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Medical support

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International Space Station medical working groups

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Medical personnel from each International Space Station (ISS) partner work together in the following groups to solve medical issues related to the ISS:

Acoustics sub-working group


To support the Multilateral Medical Operations Panel (MMOP) in coordinating input from the international partners regarding acoustic issues for the maintenance of astronaut's health and optimal performance.

Examples of issues

  • ISS acoustic environment
  • In-flight monitoring of crew

Biomedical training working group


To support the MMOP in coordinating input from international partners regarding:

  • Biomedical training of crewmembers, crew surgeons, and other biomedical mission support personnel
  • Training and certification documents and websites for biomedical training
  • Maintaining a training completion database
  • Planning crewmember hazardous duty training
  • Monitoring of the training plan implementation

Example of activities

  • Developing the Flight Surgeon training manual

Countermeasures working group


To support the MMOP in coordinating input from the international partners regarding:

  • Pre-flight, in-flight, and post-flight assessments of physical fitness and exercise prescription
  • Countermeasure strategies, planning, and implementation

Examples of issues

  • In-flight fitness testing regimen implementation
  • Second generation treadmill requirements
  • In-flight exercise prescriptions
  • Countermeasure Evaluation and Validation Project (CEVP)
  • Success criteria/standards for return-to-duty post-mission

Environmental health working group


To support the MMOP in coordinating input from international partners regarding:

  • Recommendations on medical and medical engineering issues for environmental quality assurance with respect to air and water, microbiology, acoustics and other physical parameters
  • Development, review, and updating of documents with medical and medical engineering requirements

The Environmental Health Working Group is composed of four sub-groups: air quality, water quality, microbiology and acoustics

Examples of issues

  • High noise levels on the ISS
  • Modification of on-orbit hardware to obtain accurate samples of the atmosphere on the ISS

Extravehicular activity working group


To support the MMOP in coordinating input from the international partners regarding:

  • Utilization of research data and new technologies in Extravehicular Activity (EVA) support

Examples of issues

Human behaviour and performance working group


To support the MMOP in coordinating input from the international partners regarding:

  • Psychological adaptation and support
  • Behavioural health
  • Sleep and circadian health and fatigue monitoring
  • Human-system interface issues

Examples of issues

  • Psychiatric/psychological selection and certification standards
  • Content of psychological training of individual crewmembers and/or entire crews
  • In-flight behaviour and performance monitoring standards
  • Planning, provision, and coordination of pre-flight, in-flight, and post-flight behaviour and performance support
  • Astronaut work/rest schedules
  • Emergency support of crewmembers experiencing difficulties in their performance or behaviour

In-flight clinical medicine working group


To support the MMOP in coordinating input from international partners regarding:

  • Provision of medical diagnostics, monitoring and care to the ISS crew
  • Develop and maintain standards for in-flight clinical care

Example of issues

  • Criteria for ordering the early termination of a flight due to medical reasons

Medical informatics and technology working group


To support the MMOP in coordinating input from international partners regarding:

  • The definition of technical means, rules and procedures to document and capture the provision of medical care
  • Effectively and securely share data among the ISS Medical Operations community

Examples of issues

  • Protection of medical and health-related data of all crewmembers and space flight participants

Medical standards working group


To support the MMOP in coordinating input from the international partners regarding:

  • Requirements and procedures for Medical Assessment Testing (MAT) and managing the MAT database
  • Medical standards for ISS crewmember selection
  • Standards and procedures for periodic monitoring during training, pre-flight, in-flight, and post-flight

Examples of issues

  • Management/access to MAT data
  • CEVP
  • Development of medical standards for spaceflight participants
  • On-going review of the Astronaut Medical Evaluation Requirement Document (AMERD)

Nutrition working group


To support the MMOP in coordinating input from the international partners regarding:

  • Nutritional requirements and methodologies for astronauts
  • Assessment of nutritional status
  • Validation and implementation of new nutrition strategies

Examples of issues

  • Nutritional status assessment
  • Nutrient intake requirements (e.g. dietary sodium, vitamin K, and iron)
  • Microbiological and toxin standards for food
  • Crew training (e.g. nutrition education, food preparation)
  • Menu list (e.g. provision of food items by international partners)
  • Food packaging

Radiation working group


To support the MMOP in coordinating input from the international partners regarding:

  • Radiation limits and control principles
  • In-flight dosimetry including radiation biodosimetry
  • Radiation exposure monitoring and dose management
  • Radiological equipment and procedures
  • Radiological training

Examples of issues

  • Exposure limits for radiation from space environment and man-made radiation sources
  • Radiation protection requirements and strategies
  • Crewmember radiation training content
  • Operational countermeasures
  • Radiation protection hardware responsibilities
  • Radiation monitoring requirements
  • Radiation health risk assessment procedures
  • Operational procedures
  • Radiation biodosimetry methodology
  • Non-iodizing radiation

Is there a doctor in the house? The role of a flight surgeon

In this section

What is a flight surgeon?

Canadian Space Agency (CSA) flight surgeon, Dr. Jean-Marc Comtois, provided medical support to CSA astronaut Marc Garneau during extravehicular activity (EVA) training at the National Aeronautics and Space Administration (NASA) Neutral Buoyancy Laboratory in Houston, Texas in preparation for mission STS-97.

A flight surgeon is not actually a surgeon, but rather a doctor with training and experience in aviation and space medicine. Flight surgeons provide medical support for astronauts during training exercises and space missions. Their main role is to make sure that astronauts are physically and mentally fit to participate in these activities. It is also their responsibility to advocate a safe environment for the astronauts on earth or in space. When a medical problem does occur the flight surgeon provides medical care to the astronaut. In the words of Canadian astronaut Chris Hadfield, "the flight surgeon's job is to keep you healthy enough to stay flying."

Astronaut health

One of the most effective ways to decrease the chance of a medical problem in space is to select and retain healthy astronauts. Flight surgeons play a major role in the selection of new astronauts and in deciding which astronauts should fly on each mission. They set the medical standards that people must meet to become an astronaut. These standards are based on the current understanding of the risks of space travel, the effect of micro-gravity on the body, the countermeasures that are available to decrease these effects and the limited medical care that is available in space if a problem should occur. Flight surgeons then use these standards to screen applicants during astronaut selection.

Once new astronauts are selected, flight surgeons conduct physical examinations every year to ensure that the astronauts are medically fit for spaceflight. If astronauts do not pass the annual physical examination, the flight surgeons would work with them to resolve the medical problem and return them to flight status.

When an astronaut is recommended for a space mission, the flight surgeons will ensure that the astronaut is fit for the specific activities on the mission and that the mission will not have negative long-term effects on the astronaut's health.

In the remote circumstance that an assigned astronaut develops a medical problem before the mission, the flight surgeon would only suggest the astronaut be removed from the mission if the problem could worsen during spaceflight, affect the health and safety of the crew or have a negative impact on the mission.

Flight surgeons also sit on medical boards and panels that develop the procedures to keep astronauts healthy and safe in space, and to review these procedures regularly to ensure they include the most recent research findings.

Medical support for spaceflight

Since flight surgeons are ultimately responsible for the health and safety of the crew, they need to know the risks associated with a mission and the medical history of each astronaut in order to anticipate possible hazards, minimize danger to the crew, and maximize mission success. Flight surgeons not only rely on their own knowledge, but also on the expertise of the medical support team. This team is made up of biomedical engineers and medical specialists such as psychologists, psychiatrists, exercise physiologists, nutritionists, and radiation health officers. The flight surgeons are the focal point for all medical activities and manage the information they receive from the medical support team to determine how to best respond to each medical situation.


The flight surgeon's main goal before the flight is to ensure that the crew remains healthy and free from injury. Flight surgeons supervise mission planning from a medical perspective, deal with medical problems that affect the crew's ability to train or remain qualified, and familiarize themselves with the mission activities. For example, flight surgeons monitor and may even participate in training to use equipment and perform EVA. This helps to better understand the astronauts' work as well as the physical and psychological stress they may face in space. Since flight surgeons do not fly in space, they train one astronaut as the Crew Medical Officer (CMO) for the mission. The CMO serves as the eyes and ears of the flight surgeons during the mission. If one of the astronauts in the crew was a medical doctor, he or she would normally be designated the CMO. If not, one of the crewmembers would undergo training to perform basic medical procedures.

The flight surgeons ensure that all medical supplies are in place for the flight and that the crew is trained to use countermeasures to decrease the negative effects of spaceflight on their health. The flight surgeons conduct the pre-launch medical tests and support the crew at the launch facility.


The flight surgeon's top priority during spaceflight is to maintain the health of the astronauts. A team of flight surgeons provides 24-hour medical support to the astronauts from the ground at the Mission Control Center. During shuttle flights, flight surgeons hold daily private medical conferences with the crew and the CMO. On longer space station missions, flight surgeons hold weekly private medical conferences with each crewmember, and the CMO performs periodic in-flight medical evaluation for the flight surgeons. On the Space Shuttle, the Soyuz and the International Space Station (ISS), minor injuries and ailments can be treated but there are limited medical capabilities for treating more severe injuries and illnesses. If the flight surgeons believe that a medical condition cannot be treated properly in-orbit, or has a harmful effect on crew health, safety, or performance, they can recommend that the crew return to Earth.


Flight surgeons perform a brief medical examination on the astronauts at the landing site. During the first few weeks following the landing, flight surgeons continue to perform a number of medical assessments to monitor the health of each astronaut. They also oversee the crew's rehabilitation to allow the astronauts to return safely to Earth-based activities and flight status as soon as possible.

Medical support during astronaut training

In addition to providing medical support during missions, flight surgeons provide medical support for astronauts during basic and advanced training. By being involved in training, the flight surgeons also get to know the astronauts and gain a better understanding of the potential medical problems they could face in space. For example, CSA flight surgeons have provided medical support in extreme environments during non-mission training like NASA Extreme Environment Mission Operations (NEEMO).

Career opportunities

CSA flight surgeon, Dr. Jean-Marc Comtois, checks up on the crew of NEEMO 7, an underwater simulated space mission.

Since aerospace medicine is a small field, there are a limited number of flight surgeon positions in Canada, especially in the space program. Other than at the CSA, government agencies such as the Department of National Defence or Transport Canada, and private companies in the aviation industry, such as major airlines, employ flight surgeons.

Training for flight surgeons is offered in Canadian and international institutions. For more information, visit CSA's Aerospace medicine training.

Medical support for the International Space Station

In this section

The Multilateral Medical Policy Board (MMPB)

The MMPB is made up of one physician from each of the international partners (IPs). It is the top-level medical policy board, which oversees the Multilateral Medical Operations Panel (MMOP) and the Multilateral Space Medicine Board (MSMB).

The Multilateral Space Medicine Board (MSMB)

The MSMB is one of the MMPB's primary working-level groups and is responsible for certifying that ISS crew meets the medical certification requirements. It also ensures that mission-assigned flight surgeons selected by the MMOP have completed the established credential standards. After reviewing and approving the MMOP's findings and recommendations, the MSMB forwards its recommendations to the MMPB.

The Multilateral Medical Operations Panel (MMOP)

The MMOP establishes common medical standards, preventive medicine guidelines, certification criteria, operational countermeasures, clinical care, medical hardware responsibilities, operational procedures, and environmental monitoring requirements. It also develops training certification guidelines for ISS flight surgeons and recommends mission-assigned flight surgeons to the MSMB. The MMOP receives and evaluates input from various working groups to solve key medical issues and presents its findings to both the MMPB and the MSMB.

Space Medicine Operations Team (SMOT)

The SMOT meets weekly via teleconference to discuss immediate and pertinent medical issues related to the ISS. Crew health, safety, well-being and performance, working conditions, ISS external and internal environment, and other medically relevant matters are discussed. Participation is limited to physicians from ISS partner agencies, essential support personnel, and experts invited for specific topics.

Space Medicine Management Team (SMMT)

The SMMT meets monthly via teleconference to identify the issues pertaining to the ISS crew health, safety, well-being and performance, working conditions, external and internal environment, and other medically relevant matters. Participation is limited to physicians from ISS partner agencies, essential support personnel, and experts invited for specific topics.

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