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Table 1 Constraints to medical care delivery during a space exploration mission and the simulation setting at MDRS. Adapted from Marshburn and Norfleet [17, 36]

From: Intubation after rapid sequence induction performed by non-medical personnel during space exploration missions: a simulation pilot study in a Mars analogue environment

Feature of an actual space exploration mission Constraint replicated at MDRS?
Physiological changes
 Physiological alterations induced by the space environment: space motion sickness, muscular and bone loss, orthostatic hypotension upon return to gravity, loss of aerobic capacity, immunodeficiency Partially (cardiovascular deconditioning only)
 Poor expected hemodynamic tolerance to hypovolemia, general anaesthesia, mechanical ventilation Yes
 Pharmacodynamics and pharmacokinetics changes Partially (drugs distribution affected by lower cardiac output)
 Reduced wound healing No
Technical constraints
 Isolation and impossible urgent evacuation Yes
 Communication delay Yes
 Immobilisation of patient, operator and equipment (in weightlessness) Not applicable
 Limited medical equipment and consumables (mass, volume, power requirement) Yes
 Limited choice and volume of IV fluids Yes
 Specific IV fluid infusion system (in weightlessness) Not applicable
 Altered drugs shelf-life No
 Risk of closed environment contamination with gas, liquids or biological substances No
 Lack of blood substitutes Yes
 Management of healthcare waste Yes
Human factors
 Limited medical skills (especially if crew doctor injured or ill) Yes
 Fading of skills during the flight No
 Psychological stress Partially