Mission Medical Kits: Equipment, Drugs and Supplies from Suborbital Flights to Mars

The big idea: distance changes everything

On Earth, a remote clinic can always call an ambulance. In space, the medical kit has to match how long it takes to get the patient to a hospital, and that time grows with distance:

• Low Earth orbit (LEO). Evacuating an ill or injured crewmember to definitive care is feasible in a reasonable time [17].
• The Moon. Evacuation takes longer, so the kit must be able to stabilize a patient for a long transfer [17]. A return from the Moon can take 144 hours or more [6].
• Mars. There is no evacuation during transit, Mars orbit or the return leg [4][17]. Communication has a one-way delay of up to about 22 minutes, and 2-week blackouts are possible [4].
• Resupply. The resupply chain that exists in LEO will be strained for lunar missions and will not exist at all for a Mars mission [17].

NASA no longer prescribes a fixed kit per mission type. NASA-STD-3001 Vol. 1 Rev C requires every program to provide medical kits (personal, routine, emergency and survival), ancillary tests (imaging, laboratory analyses, ECG), procedures, restraints and training. Each item is chosen through probabilistic risk assessment (PRA) for that vehicle and mission, considering duration, return time, destination and radiation profile [1] ([V1 3004]). NASA’s Integrated Medical Model (IMM) is one such tool. It models 100 medical conditions and can test what happens when supplies run out [17].

Comparison: kit capability by mission type

The five columns are the mission types used on this site. Entries summarize published NASA and FAA material. Where no public source exists, the cell says so.

Drugs by category

What the ISS actually carries

The most detailed public list is the 2023 ISS formulary, analyzed by Diaz and colleagues [7]:

• 111 medications in five packs [7]:
  • convenience medications (23);
  • emergency medical treatment (4);
  • oral medications (36);
  • topical and injectable medications (37);
  • vascular contingency (11).
• Earlier and broader descriptions differ. NASA’s pharmaceutical brief describes two kits (U.S. and Russian segments) containing 190 medications, plus personal kits for each crewmember [6]. Its figure from the 2016 ISS medical checklist shows nine packs: Emergency Medical, Convenience Medication, Oral Medication, Topical & Injectable, Diagnostic, Minor Treatment, Medical Supply, IV Supply and Physician Equipment [6].

The table names drugs only where the 2023 formulary [7], the landing kit [12] or a NASA brief [20] lists them. It is a description of what has flown, not a prescribing recommendation. Doses are deliberately omitted.

Shelf life and drug stability: the Mars problem

• Most drugs expire too soon. Current medicines have average expiration dates of 1–2 years, while long missions are planned for 1–5 years [6]. Only 16% of the 107 medications then on the ISS formulary would last 2.5 years by expiration date, once pre-launch ordering and packing time is counted [10]. In the 2023 formulary, 54 of 91 medications with data had a terrestrial shelf life of 36 months or less, and 14 would expire within 24 months [7]. Fifteen medications (14%) had no public expiry data [7].
• Only labeled drugs can fly. NASA can only legally pack medications that have manufacturer expiration data [6]. NASA reports it lacks reliable shelf-life information for exploration formulary drugs. Of 277 drugs on its list of resources for exploration missions, 64 appear in a 2006 partial list from the U.S. Shelf Life Extension Program (SLEP) [11].
• What flight itself does. Across six studies of 36 drug products flown for up to 2.4 years in LEO, most stayed within 10% potency of matched ground controls. Degradation was faster in flight, and non-protective repackaging was the main controllable factor [8].
• Radiation. Radiation in LEO has not been found to significantly interfere with medications. The deep-space radiation environment is different and its effect is unknown [6][9].
• Selection is hard. Choosing a formulary for exploration remains difficult because few studies exist [9]. NASA guidance favors multipurpose medications and attention to how drugs interact with closed-loop life support [13].

For more detail see Space pharmacology: medical kits and drug stability.

Diagnostics, procedures and oxygen

• Ultrasound is the workhorse. Ultrasound has flown on the ISS since 2002 [10]. Minimally trained crew performed remotely guided trauma ultrasound (the FAST exam) with a 2-second communication delay [19]. Ultrasound images the skull and lungs poorly, so radiography would complement it [10]. See Point-of-care ultrasound.
• ISS emergency hardware. The ISS Crew Health Care System (CHeCS) catalog describes [5]:
  • an advanced life-support pack (airway, assessment, bandage, drug, emergency surgery and IV packs, with 4.5 L of IV saline);
  • an ambulatory medical pack (oral and topical medicines, a portable blood analyzer, dental and physical-exam supplies);
  • a crew medical restraint system that restrains the patient, stabilizes the spine and electrically isolates for defibrillation;
  • an automated external defibrillator (AED);
  • an intubating laryngeal mask airway (ILMA), which the catalog credits with a 99% airway success rate for crew medical officers versus 50% with an endotracheal tube;
  • a respiratory support pack (low-flow oxygen, bag ventilation, automatic ventilator).
• Oxygen is a shared resource. Giving oxygen or intubating can use up the crew’s oxygen supply (on the Moon) or raise fire risk (on the ISS), so triage becomes necessary [2].
• Surgery. Over interplanetary distances, Earth-based treatment and telemedicine become unfeasible. Surgical capability must be self-sufficient and adaptive. Appendicitis and trauma are among the conditions anticipated [18].
• Spacesuits. NASA-STD-3001 Vol. 2 requires a way to give medication to a suited, pressurized crewmember for suited exposures over 12 hours [6][22] ([V2 11027]). Suit decompression treatment is covered in Decompression sickness and EVA.
• When care runs out. Programs must provide palliative comfort care when resources are exhausted, timely return is not possible and survival is judged impossible [1] ([V1 3009]).

Training by mission type