NASA-STD-3001 Technical Brief

Relevant Technical 

Requirements

Spaceflight 

Experience and 

Medical Care

OCHMO-TB-033

Rev D

This technical brief is inclusive of NASA-STD3001 Volume 1, Rev C as a whole. The full 

document can be found at the following link: 

https://www.nasa.gov/directorates/esdmd/h

hp/human-spaceflight-and-aviationstandards/

NASA-STD-3001 Volume 1, Rev C

[V1 3001] Selection and Recertification 

[V1 3002] Pre-Mission Preventive Health 

Care

[V1 3003] In-Mission Preventive Health Care

[V1 3004] In-Mission Medical Care

[V1 3012] Terrestrial Launch/Landing 

Medical Support

[V1 3016] Post-Mission Health Care

[V1 3017] Post-Mission Reconditioning

NASA-STD-3001 Volume 2, Rev D

[V1 7043] Medical Capability

Executive Summary

Regardless of mission length or objectives, all 

human spaceflight requires some degree of inmission medical support. The transition from a 

gravitational environment to microgravity, coupled 

with living in a closed-loop environment, can result 

in variable physiological effects and health risks. For 

example, anticipated physiological impacts of the 

microgravity environment include fluid 

redistribution and subsequent head congestion, 

particularly during the space adaptation phase. 

Such effects typically occur within a predictable 

timeframe and will affect all crewmembers to some 

degree. To ensure mission success and a positive 

spaceflight experience, known physiological effects 

of the spaceflight environment must be anticipated 

and mitigated where possible. Integration of varied 

strategies, including crew selection processes, premission quarantine, in-mission medical capabilities, 

and ground medical support, are necessary to 

ensure crew health and optimal performance. 

Simultaneously, vehicles must be designed to optimize crew health and performance and 

accommodate any necessary medical capabilities, equipment, crew training, and physical space. 

The knowledge and tasking of medical actions can be distributed among crewmembers, 

medical devices or aids, artificial intelligence systems, robotic systems, or similar. Additionally, 

incorporating ground medical support is key to many medical capabilities during flight and 

requires streamlined integration of variable technologies, ground communications, and support 

systems. Integration of these systems enables the provision of medical care and ensures crew 

health during a mission.
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Background

This table displays the interaction between five key elements necessary to promote crew 

health and performance: 

1. Crew Selection Standards – reference OCHMO-TB-034 Crew Selection and 

Recertification

2. Health Stabilization Program (HSP) – reference OCHMO-TB-006 Health Stabilization 

Program

3. In-mission Medical Treatment & Capabilities – discussed in this technical brief

4. Immediate Post-landing Medical Care i.e., care provided immediately upon return to 

Earth – discussed in this technical brief

5. Longitudinal Health Surveillance – reference OCHMO-TB-043 Longitudinal Health 

Surveillance

2 12/01/2023

Rev D

Pre-mission In-mission Post-mission

Selection 

Standards

Health Stab.

Program

In-mission Medical

Treatment & Capabilities

Immediate Postlanding Care

Longitudinal Health Surveillance

At NASA Kennedy Space Center's 

Shuttle Landing Facility, emergency 

rescue personnel gently place an 

"injured astronaut" onto a stretcher 

during a simulated emergency 

landing. 
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Background

Prevalent Physiologic Changes Experienced due to Microgravity and 

Vehicle Design

3

Vision Changes/Loss

Bone Remodeling 

and 

Renal Stones

Muscular and 

Aerobic Decrements

Head and/or Nasal 

Congestion

Metabolic Capacity 

Deficits

Space Adaptation 

Lower Back Syndrome

Tightness & Pain

Vehicle Environmental Considerations 

(e.g., increased radiation exposure, 

atmospheric CO2, toxic chemicals, and VOCs; 

altered pressures & DCS)

Sensorimotor 

Deconditioning

Genitourinary Issues

Fluid Shifts, Altered 

Vascular Motility, 

and Orthostatic 

Intolerance

All crewmembers experience the above effects to some extent. Minimizing the potential for 

communicable disease transmission through screening and effective pre-flight quarantine in the 

Health Stabilization Program (HSP) (see OCHMO-TB-006 HSP) lessens potential in-mission impacts of 

infectious disease. Subsequent in-mission medical support is critical for the mitigation of the above 

effects and maximizing crew performance and experience. Finally, NASA crewmembers are selected 

through a rigorous set of procedures in order to minimize some of the above effects (see OCHMOTB-034 Crew Selection & Recertification). For example, certain cardiac, musculoskeletal issues, and 

osteopenia are selected out to enhance mission success.

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Background

Physiological Timeline

4

≤3 days

• Space Adaptation 

Syndrome

• Fluid redistribution 

and temporary 

diuresis

• Back pain

• Genitourinary issues

• Metabolic capacity 

deficits

≤2 weeks

• Space Adaptation 

Syndrome

• Back pain

• Sensorimotor and 

neurovestibular 

deconditioning

>2 weeks

• Muscular and aerobic 

decrements

• Bone effects and renal 

stone risk

• Vision loss/changes

Vehicle/environmental features (incl. increased CO2 and radiation exposure)

Head/nasal congestion

Fluid shifts and altered vascular motility

Changes associated with 

initial adaptation to space; 

e.g., transfer missions

Concerns after initial 

adaptation to space occurs

Concerns related to long 

spaceflight missions; e.g., 

ISS or lunar missions

≤3 Days – changes associated with initial adaptation to space; e.g., transfer missions

Space Adaptation Syndrome (SAS) – neurovestibular adaptation to microgravity; symptoms include nausea, 

emesis, headache, malaise, vertigo; cephalad shift of fluid, resulting in facial “stuffiness”

• Affects 50-70% of crewmembers

• Treatment: pharmaceutical options, inactivity, head movement exercises, head restraints, 1g orientation 

and pre-mission training / prophylaxis

Head/nasal congestion – space adaptation or CO2-related

• Affects >50% of crewmembers

• Treatment: pharmaceuticals (congestion or allergy meds)

• Leading cause of prolonged medication use in-mission

Fluid redistribution – 12-15% reduction in whole body volume, temporary diuresis with polyuria

• Affects all crewmembers

• In-mission treatment is not needed; vehicle must accommodate temporary increased urine output 

• Subsequent euvolemia, but continued third spacing of fluids throughout the mission

Genitourinary issues – subset of crew who experience urinary retention with space adaptation

≤2 weeks – concerns after initial adaptation to space occurs

Lower back tightness & pain (i.e., Space Adaptation Back Pain, SABP) – back pain associated with the 

physiological changes in spaceflight; SABP is distinguished from other types of back pain if it develops 

within the first few days of the mission

• Affects 52% of crewmembers

• Positioning, exercises, and pharmaceutical options to manage (≥85% pain relief effectiveness for all 

treatments)

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Background

Physiological Timeline (cont.)

>2 weeks – concerns related to longer missions; e.g., ISS or lunar missions

Aerobic and muscular decrements – decrease in aerobic capacity and muscle mass and tone over the mission

• Begin for all crewmembers upon exposure to microgravity, but are mainly a concern for longer missions: 

more muscle & aerobic capacity are lost the longer the crew is in microgravity

• Countermeasures/treatment: exercise – resistive and aerobic, can be highly effective

• Upon re-exposure to gravity, decrements incurred due to spaceflight must be accounted for

Bone effects and renal stone risk – microgravity induces bone atrophy, approximated at 1.5%/month; almost 

fully mitigated by exercise; bone loss increases circulating calcium, which impacts renal stone risk

• Bone effects begin for all crewmembers upon exposure to microgravity, but are mainly a concern for longer 

missions – more bone is lost the longer the crew is in microgravity, which leads to an increased risk of renal 

stones

• Countermeasures/treatment: pharmaceutical options and exercise

Vision alterations (Spaceflight-Associated Neuro-Ocular Syndrome (SANS)) – ocular changes including disc 

edema, choroidal folds, globe flattening, and/or hyperopic shifts in refractive error; believed to be associated 

with cephalad fluid shifts and possibly with diet or environmental factors. Vision changes could impact 

performance.

• 16% of crewmembers show disc edema during/after long-duration missions; most findings subclinical, 

some require corrective lenses

• Treatment: corrective lenses, and adjustable glasses can be flown to aid vision adjustments; potential 

countermeasures: pharmaceuticals, environmental/dietary considerations

Altered vascular motility – stagnant or reverse flow in the internal jugular vein has been observed in 6 of 11 

crew members (55%) tested in mission on approximately flight day 50; one crewmember was found to have 

an occlusive internal jugular vein thrombus. This is an emerging finding and has potential impacts on flight 

participants with cardiovascular conditions. 

Increased radiation exposure – an increased risk of developing cancer post-mission 

• Space Environment radiation exposure – increased exposure outside of low-Earth orbit

• Shielding is effective against some radiation exposure (solar particle events, but does not mitigate Galactic 

Cosmic Radiation exposure

• Primary risk is for carcinogenesis (post-mission); additional risks for cataract development and potential 

cardiovascular or neurological sequelae

Upon re-entry to 1g: descent and landing

Sensorimotor and neuro-vestibular deconditioning – the brain and neurological systems that control balance

and motor skills adapt to microgravity within 2 weeks of spaceflight missions; it takes hours to days for the

body to readapt to gravity upon landing, with associated balance issues and visual inconsistencies

• Affects all crewmembers post-landing to some extent; may be severe enough that crew cannot perform 

functional operational tasks (e.g., fall recovery) 

• Impacts vehicle design (e.g., displays and controls)

• Prevention: in-mission exercise provides some benefit

• Treatment for symptoms similar to SAS

5

Relevant Technical Briefs

OCHMO-TB-030 Bone Loss

OCHMO-TB-020 Radiation Protection

OCHMO-TB-010 Sensorimotor

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Health and Medical Care Standards for Astronauts

NASA updated the Health and Medical Care technical requirements for astronauts. The following 

requirements reflect this comprehensive approach to astronaut health and well-being, addressing 

screening, preventive health strategies, medical care, contingencies during launch and landing, and postmission healthcare, reconditioning and long-term monitoring. These detailed requirements can be found 

in NASA-STD-3001, Volume 1, Revision C.

Reference Data

6

Comprehensive set of Health and Medical Technical Requirements 

from crew selection to post-mission health care.

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

Medical Program Design Guidance Overview

7

• The importance of the interaction between crew selection, health stabilization 

programs, longitudinal health surveillance, in-mission medical capabilities, and 

immediate post-mission medical care cannot be overstated. These program aspects, in 

conjunction with vehicle design, work together to maximize crew health and 

performance over the mission, while helping to minimize resource footprint and 

wasted time during the mission. 

• By employing selection criteria and selecting out certain conditions, healthier 

individuals are flown and less risk is present in-mission. 

• Crewmembers participate in a health stabilization program (HSP) to promote success 

over the full length of the missions. 

• To reduce the need for in-mission medical care and mitigate the risks of spaceflight, 

activities should be performed pre-, in-, and post-mission to help the crewmember 

achieve maximal health (i.e., longitudinal astronaut health surveillance, training, 

countermeasures, and reconditioning should be employed). 

• Based on the most common conditions expected and seen during missions, NASA 

tailors in-flight medical capabilities and skillsets to ensure that the most likely or 

impactful medical or physiological events can be managed and crew health optimized. 

There are additional conditions and capabilities that may be applicable after an overall 

mission architecture assessment is completed; these are similarly tailored to every 

program. 

Medical Program Design begins with crew selection but is maintained 

throughout the pre-flight and mission cycle.

HSPs help reduce the burden of spaceflight adaptation by ensuring the crew 

begin missions with good health & minimize risk of communicable diseases.

By taking a preventive approach rather than a reactionary one, total onboard 

resources and required mission capabilities can be reduced and optimized.

If the selection criteria is broadened, in-mission medical capabilities need to 

accommodate the anticipated conditions and if the conditions are 

exacerbated by spaceflight.

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

Pre-Mission Healthcare

8

• Pre-Mission health care is all of the 

health care provided after crew 

selection

• Pre-Mission health care is focused on 

preventative care and reducing inmission as well as long-term health 

risks

• Many studies and tests are conducted 

pre-mission to provide a baseline to be 

compared to post-flight results

• The longer the duration of the mission 

is, the greater the extent of the 

preventative interventions need to be

Pre-Mission medical care includes but is not limited to the following strategies:

1. Optimization of Nutrition 

2. Vitamin D Supplementation 

3. Specialized Assessments and Exams (e.g., ECG, Ophthalmological exams, Photo 

documentation of skin)

4. Maintenance of Optimal Aerobic and Strength Physical Fitness 

5. Maintenance of Flexibility, Agility, and Balance

6. Annual and Pre-Flight Physicals 

7. Preventative Dental Care

8. Behavioral Health Resiliency Training

9. Total Radiation Dose Control/Monitoring (Bio-dosimetry Testing)

10. Pre-mission Health Stabilization Programs (e.g., communicable diseases 

prevention (influenza, cold), vaccinations)

11. Assisted Reproductive Technology (ART) to preserve gametocytes prior to mission 

exposure to radiation)

Care can be tailored (i.e., how assessments are performed) according to the mission 

profile and agency.

NASA commercial crew astronaut Victor Glover 

performs physical training on the Advanced Resistive 

Exercise Device (ARED) at the agency’s Johnson 

Space Center in Houston. 

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

Medical Program Design Guidance

9

In-mission medical care is influenced by the following:

1. Expected conditions due to spaceflight adaptation (e.g., neurovestibular adaptation, 

back pain, muscle loss, etc.)

2. Pre-mission Health Stabilization Programs (e.g., communicable diseases prevention 

(influenza, cold), vaccinations)

3. Mission architecture (EVAs, decompression protocols, environmental conditions of 

vehicle, etc.)

4. Crew selection criteria (e.g., cardiovascular conditions, behavioral conditions)

5. Mission duration

6. Distance from Earth, time to definitive medical care, and required autonomy

7. Destination/gravitational environment

Some conditions present due to the microgravity environment are treated differently compared to 

terrestrial practices. These conditions include, but are not limited to:

• Sleep Loss and Alertness: circadian shifts and abnormal sleeping orientations lead to loss of sleep in 

crewmembers and subsequent alertness deficits

• Treatment may be as simple as sleep aids (~71% use in crew; 10x higher than use in adult 

ambulatory medicine) and alertness aids (~21% use in crew)

• Sleep aids are the leading reason for acute medication use in-mission

• Headaches: increased incidence during spaceflight, with contributory factors including elevated CO2

levels, fluid shifts, pressure changes, and other non-spacecraft-associated factors

• Joint and Muscle Pain: increased incidence due to extravehicular activity (EVA) and exercise 

equipment used during the missions

Most conditions can be treated as they are on Earth, though mass, volume, consumables, and capability 

restrictions may limit the scope of in-mission medical treatment. Since full terrestrial care and treatment 

may not be possible, medical kits should be optimized to provide the best available care. Pertinent 

considerations include minimizing long-term health impacts and future mission success. In addition, 

prioritization should be given to medications that can serve multiple purposes and minimize adverse or 

unwanted side effects.

Extensive consideration should be given to all medications administered in-mission due to the closed-loop 

environment. For example, a medication that increases urinary calcium output is not only putting the 

crewmember at a greater risk of developing kidney stones but may also cause further stress on a vehicle’s 

water reclamation system. Another consideration is the pharmaceutical treatment pathway. Sprays, for 

example, may not be as desirable as solid medications due to lack of gravity and vehicle air flow patterns.

Side effects of all medications should also be considered due to the bevy of spaceflight-induced 

physiological changes. For example, cardiovascular deconditioning and fluid redistribution is seen in all 

crewmembers. Thus, medications that produce effects such as cardiac depression or vasodilation should 

be avoided.

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

In-Mission Preventive Health Care & In-Mission Medical Care

All programs shall provide training, in-mission capabilities, and resources to monitor and treat 

physiological and psychosocial well-being and enable delivery of in-mission preventive health care, based 

on epidemiological evidence-based probabilistic risk assessment (PRA) that takes into account the needs 

and limitations of each specific design reference mission (DRM), and parameters such as mission duration, 

expected return time to Earth, mission route and destination, expected radiation profile, concept of 

operations, and more. 

10

From NASA-STD-3001 Volume 1, Rev C

Epidemiological evidence-based probabilistic risk assessment (PRA) approach utilizing ISS experience 

and terrestrial data.

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

11

The Integrated Medical Model 

probability risk assessment 

output includes a list of 

potential medical conditions 

experienced during spaceflight 

and is utilized by flight 

physicians to generate an 

inflight medical system.

From NASA-STD-3001 Volume 1, Rev C

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

12

Required In-Mission Capabilities

The following are examples of in-mission capabilities (i.e., procedures, protocols, vehicle 

accommodations, etc.) that might be required for a spaceflight mission.1

Administer and manage medications

•e.g., blood pressure, oxygen saturation, heart rate, respiratory rate, etc.

Assess and store vital signs

Perform physical exam and conduct screening exams/tests

•e.g., inserting a catheter, suturing, blood draw, etc.

Perform procedures

•e.g., recreational time, books, movies, music, crew care packages, access to fresh produce, Earth viewing 

opportunities

Delivery of basic behavioral health and performance countermeasures

•e.g., private medical/psychological conferences, computer-based programming, cognitive and 

psychological assessments, etc.

Assess and monitor physical, behavioral and cognitive health with neurobehavioral 

measurements

Monitor, manage, and control sleep/fatigue

Dietary control and nutrition monitoring

Evacuation

Configure environment for care

•e.g., restraint systems, various medications

Physical or pharmaceutical restraints for physiological and psychological use

Medical support system (i.e., inventory monitoring/maintenance, etc.)

•with ground medical and psychological support, family, and crew support system

Private two-way audio and video communication with ground

•e.g., in-mission computer-based therapy, smart medical devices, just-in-time training, etc.

Knowledge augmentation

1Capabilities can be tailored (i.e., added in or taken out) according to the mission profile and spacecraft design 

Procedures & Protocols Vehicle Accommodations

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

13

Additional In-Mission Conditions for Program Consideration

The below conditions are dependent on mission length, mission architecture, spacecraft design, 

launch/landing loads, the program’s Health Stabilization Program (HSP), and mission activities. Thus, this 

subset of conditions may not apply to every spaceflight mission. Conditions from this list that are required 

to be treated in-mission should be tailored to each program. Such conditions may include:

• Musculoskeletal conditions – muscular sprain/strain; joint 

sprain/strain (shoulder, elbow, wrist, hip, knee, ankle); 

dislocation (finger, elbow, shoulder); fracture (wrist, 

hip/proximal femur, lumbar spine); lower extremity stress 

fracture 

• Ophthalmic conditions – eye penetration (foreign body) / 

chemical burn / corneal ulcer / infection; SANS and potential 

vision changes; retinal detachment; acute glaucoma

• Dental conditions – caries; exposed pulp; dental abscess / filling 

loss / avulsion / crown loss

• Abdominal conditions – abdominal wall hernia; nephrolithiasis; 

acute pancreatitis; acute cholecystitis / biliary colic; small bowel 

obstruction; appendicitis; acute diverticulitis; acute prostatitis; 

hemorrhoids abnormal uterine bleeding

• Psychological, Cognitive, or Behavioral Conditions – work 

overload / burnout / exhaustion; lack of meaningful work and/or 

monotony; apathy / low motivation; grief reaction; depression; 

delirium; relationship problems (family, crew, mission support 

personnel); adjustment, mood, anxiety, trauma-related, stressrelated, and neurocognitive disorders; psychosis

• Infectious/Immune diseases – pharyngitis; influenza; 

gastroenteritis; respiratory infection; herpes zoster reactivation

Rigorous crew selection should prevent major conditions from occurring. At NASA, individuals with 

any substantial risk of significant medical illness or decompensation from conditions are not certified 

for flight. If NASA-level crew selection criteria is not used, additional conditions may need to be 

considered for treatment in-mission, such as:

• Major cardiovascular events, e.g., myocardial infarctions and atrial fibrillation

• Major neurologic events, e.g., seizures and strokes (cerebrovascular accident (CVA))

Based on the required overall mission architecture assessment (activities, duration, vehicle design, etc.), 

the following conditions may need to be treated in-mission. While some of the conditions can be 

treated as they are on Earth, mass, size, consumables, and capability restrictions may limit the scope 

of in-mission medical treatment. Since full terrestrial care and treatment may not be possible, medical 

kits should be optimized to provide the best available care. 

• Other traumatic injuries – back, 

neck, head, chest, abdominal 

injury; traumatic hypovolemic 

shock; neurogenic shock; 

barotrauma

• Hearing loss

• Paresthesia

• Decompression Sickness, 

secondary to EVA

• Fingernail delamination

• Burns, secondary to fire

• Smoke inhalation

• Choking / obstructed airway

• Altitude sickness

• Toxic exposure (e.g. 

ammonia, hydrazine, 

methane, formaldehyde, 

Freon, etc.)

• Sepsis

• Acute Compartment Syndrome

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

14

Additional In-Mission Capabilities for Program Consideration

The following list of additional in-mission capabilities (i.e., procedures, protocols, vehicle 

accommodations, etc.) may be required based on mission length, mission architecture, spacecraft design, 

launch/landing loads, the program’s HSP, and mission activities. Capabilities should be tailored to each 

program based on applicability and mass/volume constraints. Asterisked (*) conditions are capabilities 

that may be needed for medically autonomous missions (i.e., no real-time ground communications). 

•countermeasures intended to counteract cardiovascular, musculoskeletal, and neurovestibular 

deconditioning; e.g., exercise

Delivery of physical health countermeasures

Monitor and trend vital signs

Perform imaging

Perform cardiac waveform monitoring

Perform laboratory analyses

Monitor and alter work/rest schedule and balance

•e.g., each crewmember has access to their own personal device with entertainment, photos, audio, 

personal video clips, virtual reality, store and forward communications with family and friends

Individualized behavioral health and performance countermeasures suite*

Evidence-based asynchronous behavioral health treatment protocols available on electronic devices*

Medical devices for treating neurobehavioral disorders

•e.g., novelty, virtual reality, greenhouse

Sensory deprivation countermeasures*

•e.g., games, observance of important holidays/events

Social isolation countermeasures*

Monitor and assess environment

Access to private personal spaces and sleep accommodations with visual and auditory 

privacy

Procedures & Protocols

Vehicle 

Accommodations

See the OCHMO-TB-006 Pharmaceuticalsfor additional information regarding the medical kit and 

pharmaceuticals used in-mission

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Application

15

Post-Landing Considerations and Crewmember Treatment

Cardiovascular

• Cause / Background: fluid redistribution, third-spacing of total

body water, relative intravascular depletion

• Symptoms: orthostatic intolerance; decreased blood pressure; increased heart rate; nystagmus 

and/or blurry vision; nausea; weakness/malaise; syncope

• Medical Recommendations & Treatment: compression garment (often donned prior to reentry); oral 

fluids (as tolerated); normal saline bolus; medications to treat symptoms; rest

• Due to relative intravascular depletion, IVs can be challenging to start. Thus, ground crew personnel 

need to be prepared appropriately.

Pre-landing Preparations

• Crewmembers can take measures before reentry to mitigate 

symptoms post-landing. These measures may include 

prophylactic medication use, fluid loading, and orthostatic 

intolerance compression garments. 

Neurovestibular

• Cause / Background: neurovestibular system is still adapted to 

the spaceflight environment (i.e., microgravity)

• Symptoms: vertigo; unstable gait; nausea; vomiting

• Medical Recommendations & Treatment: medications (e.g., 

meclizine, promethazine); avoid rapid head movements; slow, 

progressive increase in activity; rest

Musculoskeletal

• Cause / Background: weightlessness causes bone and 

muscular atrophy; may be mitigated by in-mission 

countermeasures, such as exercise

• Symptoms: weakness; fatigue; poor coordination; impaired 

physical abilities; feeling of heaviness; slow & deliberate 

movements; muscle pain due to gravitational forces (esp. 

back aches from spinal recompression)

• Medical Recommendations & Treatment: assistance with 

ambulation; rest; long-term rehab and physical therapy may 

be needed

Vehicle-Induced Trauma and Toxic Exposures

• Spaceflight re-entries and landings may result in traumatic injuries to the crew (e.g., fractures, neck 

injuries, etc.) or exposures to toxic chemicals (e.g., hypergolic substances). Upon landing, ground 

medical personnel must be able to accommodate and care for a crewmember who incurs injury or 

exposure due to the vehicle operations.

Egress is often difficult for crewmembers 

upon landing. Assisted egress will most likely 

be needed for missions >2 weeks.

12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Back-Up

16 12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Rev C  Rev D

• Updated information to be consistent with NASA-STD-3001 Volume 1 Rev C and 

Volume 2 Rev D

Rev B  Rev C

• Added additional pre-mission medical care information

• Added references to OCHMO technical briefs

Rev A  Rev B

• Updated information to be consistent with NASA-STD-3001 Volume 1 Rev B and 

Volume 2 Rev C

Original  Rev A

• Added ‘fluid shifts and altered vascular motility’ to spaceflight changes

• Added a crew selection page

• Changed the medical care philosophy

• Removed ‘14 day’ time break from the Levels of Care and created a twostep process for selecting applicable conditions

• The two steps include: 1. conditions required for every mission; 2. 

conditions tailored to each program based on mission architecture 

assessments

• Further sorted conditions and capabilities

• Deleted the Levels of Care pyramid 

• Updated the total medical conditions list

• Reformed the example medical kit, including removal of the short- vs. longduration denotations

• Updated the example medical kit contents to become closely aligned with 

current medical kits

Major Changes Between Revisions

17 12/01/2023

Rev D
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

NASA-STD-3001 Volume 1 Revision C

[V1 3001] Selection and Recertification Crewmembers shall be medically and psychologically selected 

and annually recertified following the guidance in OCHMO-STD-100.1A, NASA Astronaut Medical 

Standards Selection and Annual Recertification.

[V1 3002] Pre-Mission Preventive Health Care Pre-mission preventive strategies shall be used to reduce 

in-mission and long-term health medical risks including, but not limited to: (see NASA-STD-3001 Volume 1 

Rev C for full technical requirement).

[V1 3003] In-Mission Preventive Health Care All programs shall provide training, in-mission capabilities, 

and resources to monitor physiological and psychosocial well-being and enable delivery of in-mission 

preventive health care, based on epidemiological evidence-based probabilistic risk assessment (PRA),

individual crewmember needs, clinical practice guidelines, flight surgeon expertise, historical review, 

mission parameters, and vehicle derived limitations. These analyses consider the needs and limitations

of each specific vehicle and design reference mission (DRM) with particular attention to parameters such 

as mission duration, expected return time to Earth, mission route and destination, expected radiation

profile, concept of operations, and more. In-mission preventive care includes, but is not limited to: (see 

NASA-STD-3001 Volume 1 Rev C for full technical requirement).

[V1 3004] In-Mission Medical Care All programs shall provide training, in-mission medical capabilities,

and resources to diagnose and treat potential medical conditions based on epidemiological evidencebased PRA, individual crewmember needs, clinical practice guidelines, flight surgeon expertise, historical

review, mission parameters, and vehicle-derived limitations. These analyses consider the needs and 

limitations of each specific vehicle and design reference mission (DRM) with particular attention to 

parameters such as mission duration, expected return time to Earth, mission route and destination, 

expected radiation profile, concept of operations, and more. In-mission capabilities (including hardware 

and software), resources (including consumables), and training to enable in-mission medical care, and 

behavioral care, are to include, but are not limited to: (see NASA-STD-3001 Volume 1 Rev C for full 

technical requirement).

[V1 3012] Terrestrial Launch/Landing Medical Support All programs shall have medical capability at the 

site of terrestrial launch and landing to address nominal operations and launch/landing contingencies, 

including, but not limited to the following:

a. HSP requirements for the crew, the crew’s family, and supporting personnel for purpose of disease 

prevention.

b. Access to the full spectrum of medical capabilities, from routine medical and mental health care to 

advanced trauma life support (ATLS) capabilities, or equivalent.

c. Incorporation of civilian and/or Department of Defense (DOD) facilities and Emergency Medical Services 

(EMS). 

[V1 3016] Post-Mission Health Care Post-mission health care shall be provided to minimize occurrence of 

deconditioning-related illness or injury, including but not limited to: (see NASA-STD-3001,

Volume 1 Rev C for full requirement). 

Referenced Technical Requirements

18 12/01/2023

Rev D

View the current versions of NASA-STD3001 Volume 1 & Volume 2 on the 

OCHMO Standards website
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

NASA-STD-3001 Volume 1 Revision C

[V1 3017] Post-Mission Reconditioning All programs shall provide the planning, coordination, and 

resources for an individualized post-mission reconditioning program, specific to each crewmember, 

mission type, and mission duration. The post-mission reconditioning starts with crew egress at landing 

and includes a guided, phased reconditioning protocol. The goals of the reconditioning program include 

the following:

a. To ensure the health and safety of returning crew.

b. To actively assist the crew's return to full functional abilities and return-to-flight status.

c. To actively assist in the crew’s return to pre-mission fitness.

NASA-STD-3001 Volume 2 Revision D

[V2 7043] Medical Capability A medical system shall be provided to the crew to meet the medical 

requirements of NASA-STD-3001, Volume 1.

Referenced Technical Requirements

19 12/01/2023

Rev D

View the current versions of NASA-STD3001 Volume 1 & Volume 2 on the 

OCHMO Standards website
NASA-STD-3001 Technical Brief

OCHMO-TB-033 Spaceflight Experience and Medical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Reference List

1. Human System Risk Board Risk Packages – including Orthostatic Intolerance; Radiation; Back Pain; 

Sensorimotor Alterations; Reduced Muscle Mass, Strength; Reduced Aerobic Capacity; Renal Stone 

Formation; and Vision Alterations

2. Space Operations Medical Support Training Course: Space Physiology and the Deconditioned 

Astronaut. NASA JSC, Space Medicine Operations Division

3. Wotring, V. E. Medication use by U.S. crewmembers on the International Space Station. FASEB J. 29, 

4417–4423 (2015).

4. Marshall-Goebel K, Laurie SS, Alferova IV, et al. Assessment of Jugular Venous Blood Flow Stasis and 

Thrombosis During Spaceflight [published correction appears in JAMA Netw Open. 2020 Jan 

3;3(1):e1920195]. JAMA Netw Open. 2019;2(11):e1915011. Published 2019 Nov 1. 

20 12/01/2023

Rev D