Terrestrial trauma systems in support of human spaceflight.

As spaceflight expands to the private sector, the number of space travelers potentially at risk for traumatic injury during a spaceflight emergency will increase. Intersection with terrestrial health care systems will most likely occur during launch and landing phase emergencies for the majority of providers. The terrestrial trauma system should be prepared to provide prehospital and hospital care for this unique patient population. Emergency medical providers should be aware of potentially altered physiology from long-duration microgravity exposure as well as chemical and thermal exposures. Furthermore, evacuation from landing sites is anticipated to take several hours in the best-case scenario. Therefore, prehospital and transport care should focus on Advanced Trauma Life Support (ATLS) principles with the ability to provide temporizing care for several hours before transfer to a tertiary care center. Procedures that are performed as a bridge to expedient definitive management, such as a resuscitative thoracotomy, would be contraindicated in this setting. Transport plans to specific level I or II trauma centers within proximity of launch and landing sites should be streamlined with mass casualty incident plans in place if needed.