50. The Commercial Spaceflight Industry: Medical Challenges and Risk Mitigation

This chapter will discuss the challenges of suborbital and orbital commercial human spaceflights, the recommended medical standards and management of medical risks, and the inform consent process applicable to the launch, flight and landing. Spaceflights are associated with a number of physiological and psychological changes that may cause and/or aggravate certain medical conditions during flight, and could adversely impact an individual’s health and safety. The spaceflight environment is far more hazardous compared to the operational risks encountered during commercial aviation flights. Such increased risk factors include: acceleration, barometric pressure, microgravity, ionizing radiation, non-ionizing radiation, noise, vibration, temperature and humidity, breathable air and ventilation, as well as behavioral issues. The main challenge for Aerospace Medicine Specialists is to identify and mitigate significant pre-existing diseases, illnesses, injuries, infections, treatments (pharmacological, surgical, prosthetic, or other), or other physiological or pathological or psychiatric conditions among commercial space vehicle occupants (flight crews and passengers). These medical conditions have the potential of resulting in inflight medical emergencies, resulting in inflight deaths, compromising the health and safety of commercial space vehicle occupants, interfering with the proper use (don and doff) and operation of personal protective equipment, interfering with emergency procedures (including evacuation), and/or compromising the safety of the flight. Therefore, prospective commercial space vehicle occupants will have to be medically evaluated very carefully before allowing them to participate in suborbital and orbital spaceflights.