SMF-E-0001 · guide · Equipment · Pre-Flight & Post-Flight Clinic

Pre-Flight & Post-Flight Clinic: Designing and Equipping a Spaceflight Medical Evaluation Clinic

Also: Astronaut clinic design · Spaceflight medical certification clinic · Return-to-Earth evaluation clinic

Gravity Fields Hostile/Closed Environment Cardiovascular Musculoskeletal Neuro-ophthalmic Neurological & Cognitive Vestibular & Sensorimotor Behavioral Health & Sleep Pulmonary Renal & GU Selection & Certification Preflight & Training Postflight Recovery Lifetime Surveillance Suborbital LEO short-duration LEO long-duration Cislunar / Lunar orbit Lunar surface Clinician Operator / SFP

draft AI-assisted Last reviewed: Pending review · Reviewer: Pending review

Bottom line for clinicians

Build the clinic around the tests that published schedules actually call for. For career astronauts, NASA's OCHMO-STD-100.1A lists pre- and post-flight tests by domain (ECG, audiometry, eye exams with OCT and retinal photos, DXA, ultrasound, labs, active stand test, fitness, balance platform, behavioral health). For commercial orbital passengers, the FAA's 2006 guidance suggests a much shorter set (history and exam, blood and urine tests, resting ECG, chest X-ray, corrected vision, hearing). ◆◆◆◆ High · E
Suborbital passengers: the FAA guidance suggests a medical questionnaire reviewed by a physician with aerospace medicine training, without a mandatory exam. 14 CFR Part 460 sets no medical standard for spaceflight participants. Its only medical requirement is an FAA second-class medical certificate for crew in safety-critical roles. ◆◆◆◆ High · E
The post-flight side needs a fall-safe recovery area and orthostatic testing on landing day, because orthostatic intolerance and balance problems are common after flight (only 2 of 6 ISS astronauts tested completed a 10-minute tilt on landing day). Eye, bone and balance re-tests follow over days to a year. ◆◆◆◇ Moderate · F E
Most clinics can cover the essential tier in-house (exam, vitals, ECG, spirometry, basic vision and hearing, point-of-care tests, stand test, emergency cart with AED). MRI, CT and often DXA, panoramic dental X-ray and advanced eye imaging are usually referred to accredited partners. ◆◆◇◇ Low · E
Space and infrastructure figures here are SMF planning estimates, not published standards, and are marked pending verification. No prices or brands are given. ◆◇◇◇ Very low · E

Proposed certainty (◆ High → ◇ Very low) and evidence-type tags: F flight · A analog · M model/animal · C computational · E expert/operational/standards. Grades are AI-proposed and pending medical reviewer confirmation. How we grade.

Who this clinic serves

This guide is for a clinic, or a space inside an existing hospital or occupational-health service, that does two jobs:

Pre-flight evaluation and certification. It confirms that a person is fit to fly and records a baseline to compare against after landing.
Post-flight return evaluation. It checks how the body is readjusting to gravity and follows recovery.

Two groups of patients come through the door. Their requirements are very different:

	Career astronauts (government or agency crews)	Commercial spaceflight participants and private crew
Medical standard	NASA-STD-3001 Vol. 1 [V1 3001] requires selection screening and annual recertification against OCHMO-STD-100.1A [2][1]	None in U.S. regulation. 14 CFR Part 460 requires an FAA second-class medical certificate only for crew with safety-critical roles [6]. See Commercial SFP screening
Typical pre-flight work-up	Specialist exams by domain, repeated on a schedule. NASA lists example timings from about 2 years before launch (L-21/18 months) to launch [1]	Suborbital (up to about +3 Gz): medical questionnaire reviewed by a physician with aerospace-medicine training; no exam required. Orbital: history and physical plus a short test set [4]
Typical post-flight work-up	Exams on landing day (R+0), then R+3, R+7/14, R+30, R+60 and up to a year for bone, depending on the test [1]	No regulatory requirement. Research programs have tested civilians before and after short flights (for example ocular alignment, cognition, ultrasound and blood tests on Inspiration4) [22]

Important

OCHMO-STD-100.1A says its mission medical evaluations are not required for commercial astronauts, and that its schedules are examples, not fixed rules [1]. Use it as the most detailed public map of what a full evaluation contains. Do not treat it as a legal requirement for private flights. FAA guidance assumes a cabin pressure altitude of up to about 8,000 ft and accelerations up to about +4 Gz [4]. In a centrifuge study, most volunteers with well-controlled chronic conditions tolerated simulated suborbital profiles without significant adverse responses [23].

How to read the equipment tables

Each domain section below has a table with five columns:

Item: what it is.
Why spaceflight needs it: with a link to the matching clinical article.
Pre / post use: when it is used before and after flight.
In-house or refer out: an SMF suggestion for a typical outpatient clinic.
Space & infrastructure: a pending verification planning note.

The tier label after each item name is an SMF editorial suggestion:

E — essential.
R — recommended.
A — advanced.

Citations in square brackets point to the reference list at the bottom of the page. Acronyms link to the glossary.

Planning notes are estimates

NASA, the FAA and the cited standards do not publish room sizes or utility specifications for astronaut clinics. Every “Space & infrastructure” note is a practical estimate for planning conversations, labeled pending verification. Confirm them with:

the equipment manufacturer’s site-planning guide;
a qualified medical physicist (for any X-ray room);
the Facility Guidelines Institute (FGI) guidelines or your local health-facility code;
local radiation, laboratory and building regulators.

Equipment by evaluation domain

1. Intake, vitals and history

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Structured history and questionnaire (paper or electronic) · E	Suborbital passenger screening rests on a questionnaire reviewed by an aerospace-medicine-trained physician [4]. Orbital passengers need a full history [4]. Astronauts have periodic history and exam at set points before and after flight [1]. See the Clinician quick-start	Pre: every evaluation, plus an abbreviated re-check 1–2 weeks before orbital flight [4]. Post: symptom review at each visit	In-house	Private interview space; secure electronic record
Vital-signs set: automated and manual blood-pressure cuffs in several sizes, pulse oximeter (measures oxygen saturation, SpO2), thermometer · E	Baseline for orthostatic and cardiovascular comparisons after landing [1][9]	Pre and post, every visit	In-house	Wall-mounted or mobile units in each exam room
Calibrated scale and stadiometer (height) · E	Body mass and height feed suit fit, seat fit and drug dosing. Height changes with spinal elongation in weightlessness [14]	Pre: baseline. Post: early return visits	In-house	Floor space near intake; level floor
Infection screening at intake (swabs, symptom check) · E	NASA’s health stabilization program reduces infections carried into flight. The current NASA protocol starts it 14 days before launch [26]. Astronaut work-ups include nasal Staphylococcus aureus and throat Group A streptococcus swabs at L-90/30 days [1]	Pre only	Collect in-house; culture at a reference lab	Separate entrance or scheduling for quarantined crew (planning suggestion)

2. Cardiovascular

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
12-lead electrocardiogram (ECG) · E	Baseline before launch for comparison during and after flight [1] ([6006]). Resting ECG is also on the FAA orbital-passenger list [4]	Pre: e.g. L-9/6 months to L-10 days. Post: R+0/3 days for long missions [1]	In-house	Exam couch; ECG cart; the NASA description uses 15 minutes supine [1]
24-hour ambulatory ECG (Holter) · R	Captures rhythm disturbances a resting ECG can miss. Listed for selection and long missions [1]	Pre: e.g. L-365/330 days. Post: R+0 and R+10/14 days [1]	Apply in-house; analysis in-house or by a cardiology service	Small hook-up area; secure storage and charging for recorders
Exercise stress test / cardiopulmonary exercise test (CPET) with treadmill or cycle and metabolic cart · R	NASA requires maximal testing before flight to find peak heart rate, workload and maximal oxygen uptake (VO2max), screen for exercise-induced arrhythmia, and track recovery after flight [1] ([6028]). See Exercise countermeasures	Pre: e.g. L-90/30 days. Post: R+5 and R+30 days [1]	In-house if the clinic can meet clinical exercise-laboratory standards for staffing and emergency readiness [18][19]; otherwise refer to a cardiology lab	Dedicated room for treadmill or ergometer plus crash cart; ventilation; gas calibration; physician or trained staff present [18][19]
Echocardiography (heart ultrasound) · R	Obtained periodically as part of the annual astronaut physical [1] ([6014]). Selection lists echo within 5 years [1]	Pre: periodic or annual. Post: as clinically indicated	In-house if a credentialed sonographer and reader are available; otherwise refer	Shares the ultrasound room (see Imaging)
Tilt table / active stand test kit (automated BP monitor, timer, chair, fall-safe area) · E for stand test, A for tilt table	Orthostatic intolerance is common after landing. NASA requires an active stand test: supine, then seated 5 minutes, then standing 10 minutes, with BP and pulse each minute [1] ([6023]). In a research tilt protocol, only 2 of 6 ISS astronauts completed 10 minutes of 80° head-up tilt on landing day, compared with 52 of 65 Shuttle astronauts [10]. See Orthostatic intolerance after landing	Pre: baseline. Post: R+0, then daily until stable [1]	Stand test in-house (essential). Tilt table in-house or at an autonomic-function lab	Stand test: exam room with a chair, a wall to stand against and a stretcher nearby. Tilt table: about the footprint of a stretcher plus staff access on both sides; continuous ECG and BP; emergency cart within reach

3. Vision and neuro-ophthalmic

Spaceflight-associated neuro-ocular syndrome (SANS) is the main reason for this domain. NASA reports that about 70% of long-duration crew show one or more signs and 18% are diagnosed with clinically concerning SANS [7]. It is detected with fundoscopy and photography, optical coherence tomography (OCT), and in more severe cases MRI and ultrasound [7]. See SANS: clinical monitoring and management.

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Visual acuity (distance and near), Amsler grid, color-vision plates, refraction (manifest and cycloplegic) · E	Corrected acuity is on the FAA orbital list [4]. Hyperopic shifts are a known SANS sign [7]. Astronaut ocular assessments list acuity, refraction, Amsler grid, visual fields and pupils [1] ([6012])	Pre and post	In-house (acuity, Amsler, color). Refraction in-house if an eye professional is on staff	Acuity lane at the chart’s test distance, or a mirror arrangement or digital chart; controlled lighting
Ophthalmoscope / slit lamp (biomicroscopy) and dilated fundus exam · E (ophthalmoscope), R (slit lamp)	Flight-surgeon ophthalmoscopic exam on R+0/1; specialist exam with slit lamp and dilated fundus exam at L-90/30 and R+3 [1] ([6011], [6012])	Pre and post	Ophthalmoscope in-house. Slit-lamp exam in-house with an eye professional, or refer	Dimmable exam room; slit-lamp table
Tonometer (eye pressure) · E	On the astronaut ocular list [1] and “if clinically indicated” for orbital passengers [4]	Pre and post	In-house	Fits in an eye exam room
Fundus (retinal) camera · R	Retinal photographs document optic-disc swelling and folds [1][7]	Pre: e.g. L-21/18 months. Post: R+1/10 days [1]	In-house or refer to ophthalmology	Darkened room; network link to the image archive
OCT (high resolution) · R	Measures retinal and optic-nerve layer thickness. NASA uses OCT pre-, in- and post-flight to track SANS [1][7]	Pre and post, as above	In-house if volume justifies it; otherwise refer	Darkened room; table-top device; image storage
Automated threshold visual-field analyzer (perimetry) · R	On the astronaut ocular list [1]	Pre and post	In-house or refer	Darkened, quiet booth or room
Optical biometry and 2-D ocular ultrasound · A	On the specialized ocular list [1] ([6012])	Pre and post	Usually refer to ophthalmology	Specialist equipment
MRI of brain and orbits (SANS protocol) · refer	Measures globe flattening and other changes. NASA measures globe flattening by MRI before and after flight [7], on a SANS protocol [1]	Pre: L-21/18 months. Post: per protocol [1]	Refer out	Not in a typical clinic

4. Neurologic and vestibular (balance)

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Standardized neurological exam kit (reflex hammer, tuning fork, penlight, rating scale) · E	NASA uses a brief standardized neuro assessment: headache, dizziness, vertigo, nystagmus, finger-to-nose, drift, rising from a chair, Romberg [1] ([6004])	Pre: baseline. Post: R+0/3/7/14 for long missions [1]	In-house	Exam room with space to walk and stand safely
Cognitive test station (computer-based battery) · R	Memory, attention, reasoning and spatial processing tested before, during and after flight. Each test session takes about 30 minutes [1] ([6035]). See Behavioral health monitoring	Pre: several baselines. Post: e.g. R+30 days [1]	In-house	Quiet room or booth; computer
Computerized dynamic posturography (CDP) platform with safety harness · A	Objective balance test used to set return-to-normal-activity and return-to-duty criteria [1] ([6005]). In 37 ISS crewmembers, dynamic head-tilt conditions were more sensitive than standard tests [12]. See Space motion sickness	Pre: L-90/30 days. Post: R+7/10 days and until stable [1]	Often refer to a vestibular or balance lab	Booth-sized enclosure with overhead harness; dedicated power; ceiling height for the harness
Simple balance tests (Romberg, tandem walk, functional mobility course) · E	Post-landing sensorimotor problems affect egress, walking and safety [11]	Post: landing day onward	In-house	Clear, padded or carpeted walkway with handholds

5. Musculoskeletal

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Dual-energy X-ray absorptiometry (DXA) · R	Bone density is lost in flight. DXA is NASA’s primary tool for skeletal health, required pre- and post-flight since 1997 [8]. Quantitative CT can add information on trabecular bone [1][8]. See Bone loss	Pre: e.g. L-21/18 months and L-180/30 days. Post: within 30 days of return, at R+1 year, then as indicated [1]	In-house only if volume justifies a scanner and radiation licensing; otherwise refer	Dedicated room. Radiation-shielding assessment by a qualified expert [21]; state radiation registration
Functional fitness kit: hand-grip dynamometer, sit-and-reach box, bench and leg-press, agility course · E (grip, simple tests), R (full set)	NASA lists sit-and-reach, push-ups, pull-ups, bench, crunches, leg press, agility, stand test, hand grip and isokinetic testing [1] ([6024])	Pre: L-90/30 days. Post: R+5/7 and R+30 days [1]	In-house; often shared with a physical-therapy or rehab team	Open gym area; anchored equipment; rubber flooring
Isokinetic dynamometer · A	Measures muscle strength at controlled speeds; on the NASA fitness list [1]	Pre and post	Refer to sports medicine / physical therapy, or in-house in a large program	Large footprint; dedicated circuit
Spine MRI · refer	Pre- and post-flight cervical and lumbar spine MRI for long missions [1]	Pre and R+1–14 days [1]	Refer out	—

6. Pulmonary

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Spirometer with calibration syringe · E	Pulmonary function tests (PFT) are part of astronaut cardiopulmonary screening [1]. Spirometry is “if clinically indicated” for orbital passengers [4]. Use the American Thoracic Society / European Respiratory Society quality standard [20]	Pre: screening. Post: as indicated (for example after a cabin air contamination event)	In-house	Exam room with a chair; filters and infection control per [20]
Chest X-ray (PA and lateral) · R	On the FAA orbital-passenger list [4] and in astronaut screening [1]	Pre	Refer, or in-house if there is an X-ray room	X-ray room shielding [21]

7. Imaging

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
General ultrasound system (abdominal, renal, thyroid, carotid and vascular probes) · R	NASA lists abdominal/retroperitoneal/pelvic, thyroid and carotid ultrasound [1] ([6014]), and duplex ultrasound of the internal jugular veins to screen for clots [1][17] ([6041]). Astronauts are screened by ultrasound for kidney stones before flight [16]. See Point-of-care ultrasound and Kidney stone risk	Pre: e.g. L-21/18 months; jugular veins L-12/3 months. Post: R+0/45 days for jugular veins [1]	In-house with a credentialed sonographer; formal reads by radiology	Dimmable room with exam bed; also used for echo
Handheld point-of-care ultrasound (POCUS) · E	Same probe types as flown hardware. NASA’s landing kit includes a handheld ultrasound [15]	Post: landing day and early return	In-house	Portable
Digital X-ray · A	Chest X-ray [4]; dental panoramic X-ray (see Dental)	Pre	Usually refer	Shielded room [21]
CT and MRI · refer	QCT for bone [1][8]; MRI brain and orbits [1][7]; brain MRI and MR angiography; spine MRI [1]	Pre and post per protocol	Refer to an accredited imaging center with agreed protocols	—

8. Laboratory

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Phlebotomy station and specimen handling · E	NASA’s panels include complete blood count, chemistry, thyroid, iron, high-sensitivity CRP, vitamin D and urinalysis before flight, plus panels on R+0/1 and later [1] ([6019]). Routine hematology, chemistry and urinalysis are on the FAA orbital list [4]	Pre: L-90/30 days. Post: R+0/1, R+3/7, R+14/30 days [1]	Collect in-house. Send to an accredited reference lab	Phlebotomy chair; centrifuge; refrigerator; courier pickup
Point-of-care tests (urine dipstick, pregnancy test, glucose, and possibly a handheld blood analyzer) · E	Same-day decisions: pregnancy test (optional on the FAA list [4]); urinalysis [1][4]	Pre (including the abbreviated check 1–2 weeks before flight [4]); post on landing day	In-house	Bench space; quality-control logs. U.S. labs need the appropriate Clinical Laboratory Improvement Amendments (CLIA) certificate pending verification

9. Dental

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Dental exam and panoramic X-ray (orthopantomogram) · refer or A	Brief dental exam before launch, and a panoramic or full-mouth X-ray series within 2 years of launch, so problems can be fixed well before flight [1] ([6009], [6010]). Preventive dental care is part of pre-mission care [2]	Pre	Usually refer to a partner dentist with panoramic imaging	Dental operatory and shielded imaging, if in-house

10. Audiology

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Calibrated pure-tone audiometer · E	Hearing is tested before and after flight to detect changes from vehicle noise [1] ([6007]). The FAA orbital list uses a conversational-voice test at 6 ft [4]	Pre: L-90/30 days. Post: R+3 days; if abnormal, R+10/14 and R+60 [1]	In-house	NASA specifies a quiet room [1]. A sound-treated booth is the usual way to meet this
Tympanometer · E	Middle-ear function; “if clinically indicated” for orbital passengers [4]	Pre and post	In-house	Fits in an exam room
Hearing-protection fitting · R	Crew are fitted for hearing protection [1] ([6008])	Pre	In-house or audiology	—

11. Behavioral health

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Private consultation room with secure telehealth · E	Specialist psychiatric/psychological readiness check before flight and a clinical interview after flight [1] ([6032], [6034]). Behavioral health support spans selection to post-flight [13]. FAA orbital-passenger guidance includes a brief mental-status assessment [4]. See Behavioral health monitoring	Pre: e.g. L-12 months. Post: e.g. R+3/10/14/30 days [1]	Specialist in-house or by telehealth	Soundproofed room; video-capable; separate from busy corridors
Sleep assessment tools (questionnaires, actigraphy) · R	Daily sleep logs in flight; sleep and motion-sickness medications are test-dosed on the ground before L-30 days [1]	Pre and post	In-house	—

12. Anthropometrics and suit or seat fit

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Anthropometer, tape measures, calipers, optional 3-D body scanner · E (manual), A (scanner)	Body dimensions must fit seats, restraints and suits. NASA-STD-3001 Vol. 2 [V2 4102] covers anthropometric design. The spine lengthens in weightlessness, and suited dimensions differ from unsuited ones [14][24]	Pre (fit checks, often with the vehicle operator). Post: not usually needed	Manual measures in-house. Suit and seat fitting is done by the vehicle provider	Measurement area with a wall stadiometer; privacy screen

13. Emergency cart and safety

Item	Why spaceflight needs it	Pre / post use	In-house or refer out	Space & infrastructure pending verification
Emergency cart: automated external defibrillator (AED) or monitor-defibrillator, airway kit with suction, oxygen, IV supplies, drugs for advanced cardiovascular life support (ACLS) and anaphylaxis · E	Exercise testing needs emergency readiness [18][19]. Post-flight patients can faint during stand or tilt tests [9][10]. NASA’s landing-site cart includes airway and suction, IV access, ACLS drugs, a defibrillator with BP, SpO2 and end-tidal CO2 (ETCO2) monitoring, and drugs for common post-landing symptoms [15]. See In-flight emergencies	Both	In-house	One cart within quick reach of the exercise lab, tilt area and recovery suite; oxygen supply; staff trained in ACLS
Transfer agreements with a hospital (trauma-capable for landing support) · E	Landing support must include a trauma-capable definitive medical care facility (DMCF), and rescue vehicles must have advanced trauma life support (ATLS)-equivalent capability [2][15] ([V1 3013], [V1 3014])	Post (landing)	Arrange in advance	—

Post-flight return: what is different

A crewmember returning to the clinic after landing is not the same patient you saw before flight:

Orthostatic and balance problems. Orthostatic intolerance and sensorimotor (balance and coordination) problems are common [9][11]. NASA requires an exam by a flight surgeon immediately after landing and periodically until stable [2] ([V1 3016]), and a phased reconditioning program that starts at egress [2] ([V1 3017]).
Landing kit. NASA’s crew-surgeon landing kit includes: a BP cuff; a pulse oximeter; IV saline (at least 3 L per crewmember) with IV sets; antiemetics (promethazine, ondansetron, meclizine); diphenhydramine; analgesics; a thermometer; and a handheld ultrasound [15]. See Space motion sickness and Postflight recovery.
Long-term follow-up. Eye, bone and fitness re-tests stretch over weeks to a year [1]. Long-term health monitoring is a separate requirement [2] ([V1 3018]).

Post-flight recovery suite: design checklist (SMF planning suggestions pending verification)

Entrance close to vehicle or ambulance drop-off; stretcher-width doors and corridor
Recovery bed or stretcher that tilts to head-down; IV pole; monitor with BP, ECG and SpO2
Chair with armrests and a clear wall area for the active stand test [1]
Grab bars, non-slip floor and short walking distances to the toilet and shower
Low-stimulus lighting and noise (motion sickness and readaptation symptoms) [11]
Emergency cart within reach; oxygen; suction
Point-of-care ultrasound and phlebotomy at the bedside

Room-by-room layout

The table below groups the equipment into rooms. Small clinics can combine rooms where the column on the right says so.

Room	Main equipment	Domains	Combine with? pending verification
1. Reception and intake	Questionnaires, record system, infection screening	Intake	Must be separable from public waiting when crew are in health stabilization [26]
2. Vitals and anthropometrics	Scale, stadiometer, BP, SpO2, measuring tools	Intake, anthropometrics	Can sit inside exam rooms in a small clinic
3. Exam rooms (2 or more)	Exam couch, ophthalmoscope, neuro kit, ECG cart, spirometer	Intake, cardio, neuro, pulmonary	—
4. Phlebotomy and point-of-care lab	Phlebotomy chair, centrifuge, refrigerator, POC analyzers	Lab	Small footprint
5. Cardiopulmonary and exercise lab	Treadmill or cycle, metabolic cart, 12-lead stress ECG, Holter hook-up, emergency cart	Cardio, pulmonary, MSK fitness	Designed to clinical exercise-laboratory standards [18][19]
6. Ultrasound and echo room	General and cardiac ultrasound	Cardio, imaging	—
7. Eye suite (dimmable)	Acuity lane, slit lamp, tonometer, fundus camera, OCT, visual fields	Vision	Needs a long room or mirror arrangement for the acuity lane
8. Audiology booth	Audiometer, tympanometer	Audiology	Sound-treated booth
9. Orthostatic and balance room	Stand-test chair, tilt table, posturography platform, walkway	Cardio, neuro/vestibular	Can double as the post-flight recovery suite
10. Fitness area	Grip dynamometer, leg press, bench, agility course, isokinetic device	MSK	Often shared with rehab and physical therapy
11. Imaging (optional)	DXA, digital X-ray	MSK, pulmonary, dental	Shielding design by a qualified expert [21]
12. Behavioral health / telehealth room	Private, soundproofed, video	Behavioral	Can host private medical conferences
13. Dental (optional)	Operatory, panoramic X-ray	Dental	Usually referred out
14. Post-flight recovery suite	See checklist above	Post-flight	Near the entrance; adjacent to room 9
Emergency cart alcove	Defibrillator, airway, drugs, oxygen	All	Central, near rooms 5, 9 and 14

Tiered build: essential, recommended, advanced

These tiers are an SMF editorial proposal that maps the published test lists onto a clinic’s growth path. They are not an official NASA or FAA classification.

Tier	Who it serves	What to have in-house	What to refer out
Essential	Commercial orbital and suborbital passengers [4]; annual exams; basic post-flight checks	Questionnaire and exam; vitals; scale and stadiometer; 12-lead ECG; spirometer; visual acuity, Amsler grid, color plates; ophthalmoscope; tonometer; audiometer in a quiet room or booth; tympanometer; phlebotomy and point-of-care tests; active stand-test setup; neuro exam kit; handheld POCUS; private behavioral health room; emergency cart with AED and oxygen; transfer agreement	Chest X-ray; reference lab; all specialist eye imaging; dental; DXA; MRI and CT; formal exercise testing
Recommended	NASA-style evaluations for short and long missions [1]	Essential tier plus: exercise lab with CPET; Holter; general and cardiac ultrasound with credentialed staff; fundus camera; OCT; visual-field analyzer; slit lamp; cognitive test station; functional fitness kit; recovery suite	Optical biometry; posturography; DXA (unless volume justifies it); dental panoramic X-ray; MRI and CT
Advanced	High-volume or research-linked programs; long-duration and exploration crews	Recommended tier plus: computerized dynamic posturography; tilt table with continuous hemodynamics; isokinetic dynamometer; DXA; digital X-ray; optical biometry and ocular ultrasound; 3-D body scanner	MRI (brain and orbits SANS protocol, MRA, spine); CT (QCT, sinus); colonoscopy and other specialist tests in the selection lists [1][3]

Staffing and training notes

Clinical oversight. Astronaut evaluations are led by flight surgeons: physicians with aerospace medicine training. NASA requires its flight surgeons to complete a certified aerospace medicine program [25]. FAA guidance asks for suborbital questionnaires to be reviewed by a physician with aerospace-medicine training [4].
Specialists. Eye, dental, ENT, cardiology, psychiatry/psychology and radiology input is built into the astronaut schedules [1].
Emergency skills. Staff running exercise and tilt testing should hold current ACLS. Clinical exercise-laboratory staffing is covered in the AHA statements [18][19].
Commercial programs. FAA recommended practices call for medical equipment consistent with the mission and number of occupants, and for training people to recognize when care exceeds capability [5]. These apply to vehicle operators, not ground clinics, but are useful benchmarks.

What this guide does not cover

Legal licensing of a clinic, radiation registration, laboratory certification and accreditation. These vary by country and state.
Research-only protocols (for example, multi-omic sampling used on Inspiration4 [22]).
In-flight and landing-site medical equipment. See Mission Medical Kits.

Evidence profile

Overall certainty: ◆◆◆◇ Moderate (proposed)
Evidence types: F · Flight dataE · Expert / operational / standards
Literature through: 2026-10-14
Pending verification: 1 reference(s); individual statements flagged in text

Requirements referenced 15

Requirement	Title	Plain-language meaning
[V1 3001]	Selection and Recertification	Crew are screened at selection and recertified yearly against OCHMO-STD-100.1A. Screening scope may vary by role, for example for spaceflight participants.
[V1 3002]	Pre-Mission Preventive Health Care	Pre-flight physicals, triennial bone density imaging, fitness, preventive dental care, vaccinations, behavioral training and the health stabilization program.
[V1 3012]	Terrestrial Launch/Landing Medical Support	Medical support at launch and landing, at advanced trauma and cardiac life-support level.
[V1 3016]	Post-Mission Health Care	Physical exams by a flight surgeon immediately after landing and periodically until the crewmember is stable.
[V1 3017]	Post-Mission Reconditioning	An individualized, phased reconditioning program that starts at crew egress.
[V1 3018]	Post-Flight Long-Term Health Monitoring	Returning crew are followed long-term in a standardized way.
[6006]	Resting ECG	12-lead baseline before launch, for comparison after flight.
[6007]	Hearing Assessment	Pure-tone air-conduction audiometry with a calibrated audiometer in a quiet room, before and after flight.
[6011]/[6012]	Ophthalmology & Specialized Ocular Assessments	Eye-specialist exams; retinal photos and OCT; visual fields, tonometry, optical biometry, ocular ultrasound; MRI of brain and orbits on a SANS protocol.
[6013]	Bone Densitometry	DXA before and after flight. Quantitative CT may be used as a supplement.
[6014]	Ultrasound Imaging	Abdominal/retroperitoneal/pelvic, thyroid and carotid ultrasound, plus periodic echocardiography.
[6019]	Laboratory Testing	Blood and urine panels before and after flight.
[6023]	Active Postural Stand Test	Supine, then 5 min seated, then 10 min standing, with BP and pulse every minute. Done on landing day, then daily until stable.
[6041]	DVT Screening	Duplex ultrasound of the internal jugular veins.
[V2 4102]	Anthropometric data (as cited in OCHMO-TB-049)	Design for the full range of crew body sizes, including suited dimensions.

[V1 …] and [V2 …] IDs as published in NASA-STD-3001 Vol. 1 Rev C (2023-09-15) and NASA-STD-3001 Vol. 2 Rev F (2026-07-14); bracketed four-digit IDs such as [6006] are OCHMO-STD-100.1A mission medical evaluation requirements (NASA astronaut medical standards). These bind NASA programs; they are not regulations for commercial flights. Paraphrased; read the source for exact wording. Standards quick reference.

References 26

NASA OCHMO. OCHMO-STD-100.1A, NASA Astronaut Medical Standards: Selection, Annual Recertification and Mission Medical Evaluations (Rev A, released 2024-09-09). Tables 6–8 and Section 6. www.nasa.gov/wp-content/uploads/2023/04/ochmo-std-100.1a.pdf Standard E
NASA OCHMO. NASA-STD-3001, Volume 1: Crew Health, Revision C (2023). Requirements [V1 3001]–[V1 3018]. www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Standard E
NASA OCHMO. Crew Selection and Recertification. NASA-STD-3001 Technical Brief OCHMO-TB-034 Rev A (2023). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-034-crew-se… NASA E
Antuñano MJ, Baisden DL, Davis J, et al. Guidance for Medical Screening of Commercial Aerospace Passengers. FAA Office of Aerospace Medicine; Report DOT/FAA/AM-06/1. January 2006. www.faa.gov/media/72446 FAA / regulation E
FAA Office of Commercial Space Transportation. Recommended Practices for Human Space Flight Occupant Safety, Version 1.0 (August 27, 2014). www.faa.gov/about/office_org/headquarters_offices/ast/media/… FAA / regulation E
U.S. Code of Federal Regulations, 14 CFR Part 460 — Human Space Flight Requirements, incl. §460.5(e) (eCFR, current). www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… FAA / regulation E
NASA OCHMO. Spaceflight Associated Neuro-ocular Syndrome (SANS). Medical Technical Brief OCHMO-MTB-001 (2024). www.nasa.gov/wp-content/uploads/2024/02/ochmo-mtb-001-sans.p… NASA F
NASA OCHMO. Bone Loss. Medical Technical Brief OCHMO-MTB-013, Rev D (2026). www.nasa.gov/wp-content/uploads/2026/02/ochmo-mtb-013-bone-l… NASA F
NASA OCHMO. Orthostatic Intolerance. Technical Brief OCHMO-TB-019, Rev B (2023). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-019-orthost… NASA F
Lee SMC, Feiveson AH, Stein S, Stenger MB, Platts SH. Orthostatic intolerance after ISS and Space Shuttle missions. Aerosp Med Hum Perform. 2015;86(12 Suppl):A54-A67. doi:10.3357/AMHP.EC08.2015 PMID:26630196 Peer-reviewed F
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Wood SJ, Paloski WH, Clark JB. Assessing sensorimotor function following ISS with computerized dynamic posturography. Aerosp Med Hum Perform. 2015;86(12 Suppl):A45-A53. doi:10.3357/AMHP.EC07.2015 PMID:26630195 Peer-reviewed F
NASA OCHMO. Behavioral Health and Performance. Technical Brief OCHMO-TB-016, Rev B (2023). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-016-behavio… NASA E
NASA OCHMO. Anthropometrics. Technical Brief OCHMO-TB-049 (2025). www.nasa.gov/wp-content/uploads/2025/07/ochmo-tb-049-anthrop… NASA E
NASA OCHMO. Crew Medical Support for Entry, Descent, and Landing. Technical Brief OCHMO-TB-051 (2026). www.nasa.gov/wp-content/uploads/2026/05/ochmo-tb-051-crew-me… NASA E
NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf NASA F
NASA OCHMO. Venous Thrombosis in Spaceflight. Medical Technical Brief OCHMO-MTB-007 (2026). www.nasa.gov/wp-content/uploads/2026/01/ochmo-mtb-007-venous… NASA F
Myers J, Arena R, Franklin B, et al. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation. 2009;119(24):3144-3161. (Cited by title and scope only; full text not accessed.) doi:10.1161/CIRCULATIONAHA.109.192520 PMID:19487589 Peer-reviewed E
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NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health, Revision F (2026-07-14), NASA Technical Standards System entry. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Standard E
NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… NASA E
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Sources were fetched and read on 2026-10-14; DOIs were matched to title, journal and year via Crossref and PMIDs via PubMed. Human verification of each cited claim against its source is still required before review. NASA and FAA documents are U.S. Government works (public domain) and are summarized with attribution; journal articles are summarized, not reproduced.

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