Management of trauma and emergency surgery in space.

Trauma may cause morbidity or mortality in expeditionary spaceflight settings. Physiologic and mechanical changes related to microgravity may increase susceptibility to and complicate the management of injuries in spaceflight. Limited surgical experience in microgravity suggests that special apparatuses and techniques will be needed to maintain the stability of patients, surgeons, and equipment, and to control fluids. A prototype microgravity surgical workstation and suction unit and modifications of standard procedures were devised to address these needs. Using these devices and methods and selected surgical supplies during repeated 25-second intervals of microgravity generated by parabolic arc flight, the "ABCs" of trauma management, limb traction and immobilization, and minor surgical procedures were performed in flight and problems were identified. Convincing "qualification" of spaceflight surgical equipment and protocols will require evaluations in continuous microgravity. As on Earth, the major determinant of emergency surgical care in spaceflight may be the presence or absence of a well-trained surgeon.