develop to support long-duration missions, including interplanetary travel, in which timely evacuation of crewmembers will not be an option. Medicalcare provider training, specialty mix, nonmedical crewmember skills, use of advanced technology, surgical/intensive care capability in space, rehabilitation approaches to cope with exposures to gravitational fields following exposures to microgravity, psychological/human factors challenges and use of robotics for health monitoring, education, and possible surgery are examples of the types of issues we would like you to address. We would also like you to consider the use of analog environments, such as remote Antarctic stations, for training and research. Ethical considerations in the face of limited medical-care capability are also important issues that need examination” (Goldin, 1999a). IOM asked experts in health sciences research and clinical medicine to address the health risks, medical needs, and patient care dilemmas that are likely to arise during long-duration space travel.

The committee’s charge is shown in Box 1–1.


The committee has focused on the development of principles and general and developing practices for provision of the best possible health care to astronauts. This report covers the continuum of health care, from preventive services before departure, to treatment of conditions that might conceivably arise during long-duration space travel beyond Earth orbit, to health care on Mars and during the return to Earth. It also discusses the need for restorative and rehabilitative services for astronauts upon their return to Earth.

On the first exploration-class mission to Mars, expected to last nearly 3 years, the goal will be to keep the astronauts healthy, productive, and reasonably comfortable in an environment that is almost unimaginably distant and unforgiving. The IOM Committee on Creating a Vision for Space Medicine During Travel Beyond Earth Orbit envisions a health care system for astronauts that can deliver high-quality medical care, extensive psychological support, and excellent (albeit basic) surgical services to a special population of astronaut-patients who are unusually fit but also uniquely vulnerable. In the course of the committee’s information gathering and data analysis five elements emerged as critical to the committee in addressing its charge.

  • Risks to astronauts’ health The committee sought to understand the

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