Shuttle Transoceanic Abort Landing (TAL) sites, located on the African coast and in Spain, require an emergency medical capability for astronauts who may be injured in an abort landing. The remote African TAL sites present unusual medical planning and logistical problems.Two broad options to meet the challenge of providing advanced emergent medical care at TAL sites were explored by the Department of Defense (DOD) and the National Aeronautics and Space Administration (NASA). The first option considered using a modified surgical response team, and the second involved using physician/medical technician teams. The physician/technician team concept proved the more cost-effective solution for providing medical support in these regions. Research on the logistics of blood procurement, blood refrigeration, power, air evacuation, and search and rescue (SAR) requirements led to the development of an effective TAL site astronaut medical support system. The system consists of on-scene stabilization by the medical personnel, and C-130 air evacuation to trauma centers and DOD tertiary medical centers in Europe.In summary, remote medical care planning requires attention to details far different from those encountered in the routine medical setting. The balance between on-site medical capability and cost-effectiveness is the primary determinant in planning and logistics.The emergency medical concerns inherent in a space vehicle capable of 25 MACH are bad enough. When you add to that a bailout capability, the extreme remoteness of some of the foreign abort sites, the lack of accessibility to adequate medical care, and the virtual celebrity status of the astronauts, all of the elements of a medical contingency planning nightmare are in place.Astronaut rescue and emergency medical care for Shuttle contingencies is a responsibility of the Department of Defense Manager's Space Transportation System Contingency Support Office (DDMS). DDMS, a joint service DOD organization, serves as the liaison between NASA and the DOD in support of manned space operations. It is chartered through the Joint Chiefs of Staff by the Secretary of Defense to provide whatever DOD support may be necessary to accomplish astronaut rescue and medical support in the event of a Shuttle contingency. Under contingency circumstances, DDMS has direct access and tasking authority to any DOD organization necessary to provide the required support.DOD rescue efforts for all Shuttle abort modes are coordinated by the DDMS Support Operations Center (SOC) at Cape Canaveral Air Force Station, Florida. In this center, there are public affairs, medical, aircraft operations, and communications specialists available throughout each mission. In the event of a Shuttle contingency, the SOC is in direct contact with the Joint Chiefs of Staff, the National Military Communication Center, the Rescue Coordination Center at Scott Air Force Base, the Johnson Space Center, the Kennedy Space Center, and world-wide rescue forces, as well as the transoceanic abort and DOD emergency landing sites.