Cleared for Launch: Pre-flight Medical Assessment in the Commercial Spaceflight Era

Area of Science:

• Aerospace Medicine
• Spaceflight Physiology
• Clinical Evaluation

Background:

• Commercial human spaceflight has rapidly expanded since 2021, including civilian participation in various mission types.
• Current pre-flight medical assessments rely on outdated guidance, primarily focusing on G-load exposure and not incorporating recent findings.
• New mission profiles and a broader participant demographic necessitate an updated, unified evaluation framework.

Purpose of the Study:

• To synthesize current aerospace medicine and clinical literature over the past two decades.
• To develop a comprehensive framework for evaluating civilian spaceflight participants.
• To propose an updated clinical routine for pre-flight medical assessments.

Main Methods:

• Narrative review of aerospace medicine and clinical literature from the last 20 years.
• Framework distinguishes between mission-related factors (e.g., acceleration, radiation) and participant-related factors (e.g., age, comorbidities).
• Analysis of documented civilian cohorts, including age ranges and comorbidities.

Main Results:

• Civilian participants range from 18 to 90 years, with orbital participants aged 29-71.
• Documented comorbidities include cardiovascular, metabolic, and oncological conditions.
• A three-tiered clinical routine (Tier 1, 2, 3) is proposed, spanning 90 days pre-flight to launch.

Conclusions:

• The proposed tiered clinical routine offers an operational starting point for civilian spaceflight medical evaluations.
• Integration of recent evidence on spaceflight effects and participant factors is crucial.
• Prospective validation is required as the commercial spaceflight era evolves.