WHAT KEEPS US UP AT NIGHT? BLACK SWANS IN SPACE.

BACKGROUND: The rise in commercial human spaceflight opportunities for civilians and varying medical screening standards for commercial spaceflight flight participants will result in increased risk of medical event 'outliers' in spaceflight. We illustrate an analogue case from polar medicine to discuss unpredictability in risk models, as well as the need for novel medical systems to better embed flexibility and resilience for long duration missions. OVERVIEW: At 5:30 A.M. on June 14th 2018, a polar bear walked into Summit Station--the NSF's research station in remote Greenland--nearly 300 m from individuals sleeping in arctic tents. Summit Station possessed no bear deterrents other than heavy machinery. Over 40 Station residents were required to shelter in the two hard-sided buildings for 36 hours. Having little recourse to relocated the animal, ultimately hunters were flown to Summit Station and euthanized the bear. The epilogue of this encounter was a cascade of mental health complaints amongst the camp denizens, with reactions that included fear, anger, indifference, anxiety, grief and guilt stemming from the loss of autonomy, experiencing or witnessing a life-threatening encounter and the bear's death. The US-based medical team in support of Summit Station quickly mobilized psychiatric first aid support for the camp, in an effort to normalize reactions, explain coping mechanisms and re-establish a group connection (1). DISCUSSION: When considering medical risk assessment for extreme and/or remote missions, this encounter epitomizes a 'black swan' event-- beyond any historic predictive data and characterized by unpredictability; has a potentially massive impact to the mission; and post-hoc predictability, with a sentiment that this encounter was less random and more predictable than it actually was, often saying it was "bound to happen."(2) As NASA endeavors to create evidence-based risk databases and predictive analytics for long duration missions, the 'black swan effect' reminds us that unforeseen outliers demonstrate the fragility of systems based on prediction and standard deviation; the dangers of placing too much confidence in a narrowly-focused expertise; and how rare and unpredictable events have a much greater impact than regular occurrences. This Arctic event speaks to the importance of resilient progressively earth independent medical systems that include redundant characteristics and improvisational skillsets. Learning Objectives 1. The participants will understand the the fragility of systems based on prediction and standard deviation. 2. Participants will comprehend the dangers of placing too much confi- dence in a narrowly-focused expertise. 3. Participants will discern in large systems how rare and unpredictable events have a much greater impact than regular occurrences. [ABSTRACT FROM AUTHOR]