Organization and management of the International Space Station (ISS) multilateral medical operations

The goal of this work is to review the principles, design, and function of the ISS multilateral medical authority and the medical support system of the ISS Program. Multilateral boards and panels provide operational framework for, direct, and supervise the ISS joint medical operational activities. The integrated medical group (IMG) provides front-line medical support of the crews. Results of ongoing activities are reviewed weekly by physician managers. A broader status review is conducted monthly to project the state of crew health and medical support for the following month. All boards, panels, and groups function effectively and without interruptions. Consensus prevails as the primary nature of decisions made by all ISS medical groups, including the ISS medical certification board. The sustained efforts of all partners have resulted in favorable medical outcomes of the initial 15 long-duration expeditions. The medical support system appears to be mature and ready for further expansion of the roles of all Partners, and for the anticipated increase in the size of ISS crews.