High Alert Institute



To Infinity & Beyond: Healthcare Innovation and the All Hazards, One Health, One Nature Framework

by | Feb 9, 2023

To Infinity & Beyond: Healthcare Innovation and the All Hazards, One Health, One Nature Framework

Co-Authors: Maurice A. Ramirez, DO, PhD & Allison A. Sakara, NP, MSN, RN, PHRN

Government, industry, and non-profit organizations worldwide are shifting to the All Hazards, One Health, One Nature (AHOHN) Framework. This structure provides a common foundation for the development of goal-oriented and data-driven plans of action across countless areas of impact. Taking into account the interconnectedness of our entire ecosystem, the AHOHN Framework is giving rise to sweeping innovations and novel technologies to meet the unified needs of all living things. Soon, though, understanding the interrelationships between humans and their habitats will not be limited to a single planet. And the same AHOHN Framework already provides the basis for meeting the challenges of interplanetary existence. This article will discuss one of these challenges – providing healthcare to people and animals in off-Earth, austere environments.

Our knowledge of the effects of living off-Earth is limited. The only data we have collected comes from a small population of astronauts and cosmonauts, with an even smaller number who were ill or suffered an injury during their mission. While this data has been an essential first step, setting the standards for healthcare in space will require the study of much larger populations. The fact that knowledge from healthcare on Earth was extrapolated and adapted to provide healthcare in space is an important point. Once again, the AHOHN Framework reminds us that medicine and habitat remain interconnected, regardless of location. Is it possible that this approach will help us meet the challenges of interplanetary healthcare and benefit healthcare on Earth simultaneously?

Initially, the number of healthcare professionals traveling to the moon or Mars will be limited, as will the populations they serve. Some specialties, such as emergency-related providers, likely will be among the first to arrive. But the entire complement of healthcare providers accessible at even a small rural hospital will not. Existing technologies for telemedicine may be helpful if a provider’s help is needed for a patient on the moon, as the time delay for transmitting is short. However, consider a patient on Mars, where the round-trip time delay from question to answer can take 38 minutes even with ideal conditions. Waiting that long for expert instruction may be appropriate if the complaint is a simple skin rash but would never work for an emergency appendectomy. So how is this threat being addressed, and how will medicine on Earth adapt?

Enter the Artificial Intelligence-based Decentralized Interglobal Medical Expert (AI-DIMES). Yes, sci-fi fans, we really are talking about digital doctors and veterinarians. From their collective experience and research, international space agencies have already defined the essential aspects of space healthcare. These aspects have been incorporated into the step-wise progression of how AI-based systems can be employed to augment healthcare delivery and decrease disparities when on-site expertise is not available. Using this hybrid of care needs and data types, the information that an AI-DIMES would need to “understand” has been drafted as follows:

Information about an individual patient – medical records, test results, data from wearables (like a Fitbit or iWatch), data from devices (like a pacemaker or glucometer), etc.

Data compiled from a provider’s entire patient population – establishes a larger group that has something in common, such as environment or specialty diagnosis

Big Data analyses from Determinants of Health, Smart City, and Census data – adds the broad scope of disease and outcomes across environments, facilitating extrapolation to new environments (like space or other planets)

Access to current scientific literature and regulatory databases – provides the scope of disease tracking, outcomes, side effects, adverse events, failure modes, recalls, and advisories that are key to any healthcare system

Be able to advise healthcare providers and patients on possible diagnoses and treatment options (including likely outcomes) that fit the patient’s preferences and lifestyle – incorporates autonomy, choice, and informed decision-making

Functions as a digital healthcare provider with the ability to examine, diagnose, order tests, and provide treatment without human healthcare provider oversight or review – able to provide emergency medical back-up, augment the skillsets of trained providers and facilitate patient education

Healthcare professionals and governments strive to correct healthcare disparities, eliminate healthcare illiteracy, and compensate for provider shortages across planet Earth. True to the interdependency of an AHOHN Framework, solving the challenges of interplanetary healthcare will contribute to resolving these healthcare challenges. While a digital doctor may sound like science fiction, AI-based healthcare advances to meet the needs of space exploration and habitation make solutions like AI-DIMES inevitable.


About the Authors:

Maurice A. Ramirez, DO, PhD, is a physician and innovator with over a quarter century of service in emergency medicine, artificial intelligence, computing, regulatory affairs, and disaster response. Dr. Ramirez is the recipient of the Lifetime Achievement Award in Disaster Medicine and Co-Founder of the High Alert Institute.

Allison A. Sakara, NP, MSN, RN, PHRN, is a nurse practitioner with decades of experience in pediatrics, hematology/oncology, regulatory affairs, software as medical device (SaMD) consulting, and disaster response. Allison is the Co-Founder & Executive Director of the High Alert Institute.

The High Alert Institute is a 501c3 not-for-profit educational public charity dedicated to providing disaster readiness education and resources to unserved and underserved communities, industries, and charitable organizations in an All Hazards, One Health, One Nature Framework. Learn more about the High Alert Institute at www.HighAlertInstitute.org


Griffin Works offers Pawsitive Interactions with Service Dogs During Response Operations©, an audience-customized training that breaks down barriers by offering hands-on handling training and demonstrations with working service dogs for fire departments, EMS agencies, and public safety organizations.

Part of the National Domestic Preparedness Consortium and home to the National Emergency Response and Recovery Training Center, TEEX has been leading homeland security training since 1998. The major TEEX programs include fire and rescue, infrastructure and safety, law enforcement, economic and workforce development, and homeland security. As a member of The Texas A&M University System, TEEX is unique in its ability to access a broad range of emerging research and technical expertise. Beginning with course design and development all the way through hands-on instruction and national certification testing, TEEX delivers comprehensive training through both classroom and hands-on instruction and as online courses.

The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000 as part of the Children’s Health Act to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of child-serving professionals, caregivers and young adults, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S. The NCTSN is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS). 

The Emergency Management Institute (EMI) is part of the Department of Homeland Security’s Federal Emergency Management Agency (FEMA). The EMI provides national leadership in developing and delivering training to ensure that individuals and groups having key emergency management responsibilities possess the requisite skills to effectively perform their jobs.

The High Alert Institute maintains a list of reviewed courses provided by governments, universities and professional organizations. This list is geared towards the non-emergency management person who participates in disaster planning, preparedness, response, recovery or mitigation as part of their job responsibilities.

The High Alert Institute has partnered with Shutterstock to distribute stock images from the nature images donated by our supporters. For eligible stock images, Shutterstock will donate a portion of the royalty to the High Alert Institute. There is no cost to charitable organizations or to Shutterstock customers.

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Koi need forever homes, too! For pond enthusiasts, freshwater exotic and ornamental fish may not be available through pet stores or rescues in their area. The High Alert Institute Aquatic Pet Shelter Rehoming Program will be happy to assist you in stocking your new pond or adding a new finned friend to your school. Coming soon – when you adopt a Koi from the High Alert Institute Aquatic Pet Shelter Rehoming Program, we can arrange for delivery to your door anywhere in the continental United States.

Have you always wanted a Koi pond but don’t have the space one? Sponsor a Koi in our community shelter pond and we send you photos of your sponsored animal. Coming soon are live Koi Cameras above and below the water to enjoy your sponsored Koi anytime.

Dumping of freshwater non-native species and exotic aquatic pets into wild habitats is a man-made disaster that is truly preventable. The Institute’s Aquatic Pet Welfare Partnership works to raise awareness and reduce the impact on healthy ecosystems through education, as well as rescue and rehoming. Joined by champions of animal welfare and environmental stewardship, this  association of aquatic pet rescue operations and aquatic pet shelters across the United States aims to save our finned friends and preserve our waterways together.

Want to share our cause with family, friends, and colleagues? Looking for a non-traditional way to celebrate a birthday or honor someone special? Support the Institute by starting your own Peer-to-Peer fundraising challenge! Let your contacts know why our mission is important to you and what they can do to support your cause. START YOUR OWN FUNDRAISER for the High Alert Institute.

From the staffing pool to the shelter ponds, from the boardroom to the classroom, and from reading the science to writing the analyses, High Alert Institute programs and services benefit from the experience, expertise, and generosity of our volunteers. Put your talents to use for good and to good use – VOLUNTEER TODAY.

Make your donation twice as nice by rehoming aquatic pets and providing a rehabilitation companion pet to a deserving person, family, or facility. Sponsor part or all of a Joy of Koi Program pond installation – complete with rehomed koi – and give the gifts of love and recovery.

Professional photographers, amateurs, and legal copywrite holders are all welcome to participate in the High Alert Institute Nature Photo Donation Program. Sales of the images benefit the Institute and donors are eligible for tax deductions equivalent to the fair market value of their photos. Landscapes, seascapes, animals, flowers – all may be accepted – whether new or vintage  images. People may be included in the photo but only if unidentifiable (i.e., blurred figures at a distance).

Did you know that unused patents and copyrights can be donated to charity? Intellectual Property (IP) just sitting on a shelf will lose value as it becomes obsolete. The High Alert Institute IP Donation Program seeks to rescue stranded, technology-related IP with the potential for development into marketable products. Once accepted by the program, the owner/inventor is eligible for a tax deduction equivalent to the fair market value of the IP. The Institute receives the patent licensing fees or revenue from the sale of the IP to businesses, helping us to fund our mission. In turn, businesses are able to advance their markets and create jobs for less money than starting a project from scratch.

Disasters are defined as situations in which needs exceed or overwhelm available resources. Some disasters affect an entire community, while other disasters impact individuals and families. Crises of physical or psychological health can be very personal disasters.
The therapeutic value of pets during illness, trauma, and recovery is well established. And Koi fish may be well suited for people who are not able to provide verbal pet commands or physically care for pets like dogs and cats. Koi ponds are also a source of beauty and peace, providing an ideal setting for quiet reflection or meditation.
We are working to partner with pond installers and aquatic pet rescues/shelters to offer free or reduced-cost ponds with rehomed Koi fish to people seeking this type of pet therapy.

Disasters disrupt life and impact our sense of personal, family, and community safety. Survivors and responders alike often are not aware of the emotional, psychological or spiritual challenges that they may face from disaster onset through recovery. With two decades of experience training responders and communities to prepare for the behavioral health aspects of disasters, we will continue to provide education and a curated list of resources to groups or individuals.

Non-medical factors that impact overall health are termed Social Determinants of Health or SDoH. Noise pollution, poor air quality, and poor water quality are three environmental factors known to have a strong link to overall health. And the same environmental factors that impact humans impact their pets and other animals in their care. We continue to assist in advocacy, education, and technology development to mitigate the impact of SDoH on humans and animals alike.

Our efforts in shelter and rescue are the main focus of our environmental stewardship, reducing the environmental impact of non-native aquatic animals being dumped into public waterways. The High Alert Institute also assists innovators with the design, development, and evaluation of green and renewable energy technologies. Reducing the carbon footprint associated with disaster preparedness, response, and recovery furthers our continued mission to mitigate risk and improve resilience.

We partner with public and private organizations, sharing resources and fostering partnerships to improve disaster preparedness, response, and recovery, and mitigation.

The High Alert Institute team has over a century of combined research experience in medical, nursing, behavioral health, and disaster sciences. Our team provides support to researchers and technology developers through comprehensive literature searches and reviews, as well as failure mode database searches and adjudicated reviews.

When disaster strikes, most aquatic pet owners have limited options to secure the safety of their pets. Sheltering in place may not be possible if there is no power to provide aeration and “pet-friendly” shelters do not include ponds or aquariums. Our goal is to provide an option for aquatic pet owners in need of rescue and shelter for their finned friends.

Our goal is to share our two decades of disaster readiness experience with animal welfare organizations, shelters, caretakers, and pet owners, as they implement contingency  plans for natural and manmade disasters.

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