O CASE STUDY 9-1: Implications of the Effects of Weightlessness in Space on Health Policy A retired 62-year-old astronaut has just fractured his hip after taking a fall while playing tennis. The astronaut is currently being worked up in the emergency department and the orthopedic surgeon is on his way. A NASA flight surgeon calls the attending physician in the emergency department and advises her that, although the patient is retired from NASA, the fracture may be related to the astronaut’s spaceflight experience and bone density loss as a result of spending six months on the International Space Station, thus making this injury potentially work related. He also advises that the surgical procedure, rehabilitation, and forward plan may need to be revised secondary to this occupational exposure. With regard to the surgical procedure, although most young patients with hip fractures have uncemented prosthetics, this patient may need a cemented prosthetic due to loss of trabecular bone as a result of the microgravity of spaceflight. The emergency physician has asked you as the nurse manager in the emergency department to coordinate the interactions and inputs of all the caregivers at the hospital, the patient and family, and NASA Discussion Points 1. Assess all the potential policy implications for this collaborative team. How will the team share information from a government healthcare entity (NASA) and the hospital? Whose policies regarding electronic health records, the Health Information Portability and Accountability Act, and information sharing will take precedence? How will the team members impart the knowledge of the physiological changes from spaceflight to the surgery, nursing, and physical therapy staff so they can devise the proper plans? How can this scenario be made into an interprofessional plan? 2. Discuss the implications of this patient’s injury potentially being related to a work experience in the remote past. Are there health policy or payment implications? If so, who else should be included in an expanded team (eg. social worker, government relations personnel)? 3. NASA is governed by specific legislation related to health policy concerning the care of astronauts, Who should be liaisons with NASA, and how should communication be coordinated with the care providers, risk management, and administration at your facility?

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