For the medical teams supporting the historic Artemis II recovery mission this past April, success meant preparing for every possible outcome.

Lt. Cmdr. Kristine Tolentino Parra and Lt. Stephanie Ryan recently shared their experiences from the operation, giving the Naval Medical Forces Pacific team an exclusive look at the role of Navy Expeditionary Medicine.

Parra, a general surgeon and platform lead for Expeditionary Resuscitative Surgical System 14 at Navy Medicine Readiness and Training Command Camp Pendleton, and Ryan, a Navy nurse with En Route Care System 11 at NMRTC San Diego, provided medical support to the Artemis II astronauts and the Navy recovery team.

During their presentation, they emphasized that the mission required clear teamwork among diverse groups, including NASA crew surgeons, dive teams, helicopter squadrons and waterfront medical staff.

"Although you may be wearing a different patch on your chest, at the end of the day, true integration allows everyone to serve a role and a purpose," Parra said.

Because personnel is the scarcest resource for any EXMED mission, Parra noted that understanding each team's strengths and weaknesses acts as a "force multiplier" for patient care.

“Each team has different composition of members and trains differently,” Parra said. “Familiarizing yourself with each team’s strengths and weaknesses allows you to utilize each member to create an integrated team where the sum of the parts are greater than the whole.”

One unique challenge the EXMED team faced involved the astronauts' gear. The Orion Crew Survival System is a custom-fitted life-support system that provides oxygen, cooling, communication and protection. It also costs millions of dollars.

Because the suit is integrated with electrical wiring, oxygen tubes and coolants, standard trauma protocols of simply cutting away a patient's clothing do not apply.

To adapt, the medical team worked directly with a NASA suit technician for hands-on training. They studied diagrams showing where they could safely cut the suit in an emergency, and every medical team member practiced taking the suit off a patient in a controlled manner. Parra said they realized a slow, controlled removal might be faster and safer than cutting, a decision they would make on a case-by-case basis depending on the injuries.

This level of preparation extended to observing the mission's integrated drills, which practiced everything from recovering the capsule to flying patients to the ship.

“We familiarized ourselves with moments in the operation that posed a particularly high risk, not only to the NASA astronauts but also to the crew on board the ship,” Parra said. “By identifying the likely injury patterns for both astronauts and Sailors, we were able to prepare to address those injuries and verify we had the appropriate equipment to do so."

While Artemis II was a highly visible event, Parra emphasized that her team treats every assignment as a no-fail mission. By reviewing past lessons learned and communicating early with logistics teams, they ensure they understand the medical risks before a mission begins.

Ryan added that these lessons translate directly to everyday military readiness, noting some similarities between a space recovery mission to medical evacuation in a combat environment.

"We always try to plan for the type of injury that is most likely to occur," Ryan said. "For Artemis, the most critical injuries would have come from high impact on landing, such as crush injuries, pelvic injuries and burns. This is not much different from how we train and plan for combat-related injuries."

Following the brief, the audience asked the speakers about broader operational impacts, including the transport time required to move a critically injured patient from the recovery ship to the nearest higher-level care facility and the specific critical care equipment used during the operation.

Ryan explained that her team relies on the Mobile Oxygen Venting and Environmental System – Suction, Life-Support and Circulation (MOVES SLC), a 45-pound portable life-support system used by emergency medical teams.

"This machine is able to hold battery life for roughly eight hours," Ryan said. "It also produces its own oxygen via a concentrator. It is an amazing piece of equipment and allows us to fly without needing to carry supplemental oxygen cylinders."

To ensure all that equipment and training works seamlessly, Ryan said the biggest takeaway she plans to implement in standard ERCS training is a renewed focus on the basics.

“I would continue to emphasize how important walk-throughs and rehearsals are, especially when various medical teams are working together for the first time,” Ryan said. “It is crucial to rehearse patient movement, emergency responses, roles and responsibilities, and communication chains.”

The presentation left NMFP personnel with a sense of pride, showing how Navy EXMED teams project their capabilities on the world stage.

NMFP provides oversight for 10 Navy Medicine Readiness and Training Commands (NMRTC) on the West Coast and Pacific Rim that train, man and equip medical forces, primarily in military treatment facilities. Globally, NMFP oversees eight research laboratories that deliver research expertise in support of warfighter health and readiness. Additionally, NMFP manages the Naval Expeditionary Medicine Warfighter Development Center (NEMWDC), which plays a critical role in preparing medical teams for expeditionary and operational environments.