  Space agencies and private companies prepare the beginning of human space
exploration for the 2030s with missions to put the first human on the Mars
surface. The absence of gravity and radiation, along with distance, isolation
and hostile environments, are expected to increase medical events where
previously unseen manifestations may arise. The current healthcare strategy
based on telemedicine and the possibility to stabilize and transport the
injured crewmember to a terrestrial definitive medical facility is not
applicable in exploration class missions. Therefore, the need for deploying the
full autonomous capability to solve medical emergencies may guide the design of
future onboard healthcare systems. We present ten basic principles and concept
design of a software suite to bring onboard decision support to help the crew
dealing with medical emergencies taking into consideration physiological
disturbances in space and spaceflight restrictions. 1) give real-time support
for emergency medical decision making, 2) give patient-specific advice for
executive problem-solving, 3) take into account available information from life
support and monitoring of crewmembers, 4) be fully autonomous from remote
facilities, 5) continuously adapt predictions to physiological disturbance and
changing conditions, 6) optimize emergency medical decision making in terms of
mission fundamental priorities, 7) take into account medical supplies and
equipment on board, 8) apply health standards for the level of care V, 9)
implement ethics responsibilities for spaceflights, and 10) apply ethical
standards for artificial intelligence. Based on these principles, we propose an
autonomous clinical decision support system (CDSS) to provide real-time advice
for emergency medical interventions on board of space exploration missions.
