Severe traumatic injury during long duration spaceflight: Light years beyond ATLS

In addition to discussing the impact of various mission profiles on the risk of injury, this manuscript outlines all issues relevant to trauma during space flight. These include the epidemiology of trauma, the pathophysiology of injury during weightlessness, pre-hospital issues, novel technologies, the concept of a space surgeon, appropriate training for a space physician, resuscitation of injured astronauts, hemorrhage control (cavitary and external), surgery in space (open and minimally invasive), postoperative care, vascular access, interventional radiology and pharmacology.Given the risks and isolation inherent in long duration space flight, a well trained surgeon and/or surgical capability will be required onboard any exploration vessel. More specifically, a broadly-trained surgically capable emergency/critical care specialist with innate capabilities to problem-solve and improvise would be desirable. It will be the ultimate remote setting, and hopefully one in which the most advanced of our societies' technologies can be pre-positioned to safeguard precious astronaut lives. Like so many previous space-related technologies, these developments will also greatly improve terrestrial care on earth.Despite significant operational and economic challenges, the International Space Station (ISS) has been continuously manned for over eight years. Although it serves primarily as a human research facility in low earth orbit (LEO), on-board medical care is extremely limited. As a result, all patients with serious injuries will be evacuated to earth as soon as possible. The National Aeronautic and Space Administration (NASA) also envisions extended-duration exploration missions beyond LEO (Exploration Class Missions (ECM)) in the near future [1-3]. These plans were recently supported by the outgoing President of the United States, who stated an intention to pursue ECMs as early as 2015. A serious traumatic injury on such a mission would require in-flight treatment because a