing temporarily for the grant, without examination, of

.18 certificates of licensure to practice medicine and surgery to

19 certain persons who bccone members of the arned forces of the

20 United States; and suspending inconsistent lavs." • .

21 (<J) The act of June 3, 1911 (P.L.639), known as the "Medical

22 Practice Act"; act of J1'5'/ 31/ 1919 (P.L.358); act of April 20,

23 . 1921 (P.L.158); act of July 12, 1935 (P.L.703); act of July 19,

?A 1935 (P.L. 1329); act of Kay 20, 1937 (P.L.725); act of August 6,

25 1941 (P.L.903); act of August 10, 1951 (P.L.115'1); act of

26 December 15, 1959 (P.L. 1766); act of September 1, 1961

27 (P.L.11K9); and the act of August 1H, 1963 (P.L.957).

28 (b) All other acts -and parts of acts inconsistent herewith%*/

29 are 'repealed to the e x t e n t of such inconsis tency.

C 15L31J V1972D005G1 - 1C -

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HA-60-U]

:5-2720-HOU- 3-221

February 1, 1973

To:

Subject:

Norm Belasco, Chief, DE2

Information on Legislation on Physicians' Assistantsin New Mexico !

Per request from IPO, contact was made with 'persons occupying non-politicalpositions in New Mexico who could advise on their current legislative efforton Physicians' Assistant, us of January 30, 1973. Our .earlier contacts inthe State Comprehensive Health Planning Office suggested contact withMr. Ralph Marshall of the State Medical Society. Mr. Marshall advised thatthe Legislature was scheduled to consider the bill sponsored by the MedicalSociety on the next day (January 31), and that they were deferring actionon a different bill which would amend the act to permit a physician to useup to five Physician's Assistants. Mr. Marshall stated that interestedgroups such as the Nurses' Association had endorsed the proposed legislation,

.and that it had no known opposition.

He promised to send a copy of the bill, and stated that it was patterned fromthe Oklahoma Act, which is relatively non-restrictive. The Board of MedicalExaminers in each State is charged with implementation of the Act,_thus,through intent and experience, the privileges of Physicians' Assistants canbe either extended or withdrawn, and this can be made to apply to individualcases.

Prepared by__Gaswell Grave

Approved by_B. Lewis

CG:sg

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HA-60-112

5-2720-HOU-3-222

February 1, 1973

' To: Norm Belasco, Chief, DE2

Subject: /Update of Information on Utilization of Parameds

PHYSICIAN ASSISTANT TRAINING

Per request of IPO for information on parameds, the American Medical As-.sociation was contacted by telephone on January 29, 1973, for any updatesto their position statements and studies beyond:

0 Anon..: Current Status of the "Physician's Assist~n£" Concept,Informational Bulletin, AMA, Chicago, JuneTi971.

0 Points, T.C.: Guidelines for Development of New Hexlth Occupations,JAMA 213:1169-70, 1970.

The first lists 48 sites where PA's are trained along withprerequisites, duration of training, and av&,rd upon completion.

The second proposes development of new career fields in healthcare by real location of tasks, design of training programs,requirement validation, and certification.

The AMA spokesman stated that they had nothing more recent.

The National Institutes of Health were contacted on January 29, 1973, forinformation and publications more recent than:

0 Anon.: Selected Training Programs for Physician Sujoort Personnel,Bureau of Health Manpower Education, NIH, KEW, 1971.

0 Anon.: Program Support for Physician's Assistants Tin Primary Care, Bureauof Health Manpower Education, NIH, DHEW, 197>2.

0 Collins and Bonnyman: Physician's Assistants and Mirse Associates - AReview, Institute for the Study of Health md Society, Wash. , D.C.,1971 (HSMHA Contract).

The first lists training courses including 4:3 for Physician'sAssistants and 25 for expanded roles for nurses.

The second describes federal support available for PA trainingprograms. Funds are available for start-up, instruction, studentsupport, and follow-up costs. The goal of Hie support seems to beto control course content. In time this shiuld control the career

• fields, prevent overlap, and assure usability of the graduates.

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I.Norm Belasco . . 5-2720-HOU-3-222NASA ' . 2

The third reviews the background, describes the graduates andprograms, weighs problems such as status, recognition, mobilityand insurability, and the current usability of the graduates ofPA and Nurse Associate programs.

The Health Manpower Education Office, NIH, (Mr. Braun, 301-496-1981) had noupdates to these references nor.pertinent newer materials.

No compendia review the federal training programs for military corpsmen, IndianCommunity Health Medic, VA Assistant, or Merchant Marine. Syllabus-type

.information on the Gallup and Phoenix CHM programs is on hand.

Lack of pertinent activity by the AMA on paramedical personnel in. leadpositions is understandable because of the diversity of opinion in theirmembership. Adding their prestige to that of the several States who haveaccredited Physician's Assistant training programs would be a boon to thosetroubled by potential problems in gaining acceptance by prospective patientsof health care delivery by paramedical personnel.

It is suggested that the entries in Volume II, Medical Considerations inSite.Selection (II-3LKS), be reviewed. Updating in specific areas will becompleted upon request. This could include specifics on State legislation,new programs in being which utilize parameds in primary patient contacts,current and new training programs with respect to course content,'evaluation,etc .

Prepared byCaswell Grave

Approved by_W: B.aewis

CG;sg

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HA-60-113

Subject: Pennsylvania Physician's Assistant Legislation

Mr. Henry W. Walkowiak, Director of Comprehensive Health Planning,Commonwealth of Pennsylvania, was contacted on Feb. 6, 1973, on the currentstatus of amendments to the statute on Physician's Assistants which would haveamended the basic act to permit "under the supervision of" in place of thecurrent stipulation which amounts to..."in the presence of" a physician. The

.-amendments..were .defeated by .not .being reported out of committee, and nochange is in immediate prospect.

Nurse Practitioners do not enjoy a legal right to practice as practitioners.The nurse licensure act is 55 years old, and amendment is proposed, butnurses are generally against an alteration of their relationship whichwould give them expanded roles.

Copies of applicable acts were promised and the respondent verified hisnon-political posture. He asked only about, the v/eather, and no informa-tion was divulged on topics other than the weather.

Caswell Grave, Ph.D.

CG:sg2/7/73

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HA-60-114*

Subject: New Mexico Physician's Assistant Legislation

Mr. Ralph Marshall, of the New Mexico Medical Society, was contacted by.telephone on Feb. 6 to determine status of the P.A. legislation pendingenactment in New Mexico. Mr. Marshall stated that the session lasts 6weeks and action in less than one month would not be anticipated. TheOptometric Society is seeking to amend the bill, and the Medical Society isaligned against amendment. Mr. Marshall stated that the Medical Societywould rather lose the bill than accept amendment.

Mr. Marshall suggested .contact wi.th .the .Nurse Examining Board in NewMsxico for nurse status briefing (503-268-7744).

Attached is an interpretation of the draft Physician's Assistant Act of-New Mexico.

Caswell Grave, Ph.D.

Attachment

CG:sg2/7/73

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'Subject: New Mexico Physician's Assistant Legislation

'-: INTERPRETATION OF NEW MEXICO HOUSE BILL ON•:. • ' MEDICAL PRACTICE AND REGISTRATION OF PHYSICIANS'

•' . ASSISTANTS, ALSO KNOWN AS SENATE BILL - 62,i;; " 31ST LEGISLATURE, 1ST SESSION, 1973 (DRAFT COPY)

y:If enacted, this Bill v/ill exempt Physicians' Assistants from most of the

-provisions of a detailed and restrictive medical practice act. Remaining'privileges and restrictions of the P.A. v/ill be implemented by and be atthe discretion of the State Board of Medical Examiners, which is the usual•legislative solution. The Board will apparently not be able to waive•detailed legislative restrictions, to wit:

(1) The P.A. receiving compensation from other than a physician.

(2) The physician supervising more than 2 P.A.'s.

(3) The practice of pharmacy'without a license.

(4) The practice of physical therapy without a license.*

(5) Any act not performed at the direction or under the supervision ofa licensed physician in accordance with Board rules.

(6) Any act not otherwise permitted by law nor established by custom.

•It is believed that the intent and probably the letter of each can be accom-modated by techniques suitable to the Board, such as:

(1) Compensation. The intent is to prevent hanging out a shingle. Thereceptionist can prevent misunderstandings by collecting in the nameof the Government, and the responsible physician can approve eachpertinent payroll entry. See attached Oklahoma utilization.

(2) Two P.A.'s per physician. P.A.'s can be assigned administratively todesignated physicians. Another physician can be scheduled to fill infor the designated physician on a shift basis. When more than 2 P.A.'sare actively seeing patients, more than one physician would have tobe on call. See attached Oklahoma Utilization.

(3) Practice of pharmacy. A licensed pharmacist or physician is oftenlegally required to act in dispensing drugs, which consists basicallyof labelling the drug and dose. A nurse or other designated assistant(in a hospital, nursing home, or elsewhere) can complete the delivery

T T 1C

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Subj: New Mexico Physician's Assistant Legislation

without being in violation of usual pharmacy laws. Depending on theNew Mexico statutes, it may be necessary for a pharmacist to visit theLHSC periodically to fill patients' containers. All other acts of apharmacist are apparently not restricted.

(4). Practice of physical therapy. This will not become a problem unlessand until physical therapy is ordered. Tentative IfBLMS lists did notlist physiotherapy equipment.

(5) Physician's direction and supervision. The detail required in direction\ . and supervision is left to the Board of Medical Examiners. The usual; technique is for the physician to state his intended mode of use of

the P.A. and receive approval of the Board.

(6) Legal and customary acts. The P.A. can do anything that is legallypermitted to him, or can be legally delegated, or is customarilydelegated. This is not defined in this bill, but is left to the Boardfor regulation and to the courts for adjudication.

It is suggested that something concrete like the Oklahona P.A. utilizationplan of the Veterans' Administration be referred to the New Mexico Board ofMedical Examiners for approval in the near future, whenever legislation hasbeen enacted. Since they hold the approval authority, they will be deter-mining the manner of performance of Physicians' Assistants.

Caswell Grave, Ph.D.

.AttachmentCG:sg2/7/73

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Positiot- Description,^?-^Two Graduate Physician's A. x.-mts Employed by_the

Veterans Administration Hospital in M.iskoocc, Oklahoma

I. Principal Duties and'Responsibilities:

The incumbent must be a graduate of an-approved program for Physician'sAssistants and duly registered by the American Association of Physician'sAssistants and performs all duties listed below.

A.. Professional " • . •t * ,

1. Performs initial history and physical exraluations on new inpatientsand outpatients, establishes presumptive diagnoses, establishes

• general workup of patients by ordering appropriate laboratory(: studies, performs routine incisions and drainages, wound care and

debridement, nasogastric intubations, gastric analysis, lumbarpunctures, sutures lacerations, etc., the majority of which areperformed directly or indirectly under the physician's supervision.

'"\\. 2. Performs diagnostic tests such as insulin and I.V. glucose toler-ance tests and tolbutaiiude tests, tissue biopsies,.lumbar punctures,paracentesis, thoracentesls and other procedures in consultation

" with the physician. .

']-. ' 3. Places indwelling arterial catheters and performs the necessaryr", blood gas analysis. • . .

i.-. 4. Starts whole blood.'"•' . • ' " ' ' • . ' • ' ' •

5. Starts I.V. solutions. • . .* " ' '.

6. Administers emergency medications.

7. Manages cardiac arrest patients until attending physician is; present.

8." Manages acute respiratory failure until attending physician ispresent. . •

9. Manages life-endangering traumatic injuries until the attendingphysician is present.

• 10. Administers intravenous medications when necessary.

11. Assists the physician in planning, organizing and deliveringorderly medical management programs for patients under his care.

.12. Arranges consultations and sees that patients are correctlyscheduled for special tests.

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13. Is availat( 3i call to any area in the hr/"r\yil during histour of duty to assist in any emergent pal^tnt care situationthat.may arise.

14. Is thoroughly familiar with all current diagnostic, therapeutic,'. clinical and medical management techniques.

B. Technical and Administrative

1. Assists and trains individuals in certain diagnostic, therapeutic,clinical and medical techniques.

'2. Assists in the training of students enrolled in OklahomaUniversity's baccalaureate degree program for Physician'sAssistants.

3. Maintains a file of current reference material and keeps abreastof current knowledge in the field of medicine.

4. Assists the Chief of Medical Service in the discharge of adminis-trative and educational responsibilities associated with thatservice.

II. Supervisory Control Over the Position:

He-is under the direct supervision of the Chief of Medical Serviceand general supervision of the physician as designated by the Chiefof Medical Service.

III. Other Significant Facts: . •' '

"Die incumbent will work with a minimum of direct physician supervisionon both Medical Service and Outpatient Service. He must exercise personaljudgment in planning and carrying out a medical care program to meet complexdiagnostic and therapeutic objectives on the basis of his personal knowledgeand experience. He must exercise originality in solving problen\s not coveredby guides and make adaptations and modifications of procedures with minimalsupervisory guidance or review to meet the complaints and highly varyingneeds of the patients. He is expected to have an in-depth knowledge ofhuman anatomy, chemistry,' physiology, as well as diagnostic, therapeutic,clinical and medical management techniques. He is further expected toassist in the instruction and training of such physician's assistant studentsas may be assigned to him from time to time.

11-39

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HA-60-115

NASA/HEW PAP AGO AHSFU CONFIGURATION' COST REDUCTION ANALYSIS

I. Replace the KHSF with an increased'capability dispensary ambulance (called

a Mobile Health Unit). This option will eliminate the two large Cleveland

vans presently planned and replace them with one Manitowoc Motor Coach

(expanded version). X-ray,'microwave, and TV capability would have to be

, added to this unit.• *

Rationale - The MHSF (2 vans) is not suited to the constant relocation

requirements associated with the low population density existing at the, *

Papago site. The current LMSC site analysis report calls for the MHSF to

move on a daily basis which will result in reduced service capability and

a waste of manpower. ' ,

Savings - Estimated: $100K-$150K (the base cost delta for each unit

r without special equipment is approx. $60K per LMSC cost proposal).' \ . ' " » . . . .

'\_-' . '-;. . ~ ~" "" ' '

II. Use IMS physicians, physicians' assistants, secretaries, clerks, receptionists,

and drivers during Part III (operation and evaluation) in place of KFI person-

nel. LMSC would provide the system operators and maintenance technicians,

IHS/HEW would supply the remaining personnel.

Rationale - (1) IHS medical personnel are available (see site selection for

the DHEW/HASA-IK3LMS AHSFU Test Project, p. 4.). (2) LMSC will design and

l?uild the systems and therefore should be better suited to operate them.

Savings - Based on a 2-year Part III and burden costs of $15K per man per

year, total savings to NASA would be equal to $270K.

Impact - IHS has agreed to furnish only 9 people at this time. The critical—

•people to be supplied for this option v/ould include 4 P.A. ' s and 3 X-ray

technicians.

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I I I . El iminate the redundant and hot standby capabi l i ty from the communicat ions

system. These options effect ively double the cost of the terminal equip-

ment. LMSC is now proposing going to a redundant (command on) terminal

capability. LMSC is now also proposing to handle only video on the micro-

wave system. Voice and automated data would be via UHF/VHF.

Recommendation - E l imina te the redundancy and hot standby features of the

microwave system, i.e., provide only one terminal at each facility and in

the relay station.

- Rat ionale - A loss of microwave would only cause a loss of video capabi l i ty .

Impact - Non-elective surgery (emergency) might have to be directed by

voice only corrmunication.

Savings - Estimated: $52,500 (based upon Motorola cost proposal/hot

standby estimate).

DM:sg

2/9/7311-41

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PROGRAM IMPACT OF A BUILT- IM HOLD AFTER PART I'

Assumptions

1. Consider Papago site only.

2. Three hold periods - 30, 60, or 90 days.

3. No construction architectural lead time required.

4. LMSC w i l l hold a team of key people on board. The size of this team

-will become smaller as length of hold is increased.

5. A 90-day lead time is required for computer system equipment.

6. Some redesign wi l l be required and another design review wi l l be held.

7. Computer hardware and software people wi l l be double-shif ted to m i n i m i z e

schedule impact.

8. Computer system would be firmed and go-ahead given to lease or purchase

- immediately after hold.

9. Revision of all plans and specifications would be required prior to

second CDR./

At a cost of $1000/per day to maintain a team at LMSC, the hold cost would

be $1000.00 x no. of days in hold + cost of ma in t a in ing team through Part I

(not shift into Part II as' p lanned) + cost of replanning and redesign,

approximately 2 months @ $1500.00 per day.

Total cost for 30-day hold

30 x 1000 + 60 x 1500'= $120,000 +_ delta equipment costs

Total cost for 60-day hold

60 x 1000 + 60 x 1500 = $150,000 +. delta equipment costs

Total cost for 90-day hold••

90 x 1000 + 60 x 1500 = $180,000 +_ del ta equipment costss

Schedule impact approximately (days in hold + 60)«••

11-42

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NOTE: As hold period increases, team members w i l l be lost and not replaced

until program is restarted. This Savings would be offset by recruiting

training time of their replacements.

BKrsg

2/12/73

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HA-60-118

ADVANTAGES OF CONSERVING THE MOBILE UNIT CONCEPT

PART I - Listing of advantages to the I MBIMS Programof.maintaining the mobile unit concept.

PART II - Listing of advantages to the site/service areasin the maintaining of the mobile unit concept.

11-44

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Advantages to the IMBLMS Programof

Maintaining the Mobile Unit Concept

1. Communications

Maintenance and Logistics more representative in .mobile unit

Ruggedized equipment

Space and weight limited system

Variations in signal strength and noise content more representative

of space situation

2. Medical

Modular packaging for equipment tested in more realistic conditions

Supplies and expendables logistics for supply evaluated

Supplies and expendables handling of disposable wastes evaluated or

developed

3. Personnel

Greater (more representative) scope of individual responsibility and

training requirements

Nature of physician/paramed interface more representative of space

Rotation of personnel to evaluate learning rates and effectiveness

of training procedures

Provides broader spectrum of health care delivery operating environment

11-45

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Advantages to the Site/Service Areasof

Maintaining the Mobile. Unit Concept

1. Medical

Meet more people and get more utilization data

Do more preventive care by bringing care to people

Do more health education by bringing care to people

Shorter trip to medical facility

2. Training

Opportunity to rotate personnel meaningfully

Provide better scope and variety of tasks to develop higher competence

3. Costs

Provides better opportunity to compare costs and effectivenesss of

different models/

4. System

Cushions impact of poor selection of site for LHSC

Provides better opportunity for system demonstration because of additional

facilities and equipment that are not part of current models in

Florida, New Mexico, Utah, Wisconsin, and elsewhere

Provides better planning data for other applications than afforded by

one fixed facility

Provides better opportunity to compare capabilities of different modes

Cover larger area

Better evaluate future sites for facilities

5. ManagementBetter able to serve distant emergency

11-46

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HA-60-103

REVIEW OF THE LMSC SUMMARY OF IMBLMS PHASE C' CONTRACT KICKOFF MEETING - DEC. 20, 1972

ACTION ITEMS AND RESPONSIBILITIES

I. SITE ANALYSIS

A. NASA/HEW Action

1. Mr. Tuff - Request additional information from proposingcommunities.

a. Pennsylvania - Clarification of independent paramedic,- operations.*

* Site proposal refers to "Nurse-Practitioners."

o _ Clarification of independent paramedicoperations required.

B. LMSC Action ' . .

1. Revise the Site Analysis Plan Schedule and incorporate comnents.

2. Release Preliminary Site Analysis Report 1/21/73.

II. PROGRAM MANAGEMENT AND CONTROL

A. LMSC Action ' .•

• 1. Work Breakdown Structure (WBS) accompanying write-up. No duedate specified.

'2. Key Personnel Responsibility Definition. No due date specified.-

III. COMMUNICATIONS AND DATA MANAGEMENT '

A. NASA Action •

1. NASA will provide LMSC with information on MEDICS program/system. No due date (Ed Moseley).

2. NASA will provide LMSC information on the NASA/SCI TV Viewing/Diagnosis Study. No date (R. L. Lindeman)

B. Kickoff Meeting Items Needing More Discussion

1. The Data Management (Software and Hardware, GFE Package) meetingindicated that LMSC needs a lot more information on the Philcoand Ed Moseley programming effort.

11-47

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; REVIEW OF THE LMSC SUMMARY OF IMBLMS PHASE CCONTRACT KICKOFF MEETING - DEC. 20, 1972

ACTION ITEMS AND RESPONSIBILITIES

III. COMMUNICATIONS AND DATA MANAGEMENT-(Conf.)

'•• RECOMMENDATION: LMSC should plan to have an LEC programmer assignedto IMBLMS in Houston for approximately one year towork with Dr. Moseley/Philco/Varian on IMBLMS soft-ware development. Then this man should plan to gointo the field with the system for about one monthon system start-up. :

LMSC did not address this in the minutes of the meeting.> •• .

2. Data Management '

On Video Recordings

"a.. Will all patient encounters be video taped?

• b. Will the video tape become a permanent part of thepatient history?

Boeing Answers:

. a. Video-tape capability will be included as a systemJ-? feature. However, the physicians will decide what he

wants taped. •

IV. QUALITY ASSURANCE - . . / , "/

Action Required: -.

General - No responsibility assigned - items requiring further investigation

• 1. Contain"!nation control of gas systems

• 2. Certification of gases

3. Review of PRL for components criticality. •

'4. On-site calibration equipment definition«

No due dates assigned.

V . RELIABILITY . . .•

• A. NASA - Dan Becker';

. .1. Failure Report Format definition - due 12/22/72

11-48

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•• REVIEW OF THE LMSC SUMMARY OF IMBLMS PHASE CCONTRACT KICKOFF MEETING - DEC. 20, 1972

ACTION ITEMS AND RESPONSIBILITIES

V; RELIABILITY (Cont.)

B. NASA/LMSC Action

•1. Resolution of off-the-shelf equipment technical data acquisi-tion. Combined action -.no due date.

VI. SAFETY '

NASA/LMSC Action> • '

1. Resolution of off-the-shelf equipment technical data acquisi-tion. Combined action - no due date.

VII. MEDICAL ASPECTS AND OPERATIONS

NASA/LMSC

•Resolution of patient referral philosophy - no due date.

* Add.G. Lab to identify area - specific medical problems whichaffect System Design Requirements. • •

11-49

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COMMENTS CONCERNING DATA MANAGEMENT PRESENTATION AT IMBLMS PHASE C

KICKOFF MEETING - . HELD AT NASA-HSC, ON 12/20/72

1. The functions to be performed by the Data Management System are not

well defined nor understood. There is a critical need for an in-depth

functional analysis. It is believed that KFI must perform this analy-\

§is in the near future in order to create a clear definition of data

system needs. This problem v/as mentioned in the text but was not

included as an action item. ' ]

2. The Data Management. System design definition is relatively vague.

This problem is closely related to comment 1. above.

3. No data v/ere presented for helping verify.that adequate hardware is

being proposed for the Data Management System, e.g., Variah 620 hard-

ware may not be the best available because of relatively recent

advances in hardware design. '•.

4. Proposed development plans for the Data Management System v/ere not

available. It must be assumed that there are major development prob-

lembs because, historically, data systems always have their share. A

detail development plan should be developed in the near future, e.g.,

level of manpower schedules for meeting critical milestones, etc.

EC:sg1/4/73

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HA-60-129

A memorandum was prepared to point out unresolved topics in AHSFUdevelopment (HSSCC, MHU, Medical Operations, Communications, DataSystem, Training, and Administrative Functions).

The list served as a topic guide during a joint NASA/HEW/LMSC Inter-face Coordination and Planning Meeting held in Tucson, Arizona,April 26 and 27, 1973. It also provided a pre-meeting, agreed-uponIPO position on each unresolved item.

11-51

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HA-60-129

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11-66

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HA-60-123

WORKING MATERIAL

FOR CONSIDERATION IN ARRIVING AT AGREEMENTS

BETWEEN HEW, IHS, NASA, AND LMSC,

AS A RESULT OF '

THE IM8LMS PROGRAM REDEFINITION

MARCH 20, 1973

11-67

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I. REDE FIN ITION OF THE SYSTEM

In accordance with the NASA/HEW program rede f in i t i on , the fo l lowing areas

are ident i f ied as requi r ing consideration for change:

A-. Identify nev.' system conf igurat ion

1. HSSC at Sells

a. Modi f i ca t ion of exis t ing fac i l i ty ( ins ta l la t ion of

physician's and operator's console and computer

equipment

b. Provision for support trailer

2. LHSC

a. Modif icat ion of exist ing faci l i t ies for communications and

associated equipment - microwave transceiver, antenna, and mount

b. Impact of these modificat ions on existing operations

3. Relay Stations

Location of site - modif ica t ions , addi t ions , or construction,/

as required

Power

Access

Ownership end permits

(1) Logan (on site)

(2) Mt. Lemmon

(3) Kitt Peak (existing)

4. Tucson Computer Center

Authorization to instal l antenna, transceiver, and terminal

Modif icat ion requirements ( fac i l i ty , electrical , and grounds) to

install the equipment in the Bejl Aerosysterns fac i l i ty

Impact on exist ing operations - s t a f f i n g to operate this terminal

1 11-68

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5. Mobile Health Unit (MHU)

a. ' Define and explain the new MHU concept and configuration

b. Base of operations

c. Route-schedules

d. Support requirements (utilities, waste handling, etc.)

e.' Logistics

6. Litter Wagons (existing)

Impact "of "RAM instal 1 ati on and op'erati on

B. Identify areas to be changed based upon:

1. Communications equipment

a. HSSC and LHSC

i. Loop assignments - authorizations and transmission path proving

(a) 2.1 G hz - voice loop (UHF)

(b) 7.7 G hz video loop (one-way, receive at HSSC)

ii. Definition of power and grounding in existence>

iii. Definition of additional Bell equipment and lines required

b. MHU

Definition of power availability and probable MHU sites

c. Litter Wagons (existing)

i. Reservation coverage (identify areas of communication

blackout)

ii. RAM installation and interface (power and isolation)

d. RAM

i. Relay or direct link

11. Maintenance (since RAM is GFE)

211-69

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• 2. Medical equipment in KHU - Refer to marked-up PRL

3. Computer system

Computer hardware procurement (lease) and Maintenance Contract

4. Existing/additional facilities required'

Define the existing facilities available and discuss additional

facilities required such as support trailer, relay sites, and

associated maintenance facilities

5. GSA vehicles will be required to support AHSFU operations

C. Identify software requirements/division and responsibilities

1. Discuss and define what software HEW, NASA, and LKiSC will provide

a. Systems software

b. Applications software

c.' Interface software (to facilitate interaction between IM8LKS

and HIS software and data)

2. In areas where original software must be developed, define who is

responsible for the development

a. Responsibility for the production of interface software require-

ments and programs

b. Modification responsibility (maintaining and updating the

software)

c. Define software configuration control techniques and modification

methods and records to be maintained

11-70

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II. MODIFICATION OF THE CONTRACT (STATEMENT OF WORK)

A. Rewrite basic contract

B. Rev/rite subcontracts

C. Interagency agreements

(NASA/HEW)

11-71

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. I I I . PROGRAM A D M I N I S T R A T I O N AMD MANAGEMENT

A. Es tabl ish IHS/NASA/LMSC interface agreements

1. Resolve and ident i fy point of s ingle commitment source on HEW/IHS

and NASA/LMSC agency responsib i l i t ies

2. Define organizat ion and communication structure for interfacing the

par t ic ipat ing groups to insure informat iona l flow betv/een NASA/LMSC

-•and HEW/IHS

3. Subordinate communicat ion interfaces in categories of interest, i .e . ,

data management, fac i l i t i es , provisions, or logist ics, etc.

B. Agreement on schedule of milestones

1. HEW/IHS provide inputs to program p l a n n i n g and schedul ing

- 2. • Program p lanning would inc lude preparation of all program documentation

C. 1. Resolution of details in cost reduction and d iv i s ion

2. Cost considerations must inc lude requirements for and procurement of

medical supplies i n c l u d i n g replacement of consumables

D. Define and resolve interface on equipment specified or procured by LMSC

to be insta l led in IHS faci l i t ies inc lud ing required agreements on

procurement, maintenance, and operation of the equipment

E. Define organizat ional interfaces when LMSC personnel work in IHS fac i l i t i e s

which are under the general supervision of the IHS. Establish a team

concept for the par t ic ipa t ing parties to insure maximum program benef i t .

F. When it becomes necessary to change the system to accomplish NASA goals ,

required changes wi l l necessitate agreement from IHS/HEW personnel.

511-72

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Such changes as protocols, equipment, or type of data being recorded and

level of treatment being administered, may be required to satisfy NASA

system evaluation requirements. Define the type of agreement required

to assure that the desired changes will be incorporated.

G. Discuss staffing, skill levels, headcount, definitions, and agreements

H. Program reporting plan

Define HEW/IHS and NASA/LMSC program reporting plans for technical

progress and contact status

I. Patient population, participation, and enhanced communication relations

will be encouraged through presentations and informational releases by

HEW/IHS

611-73

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IV. AHSFU EVALUATION

Determine the evaluation and coordination plan for the program to highlight

HEW and NASA participation and define LMSC/HEW coordination to prepare a

unified evaluation plan.

A. Effectiveness of hardware, software, and personnel

B. Evaluation and reporting will be required for NASA/HEW benefit

C. Resolve in addition report frequency, format, evaluation approach, and

who submits this data

V. OPERATIONAL ASPECTS

Resolve which agency and who would obtain authorization or clearance for such

things as rights-of-way or access, building permits and authorizations,

licenses/permits for personnel and vehicle facilities, etc.

Impact areas as follows:

1. Communications system

a. FCC authorization

b. Facility modifications

c. Staffing

2. Relay station

a. Roadway

b. Right-of-way

11-74

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3. Building permits

a. Land acquisition

b. Access

4. MHU

a. Licensing

Vehicle

Operator

b. Maintenance

VI. KFI ROLE

*-. Codif ica t ion/

5. I d e n t i f y the role of KFI

f" Assure that the previous responsibilities of KFI, which are not included

in the residual role, will be picked up by LMSC or IMS

8

11-75

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VII. GENERAL ITEKS

A. Where LMSC and IHS personnel share the use of common facilities,

equipment, or services, an agreement must be reached on how and what

procedures are established to facilitate these features (joint

occupancy rules and agreements)

B. Review the total logistics responsibility for operational supplies

in terms of:

Provisioning, utilities, expendables, consumables, inventory, etc.

C. Overhead Operating Costs

Resolve division of overhead operating costs

D. Responsibility for patient welfare and patient charges or medical fees

must be resolved/

E. Standby coverage and manning notification for off-duty

9 11-76

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V I I I . AGREEMENTS R E Q U I R E D

Items needing to be resolved:

. A. New contract

B. Modi f ied program p l a n n i n g documentation

C. Revised schedule

D. Define responsibilities and establish the roles of participants

(NASA, HEW, IHS, and LMSC)

Definition of HEW/IHS role during:

Part I - Definition and Design

Part II - Assembly and Test

Part III - Operations and Evaluation

E. Obtain authorization to install system components

1. Relay station

a. Logan - right-of-way, b u i l d i n g permit, access road, land/

acquisi t ion, transmission path proving , FCC author iza t ions

•b. Mt. Lemmon - addit ion of antenna arid relay equipment on the

existing tower, FCC authorization

2. Tucson Computer Center

Obtain authorizat ion to ins ta l l the AHSFU associated equipment

in the Bell Aerosystems facility

1011-77

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HA-60-103

5-2720-HOU-3-216

January 19, 1973

To: Norm Belasco, Chief, DE2

Subject: Engineering Reviev/ of the IMBLMS AHSFUUpdated System Block Diagram, Revision B, Figure A-2

An engineer ing review v/as performed of the preliminary system blockdiagram (updated) . This review indicated a need for addi t ional modif i -cations and/or addi t ions , as fo l lows : .

1. Physician console does not include a CRT terminal. This capabilityshould be provided to the physic ian to facilitate access and upda t ingof patient history data.

2. KSR-35 teletype wi l l be noisy and should be replaced by a thermalor electrostatic unit at the physician's console. A packet containingdata on several improved keyboard units was provided to LMSC by mai lon January 18 for consideration.

3. The physician console design concept must consider and include thecapability for s imul taneous 2-physician operation with separatemonitors and audio (headset) capabi l i ty .

4.- The equipment shown in the "Equipment located in same room as physicianand operator consoles" should be placed in the System Operator's room.

5. The ECG switching controls output l ine (to computer) has the arrov/headdrawn in the wrong direction.

6. The block diagram does not reveal how 'X-ray data is transmitted tothe HSSCC.

7. The diagram does not show what equipment utilizes the X-Y plotterin the LHSC.

Prepared byDon Mangold

Approved by < ,W= B, Lewis

DM:sg

11-78

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HA-60-109

Comments on KFI Work Sv-. i.en.er.t.

In response to your request, the IPO suggests that the work statement

be revised to:i

Add a personnel section which includes paragraphs on personnel

such as 3-7.1, Operation Plan. ..

Include physician personnel in the personnel paragraph, per Table 1,

and make the personnel lists in paragraph 3.7.1 the same' with respect to

UN's, PA's, LPN's, secretaries, and others. •• .•*-.-" ' * • » • / * '

Include a qualification statement for each specialty such as licensing

for the physicians as appropriate, registration or licensing for personnel

qualified as nurses, certification of physician's assistants by the state

of service, the state, offering the training, or the gdvernaent when the

physician's assistants are federally trained, nurse practitioners be

graduates of "expaiuied role" programs, and operators/technicians/maint-

enance personnel be qualified by training and experience to accept KFI

training on AHSFU equipment. . ..:': ' " . -

The IPO feels that the LKSC IKBLMS Medical Director should review the

qualifications of all personnel proposed by KFI to man the system and

ascertain that those persons who will make patient contacts are liberal

in their approach to me'dicel practice in rural areas across racial,

group and socioeconomic differences, as wnll as motivated to contribute

personally to the improvement of rural health care delivery.

The IPO feels that the total exclusion of HEW influence from the work

statement is undesirable; HEW should be invited to participate in scheduled

reviews ancbffer advice and assistance but not be cast in the role of

decision maker. . • .

The IPO feel a that the insurance plan for medical practice should be

defined in this subcontract.

11-79

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Comment on content of SOW:

1«1 Introduction

KFI responsibility to furnish facilities should be defined, as are personnt

services and materials. /.. . .

3-. 2.2 Surveillance

Insert LMSC before. IMBLMS Program Office. ;•;

1.2.3 Guidance . .....

Insert .LMSC before IKHLMS Program Office. One office should be prime

in surveillance, rather than shared responsibility. See note o:.

paragraph 3.7.1 below, - . ' • ' • ; : . . .

lt_2. 5 Technical Information Releases

Modify the second sentence to incorp&rate the provision "... and will provj

Lockheed the opportunity to meet NASA information release requirements

and to make suggestions ..." The IPO feels that HEW should function in

this loop. ;.'X : ' '^ " : • ;"}*lt. Preliminary Program Definition

In keeping with results of the kickoff meeting, the word "measurement(s)n

should be changed, wherever it appears, to "procedure(s)n or other less

quantitative synonym. ' .';: "•:..»•?. ';\,;V;;''V'• V'-'• • .

.7.1 Operation Plan.- ' ' . . " ' .

Hake the KFI medical administrator responsible to someone - perhaps LMSC

IMBLMS Medical Director. =-•;':; ••-.-:•'-. '• * . •

3.7.2 Logistics flar!. 8.0 Packaging

Both cover packaging.r Since neither stands alonjp, it is suggested that

the entries.be made only once. It is further suggested that KFI ascertain

whether the mobile facilities (MHSF, DA, and A) will require special

packaging for storage end transit of medial equipment,perhaps of reusable

nature, in the sense of medical instrument cases which may or may not be

routinely furnished by the vehicle or equipment vendors. Examples are

x-ray, spirometers, and microscopes. Packaging in the sense of equipment

packages that can be secure'd and used in transit, e.g., reauscltators, ECG

equipment, and IV stands, should be addressed in this or other procurement

3.7.2 LoRistics Pier.

The next to lest paragraph should-be recast to clarify the final clause •

11-80

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• • • ; • • ' ' ' ' ' . 3

in the sentence. This topic 'is regarded as operations rather th&n

logistics. The solution is too sirtple - most repeat patients should

return to the LHSC rather than be met by the KHSF or DA. The last paragrap

la also regarded as operations ir. nature, and possibly beyond the scope

of the subcontract. . :

3.10.1 Training Plan . ' . . ' . ' .

Change the first sentence to include medical and other personnel.

.3,10.3 Training Equipment and Materials

Change the 1-est li»e -to •include--medical -and other personnel.

5.0 Meeting Support

It is suggested that HEW be invited to meetings held during the operational

phase. . . . • • . '.--. • : • ..,..-..-

The reference to Las Cruces Hospital should be removed and the Control

Center and remote sites should be added. • .

Attachment E . - ' • ' ' ' - . • • . . • • / • • .

Attachment E was not available for IPO's review.

11-81

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HA-60-120

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11-89

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5/31/73

BACTERIAL SENSOR (GODDARD SPACE FLIGHT CENTFR)

Technology Utilization; Dr. Picciolo 301-932-2121In-House Program

Require table, 110-volt power, microbiological hardware, and a $900 photcreter(Amer, Inst. Cem-Glow).

Centrifuge or filter desirable.

Only DuPont makes sufficiently pure reagents from fireflies.

Chemicals require frozen storage.

Cost of determination is BOe.

Sensitivity is 10 organisms/ml.

Readout is on photometer scale.

Recorder (5 mv) desirable. Can manually read photometer scale.

Not working on automated model.

Use hand preparation of samples.

Are working on both centrifuge and filter preparation of samples.

Do not know which is preferable.

A device is still at Johns. Hopkins in clinical trial.

Could furnish automated model if funded. Want funding for photometer recorder($1»000), training, travel, other costs such as centrifuge, filters, etc.

Photometer 110V — 160 W

Recorder - 110V — 200 W

Centrifuge 110V — 5200 W (oversize); floor mount required

Filter 110V — "550"W" (Lab vacuum)"

Heater 110V — 500 W

11-92

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5/31/73

G0 ANALYZER (R&D)

Dr. Harris

Requires power, listed below.

Is currently self-sufficient (displays, printouts).

Basic components are suitcase portable.

Requires resupply of reagents, probably preloaded into expendable rotors

Components:

V W A (Peak) Wt.

Analyzer

Oscilloscope

Printer

Loader

Wash Station

Rotors

Computer

nono 14

nono

no

no

2

1/2

3/4

V2

0

TBD

30 IDS.

(3 15 Ibs.

(3 20 Ibs

@ 10 Ibs.

(a 0 Ibs.

Not present

Two items to be delivered for laboratory clinical tests in 1973 at JSC.

Analyzer uses 2 amps only while heating.

Washer uses air at +30 psi and vac at -5 psi.

Desire computer to read IBM card printout (program conversion required).

Eleven chemistries available; 9 enzyme.

Can be hand loaded.

IM8LMS availability date uncertain,

C. D. Scott; Wayne Johnson 615-483-8611 (Union Carbide at Oak Ridge)

Contract No. NASA T-1187A; AEC 40-259-71

11-93

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5/31/73

BLOOD PRESSURE MONITOR (SKYLAB)

(OSC) (Nolte)

Skylab version requires 28-volt power, gives digital display and analog signalto transmitter. Requires nitrogen for pressurization - records on tares enground. Consists of cuff, microphone, preamplifier, pneumatics, and display.Not packaged - is rack mounted.

SCI commercial models are for 110-volt operation, are packaged, and give bothanalog and digital outputs.

Three are on hand. Unit cost is $3,000.00.

Others may be on order.

Use Skylab model's gaseous nitrogen, 90-210 psi.'

28-volt models on hand. Backup unit available 2/74.

Power 28 V DC 23 W (avg.)for 10 V DC

Monitor -10 V DC

JSC . NolteSCI VickMartin-Marietta (Denver) ' Talcott

Contract No. NAS 8-24000

11-94

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5/31/73

MICROBIAL LOAD MONITOR (R&D)

(JSC) (Dr. Ferguson)

Design is in formative stage. Will give quick response, automated, C&S data.

Will require specially packaged media. Prototype availability likely 1/74.

IMBLMS availability possible 1/74.

JSC Dr. Ferguson

McDonnell-Doug!as Cliff Aldridge

Contract No. NAS 9-11877

11-95

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5/31/73

PROGRAMMED ERGOMETER (SKYLAS)

(MSFC-Developed)

Ergometer can be programmed to supply any of several loads or to load to aselected heart rate or to a sequence of heart rates.

Ergometer operates on 28 volts DC.

Watt-minute indicator operates on 5 volts DC, 0.4 amperes.

Ergometer interfaces with cardiac monitor, VCG, or other pulse driver.

Ergometer requires 16 Watts (peak).

JSC Engineer Lem

MSFC Engineer Gene Bond

Units currently at JSC.

Backup unit available to IMBLMS 2/74.

11-96

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5/31/73

FROST ANALYZER (SKYLAB)

(JSC) (Booher)

Interfaces with cap and signal conditioner.

Interfaces with tape recorder and sleep level SCR.

Operates on 28 volts DC.

Commercial models are packaged and operate on 110 volts.

Outputs are analog tape of EEC and EOG with gaps for head movement, alsochart of sleep pattern by time and stage.

JSC • BooherSCI Howard VickMartin-Marietta (Denver) E. LaRueBaylor Frost

Power requirements - 28 VDC, 25 W or 110 V, 25 W.

Items currently at JSC and currently available for IMBLMS.

Contract flo. MAS 8-24000.

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i

EEC CAP AND AMPLIFIER (SKYLAB)

(JSC) (Booher)

Power for signal conditioner from analyzer.

Interface wi th Frost analyzer.

Refrigerator storage for cap.

New, cheaper cap be ing developed by SCI, Frost patent.

JSC BooherSCI Howard VickMart in-Mariet ta (Denver) E. LaRueBaylor Frost

Skylab model operates on 15 volts from analyzer, powered by 28 VDC.

CMCL analyzer operates on 110 volts, s imi la r ly powers the cap p r e a m p l i f i e r .

Skylab model records all data on tape. .

Outputs are analog EEG, EOG and n u l l time when head is moving, also chart of

sleep pattern by time and stage.

Power requirements are included in the analyzer power requirement.

Items currently at JSC and currently avai lable for IMBLMS.

Contract No. MAS 8-24000.

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DIGITAL THERMOMETER (SKYLAB)

Environmental monitoring model.

Range is -400° to 4-200° F.

Could change probe and give body temp to 0.1° F.

Battery powered (replaceable).

Wattage trivial.

Availability - uncertain. Prototypes at JSC. Procurement only by McDonnell-Douc"Items used in SM.EAT.

JSC Bob BondSCI Vick

Contract Mo. NAS 9-9190.

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CELL COUNTER (SKYLAB)

Performs cell counts.

Lysis permits WBC count.

RBC and platelet estimation to be provided.

Army unit may be preferable.

Have 28V, 110V, and battery powered options. 5 watts.

Sample is collected, diluted, and cells counted by impedance changes asthey pass electrodes.

Beckman development.•

Jack Walsh, monitor.

JSC - Day

Items to be in-house by 8/73.

Qua! test unit available to IMBLMS 1/74.

Contract No. NAS 9-12473.

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SLIDE STAINER (SKYLAB)

(osc)

Beckman development; Jack Walsh, Mgr.

Does Wright and Gram stains.

Manual operation and timing.

Zero-g.

Stands alone.

4 IDS.

4 x 5 x 9 inches.

Stains one slide at a time.

Stain time is about 5 minutes.

Fluids moved by plungers.

Manual replenishment of stains./

Manual removal of v/aste reservoir.

JSC Engineer - Day

Backup unit on hand.

Backup unit available to IMBLMS 2/74.

'Contract Mo. NAS 9-12473. x

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VCG SYSTEM (SKYLAB)

Need electrode harness assembly; subject interface box; electrical umbilical;

electronic module (ESS) for power, calibration, timing, test, and amplification.

4 power supplies.

+28V Calibrate Signal+10V Operate-10V Operate

+5V Heart Rate

35 W constant power.

3 = X, Y, Z channels and

1 = Heart rate channel produced•

4 channel recorder on ground

On Board = Digital H.R. display only.

X, Y, Z telemetered. Also H.R./

Are qua!, DVTU (recovery); DVTU (Hof f l e r ) ; t ra ining and backup units 2/74

Ground based program for loop display + vector calculat ion and interpretat ionand printout is separate. '

Martin-Marietta (Denver) - Marty Costello

Need oscilloscope display of loops;

Computation for vectors;

Measurement for intervals , amplitudes, slopes, durations, intercepts and rates.

Contract No. NAS 8-24000.

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3-D VCG DISPLAY

Computer program is used for automated computation of vectors and displayof loops.

Now performed on CDC-1108.

Goal is to have complete analysis with interpretation.

Program name is VECTAN.

Program is similar to the Veterans Administration (Pipberger) program.

Without this device, physician can read charts of the three leads, compute .vectcvand make any desired measurements. VCG's on tape.can be displayed on scope, endloops can be photographed.

VECTAN now in use.

Complete analysis by computer may be available about mid-1975.

Manager: Dr. Hoffler.

Duplication of program for use elsewhere would require some 9 man-months./

In-house program.

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TELECARE (R&D w/SCI) PAM

Consists of:

Suitcase

Batteries (rechargeable)

Drugs

Oxygen

Semi-automatic B.P. , (Auscultatory)

Stethoscope

EKG & Display

Defibril lator •

External Pacing

Fluid Aspirator (Freon powered)

AMBU Resuscitator

Ai rways

Laryngoscope

Interface to Ambulance Transmitter

UHF Transmitter for EKG & Voice to the Ambulance

Weighs 35 pounds. Is free-standing.

JSC - Dr. PoolSCI - Howard Vick

Available to JSC 7/73.

Available to IMBLMS 1/74.

Contract No. NAS 9-13295.

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PULMONARY FLOWMETERS (R&D)

Dr. L i u , Quantum Dynamics ( turbine flowmeter)

Will require 110-volt power.

Wattage - not established.

Displays and printouts are integral.

Total device is respiratory analysis system with mask, one-way valves, massspectrometer, mass flow measurement + timers, counters and computers.

OSC Dr. RummelQuantum Dynamics Dr. Liu

Available to JSC - 1/74.

Available to IMBLMS - 1/75.

Patent: NASA-CASE-MSC-13436-1; N72-20113.

Contract No. NAS 9-11585.

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IV FLUID DEVICE (ZERO-G)4

(JSC) (Day)

Free-standing; activated by self-supplied pressure.

Formative (RFP) stage. Mot under contract,

Probably available in prototype FY 74 and in quantity in FY 75.

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ASPIRATOR

(OSC) (Day)

Free-standing in concept.

Formative (RFP) stage.

Probably available in prototype in FY 74 and available to AHSFU in FY 75.

Will probably be electrically pov/ered (28 V).

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PORTABLE DISPLAY ENTRY DEVICE

(JSC) (Moseley)

Concept stage. Not under contract.

Probably available FY 76.

Requires computer interface.

Battery powered.

LMSC may design computer interface for IMBLMS.

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DRY EKG ELECTRODES

(ARC) (Dr. Sandier)

Currently available.

No logistic problems.

Require dry electrode signal conditioner and power supply.

Utilizes FET's in electrode, plus signal conditioner in box which could becorr.ea biobelt fixture.

In-house program.

Expect to have commercial source in CY 73.

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ULTRASONOSCOPE

(ARC) (Dr. Sandier)

Formative stage.

Microwave link-up (TV transmission).

Two prototypes on hand.

Power requirements - TBD.

No current availability.

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PULSE DOPPLER BLOOD FLOW

(ARC) (Dr. Sandier)

Formative stage.

This device is pulsed, not continuous like the Frank!in-Rushmer device, andwill give volume flow instead of velocity. Not revealed whether this is aninvasive device.

i

Two prototypes.

Availability projected.

Power - not established.

Project inactive pending relocation of principal investigator from Europe to US

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BONE ANALYZER

(ARC) (Dr. Sandier)

Ready 1974.

Will be made available.

Employs a radioactive source. Isotope license required.

Free-standing.

One-of-a-kind.

Isotope is in a source box. Scanner is on the other side of the bone. Princip'is- radiation absorption. No injection.

28-volt flight model.

110-volt laboratory model.

PI is Cameron, U. Wisconsin.

12 months to produce a test item.>

Power requirement not defined.

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COMPUTER-BASED PULMONARY FUNCTION TESTING

(ARC) (Dr. Sandier)

Available 1975.

Now being demonstrated in San Diego VA Hospital.

One-of-a-kind.

Power requirements - not defined.

Contract Mo.

Monitor - John Billingham (ARC).

Tech. Monitor - John West.

Contractor - Perkin-Elmer.

This is a very large device with a computer. It may be out of place in a snaTfacility.

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SWALLOWABLE TEMPERATURE ENDORADIOSONDE

(ARC) (Dr. Sandier)

Ready 1974.

Inexpensive - cost not prohibitive.

Could be produced in the quantity necessary for clinical use.

Require tracking-receiving device (telemetry)

Self-contained battery and transmitter. Briadcast range is 1 to 2 feet. Willimprove to 5 to 10 feet.

Contractor - EPH Konigsberg.

Contract Mo.

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VISION TESTER (HAYNES)

(ARC) (Dr. Sandier)

Could be loaned and demonstrated.

Two items are currently available.

Probably no logistic support requirement or interface obstacle.

Power requirements -

In-house program. Commercial source being developed. No contractor. Nocontract number.

Investigator - Jampolski.

Monitor - Dick Haynes.

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IMSS MODIFIED (SKYLAB)

(JSC) (Chassay)

Incubator not usable in 1-g because of side loading unless modified as for S'-'EAT.

Power requirement 28 V, 1.55 amp (peak), 1-3 amp (steady).

Microscope, head-mounted light, otoscope and ophthalmoscope require spare batten'sand bulbs.

Incubator requires CC^ source such as Alka-Seltzer and water. .

In-house program.

Excellent packaging for medical items.

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STEREOMETRIC DETERMINATION OF BODY SHAPES

(JSC) (Whittle)

Requires:

Camera

Grid

Film Processing

Film analysis by manual or automatic devices

Manual or automatic computation

Alternate analyses could be effected elsewhere if images were transmitted-electronically or by mail.

Film-making and processing at site could be circumvented by TV cameras rendering

TIRR-Baylor (Houston) - R. E. Herron.

Contract No. MAS 9-11604.

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PLASMA ELECTROPHORESIS

(JSC - Kimzey)

This is a conceptual experiment for Skylab which v/as not developed. In-hcuseprototypes v;ere built by attaching micro-cells to batteries to effect seraraiicr,and determination of immunoglobulins, isoenzymes, and other plasma fractions.A flight item might be built that would weigh about tv/o pounds.

Use in IMBLMS would require a development cycle.

Systems used in in-house prototypes were Beckman.

This v/ould be a very austere version of a sophisticated, useful clinical c'svice.It would be of low practicality in a clinic for ambulatory patients whereimmunology patients, heart attacks and injury patients would be referred.

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PORTABLE DEFIBRILLATOR AND EKG DISPLAY

(JSC) - (Day)

This device would be a flight prototype of the telecare item which would belighter and more portable.

OSC - Day.

Contractor - SCI or other.

Contract No. - none assigned.

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HA-6Q-131

COMMENTS ON "A PROPOSAL FOR A MEDICAL RESEARCH SEMI-TRAILER VAN" BYCAPTAIN G. R. McCAHAN, JR. DVM, U. S. ARMY AEROMEDICAL RESEARCH LABORATORY

INTRODUCTION

This proposal was reviewed at IPO request to determine its relevance and applic-

ability to the IMBLMS program. Although this paper is called a proposal, it

is actually a fairly complete, well engineered and planned preliminary procure-

ment specification.

RECOMMENDATIONS

It is recommended that this proposal be used as a guide in the preparation

of the Mobile Health Unit (MHU) portion of the IMBLMS Statement of Work (SOW).

In addition it should be provided to Lockheed Missiles and Space Co. (LMSC)

to be used as a guideline in preparing the MHU specification and the Medical

.Coaches subcontract SOW.

DISCUSSION '

All the contents of this paper which are applicable should be considered

for inclusion in the MHU specification. The Boeing comments are of three

types:

•A. Enthusiastic agreement with the section as written.

B. Elaboration or expansion of existing areas.

C. Additions necessitated by unique MHU features.

The comments are arranged by sections, as follows:

Section I

A. Scope

This section with some modification and additions is directly applicable to

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IMBLMS. A generalized description of the MHU should be provided here

and a comment on intended utilization of the MHU included.

B. This section contains an excellent guide to what should be included in

the MHU specification or SOW.

Section II

1. General Physical Configuration

a. The statement on "good riding quality" should be better defined

for the MHU specification (i.e., riding qualities equivalent to

DOT Standards for Ambulances). Equipment shock mounting require-

ments should also be specifically defined.

b. The statement on vehicle leveling capabilities ("when stopped on

less than 10° slope, the unit must be capable of being easily

leveled") should be included (p. 2).

c. The provision for vibration limits on environmental conditioning

equipment is excellent and- should be used (p. 3); however, noise

levels of NC-60 are excessive and should be limited to NC-40 or•

lower.

2. Insulation specifications should define rate of heat transfer or

stabilized temperature gradient through the roof and walls, in addition

to the statements on insulation fire resistance, packing or settling

(p. 4). " -.

3. -Communication tower specifications are particularly applicable to the

MHU and should be included (p. 7).

2

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4. Door specifications are considered to be extremely important and

considerable effort should be exerted by LMSC to assure that this portion

of the specification is detailed and adequate (p. 9).

5. Suspension, clearance, axle loading and braking capability (normal and

emergency) should be carefully considered and defined. The emergency

braking system should be a v/arning feature which will alert the operating

personnel of malfunctions or failures (p. 11).

6. Wind loading requirements are very important features and certainly should

be included (p. 13).

7. The environmental conditions (p. 18) are considered to be acceptable

as written and should be included in the specification.

8. Electrical requirements (p. 18 and on) -

a. The KHU will probably not require the use of 208 V 3-phase

: service; however, the provisions of the National Electrical Code

(NEC) should be met in all cases.

b. Lightning protection and grounding provisions should be clearly

defined. These features were not addressed in the paper.

c. An emergency 12V system should be specified in the treatment area

to provide lighting and patient support in case of primary

electrical system failure.

d. Illumination should be used in place of lighting intensity and

luminance (pages 19 and 20). In addition, supplementary provisions

for 200'-candles lighting by spotlights should be provided in the

exam area.*

>*

3

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e. Internal Environmental Control System (IECS) - The IECS shall

provide required environmental conditions inside the MHU over a

normal exterior ambient temperature range of 100° F. to -10° F.

and over an extended range of +130° F. and -30° F. The inside

temperature shall be maintained at 75 +_ 3° F. over the normal

range and 75° +_ 8° F. over the extended range.

f. Emergency Motor - Generator capability must be sized consistent

with the MHU intended utilization and fuel availability at the

site of intended use.

9. Ancillary Equipment (p. 23 and on) - The L.P. gas system should be

evaluated and considered if L.P. gas is available at the Papago site.

10. A powered winch should be a mandatory piece of ancillary equipment.

(None was specified in this proposal.)

11. The water system drains and freezing protection features should be con-

sidered mandatory specifications^ (p. 26).

12. The medical modules concept (p. 29 and 30) and the storage and locking

features appear to be very desirable and should be given favorable con-

sideration for inclusion in the MHU specification.

13. The locations of all service connections and filler caps should be

carefully defined to provide safe, efficient service with minimal

impact upon system operations and patient handling.

14. Oxygen and breathing air systems cannot utilize petroleum lubricated

pumps, controls, regulators, or fittinos. regardless of the filtering

techniques employed.

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15. Throughout this paper the word "adequate" was used several times to

define a level of performance. Better methods of level performance

definition are required.

Section III

Performance, test, and evaluations (p. 32 and on)

1. The sections on General Provisions, Examination of the Product Dimensions

and Weights, Mechanical Inspection, and Manuals, are very complete and

should be used as a guideline in defining the MHU SOW or specification. Some

wording changes will be required because of unique MHU features, however,

the intent and scope of this section should be fully met.

2. Vehicle Performance Testing .

a. A set of readability and handling tests should be defined as part of

the MHU acceptance tests. These tests involve:

(1) Interstate roads/

(2) Two-lane asphalt highways

(3) Graded gravel and unimproved roads

(4) Off roads (sand and loose gravel) and sloped field

(5) Turning radius tests

b. Maximum and minimum load tests should be specified with 90°

crosswind components (of 30 mph wind velocity) at normal driving

speed on improved roads. Maximum and minimum load configurations.

should be defined as part of the test specification.

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3. Medical treatment configuration set-up, operational readiness checks,

and retrofit for moving tests should be specified in general agreement

with section E (p. 38 and on).

4. Weather testing is a must and should include dust exposure (fine sand,

wind-blown)./

5. Continuous operations testing (p. 42) for a span of 24 hours is considered

to be adequate and should certainly be specified.

6. Delivery, final acceptance, warranty, and correction of deficiencies

sections are considered to be adequate and should be included in the

MHU specification.

7. An evaluation of MHU patient handling capabilities must be included

in the performance testing prior to delivery. This evaluation should

be conducted using normal patient loading and include admittance,

preparation, processing, and release activities.

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HA-60-121

March 13, 1973

To: 'DA/Chief, Bioscience Payloads Office

From: DE/Chief, IMBLMS Program Office

Subject: Request for Review of Preliminary Study

Reference: DA-73-M067

Attached herewith are the comments resulting from a review of the LifeSciences Flight Research Program - Preliminary Study.

Norman Belasco

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5-2720-HOU-3-234

March 13, 1973

Subject: Review of Li fe Sciences Flight Research Program for theSpace Shuttle Program - Preliminary Study

Reference: Request for Review of Preliminary Study, DA-73-M067,dated February 8,' 1973

INTRODUCTION . ' .

This review was accomplished by Boeing Life Sciences in accordance withContract NAS 9-11756, Task 1.3.

The document provides an excellent background overview and present statusof the proposed Life Sciences Fl ight Research Program. To facil i tate th'isreview, an abbreviated out l ine was prepared and is attached (see Append ix} . .

COMMENTS , .

1. The document is informative on existing program plans but is totallylacking in de f in i t ion of a p lan for the organizat ion of the LifeSciences Research Program. Specif ical ly , the document does not mentionany organizat ion s imi la r to the exist ing research efforts i n v o l v i n gPrincipal Coordinating Scientists and/or Principal Investigators.

2. The research p lan is based upon the candidate experiments program fora manned space station ("Blue Book") . . The "Blue Book" should be updatedand corrected to reflect current l i fe sciences state-of-the-art knowledge.

3. No plan was out l ined, suggested, nor requested .which would accomplishthe dissemination of data or informational transfer between par t ic ipat ingagencies.

4. The document was vague about the assignment of roles, about the variousNASA centers, and the responsibilities associated wi th these roles andassignments.

5. The document did define technical paper and information useful asworking paper (objective no. 1); however, it was totally lacking in thedefini t ion and suggestion of an organiza t ion (or approach) to accomplishthe management of the research program as was defined in objective no. 2.

RECOMMENDATIONS ' •

The subject study is a quite thorough exercise which describes in exquisitedetail ways of developing representative payloads for the variety of 'flightopportunities which are conceived to become avai lable .

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, • • 5-2720-HOU-3-234NASA 2

The reader will develop answers to nearly all the questions for whichanswers can currently be projected. Updating can make it more useful. Itis suggested that a future version accomplish these objectives:

A. Describe a less micrometaboTic evaluation than is outlined on p. 3.8.

B. Leave open an option to refurbish and refuel the Tug in orbit ratherthan recover or relaunch it (p. 1.4).

C. Redesignate titles of crew members, i.e., Pilot and Copilot are consideredpasse1, should be Commander and/or Pilot (p. 3.2).

D. Consideration be given to the five comments above for inclusion insubsequent documentation or reissue.

E. Typographical errors should be corrected:

pps. vi, vii, 2, 1.8, 1.10, 3.2, 3.4, 3.5, 3.7, 3.8, 3.15,3.23, 3.25, 3.27, 3.28, 3.31, 3.32, 3.35, 3.37, 3.45, 3.47,and 3.55. .

Prepared b 6'C'lJ _W. Mangold/Caswell Grave

Approved byW. B. Lewis, SupervisorBoeing Life Sciences

sgAttachment (9 pages)

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APPENDIX

TO

MEMO 5-2720-HOU-3-234

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STUDY OVERVIEW OF THE LIFE SCIENCES FLIGHT RESEARCHPROGRAM FOR THE SPACE SHUTTLE PROGRAM - PRELIMINARY

STUDY.

I. BACKGROUND

A. Scientific Pay load Planning

B. Flight Opportunities

1. First manned orbital test flight

2. Carry-on

3. Shared sortie lab

4. Dedicated sortie lab

II. OBJECTIVES - The objectives of this document are:

A. Provide working paper for the development of specific l i fe sciencespayload p l a n n i n g guidance.

B. Provide a basis for developing an approach" to the management of theresearch program for the Space Shuttle.

III. ORGANIZATION

A- Part I - Framework for research - vehicles and missions; examinationof mission configurations.

&• Part II - Sortie lab l i fe sciences f l i g h t research program

1. Examine aspects of short duration low orbit spacef l ight - .

2. Life sciences payload def in i t ion and integration study

C. Part III - Candidate studies by f l igh t opportunities

Examination of research opportunities associated withvarious f l ights

IV. RECOMMENDATIONS FOR STAFF ACTION "'.

A. Staff Actions

1. Review this study as a working paper

2. Submit comments to MMS (Headquarters)

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STUDY OVERVIEW - SPACE SHUTTLE • J

B. Staff Review

1. Study is based upon Blue Book - therefore, it contains errors

2. Review of Part I - to consider revisions in assessment of flightopportunities

3. Review of Part II - to consider accuracy and sufficiency oflife sciences program as described

4. Review of Part III - to consider the "factors influencing therevision" as well as the "options and general characteristics

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DOCUMENT OUTLINE

PART I - FRAMEWORK FOR R E V I S I O N

I. MAJOR COMPONENTS

A. Booster, unmanned, solid propellent, soft landing (parachute)

B. Orbiter.- orbital altitude, internal payloads

C. Orbital Laboratory - carried in the Orbiter payload bay

1. Shirt sleeve environment

2. Man-tended experiments with modi fiable_ pro tocojs

3. Where possible, use conventional lab equipment (apparently doesnot separate from the Orbiter)

D. Sortie Laboratory - wi l l remain with the Orbiter dur ing Orbiter f l i gh t ,carried in payload bay .

1. .May be extended from the bay

2. May be exposed by opening the payload bay doors

3. Draws power from the Orbiter

E. Research and Applications Module (RAM) - Minor Items

1. Free-flying laboratory

2. Carried to orbit in the payload bay

3. Supporting power and crew accommodations

4. W i l l be revisited and resupplied by the Orbiter for crew changesand maintenance

F. External Pallet - Used with sortie lab or RAMi

1. Operated EVA or remotely

.2. May be small automated unmanned research satellite (retrievable)

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DOCUMENT OUTLINE ' 2

G. Space Tug - Reusable Propulsion Vehicle

1. Low orbit to h igh orbit boost

2. Moon or planet boost

3. Return to Orbiter after use

H. Modular Space Station - Consists of a number of RAM's

Long-term sophisticated programs

II. FLIGHT OPPORTUNITIES

A. Carry- on Flight Opportunity

1. When l i fe sciences research experiments are placed upon non-life sciences Shuttle missions

2. Flights dur ing which the payload bay is maintained empty orunavai lable for l i f e sciences research

• *

•3. -Gar ry-on-ex-periments-wou-ld be -conducted 4-n -the Orbiter crew/passenger compartment

a. Ut i l i z ing Orbiter electrical power

b. Ut i l i z ing Orbiter data management

B. Shared Sortie Lab

1. Laboratory space and resources are shared by two or more disciplines2. Shared mode decision factors

a. Experiment requirements (power, environment, etc.)

b. Compatibili ty of experiments

c. Total weight of experiments and support gear

d. Time-line compatibility

C. Dedicated Sortie Lab

1. Entire lab dedicated to l i fe sciences research

2. Offers most space and all resources to support experiment

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DOCUMENT OUTLINE 3

3. Simplified Planning

4. Liberalized schedule and protocol

D. Shared/Dedicated Sortie Lab

After full operational development of the Shuttle, these options maybe interchangeable; however, in this study, the shared sortie labopportunity will be considered as a single flight opportunity occurringprior to the dedicated sortie lab.

III. FACTORS INFLUENCING SCOPE AND DIRECTION OF.LIFE SCIENCES RESEARCH

A. Carry-on Flight Opportunity

1. Scope of life sciences effort constrained by primary missionobjectives

a. Must be compatible with flight test operational requirements

b. Compatible with Shuttle weight and balance, hatch sizes,interior dimensions, etc.

c. Places minimum demands on Shuttle power, environmental control,communications, and data

d. Simple tie-in structure/syste,ms

2. Special case: first orbital test flight

a. One or more orbital flight test plans

b. Pilot and copilot only

c. First zero-G experience with the Shuttle

d. These factors will affect any life sciences research effortproposed for the first Shuttle orbital flight

3. Subsequent development flights prior to sortie lab

a. 7-Day orbital missions of physical sciences disciplines

b. Payload bay will not be available to life sciences research

c. Carry-on life sciences experiments will be limited to thecrew/passenger area .

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DOCUMENT OUTLINE

d. Two scientist passengers per-missi 'on

e. Acceptance of a l i fe sciences carry-on payload wi l l not dictatea requirement for a l i fe scientist passenger

f. A mission specialist/payload scientist wi l l be on board(3-man crew)

B. Sortie Lab Flight Opportunities , • .

1. Vehicle Capacity and Resources

a. Payload bay dimensions 15 x 60*

b. Adequate electrical power, environmental control, datacollection/management for any anticipated l i fe sciencesexperiment (except human centrifuge)

c. No major constraints anticipated

2. Mission Duration

—a. 7-Day-mis s-i-ons (-5-day orbit-work-period)

b. 30-Day mission (28-day orbit work period)

3. Orbital Alt i tude end Inclination •

a. Low orbit (300 nautical miles)

b. Circular, Equator ia l , or Polar orbits

c. Below Van Al len Belt; however, wi l l be exposed to the SouthAmerica Anomaly and the Polar radiation environments.

4. Reentry/Landing Fl ight Prof i le

Low level of G accelerations

5. Non-astronaut Crew Members - Early sortie missions wi l l haveattendant rigorous select ion/training standards for scientist/candidates

6. Multi-member Crew - Complex array of psychophysiological funct ions ,social adjustments, and group dynamics .wi l l have to be considered

7. EVA - New applications w i l l require development of improved l i f e . •support systems and mobi l i ty aids

»

8. Teloperations - Manipulator techniques will have to be developedto play a role in payload deployment and retrieval

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DOCUMENT OUTLINE • ' 5

PART II - SORTIE LARGE LIFE SCIENCES FLIGHT RESEARCH PROGRAM

I. INTRODUCTION .

A. Suitability

1. Short Duration - Low Earth Orbital

2. Excluding experiments involving penetration of the Van Allen Beltand extended duration space flight

B. Visibi l i ty

Except for centrifuge, some level of all areas of the overall l i fesciences research program w i l l be involved

C. Research Goals

1. Detailed information on psychological adaptation to zero-G•and re-adaptation to a 1-G environment •

2. .Improved teloperator techniques, methodology, and instrumentation

3. Improved EVA systems and techniques

4. Improved design and method for l i fe support systems in extendedspace f l i gh t

5. Development of m a n ' s role and effectiveness in performingresearch tasks in the orbital laboratory

6. Selection criteria and free-flight training/indoctrination ofscientist-crew members

7. Assessment of ionization/radiation hazards

II. RESEARCH OBJECTIVES AND CANDIDATE STUDY AREAS

.A. Functional Program Elements ( F P E ' s )

V. FPE No. 1 - Medical research (human)

2. FPE No. 2 - Vertebrate research (non-human)

3. FPE No. 3 - Plant research

4. FPE No. 4 - Microorganism and cell tissue culturet

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DOCUMENT OUTLINE

5. FPE No. 5 - Invertebrate research

6. FPE No. 6 - Life support and protective systems research

7. FPE No. 7 - Manned systems integration

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DOCUMENT OUTLINE • ' 7

PART III - CANDIDATE STUDIES BY FLIGHT OPPORTUNITIES

I. CARRY-ON FLIGHT OPPORTUNITIES

A. First Orbital Flight - Special Case

1. Factors

a. First opportunity to observe crew stress to fu l ly operationalShuttle mission

b. Limited crew size (pilot and copilot)

c. Requirements for medical f l igh t operations support

(1) Monitor crew for physiological changes

(2) Evaluation of Orbiter man-system interfaces

(3) Evaluat ion of Orbiter l i fe support

(4) Environmental control and habitabi l i ty

2. Study Options

There is no "requirement" for l i fe sciences research per se onthis test f l igh t .

3. Candidate studies for first orbital test f l ight

Studies of this type are possible only if an additional medicalcrew member is accepted.

. B. Shared Sortie Laboratory Flight Opportunity

1.' Factors In f luenc ing Research Studies

2. Mission Objectives

3. Candidate Studies for First Shared Sortie Laboratory

C. Dedicated Sortie Laboratory Flight Opportunity

1. Factors in f luenc ing the research effort

2. One week dedicated sortie laboratory mission FPE's 1, 6, and 7»

3. 30-Day dedicated sortie laboratory miss ion involv ing FPE's 1through 7

,11-138

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HA-60-106

5-2720-HOU-3-214

January 12, 1973

To: Norm Belasco, Chief, DE2

Subject: Results of Life .Sciences Payl.oad DevelopmentCommittee Meeting, Jan. 8-12,'1973

..Space Shuttle Payload Analysis

Modular Space Station (MSS) mock-ups in Building 9 were examined on January8, 1973, in the company of John Mason, Charles Walkinshaw, Vernon Bailey,and others.

These mock-ups represent some"of the modules that might be carried by theSpace Shuttle. None was outfitted as a Life Sciences module, but lifesupport features were present (non-functional) such as food preparation,shower bath, waste disposal, and exercise. Utilities available were arealighting and a comfortable environment. For use, utilities would be neces-sary, as well as functional consoles, experiment hardware, and, probably,a more substantial floor. 'Some live "loads such 'as "experiments with plants,invertebrates, and vertebrates, including mammals, would be needed; and,at some stage, a simulated or actual data system will be important in providingvisualization in three dimensions of concepts undergoing Concept VerificationTesting (CVT).

A meeting v/as called by John Mason on January 9 to discuss plans for BlockII CVT in the Building 9 mock-up. Attendees included Mason, Walki-nshaw,Bailey, Simmons, Hoffman, Mangold, and Grave. The Chairman proposed a newname for the Committee to render it invulnerable to possible directivesterminating efforts in specific areas such as Space Shuttle, Biosatellite,etc., that would not be intended to invalidate the function of the Committeein attempting to provide realism and economy in future biological and medicalactivity in the space environment. The suggested name is "Life SciencesPayload Development Committee". Agenda for the Committee include:

1/9 - 1/30 Arrange for removal of irrelevant consoles.Move in Life Sciences equipment from any available sources.Crystallize initial _protocpls and their sequence

2/1 - 2/28 Begin experiment timelines for histology, radiation, andmicrobiology.

3/15 Introduce macro (animal and plant) experiments and microexperiments (tissue and cell cultures).

3/23-25- Begin analytical procedures. •

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Norm Bel asco '• 5-2720-HOU-3-214NASA = • ' . 2

The level of testing is described as Block II. Block I testing on asimilar module developed by GDA is scheduled to start on 1/15/73, at AmesResearch Center. The mock-up is to .be refined and shipped to MSFC for a.continuation of the Block I effort .at MSFC. The MSC Committee will examinethe mock-up while at MSFC. 'Effort will be made to obtain Life Scienceshardware from mock-ups for earlier programs including Skylab.

Prepared by_Caswell Grave

Approved by_W.'B. Lewft

cg;sg

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HA-60-132

DE2/4-73/16 ' . -'

MEMORANDUM

TO: DA12/Chief, Bioscience Payloads Office

FROM: DE2/Chief, IMBLMS Program Office

SUBJECT: LSP Experiments Program Plan

In line with our objective of developing planning material v/hich definesthe needs of the LSP Program, a proposed program plan for LSP ExperimentIdentification and Selection and Principal Investigator involvement hasbeen developed. A copy of this planning material is attached for yourreview and comments.

This material represents preliminary conceptual level of developmentonly as it was done under our Boeing contract (Mr. Lev/is) and our re-sources have been r.pread very thin. I believe, however, that it willserve to illustrate the level of detailed planning that can and shouldbe done to support our contention for the role of lead Center for theISP program.

Per our earlier discussions, I will be able to provide a presentationof this plan at our next LSP committee meeting.

Norman Belasco

Enclosure . - •

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PROGRAM FOR LIFE SCIENCES PAYLOADS (LSP) EXPERIMENT

IDENTIFICATION/SELECTION AND P.I. INVOLVEMENT '

LSP Experiments General Program Concepts

Provide for Solicitation of Individuals, Institutions, Agencies, etc.- Define needs of the program- Define and outline basic approach- Plan and schedule the activities- Administer the program

Resolve and Formalize a Structure for:- Submitting recommendations for experiments- Selecting and incorporating experiments- Disseminating information- Utilizing results of findings

Provide Program VisibilityWhat - Material/content of the information to be disseminatedWho - Institutions and individuals requiring visibilityHow - Media of presentation or display of informationWhen - The schedule for preparing and presentation of various

types of information

Define and Formalize the Roles and Responsibilities of NASA Centers,Participating Institutions, and Individuals

- JSC study and propose

- Centers rev lev/ and concurrence '

- NASA HQ approve and authorize release

- JSC prepare formal documentation

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MAJOR ACTIVITIES DESCRIPTION

0 Develop Plan for Solicitation of Involvement of Appropriate Individuals,

Institutions, Agencies, etc., from the Scientific Community

This plan will be developed and documented to be used as the prime •

reference for those participating in the LSP Experiments Program. This basic

plan will:

- Define the needs of the program

- Define and outline the basic approaches for accomplishing the

solicitation, proposal, selection, and incorporation of experiments

and P.I., involvement

- Provide a sequence and schedule for the major program activities

- Define the needs for and outline the administrative approach for all

aspects of the program.

This plan will define the experimental areas to be included - starting

with the broad fields of life science (morphology, anatomy and microanatomy,

embryology, physiology, ecology, biophysics, biochemistry, genetics) and

progressively refining the detail of definition until specific individual

experiments are identified. It will suggest the type and nature of experiments

sought in each field, along with general objectives, constraints, etc.

Based upon a review of the results of several recently completed studies

and- program planning efforts, a summary of past and present involvement of

various institutions, NASA, and industry, along with how the effort fits into

the overall LSP development plan, will be prepared. This summary will become

a part of the baseline information for planning new activities.

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The plan will identify and describe the approach to identify experiments

and principal investigators. It will describe the types of involvement

expected or desired, who (institutions, agencies, individuals) would be in-

volved, and the scope and schedule for this involvement.

The plan would reflect the policies that currently exist and additional

policy positions that will be required relative to the selection of experiments

and participants, assignment of responsibility, organizational structure,

program funding, program objectives, approach., benefits, and utilization of

results, etc.

0 Resolve/Formalize Structure for the Recommendation, Selection, and Incor-

poration of Experiments or Scientists into the LSP Program

A major activity involved in development of the basic plan will be

defining a proposed system (structure) including management plan, organizational

structure, documentation procedures, and directives. The plan would provide

for the generation, submittal, and processing of proposed experiments, for the

review and acceptance/selection of proposed experiments, and for the incorpor-

ation of selected experiments into the LSP experiment program.

This portion of the plan will describe the mechanics and organizational

structure for implementing the train of events (along with what, who, and how)

from the invitation to submit a proposed experiment to the final incorporation

of selected experiments and Principal Investigators into the LSP program.

11-144

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Sample forms for requests, submittals, evaluation, acceptance, incorporation, etc.,

will be developed. Proposed roles and responsibilities of organization (NASA

and others) participating in this activity will be described.

0 Develop a Program to Provide Visibility

The task of providing good program visibility to all persons involved

in the program is of significant importance. Visibility ranging in detail from

-the-program-infor-ma-t-ion-pequ-ired by NASA Headquar-ter-s personnel to-the detailed

information useful to the scientist proposing an experiment must be presented

in many forms to suit the variety of needs of the program.

A general approach to providing the visibility will be defined which

identifies: .

. 1) The types of infonnation to be presented to various people.

2) The media and materials to be used in delivering the information.

3) A method of measuring the effectiveness and provisions for main-

' taining adequacy of the information system.

A.brief study will be conducted to"define the various types of inform-

ation that v/ould be required or desirable to the many individuals who would be

involved in the program in such roles as administrator, review board member,

Principal Coordinating Scientist, or-Principal Investigator.»'

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The program for providing visibility will require a well conceived se-

quence of contacts be made to accomplish proper program indoctrination - the

who and the order as well as the media to be used in disseminating information.

In making the determination of who the proper personnel to be contacted

.are and what experiments should be included, a progression of policy and approach

meetings will be held. In-house NASA/JSC meetings will be held initially to

discuss specific functions, roles, and responsibilities, with subsequent

meetings including other centers (but more extensively MSFC and Ames).

The NASA Center meetings would define in summary form the category of life

science experiments that need to be defined and set some priorities for seeking

experiments and scientists in various discipline areas'.

The preparation of materials to provide program visibility would be

preceded by a thorough effort to assure a well planned program - a cleat-

understanding of what needs to be communicated, to whom, and the best way

to accomplish the job.«

Information would include summary information on the Shuttle Program,

the Life Sciences Payload Program, and more specific information relating to

the individual experiments. Prospective research participants or P.I.'s would

be provided with such information as the objectives, scope, and constraints

of experiments to be performed, as well as information on the mechanics of

getting an experiment included in the LSP program and the details of develop-

ments of that experiment from acceptance throughout the preparation and opera-

tions phase of the LSP flight mission.

,; * * * *

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0 Define and Formalize the Role and Responsibilities of NASA Centers,

Participating Institutions, and Individuals

The .activity will provide NASA Headquarters with a well conceived

plan for administering the program and will define for all participants

their roles and responsibilities.

This plan will be formulated in preliminary form by JSC. After

review and concurrence of the involved NASA Centers, it will be reviewed

for approval by NASA Headquarters. After NASA Headquarters approv.al and

authorization for release, JSC will prepare all necessary formal document-

ation required. • *•

11-147

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HA-60-136

Instrumentation approaches taken by IMBLMS for advanced SpaceStations .and by General Dynamics/Convair (GD/C) for the Space Shuttlewere compared.

The first five sheets show similarities and differences within thebiomedical areas for spectrophotometric, gasimetric, and pneumo-graphic analysis; also slide preparation and serial physiologicalchemical analysis. The succeeding fourteen sheets are GD/C computerprintouts which add details of application and cost estimates. Theterminal five sheets are appended to show that use of only fouritems from IMBLMS, JSC R&D, and Skylab would save an estimated $2 millionin developmental costs for a Space Shuttle Sortie Laboratory. Threeof the items selected are in the .Sky lab Launch of May 1973.

Although they have not been studied, similar savings are anticipatedin the man-system integration area.

A more intensive analysis could reveal additional significant savingsin these and other areas.

II-H9

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HA-60-136

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f B. Life Sciences Payload Development**

A brief comparative analysis was conducted on measurement techniquesand equipment associated with the General Dynamics/Convair (GD/C)computer printout generated for MSFC and the IMBLMS methods forperforming measurements common to the biomedical functional ProgramElement (FPE). The measurements in other FPE's in the GD/C print-out that have commonality with biomedicine, especially vertebrateand life support, were also examined. The analysis revealed thatseveral items from IMBLMS, Skylab, and JSC R&D Programs havepotential utility in the Shuttle laboratory. Among these are zero-G joperable hardware including the G0 analyzer, slide stainer, massspectrometer, and cell counter, all of which can be used as coreequipment with no additional development cost, and result in a develop-mental cost reduction of $2 million from the current estimates. Three |of these devices are in the '73 Skylab launch. The results of this janalysis were presented by IPO at a weekly Payload Concept Committee |Meeting. • j

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Item ° Name Substitute I. (

91 Multiple Autoanalyzer - use G0 analyzer j2327 Stain Apparatus, Wrigh'ts - "use"SkyTab -slide stainer I1351 Gas Analyzer, Mass Spec. - - use Skylab mass spec . j2371 Staining System, Bacteriological. - use Skylab slide stainer 1

* • I*Uncertain Title uncertain - part of - use Skylab cell counter

hamatologic system; usefulin other particle counting

»

Item Dev. Cost Production Cost

91 $ 700,000 $ 100,0002327 100,000 30,0001351 800,000 100,0002371 400.000 20,000

$2,000,000

*This item not costed**This paragraph extracted from the latest Monthly Progress Report

covering the Boeing IMBLMS contract.

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HA-60-138

In accordance with IPO request, an analysis was performed

on the GD/C Final Report "Life Sciences Payload Definitionand Integration Study", Volumes I, II, and III, dated

May 1973, Contract NAS 8-29150.

Comments based on this analysis are contained in Attach-ments A and B. Attachment A represents those commentsconcerned with format and organization. Attachment B

concerns comments on content and rationale.

11-174

Page 196: COPY - NASA€¦ · 1.3 (Cont'd) 2. Weekly Progress Reports. 3. Monthly Progress Reports. The medium of technical information transfer utilized was the NASA 2-Way Memo (Form 5027-102

ATTACHMENT--A to Memo HA-60-138

t

TOTAL-STUDY CRITIQUE

1. Quite comprehensive.

2. Usually very intelligible.

SUGGESTED IMPROVEMENTS .

1. Supply acronym list for each volume.

2. Give rationale for different appellations for payload, crew, and researchEC/LSS. (EC/LSS, LSS, ECS, PLSS, EC/LSPS, LSPS, ECS/LSS, organism ECS,LS subsystem test unit, et al). The functions did not appear to besufficiently different to warrant different titles, npr were the differ-ent titles consistently applied, nor did the data categories on page 7-22show a protective aspect (LS/PS) beyond what is expected of the EC/LSSfor payload and crew.

•3. Consider a shift in categories of organisms such that enzymes and sub-strates are not given a cellular classification. It appears that thistable is based on handling technique, rather than taxonomy, which leadsto several inconsistencies. (Page 10-3).

4. Add manipulation to the functions requiring light on page 10-4.

5. Provide for protection of optics from food, saliva, urine, feces, hair,etc., on page 10-6 and elsewhere that TV and photography are considered.

«

6. Make schedules on pages 10-9, 10-17, 10-23, 10-29, and 10-33 more alikeso they seem to come from the same 'report (use and meanings of nounsand verbs). Add a documentation category to those which do not havethis listing {except as implied under design or other word which subsumesdocumentation).

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7. Put dimensions in Figure 10-4.

8. Rectify discrepancies between pages 10-19 and 10-22; possibly elsewhere,on use of silica gel.

9. Change status remark on page 1-65 to something meaningful.

10. Make an apparent and consistent distinction between crew mobility aidson pp. 1-82 to 95 and crew restraint on pp. 1-96 to 110.

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TOTAL STUDY

1. Quite comprehensive.

2. Usually very intelligible.

SUGGESTED IMPROVEMENTS

1. Supply an acronym list. Each volume needs one.

2. Give rationale for use of LSS or EC/LSS (environmental control/life supportsystem) for non-human payloads, LSS or EC/LSS for human payloads, butEC/LSPS (environmental control/life support and protective system) fortest bed data. The functions did not appear to be sufficiently differentto warrant a different title, nor were the different titles consistentlyapplied. See page references for suspected inconsistencies.

.Volume I, Management Summary

1. Table 1-1, change Manned System Integration to Man System Integration.

2. Para. 2.2.13, LSS Test Unit. This paragraph presents a paradox inlumping LSS, EC/LSS, PLSS, and LS/PS under the specific title of LSSubsystem.

3. Compare LSS, PLSS, EC/LSS, and LSPS on page 2-7 with tCS, EC/LSS on page3-1, ECS and EC/LSS on page 3-2, EC/LSS on page 3-3, ECS on page 3-4,LSPS on page 3-7, LSPS on page 3-8, EC/LSS on page 3-9, ECS and EC/LSSon page 3-11, EC/LSS on page 3-12 for organisms and crew (contradictory

. to earlier definition), EC/LSS on page 4-1, LSS test unit on page 4-4(contradictory term), LSS on page 5-1 equated with LS/PS on page 5-2,LS/PS on page 5-3 and 5-4, LS/PS on page 6-3, EC/LSS on page 6-5 (con-tradictory term), organism ECS on page 7-2, organism ECS/LSS on page 7-4,and organism ECS on page 7-4.

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Volume II, Studies ;

1. Compare ECS on page viii, ECS and LS/PS on page ix, ECS on page x, all

used consistently with EC/LSS used somewhat differently on page xi and

xii, EC/LSS on page 1-2, LS/PS on page 1-3, LS/PS on page 1-6, LS/PS

on page 1-7, LS/PS on page 1-8, EC/LSS on page 1-9, LSS on page 2-1,

LSS on page 2-6, EC/LSS on page 2-7, EC/LSS on page 2-8, EC/LSS on page

2-9, LSS, EC/LSS, and LSPS on page 2-10, LSPS on page 2-1Oa, LSP on page

2-13, LSPS on page 2-14, LSPS on page 2-15, LSPS on page 2-16, the latter

meaning life support subsystem test unit, ECS on page 3-1, EC/LSS on

page 3-2, ECS on page 3-3, ECS on page 3-5, EC/LSS on page 3-5, ECS

on page 3-8, EC/LSS and ECS on:page 3-9, EC/LSS on page 3-11, ECS on

page 3-12, ECS on page 3-13, ECS and EC/LSS on page 3-14, EC/LSS on page

3-15, EC/LSS on page 3-16, LS/PS on page 3-25, LS/PS on page 3-30, LS/PS

on page 3-31, EC/LSS on page 3-39, ECS on page 3-44, EC/LSS on page

3-47, EC/LSS on page 3-48, EC/LSS on page 4-1, LSS and EC/LSS on page

* 4-2, LSS on page 4-5, EC/LSS on page 4-6, LSS on page 4-7, LSPS on page

5-1, EC/LSS on page 5-4, EC/LSS on page 5-6, LS/PS on page 6-12, LS/PS

on page 7-2, LS/PS on page 7-18, LS/PS on page 7-19, LS/PS on page

7-20, LS/PS on page 7-21, LS/PS on page 7-22, LS/PS on page 7-23, LS/PS

on page 8-3, EC/LSS on page 8-12, ECS on page 10-1, ECS on-page 10-5,

ECS on page 10-18, EC/LSS and ECS on page 10-19, ECS on page 10-22,

ECS on page 10-23, and ECS on page 10-24.

2. Change Table 1-3, page 1-8, (changed manned to man).

3. Consider treatment of the Thermal Control Subsystem as part of the ECS

(pages 3-40 to 3-45) although it has separate components.

4. Show that the data categories on page 7-22 have a protective aspect

rather than life support alone. This is not obvious.

5. Consider a shift in categories of organisms on page 10-3..such that

subcellular elements such as enzymes and substrates are not given a

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cellular classification. It seems that this table is based on handlingtechnique rather than taxonomy.

6. Add manipulation to the functions requiring light on page 10-4.

7. Provide for protection of optics on page 10-6. (Urine, feces, hair,. food, saliva, etc.)

8. Make schedules on pages 10-9, 10-17, 10-23, 10-29, and 10-33 more alikeso they seem to come from the same report (use of nouns, verbs, etc.),.-Add a documentation category to those which do not have this listing(except as implied under design or other word which entails documentation)

f

9. Put dimensions in Figure 10-4.

10. Adjust discrepancies between pages 10-19 and 10-22 on use of silica gel;

elsewhere, if it occurs.

Volume III. Appendices

1. Compare LSS on page iv, LSS on-page 1-2, EC/LS on page 1-135, EC/LSS

on page 1-361, EC/LSS on page 1-362, EC/LSS on page 1-396, LS/PS on page

1-414, LSS and PLSS on page 1-414, LSS and LS/PS on page 1-415,

PLSS and LS/PS on page 1-416, LSS, PLSS and LS/PS on page 1-417,

LSS on page 1-418, LSS and PLSS on page 1-419, and LS/PS on page 1-420.

2. Make an apparent and consistent distinction above a JND between crew

mobility aids (1-82 to 1-95) and crew restraint (1-96 to 1-110). Failing

this, lump them.

3. Change status remark on page !-65 to something meaningful.

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