Immediate management of medical emergencies in space: A scoping review

With plans to return to the Moon and explore Mars, long-duration missions beyond Low Earth Orbit (LEO) are on the verge of becoming a reality. Medical self-sufficiency will be vital as astronauts operate far from Earth, where logistic support is limited, communication delays are prolonged, and emergency evacuation may not be feasible. While previous researchers have discussed medical risks and autonomy in space, no prior research has systematically examined how immediate medical emergencies are managed during space missions, specifically analyzing preparedness and response strategies as defined by the Federal Emergency Management Agency. The aim of this review was to analyze existing medical emergency management strategies and practices for spaceflight, with a focus on the personnel, procedures, and equipment used to maintain crew health and safety across various mission scenarios. This scoping review adheres to the Joanna Briggs Institute and PRISMA-ScR guidelines, utilizing the PCC framework. To answer the question “ How are astronauts’ medical emergencies immediate(ly) managed during human Spaceflight? ” a literature review was conducted across three databases: PubMed, Scopus, and Web of Science. Publications from the past 40 years, including journal articles, conference proceedings, and books, were included that address any aspect of managing medical emergencies during space missions. Exclusions applied to articles not published in Portuguese or English, and those focused on recovery phases. A total of 4,868 publications were screened, of which 198 met the inclusion criteria. Preparedness was addressed in 47 studies (52.2%) and response in 43 (47.8%). Across both phases, studies were categorized into three dimensions: personnel, procedures, and equipment. Within preparedness, 23 studies (25.6%) focused on personnel training, 34 (37.8%) on procedures, and 30 (33.4%) on medical equipment and diagnostic tools. In the response phase, 9 studies (10%) examined crew performance during emergencies, 19 (21.1%) assessed emergency protocols, and 27 (30%) evaluated equipment performance in use. The literature shows a predominant focus on preparedness rather than addressing operational response capabilities, especially in the personnel dimension. Significant gaps remain in evaluating decision-making under stress, protocol performance in real emergency conditions, especially in communication-delayed environments. Future work must prioritize the effectiveness of crew response and procedures, as well as medical autonomy, integrating simulation-based training with human performance assessment and decision-support technologies to enable safe deep-space exploration. • Medical emergencies remain a mission-critical risk for deep-space exploration • Space medicine research prioritizes preparedness over real-time emergency response • Crew autonomy gaps threaten medical decision-making beyond low Earth orbit • Current medical frameworks are insufficient for exploration-class missions • Autonomous simulation systems are crucial for deep space medical care.