**5. Future consideration**

#### **5.1 End of life guidelines**

A very important point to raise regarding medical care during aviation is the supportive care and medical resuscitation. A structured protocol needs to be in place to guide medical practice during management of emergency situation in space missions, the development of such protocols must take into account the limited availability restorative care, pain control and psychological adjuncts.

#### **5.2 Health care providers**

It is expected that, the increasing demand for a trained personal in space missions will affect the training structure of medical schools and hospitals, and space companies will support this kind of training. In aviation at least one crew member needs to be trained to deal with medical emergencies and the physicians should be skilled and competent in all basic lifesaving procedures. A focus on psychomotor skills and telemedicine is expected as telemedicine in the shape of the future and psychomotor skills is affected by microgravity. The special skills actually required for performance of surgery can be acquired, augmented, or practiced by using simulators and a hybrid technology that has been termed "cybersurgery" Training and retraining in clinical decision-making skills, clinical problem solving, and decision making for multiple casualties or illnesses are also necessary.
