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Evacuation Decision Criteria for Lunar Medical Emergencies: A Delphi Consensus from 47 Medical Officers
Dr. Noa Ben-David
· Lunar Emergency Medicine Consortium
Lunar Emergency Medicine · Vol. 2, No. 3 · July 22, 2029
Abstract
Medical evacuation from the Moon requires 3–5 days minimum and carries its own significant risk. The decision to evacuate is therefore more complex than in terrestrial medicine. This Delphi study recruited 47 experienced lunar medical officers to develop consensus criteria for evacuation vs. local management across 18 clinical scenarios.
The evacuation decision is the defining clinical judgment in lunar medicine. Unlike terrestrial emergency medicine — where transfer to a higher level of care is typically a risk-reduction move — lunar evacuation carries substantial risk: the patient must survive 72–120 hours of transit in a constrained vehicle, with limited monitoring and intervention capability, while physiologically stressed.
The decision criteria must therefore weigh the risk of the local condition (which may be severe) against the risk of evacuation (which is not trivial) and the probability that evacuation will reach Earth-level care before a critical deterioration.
Our Delphi panel reached consensus on 18 clinical scenarios. Strong consensus (>80% agreement) for immediate evacuation: acute coronary syndrome unresponsive to initial management, progressive SANS with vision loss, hemorrhage beyond local haemostatic capability. Strong consensus for local management: appendicitis (laparoscopic capability now present at 4 habitats), uncomplicated fracture, mild-moderate SANS without vision involvement.
The most contentious scenarios were acute psychiatric crisis and end-stage cancer — where the calculus of patient autonomy, community resource consumption, and medical benefit is most complex.
The decision criteria must therefore weigh the risk of the local condition (which may be severe) against the risk of evacuation (which is not trivial) and the probability that evacuation will reach Earth-level care before a critical deterioration.
Our Delphi panel reached consensus on 18 clinical scenarios. Strong consensus (>80% agreement) for immediate evacuation: acute coronary syndrome unresponsive to initial management, progressive SANS with vision loss, hemorrhage beyond local haemostatic capability. Strong consensus for local management: appendicitis (laparoscopic capability now present at 4 habitats), uncomplicated fracture, mild-moderate SANS without vision involvement.
The most contentious scenarios were acute psychiatric crisis and end-stage cancer — where the calculus of patient autonomy, community resource consumption, and medical benefit is most complex.
Keywords
evacuation, emergency, decision criteria, Delphi, telemedicine, acute coronary syndrome