As the construction of an International Space Station approaches reality, the next phases in the exploration of Space will require long duration missions to the Moon, Mars, and beyond. The risk of traumatic injury and death will be an ever present factor in near space (within our solar system). Reviews of trauma deaths have consistently found that the greatest reduction in preventable death will occur by addressing definitive airway management, treatment of hemothorax and pneumothorax, and control of intra-abdominal hemorrhage. On a long duration space voyage realistic capabilities exist to potentially manage the first two injuries of this triad. The ability to manage a patient requiring operative control of an abdominal injury represents a quantum leap in commitment, but provides a new standard to target in surgical support of the ongoing exploration of space. Advances and developments in surgery, telemedicine, telerobotics, and the acceptance of non-operative management and operative damage control strategies have potential impact on the conduct of trauma care in Space. It will be important to incorporate the most suitable elements of these into an overall management scheme if trauma care is to be realistically provided on any long duration Space mission.