IntroductionTraditionally, NASA mission planners have used a heuristic and qualitative approach to design medical systems based on prior experience; however, this approach may result in implicit bias in design. The risk of needing to return to definitive care (RTDC) or medevac, has been particularly difficult to quantify due to the complexity of exploration spaceflight. The Informing Mission Planning through Analysis of Complex Tradespaces (IMPACT) tool is a probabilistic risk assessment approach designed by NASA to model medical risk in long duration spaceflight. This paper discusses how this tool can inform RTDC risk and improve the health and safety of astronaut crews. MethodsIMPACT was developed by subject matter experts using an evidence-based approach and can be used to quantify the risk of exceeding the onboard medical capabilities. Within the model, RTDC occurs when a condition meets a specific threshold that exceeds the on-board capabilities and requires a higher level of care. A notional lunar surface design reference mission (DRM) was modeled using IMPACT, and the RTDC rate was analyzed. ResultsOf the 119 medical conditions evaluated, thirty-four were preassigned to have zero probability of RTDC based on lack of acuity. Thirty-one conditions used the need for inpatient hospitalization or admission to intensive care as the RTDC surrogate. Twenty-six conditions used the probability of needing surgery, and ten conditions used treatment failure rates as the RTDC surrogate. The remaining 18 conditions had unique surrogates that did not fall into the above categories or were assigned a 100 % probability of RTDC due to their definition. In the sample DRM, the overall risk for RTDC was 0.32 events per mission. DiscussionQuantifying medical risk for human spaceflight is challenging but important in designing medical systems that support the health and performance of our astronaut crews. IMPACT can use the best available evidence to quantify the risk of an RTDC event based on mission parameters and help mission planners make informed design decisions. More work is underway to further refine the model and evidence that drives the RTDC calculation to improve model fidelity and utility for missions to the Moon, Mars, and beyond.