Telemedicine is a fundamental component of health care delivery in space, and attempts have been made to evaluate and validate various protocols in extreme and remote environments that replicate the resource deficient and psychologically demanding conditions of human spaceflight. Furthermore, high-fidelity clinical simulation has been suggested to be an effective means of assessing the performance of healthcare teams and observing interpersonal dynamics in acute medical situations. Simulation based learning has been shown to be most effective when the learning environment replicates the operational setting as closely as possible. The availability of technical and medical expertise, the ability of rural healthcare providers to travel to training facilities, and the maintenance requirements; and fragility of supporting equipment are some of the barriers to the delivery of this new medical education innovation in remote and rural settings. The objectives of this study was to 1) demonstrate the feasibility of using high-fidelity patient simulation supported by a low-cost, accessible communication infrastructure based on Internet technologies to remotely deliver and monitor simulated medical emergencies; 2) examine the use of these technologies provide effective telemedieal education; and 3) evaluate the capability of a telemedical provider to manage an acute medical emergency in a remote setting. Participants included medical specialists who acted as telemedical providers from areas such as critical care, anesthesia, neurosurgery, and emergency medicine, as well as in-situ providers with a diverse range of medical experience from no first aid experience to fully trained emergency medical responders. A subset of in-situ caregivers was remotely educated in advanced medical interventions by an experienced physician. All participants engaged in a number of real-time medical emergencies on a teleoperated high-fidelity human patient simulator. Feedback was obtained from in-situ caregivers, telemedical providers, and simulator teleoperators on simulation realism, communication issues, technologic barriers, and medical care given.