Flight Surgeon at NASA and UTMB MPH Alumnus Publishes Research on Behavioral Health Emergencies in Spaceflight

A recent graduate of the University of Texas Medical Branch School of Public and Population Health has published research examining pharmaceutical interventions for behavioral emergencies in spaceflight. Dr. Craig J. Kutz, who earned his Master of Public Health degree in 2023, co-authored a paper in the journal Aerospace Medicine and Human Performance that explores ketamine's potential role in treating acute suicidality during exploration missions.

Emergency Medicine Background Leads to Undersea and Aerospace Medicine

Craig's journey to aerospace medicine began in emergency departments, wilderness expeditions, and dive chambers—providing medical care on six continents worldwide. He is currently a Clinical Assistant Professor in the Department of Emergency Medicine at UTMB. After completing his medical degree and PhD at the Medical University of South Carolina, he pursued emergency medicine residency at UC San Diego, followed by a fellowship in Undersea and Hyperbaric Medicine. He then completed his Residency in Aerospace Medicine from UTMB. Craig’s experience treating patients in extreme environments—from high-altitude clinics in Nepal to Antarctica's remote medical stations and South Pole—prepared him for the unique challenges of space medicine.

"The MPH taught various behavioral health models used to identify determinants of health and strategies to communicate with stakeholders," Craig explained during a recent conversation. "I really took those lessons when I started collaborations with health professionals at NASA, the Department of Defense, and people within the community."

Psychiatric Emergencies Become Greater Risk as Missions Venture Beyond Earth Orbit

The research paper, titled "Expanding Ketamine Application for Treatment of Acute Suicidality in Long-Duration Spaceflight," addresses a critical gap in space medicine. As missions venture farther from Earth, such as to the moon and mars, astronauts face increased isolation, autonomy, communication delays, and separation from family support. While serious psychiatric emergencies have been rare in spaceflight history, the risk of occurrence may increase as a result of missions venturing longer and further from earth.

Craig worked with former NASA psychiatrist Dr. Charles Dukes as his mentor during the applied practice experience (APE) required for his MPH degree. Together, they engaged stakeholders from NASA's Behavioral Health and Performance group to identify current gaps in psychiatric emergency preparedness for exploration missions.

“Earth independent missions can magnify a crewmember’s feelings of isolation and unique behavioral stressors, similar to the effects we see in extreme environments like Antarctica”, Craig noted. "Currently, missions to the International Space Station have the ability for immediate medical care and expedited evacuation if needed. However, if you're going to the moon and Mars...crewmembers must have the ability to recognize these unique stressors and intervene if necessary—all with limited resources and delay in definitive medical care.”

Swift-Acting Drug Offers Multiple Benefits for Weight-Conscious Spacecraft

The paper examines ketamine's unique properties that make it potentially valuable for space missions. Unlike traditional antidepressants that can take weeks to show effects, ketamine can reduce suicidal ideation within hours, based on recent terrestrial literature. Additionally, as storage capacity becomes critical for expeditions, ketamine is an efficient and unique multiuse medication—indicated for pain management, sedation, and behavioral emergencies.

"It's kind of this Swiss army knife of drugs," Craig explained. "When we're going longer distance, weight and volume are a concern."

MPH Framework Provides Foundation for Stakeholder Engagement and Prevention Strategies

Craig credits his MPH education at UTMB with providing the framework for this research. The program's emphasis on identification of knowledge gaps in healthcare, stakeholder engagement, prevention strategies, and systematic approaches to determinants of health behavior proved directly applicable to space medicine.

"Trust in the techniques that are being taught," Craig advises current MPH students. "There's been a lot of really good research by a lot of really smart people out there. Each one has their strengths; each one has their weaknesses. One of the things you learn in the MPH is to critically identify and analyze those characteristics to develop actionable intervention strategies and stakeholder engagements."

Flight Surgeon Role Combines Mission Support with Ongoing Research

Now serving as an operational flight surgeon for NASA through UTMB and KBR, Craig supports astronaut health and mission planning. He recently received his flight surgeon wings in an underwater ceremony at NASA's Neutral Buoyancy Laboratory—a fitting venue given his background in dive medicine.

His work continues to bridge multiple disciplines. Whether speaking at the Wilderness Medical Society conference about Antarctic medicine or contributing to the UTMB Aerospace Medicine Seminar Series segments on decompression sickness, Craig applies lessons learned across extreme environments to advance space medicine.

Research Opens Discussions for Future Lunar and Mars Mission Planning

While the paper represents an initial exploration rather than a change to current protocols, it opens important discussions about behavioral health preparedness for future missions. As NASA and commercial space companies plan for lunar bases and Mars exploration, understanding and preparing for medical contingencies becomes increasingly critical.

"This really was identifying what we know so far and some of the challenges that we're going to face," Craig emphasized.

As humanity prepares for longer journeys into space, the intersection of public health principles and aerospace medicine will play an essential role in keeping explorers safe.

The full paper, "Expanding Ketamine Application for Treatment of Acute Suicidality in Long-Duration Spaceflight," is available open access in Aerospace Medicine and Human Performance, Volume 96, Issue 6.