Space exploration is embedded into the foundation of our past, exists at the forefront of the present and is inevitable in our society’s future. We, as a species, first set our sights on the closest celestial body, the Moon. Since then, society’s ambitions have extended far beyond the confines of the Moon, with the Martian surface becoming an extra-terrestrial target location for space exploration, data collection and potential colonization. History is known to repeat itself, whilst this common saying is often overlooked, its application is rather fitting when the details of this instance are examined. We, as an internationally divided species, have entered into a contemporary space race. In direct comparison to ascendant events of the Cold War, this modern contest is more attributed to an expression of technological prowess rather than a show of the superior ideology. Mars colonization would irrefutably be the crowning achievement of the century thus far. But beyond the technical intricacy of the task, the attributes and implications of becoming a multi-planetary species provide compelling rationales that argue in favour for crewed interplanetary exploration. With the prospect of advances in astronautical engineering, medicine and robotics, both the United States and China have become prominent figureheads of this contemporary space race to Mars. However, in pursuit of becoming the pioneering claimant of technological superiority, these two nations have perhaps overlooked the pre-existing issues that perpetually plague society. Many societal imperfections that exist are decipherable; including poverty, overpopulation and climate change. This list is not easily exhaustible, but a concentrated focus of inputs (namely capital, labour, natural resources and time) could lead to a more idealistic society. The overarching implications of the opportunity costs associated with space exploration are visualized by these issues. Thus, by dissecting the components of Mars exploration, this report seeks to evaluate the significance of the space industry and to ultimately evaluate how we, as a collective, should look to develop our civilisation going into the future.

During the ISS4Mars workshops in 2020–2021, personnel from the International Space Station (ISS) partner agencies convened to reflect on scenarios for how the ISS could be used and its operations possibly modified to simulate aspects of a human mission to Mars. Scientific leaders, operations experts, crewmembers, managers, and flight surgeons discussed the five hazards of human spaceflight—gravity transitions, radiation, isolation and confinement, distance from Earth, and hostile closed environments—and considered how an ISS-based analog of Mars transit could benefit assessments and mitigations of these hazards. A focused writing team then discussed the advantages and disadvantages of each approach identified by the workshop participants before developing a set of eight use cases to consider the feasibility of implementing on the ISS. The writing team also identified the prerequisites needed, including ground analog studies simulating a mission to Mars required to verify measurements and procedures, before testing could begin on the ISS. Five of the use cases were considered feasible to assess in simulations using an ISS-based analog of Mars transit if some ground rules and assumptions were met. These five use cases were Earth-independent medical operations, Earth-independent integrated operations, life support and food for a one year duration, lower-body negative pressure as a countermeasure against the effects of exposure to microgravity, and fitness levels after landing. In addition, three more extensive interventions—extended Mars surface operations, a small-volume transit analog, and artificial gravity—were deemed unfeasible for testing on the ISS. Experience gained from the five use cases executed on the ISS may help answer some of the questions in the deferred scenarios, or it may be possible to complete them on another platform (e.g. commercial space station, lunar habitat). Simulating conditions during a Mars mission on the ISS will afford higher fidelity for assessing multiple integrated hazards of human spaceflight, however, ground analogs of Mars missions can be used to ensure effective measures and experimental design before testing begins on the ISS. The strategic concepts refined as part of these workshops were brought to a multilateral forum, Mulitlateral Human Research Planel for Exploration (MHRPE), where ISS partner agencies are now discussing implementation plans to provide new opportunities to use the ISS to prepare for deep space exploration over the coming decade. In this publication we present a summary of the international strategic plans for future research that will enable operations, software, and countermeasures to be developed that will reduce the risk to humans during future crewed missions to Mars.

Mental Health Implications for Aviators from COVID-19 The authors present aeromedical implications from COVID-19 disruptions on the civil aviation sector, consider mental health impacts on pilots, and discuss possible helpful responses to support pilot mental health. A multiple database review investigated articles from January 2002 to May 2021 on severe commercial aviation disruptions impacting pilot mental health and on pilot mental health coping or treatment. Fifteen papers were identified. During the COVID-19 pandemic, airline flights were severely reduced. By January 2021, airlines shed thousands of jobs and 24 airlines no longer existed. General population surveys found 13% of individuals had “serious distress” from the pandemic. In two aviation focused surveys, 40-66% of pilots agreed or strongly agreed that their mental health worsened since the COVID-19 pandemic. Compared to past Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) patients, more COVID-19 patients have mental health symptoms in the acute phase of illness; while about 10% of COVID-19 patients appear to have chronic or “long haul” symptoms. Mental Health treatment and coping strategies found helpful to pilots are discussed. Pilots remain at risk for mental health symptoms and illness due to the COVID-19 pandemic. For those who develop severe distress or mental illness from the effects of the pandemic (or COVID-19 infection), early treatment with psychotherapy and/or approved medications may be warranted. This may decrease the likelihood of persistent physical or cognitive or mental health symptoms that would delay a return to flying status.

Health issues typical of the expected commercial space tourism (CST) population are considered manageable, but less is known about the impact of psychological conditions on spaceflight participant (SFP) wellbeing and safety during spaceflight. Plans to detect and prepare SFP for potential effects of psychological conditions emerging during spaceflight are unknown and may be inadequate. The purpose of this integrative literature review was to identify CST operators’ plans for SFP psychological assessment and training. Forty-four (44) articles met inclusion criteria and were largely composed of grey and popular literature sourced online. Plans for SFP psychological assessment and training prior to CST were not found, although vague descriptions of training for specific CST opportunities and limited medical assessment information was located. An undisclosed or possibly non-existent psychological support approach will likely be insufficient to ensure SFP safety and optimal performance during emergencies. Instead, detailed and focused intentional screening of SFP should be completed by appropriate members of a transdisciplinary healthcare team at various phases of the spaceflight experience. Following assessment, collaborative decision making to develop training, interventions, and mitigation strategies in support of individual SFP psychological needs should occur before, during and after spaceflight. The strategies should align with standards of care and inform urgently-needed SFP research. Knowledge gained from future research will contribute to appropriate, effective SFP psychological assessments, intervention and training development, testing, and implementation, and overall management of SFP programs and strategy development aimed at optimizing the CST experience and goals.

Management of menstruation, pregnancy prevention, and mitigation of gynecologic-related pathology in the space environment with or without the use of hormonal modalities requires thorough counseling and complex decision-making. Factors that must be considered by astronauts and their physician teams range from desirability of contraception and/or menstrual suppression to weighing the risk and benefit profiles of various formularies of progesterone or combination estrogen and progesterone-containing hormonal modalities on various pathologies, including abnormal uterine bleeding, ovarian cyst production and risk of torsion, bone mineral density and osteopenia, venous thromboembolism, and cancer. Simultaneously, the choice to use or abstain from one of these modalities may also impact onboard mass, volume, and engineering considerations relating to stowage of onboard resources and sanitation products as well as impacting the design or function of waste management systems. While significant gynecological morbidity has not been reported during spaceflight, the objective of this review is to untangle these interrelated complexities to empower astronauts, physician and pharmacy teams, and engineering teams to enable the development of systems and protocols that support astronaut autonomy in reproductive decision-making and optimally mitigate future gynecologic risk.

The review is exploring the improvement of medical proficiencies needed for health support of crewmembers in explorative manned missions to Lunar and Martian surfaces, in which is effectively crucial for missions success. This article implores the latest research developments and publications in order to understand the progress made by global scientific communities in the race of landing human on extraterrestrial planets in the near future. It dissects through the medical event rates and level of expertise projected for such missions, summary of recent physiological update, the Crew Health Habitation System profiling, and the advancement of diagnostic and interventional aptitudes.

• Space presents ample opportunities for a wide range of highly innovative applications. • Patents are an excellent barometer of innovation. • Major innovations in healthcare are a result of space medical research. • The rapid advancements in human space exploration endeavors boost the demand for research and innovation in space medicine. Space presents ample opportunities for a wide range of highly innovative applications, as well as products and services that directly benefit humanity. Patents are an excellent barometer of innovation. Over the last four decades, researchers have made novel discoveries about the human body in space, and global patent filing in the space sector has consistently grown. Space medicine, as a distinct field, was still in its infancy five decades ago. Scientists studying the effects of space travel on the human body have begun to appreciate the relevance and possibility of future discoveries in the field. Major innovations in healthcare, including insulin pumps and cochlear implants, are a result of space medical research. While patents are becoming more prevalent in space medicine, they are not as ubiquitous as other manufacturing and technology sectors. In this article, we discuss several aspects pertaining to patents in the field of space medicine. The rapid advancements in human space exploration endeavors boost the demand for research and innovation in space medicine.

Heart disease is the #1 cause of disease-related death in pilots & astronauts in the world and coronary artery disease (CAD) is found in 85% of pilot autopsies after fatal accidents [1], [2], [3]. Acute cardiovascular incidents in flight crew can result in in-flight emergencies requiring emergency diversion, or at worst a major aircraft accident. When including passengers, emergency landings, to include airport diversion, occur in 1 out of every 604 flights at an average cost of $38,000 and are most commonly caused by cardiovascular processes including myocardial infarction and syncope [4]. Medical flying standards in aviators with coronary artery disease (CAD) are well established by the United States Air Force and other military branches such as the Army, Navy, and Coast Guard as well as the Federal Aviation Administration (FAA), National Aeronautics and Space Administration (NASA), and United States NATO allies. However, CAD screening standards vary widely from one aviation organization to another and are strikingly absent in some. In this article, the authors propose an evidence-based CAD screening algorithm based on published literature from 70 years of aircrew specific cardiac data gathered from nearly 1.3 million studies performed on over 300,000 aircrew. Given the advancement of space flight and the commencement of high performance recreational flight opportunities, there is a new era of passengers that will need baseline medical screening and clearance prior to embarking on their adventures. The following proposed screening and disposition algorithms offer evidence-based models for this need.

• Saudi Arabia aims to become an integral country in the space medicine field. • Advancements will require strong research focuses and social opportunities. • Current goals include funding and opportunities for medical students and doctors. The establishment of the Saudi Space Commission in 2018 marked a breakthrough for Saudi Arabia, in which the nation expressed its capacity for space exploration. In this context, space medicine is a subspecialty of focus that aims to maintain human health and performance in the extreme environment of outer space based on scientific knowledge concerning the aerodynamic effects on the human body. The field is not widely common and is only now established in a few countries with advanced research capabilities in the field of space exploration. However, there is great potential in space medicine with a multitude of strong research opportunities. This advancing field may result in knowledge that far exceeds the currently known and well-investigated aspects of human health. Nevertheless, progress has been hindered by some challenges, including a limited number of institutions, human resources, and research funding. This article provides a roadmap for the creation, development, and improvement of space medicine in Saudi Arabia.