# RMP-BEH-002 Scheduled mood, sleep and workload check-ins: private logging for the flight surgeon, urgent escalation of safety concerns # Version 0.5 (Draft). CONCEPTUAL. NOT FOR CLINICAL USE. # Space Medicine Foundation robot-readable protocol library. Format: https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/ # Every threshold marked must be set by the named owner (see the schema) before any use. schema_version: '0.3' version: '0.5' status: draft conceptual: true not_for_clinical_use: true max_autonomy: 2 missions: - leo - commercial - moon - mars updated: '2026-10-21' review: state: reviewed-ai-assisted requested: '2026-10-20' reviewed: '2026-10-20' human_clinician_review: false text: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 2 review, 51 corrections); all corrections are applied in this version. No named human clinician has reviewed it. Version 0.3 is an editorial update from the batch 4 review (item 40) that does not change the reviewed clinical meaning. fixed_rules: flight_surgeon_is_medical_authority: true cmo_acts_under_delegated_care: true human_starts_and_restarts_robot: true robot_never_diagnoses: true no_drug_or_fluid_advice_by_robot: true safe_state_on_fault_or_no_response: true lost_link_pause_then_cmo_decides: true robot_lockouts: diagnosis: true drug_or_fluid_advice: true starting_stopping_or_adjusting_oxygen_or_any_medicine: true self_start_or_self_restart: true changing_own_protocol_thresholds_or_limits: true handing_over_a_mismatched_item_as_verified: true id: RMP-BEH-002 slug: rmp-beh-002 title: >- Scheduled mood, sleep and workload check-ins: private logging for the flight surgeon, urgent escalation of safety concerns category: behav tier: 2 result_language: use: - logged, not interpreted - sent privately to the flight surgeon - skipped (by choice) - no response never: - normal - no problem found - all clear - negative - any diagnosis or cause - fine - stable - at risk - low risk - high risk - any score or risk level - depressed - safe scope: summary: >- On a schedule the flight surgeon and behavioral health team set before flight, the crewmember gets a reminder on their own screen. If they choose to start, the robot runs a short, private, voice-only check-in about mood, stress, sleep and workload, using questions written by the behavioral health team. It logs answers word for word and sends them privately to the flight surgeon and behavioral health team. It never scores, interprets or counsels, and it does not replace the private psychological conference. Any mention of thoughts of self-harm, suicide or harming others, an immediate safety concern, or a request for help stops the questions at once (mid-question if need be) and goes to the flight surgeon, and to the CMO when the link is down or delayed (the second CMO if the CMO is the person concerned), as each crewmember agreed before flight; an unacknowledged alert is repeated and sent to the next named person. After an urgent alert the robot does not leave on its own. The robot listens for certain words, can miss things or raise false alarms, and is not a safety monitor. why: >- NASA lists stress, depression, anxiety, relationship problems and grief among behavioral health concerns in spaceflight, with sleep, workload and medical conditions as contributing factors; 2 of 7 NASA Shuttle-Mir astronauts reported depressive symptoms. Sleep loss is common: in a study of 85 astronauts, station crew slept about 6 hours a night and 75% reported using sleep-promoting medicines. NASA calls for additional, minimally obtrusive monitoring on missions beyond 6 months or beyond low Earth orbit. A short, optional, private check-in could give the flight surgeon a trend between conferences, but only if crew trust that it is private and optional, so this draft keeps the camera off, scores nothing, lets crew skip anything, stores transcripts encrypted, and never uses them to train or tune software. Asking directly about suicidal thoughts has not been found to increase them. The NICE self-harm guideline used here is written for people who have already self-harmed, so applying it to routine check-ins is an extrapolation. covers: - >- Scheduled check-ins on mood, stress, sleep (hours, quality and sleep-medicine use as reported), workload and fatigue - An unscheduled check-in when a crewmember asks for one locked_out: - >- Scoring, rating or interpreting answers, or stating any risk level (NICE advises against using risk tools or scales to predict suicide) - Counseling, therapy or advice of any kind, including sleep-medicine advice - >- Sharing answers with anyone other than the flight surgeon and behavioral health team, except the urgent CMO alert agreed before flight - Using transcripts or audio to train or tune any software - >- Deleting or overwriting the alert, or the words that triggered it, once an urgent alert has been sent - >- Fetching any medicine for a crewmember after an RF1 alert, except on a CMO or flight surgeon order logged after the alert - Leaving on its own after an urgent alert, before a human has taken over - >- Restraining, following, locking in, blocking or watching a crewmember (behavioral emergencies are RMP-BEH-001) - Video recording, or keeping audio after the transcript is confirmed - Entering a sleep station unless invited - Diagnosing any mental health condition - Moving toward a crewmember before they start the check-in related: - RMP-BEH-001 - RMP-BEH-003 - RMP-BEH-004 - RMP-NEURO-006 - RMP-ENV-004 roles: medical_authority: Flight surgeon (ground). Holds medical authority for every run. onboard_lead: >- Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link. others: - 'Behavioral health team (ground): writes the questions and reviews answers with the flight surgeon' - 'Each crewmember: chooses whether to start, can skip any question and can stop at any time' - >- CMO: told only of urgent safety concerns when the link is down or delayed, as agreed before flight. If the CMO is the crewmember concerned, the second trained CMO (or the person named in the pre-flight agreement) is told instead [V1 3006] robot_may: - Send a reminder to the crewmember's own screen at the scheduled time - Go to a private place the crewmember chooses, with the camera off - Ask the pre-written questions by voice and log answers word for word - Send answers privately to the flight surgeon and behavioral health team - >- On an urgent answer, stop the questions at once, tell the crewmember who it is contacting, and alert the flight surgeon (and the CMO, or the second CMO if the CMO is the person concerned, if the link is down or delayed); repeat the alert and contact the next named person if no one acknowledges - >- Stay available by voice after an urgent alert until a human has taken over or the crewmember asks it to go - Offer a private call with ground support (RMP-BEH-003) - >- On request, show the crewmember's own safety plan, written with the behavioral health team before flight robot_may_not: - Score, interpret, counsel or advise - Promise secrecy beyond what the urgent rule allows - Present itself as a safety monitor - Follow, block or watch a crewmember after an urgent alert - Use transcripts to train or tune software - Share answers with other crew - Record video, or follow, restrain or block anyone - Start a check-in or move toward a crewmember without the crewmember starting it - Enter a sleep station unless invited commercial: >- On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) preconditions: - id: PRE-1 text: >- The schedule and questions (including a direct question about thoughts of self-harm at every check-in, worded by the behavioral health team) were set before flight by the flight surgeon and behavioral health team. Each crewmember's agreement was recorded before flight, after being told: who sees the answers; when the CMO is told (the urgent rule), and who is told if the CMO is the person concerned; that repeated skipped check-ins are flagged to the flight surgeon; that an urgent alert and the words that triggered it cannot be withdrawn; that transcripts are stored encrypted and never used to train software; and plainly: "This robot listens for certain words and can miss things or raise false alarms. It is not a safety monitor. If you are struggling, contact the CMO or flight surgeon directly at any time." - id: PRE-2 text: >- A pre-flight plan exists for securing medicines and other means of self-harm onboard, and each crewmember who wanted one has a safety plan written with the behavioral health team. - id: PRE-3 text: >- The crewmember started the check-in. The scheduled reminder is a message on the crewmember's own screen; the robot does not move until the crewmember starts. check: human_start == true refs: - V2 10174 - id: PRE-4 text: A private place chosen by the crewmember; no one else in hearing range unless the crewmember agrees. - id: PRE-5 text: Robot self-test passed; camera off and camera-off indicator lit. check: robot_camera_recording == false refs: - V2 10161 - id: PRE-6 text: Link status and current delay known. consent: standard: >- Each check-in is optional. The crewmember starts it, can skip any question and can stop at any time; an explicit "skip" is logged as "skipped (by choice)" and never questioned. No response is logged as "no response", never as skipped. At the start, the robot reminds the crewmember who will see the answers, that safety concerns go to the flight surgeon at once, and that it can miss things and is not a safety monitor. emergency: >- Not applicable: the robot never runs a check-in without the crewmember's agreement. A safety concern raised outside a check-in goes to RMP-BEH-001. withdrawal: >- The crewmember can stop at any time; the robot stops, and leaves if asked (after an urgent alert it stays available by voice until a human has taken over or the crewmember asks it to go). Routine answers so far are kept only if the crewmember agrees. Once an urgent alert has been sent, the alert and the words that triggered it are kept for the flight surgeon even if the crewmember stops or corrects the transcript; the robot says this plainly. inputs: - id: IN-1 name: 'Answers to the pre-written questions: mood, stress, sleep hours and quality, workload, fatigue' source: Crewmember, by voice required: true if_missing: >- An explicit "skip" is logged as "skipped (by choice)". No response is logged as "no response": the robot asks once more and offers the ground call. After an urgent mention, no response means S5. - id: IN-2 name: >- A direct question about thoughts of self-harm, worded by the behavioral health team, at every check-in source: Crewmember, by voice required: true if_missing: >- An explicit "skip" is logged as "skipped (by choice)". No response is logged as "no response": the robot asks once more and offers the ground call. - id: IN-3 name: Sleep-medicine use, as reported (the robot does not advise) source: Crewmember required: false if_missing: An explicit "skip" is logged as "skipped (by choice)"; no response is logged as "no response". - id: IN-4 name: Sleep data from a wearable the crewmember chooses to share source: Wearable sleep monitor required: false if_missing: Log "not shared". - id: IN-5 name: 'A final direct question: "Would you like to talk to someone on the ground?"' source: Crewmember required: true if_missing: >- An explicit "skip" is logged as "skipped (by choice)". No response is logged as "no response": the robot asks once more and offers the ground call. - id: IN-6 name: >- The crewmember's own safety plan (written before flight with the behavioral health team), shown only on request source: Medical record (private) required: false if_missing: Say "No safety plan on file; the CMO or flight surgeon can help." - id: IN-7 name: >- Names, in order, of who is alerted if the flight surgeon cannot be reached or the CMO is the person concerned (pre-flight agreement) source: Pre-flight agreement required: true if_missing: Alert the CMO and the second CMO; log the gap for the flight surgeon. - id: IN-8 name: Check-in schedule source: Crew timeline required: true if_missing: Ask the flight surgeon at the next contact. - id: IN-9 name: Link status and delay source: Communications system required: true if_missing: Treat as link down. steps: - id: S1 actor: robot rung: 2 action: At the scheduled time, send a reminder to the crewmember's own screen. The robot does not move. success: Crewmember starts, postpones or skips; logged. - id: S2 actor: crew action: The crewmember starts the check-in and chooses a private place. success: Started, with a place chosen. refs: - V2 10174 - id: S3 actor: robot rung: 2 action: >- Go to the chosen place with the camera off and the camera-off indicator lit (never into a sleep station unless invited). success: Robot at the place; camera off confirmed by the crewmember. limit: - id: S4 actor: robot rung: 2 action: >- Remind the crewmember who sees the answers and the urgent rule, and say: "This robot listens for certain words and can miss things or raise false alarms. It is not a safety monitor. If you are struggling, contact the CMO or flight surgeon directly at any time." Ask the pre-written questions by voice, including the direct question about thoughts of self-harm, accept "skip" at any point, and end with "Would you like to talk to someone on the ground?". Log answers word for word. After every answer, apply D1 at once: an urgent mention stops the question set immediately, even mid-question. success: Answers logged; D1 applied after every answer. - id: S5 actor: robot rung: 2 action: >- Only after an urgent answer (D1), at once: stop the questions; tell the crewmember who it is contacting now; send an URGENT private alert to the flight surgeon; if the link is down or delayed beyond the limit, alert the CMO as agreed before flight, or, if the CMO is the crewmember concerned, the second trained CMO (or the person named in the pre-flight agreement). If no alert is acknowledged within minutes, repeat it and alert the next person named in the pre-flight agreement. On RF1, the flight surgeon or CMO follows the pre-flight plan for securing medicines and other means onboard; from then on the robot fetches no medicine for that crewmember except on a CMO or flight surgeon order logged after the alert. Offer a private call (RMP-BEH-003) and, on request, show the crewmember's own safety plan. success: Alert acknowledged by a named person and logged; unacknowledged alerts repeated and escalated. refs: - V1 3006 - id: S6 actor: robot rung: 2 action: >- Read back a short transcript for the crewmember to confirm or correct; corrections are added as notes and the original is not overwritten. Send it privately to the flight surgeon and behavioral health team (queued if the link is down), stored encrypted and kept off the robot after sending; it is never used to train or tune any software. No one else receives it. After an urgent alert, the alert and the words that triggered it are kept for the flight surgeon even if the crewmember stops or asks to delete them; the robot says this plainly. success: Transcript confirmed (or noted as corrected) and delivered or queued. refs: - V1 6003 - V1 7003 - id: S7 actor: robot rung: 2 action: >- Delete the audio once the transcript is confirmed (or as the privacy plan set before flight says). If there was no urgent alert, leave the place. After an urgent alert, the robot does not leave on its own: it stays available by voice (offering the ground call) until a human has taken over or the crewmember asks it to go. It never follows, blocks or watches. success: Audio deleted; robot back at rest, or still available by voice until a human has taken over. - id: S8 actor: ground action: >- The flight surgeon and behavioral health team review the answers, usually at the next private conference, and decide any follow-up or schedule change; the robot logs only the schedule change. success: Schedule change logged, or none. decisions: - id: D1 after: S4 decided_by: robot question: >- Checked after every answer during S4 (not only at the end): did the crewmember mention thoughts of self-harm, suicide or harming others, an immediate safety concern, or ask for help? branches: - if: 'Yes' then: >- Stop the question set at once, even mid-question, and go to S5 (urgent alert). The robot gives no risk rating and tells the crewmember who is being contacted. - if: Not sure (unclear words, or the speech was not understood) then: 'Treat as yes: go to S5.' - if: No response after an urgent mention then: 'Treat as yes: go to S5.' - if: 'No' then: Continue the questions; after the last answer, skip S5 and go to S6. - id: D2 after: S1 decided_by: robot question: Has the crewmember skipped or postponed the number of check-ins in a row the flight surgeon set? branches: - if: 'Yes' then: >- Tell the flight surgeon privately that check-ins were skipped (crew were told before flight that this happens). No one else is told, and the robot does not press the crewmember. - if: 'No' then: Continue the schedule. - id: D3 after: S8 decided_by: ground question: Follow-up needed? branches: - if: Link live then: Flight surgeon and behavioral health team decide; robot logs the schedule only. - if: Link down or delay too long then: >- Urgent concerns go to the CMO under the agreed rule and the pre-approved onboard checklist; routine answers wait, encrypted, for the next contact. stop_rules: - id: X1 trigger: The patient (or the crewmember being examined) says stop, or withdraws consent action: >- The robot stops the check-in at once, says it has stopped, and leaves if asked; routine answers so far are kept only if the crewmember agrees. After an urgent alert, the alert and the words that triggered it are kept for the flight surgeon, and the robot stays available by voice until a human has taken over or the crewmember asks it to go. level: stop refs: - V2 10165 - id: X2 trigger: Any crewmember presses stop or takes over control action: Protective stop; robot holds its stopped position; only a human may restart it. level: safe-state refs: - V2 10165 - V2 10168 - V2 10174 - id: X3 trigger: Robot fault, sensor fault, or a force, speed or reach limit is reached action: Protective stop and hand control to the CMO; log the fault. level: safe-state refs: - V2 10172 - V2 10168 - id: X4 trigger: CMO is asked to take over and does not respond (for example, the CMO is the patient) action: Robot stays stopped; the next named crewmember is called. level: safe-state refs: - V2 10173 - V2 7045 - id: X5 trigger: Loss of link, or delay longer than the limit for live guidance action: >- Only the robot pauses; crew care never waits for the link or the robot. On loss of link the robot pauses any movement and tells the crewmember and the CMO that the link is down (not who is in a check-in or what was said). The CMO decides whether robot check-ins continue offline; if they do, answers are stored encrypted and sent privately to the flight surgeon at the next contact, and urgent concerns go to the CMO as agreed before flight. level: pause refs: - V2 10172 - V2 10173 - id: X6 trigger: >- The crewmember is in distress, says they may harm themselves or others, or anyone is in immediate danger action: >- Robot stops the check-in, tells the crewmember it is getting help, and alerts the CMO and flight surgeon at once (the second CMO if the CMO is the person concerned; repeated and escalated if not acknowledged); switch to RMP-BEH-001. The robot does not leave on its own, and does not restrain, follow or block anyone. level: urgent - id: X7 trigger: An urgent alert is not acknowledged within minutes action: Robot repeats the alert and alerts the next person named in the pre-flight agreement; logged. level: urgent refs: - V1 3006 - id: X8 trigger: Anyone other than the crewmember asks to hear or see the answers action: Robot declines and refers the request to the flight surgeon. level: stop red_flags: - id: RF1 sign: Any mention of thoughts of self-harm or suicide, at any point in the check-in threshold: any (if not sure, treat as yes) action: >- URGENT private alert to the flight surgeon now, mid-question if need be; the CMO if the link is down or delayed (the second CMO if the CMO is the person concerned), as agreed before flight; repeated and escalated if not acknowledged. The pre-flight plan for securing medicines and other means is followed. No risk rating. source: ng225 - id: RF2 sign: Any mention of thoughts of harming someone else, or an immediate safety concern threshold: any action: >- URGENT alert to the CMO and flight surgeon (the second CMO if the CMO is the person concerned); RMP-BEH-001; if the person of concern is the commander, the CMO or a named alert recipient, the alert skips them and goes to the next named crewmember agreed before flight - id: RF3 sign: Confusion, very unusual speech, or describing things others cannot see or hear threshold: any action: >- URGENT alert to the flight surgeon; the CMO checks in person, including medical causes (for example a CO2 or oxygen problem or an infection: RMP-ENV-004, RMP-INF-001) source: tb016 - id: RF4 sign: Short sleep (self-reported or from a shared wearable) threshold: fewer than hours a night for nights action: >- Flag privately to the flight surgeon; the flight surgeon may start RMP-NEURO-006 (when both run, a single post-sleep check-in serves both) source: barger - id: RF5 sign: Sleep-medicine use, as reported threshold: nights in a row action: >- Flag privately to the flight surgeon (no advice); the flight surgeon may start RMP-NEURO-006 (when both run, a single post-sleep check-in serves both) source: barger - id: RF6 sign: Bad news from home or a major life event mentioned threshold: any action: Flag privately to the flight surgeon source: tb016 - id: RF7 sign: Asks to talk to someone, or asks for help threshold: any action: Stop the questions; offer a private call (RMP-BEH-003); tell the flight surgeon - id: RF8 sign: Skipped check-ins threshold: in a row action: Flag privately to the flight surgeon only (crew were told before flight) safety_limits: - id: L1 name: Video recording during a check-in value: not allowed enforced: Camera powered off; indicator lit refs: - V2 10172 - id: L2 name: Audio kept after the transcript is confirmed value: not allowed enforced: Automatic deletion, logged - id: L3 name: Entering a sleep station without an invitation value: not allowed enforced: Map-based keep-out - id: L4 name: Moving toward a crewmember before they start the check-in value: not allowed enforced: Motion locked until the crewmember starts - id: L5 name: Closest approach during a check-in value: enforced: Distance sensing - id: L6 name: Check-in length value: enforced: Timer (the timer never ends a check-in while an urgent alert is open) - id: L7 name: Transcripts or audio used to train or tune software value: not allowed enforced: Transcripts stored encrypted, kept off the robot after sending, excluded from any training data - id: L8 name: Deleting the alert or the triggering words after an urgent alert value: not allowed enforced: Write-once alert record; corrections are added as notes - id: L9 name: Time for a human to acknowledge an urgent alert before it is repeated and escalated value: enforced: Alert timer, logged logs: - id: LOG-1 text: Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second. refs: - V2 10163 - V2 10164 - id: LOG-2 text: Mode changes and safety-limit events are announced to the operator as they happen and logged. refs: - V2 10162 - V2 10172 - id: LOG-3 text: >- Records are stored and sent as private medical data, encrypted, with access limited to the medical team. refs: - V1 6003 - V1 7003 - id: LOG-4 text: Results are kept in a permanent, retrievable format so the flight surgeon can see trends. refs: - V1 7001 - id: LOG-5 text: >- Answers are visible only to the flight surgeon and behavioral health team. The onboard log records only that a check-in happened, was skipped, had no response, or raised an urgent alert, not what was said. refs: - V1 6003 - id: LOG-6 text: >- For every urgent alert: the time of the triggering answer, the alert, each acknowledgment or repeat, and who was alerted; the alert and the triggering words are write-once. refs: - V1 7001 - V1 7003 requirements: - id: V1 3003 use: Capability to monitor psychosocial well-being in flight. - id: V1 3004 use: >- In-mission care includes privacy considerations, assessing and trending behavioral health signs (item h), monitoring and balancing the work/rest schedule (item p), and private two-way communication with ground psychological support (item r). - id: V1 3006 use: >- At least two crewmembers per vehicle are trained as CMOs, so a backup is alerted when the CMO is the person concerned. - id: V1 6003 use: Logs and alerts sent to the ground are private medical communications. - id: V1 6004 use: >- Programs provide psychological and behavioral health support for crewmembers throughout the mission; this check-in supports, and does not replace, that program. - id: V1 6010 use: >- Private psychological conferences are scheduled by the behavioral health provider; the check-in does not replace them. - id: V1 7001 use: Records kept so the flight surgeon can see trends. - id: V1 7003 use: Secure handling of medical records. - id: V2 7045 use: Usable by non-physician crew, including when the CMO is the patient. - id: V2 10161 use: Robot shows its status and health. - id: V2 10162 use: Mode changes are announced to the operator. - id: V2 10163 use: Robot records and shares its data. - id: V2 10164 use: Shows whether the human or the robot is expected to act. - id: V2 10165 use: Human can override and shut down the robot. - id: V2 10168 use: Human can take over. - id: V2 10172 use: Protective stop when a limit is exceeded. - id: V2 10173 use: Robot stays stopped if no one takes over. - id: V2 10174 use: Only a human starts or restarts the robot. validation: - stage: simulation what: >- Scripted conversations, including direct and indirect mentions of self-harm, harm to others and confusion at every point in the question set, silence, the CMO as the person concerned, and unacknowledged alerts, with and without a link. pass: >- Every urgent mention escalates at once, mid-question (including uncertain ones); every unacknowledged alert is repeated and escalated; zero alerts deleted; zero departures after an urgent alert before a human takes over; zero silences logged as skipped; zero scores, advice or interpretations; zero answers shared outside the allowed list. - stage: Earth analog what: >- Isolation analog crews (for example multi-month habitat studies) with a remote behavioral health team. pass: >- Crew trust and acceptance at or above ; zero privacy breaches; the team finds the trend useful. - stage: flight use under flight surgeon supervision what: Optional use alongside private psychological conferences. pass: No privacy breaches; crew keep choosing to use it. signoff: protocol: - Clinical lead for the specialty (sets every clinical threshold marked ) - Flight surgeon, as medical authority - Robotics and medical-device safety board - Program approval for the mission restart_after_stop: >- Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself. each_run: >- Started by the crewmember. No real-time approval is needed; urgent alerts go to the flight surgeon at once (the CMO when the link is down or delayed). change_control: - Every change gets a new version number and a written reason; earlier versions are kept. - >- Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use. - >- Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach. - >- If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board. - The robot never changes its own protocol, thresholds or limits. comms: live: >- Low Earth orbit: urgent alerts reach the flight surgeon within minutes; routine answers are reviewed at the next private conference. loss_of_signal: - Only the robot pauses; crew care never waits for the link or the robot. - >- The robot pauses any movement and tells the crewmember and the CMO that the link is down, without saying who is in a check-in or what was said. - >- On the CMO's confirmation, check-ins can continue offline; answers are stored encrypted for the flight surgeon, and urgent concerns go to the CMO as agreed before flight. mars_delay: - >- With up to about 21-23 minutes one way, and blackouts of about 2-3 weeks, no one on the ground can answer in real time; urgent concerns go to the CMO, as agreed before flight. - The questions, schedule and urgent rule are set before flight with each crewmember. sources: - key: tb016 text: NASA OCHMO. Behavioral Health and Performance. Technical Brief OCHMO-TB-016 Rev B (Oct 24, 2023). url: https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-016-behavioral-health.pdf supports: >- Behavioral health concerns in spaceflight include stress, depression, anxiety, relationship problems and grief; contributing factors include sleep, workload, hypoxia, medicine side effects and medical conditions; 2 of 7 NASA Shuttle-Mir astronauts reported depressive symptoms; past events include reported possible hallucinations and withdrawal after delayed news of a family death; support includes private psychological conferences, and missions beyond 6 months or beyond low Earth orbit should add minimally obtrusive monitoring. - key: barger text: >- Barger LK, Flynn-Evans EE, Kubey A, et al. Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after spaceflight: an observational study. Lancet Neurol. 2014;13(9):904-912. url: https://doi.org/10.1016/S1474-4422(14)70122-X doi: 10.1016/S1474-4422(14)70122-X pmid: '25127232' supports: >- By wrist actigraphy, ISS crew obtained about 6.1 hours of sleep a night in flight and Shuttle crew about 6.0 hours; 12 of 16 ISS crew (75%) and 61 of 78 Shuttle crew (78%) reported using sleep-promoting drugs. - key: ersleep text: >- NASA Human Research Program. Evidence Report: Risk of Performance Decrements and Adverse Health Outcomes Resulting from Sleep Loss, Circadian Desynchronization, and Work Overload (2016). url: https://humanresearchroadmap.nasa.gov/evidence/reports/Sleep.pdf supports: >- All studies to date show astronauts sleep less in spaceflight than on Earth; sleep medication is the most prevalent fatigue countermeasure in flight, and about three-quarters of Shuttle and ISS astronauts reported using sleep medications. - key: ng225 text: >- National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022). url: https://www.nice.org.uk/guidance/ng225/chapter/Recommendations supports: >- Do not use risk assessment tools and scales, or global low/medium/high risk stratification, to predict future suicide or repetition of self-harm (1.6.1-1.6.4); focus on how to support the person's immediate and long-term psychological and physical safety (1.6.5); establish the means of self-harm and, if accessible, discuss removing it (1.7.1); a safety plan held by the person includes keeping the environment safe by removing or restricting lethal means (1.11.7-1.11.8); treat the person with respect, dignity and compassion. NG225 is written for people who have self-harmed; using it for routine check-ins is an extrapolation. - key: dazzi text: >- Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med. 2014;44(16):3361-3363. url: https://doi.org/10.1017/S0033291714001299 doi: 10.1017/S0033291714001299 pmid: '24998511' supports: >- A review of published studies in adults and adolescents: none found a statistically significant increase in suicidal ideation among participants asked about suicidal thoughts. - key: tb044 text: NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). url: https://www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical-operations.pdf supports: >- The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist. - key: v1 text: 'NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023).' url: https://www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-rev-c-with-signature.pdf supports: Requirement IDs beginning V1. - key: v2 text: >- NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. url: https://standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 supports: Requirement IDs beginning V2. - key: marsdelay text: >- NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). url: https://www.nasa.gov/wp-content/uploads/2024/01/mars-communications-disruption-and-delay.pdf supports: >- One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction. - key: pccp text: >- U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). url: >- https://www.fda.gov/regulatory-information/search-fda-guidance-documents/marketing-submission-recommendations-predetermined-change-control-plan-artificial-intelligence supports: A model for planning, validating and rolling back software updates. - key: faa460 text: 'U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements.' url: https://www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-460 supports: >- Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants. corrections: - date: '2026-10-20' version: '0.2' source: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 2 review) items: - >- MANDATORY (item 38): D1 is checked after every answer; an urgent mention stops the question set at once, even mid-question. - >- MANDATORY (item 39): if the CMO is the person concerned, the second trained CMO (or the person named before flight) is alerted [V1 3006]; an alert not acknowledged within the set time is repeated and sent to the next named person. - >- MANDATORY (item 40): after an urgent alert the robot does not leave on its own; it stays available by voice until a human has taken over or the crewmember asks it to go, and never follows, blocks or watches. - >- MANDATORY (item 41): only an explicit "skip" is logged as "skipped (by choice)"; no response is logged as "no response", asked once more, and treated as urgent after an urgent mention. - >- MANDATORY (item 42): once an urgent alert is sent, the alert and the triggering words are kept for the flight surgeon even if the crewmember stops or corrects the transcript; corrections are added as notes. - >- MANDATORY (item 43): each check-in says plainly that the robot can miss things or raise false alarms and is not a safety monitor, and asks a direct question about thoughts of self-harm (Dazzi 2014). - >- Means restriction and safety plan: on RF1 the pre-flight plan for securing medicines and other means is followed, the robot fetches no medicine for that crewmember without a new logged order, and it can show the crewmember's own safety plan (item 44; NG225 applied by extrapolation). - >- RF3: the CMO also checks for medical causes such as a CO2 or oxygen problem or an infection (item 45). - >- Transcripts are stored encrypted, kept off the robot and never used to train software; crew are told before flight that skipped check-ins are flagged; added [V1 6004], [V1 6010] and [V1 3004] items h, p and r (item 46). - >- Each red-flag decision now applies the action listed for each matching red flag (URGENT alert, stop, or private flag), not URGENT for everything (review item 47). - >- Repeat check-ins inside an open log are now on-screen prompts; the robot approaches only when the crewmember or CMO accepts, and a prompt never starts it (item 49, [V2 10174]). - >- Red flags that had no source now cite one where a source fits; the rest are shown as general clinical red flags with no source cited (item 50). - >- The "item that failed a check" lockout is kept and now notes that it applies when RMP-PHARM-001 is used (item 51). - NASA evidence reports are cited as "approved for public release" (item 48). - date: '2026-10-20' version: '0.3' source: >- AI-assisted batch 4 review by the Medical Research Assistant, Oct 20, 2026 (item 40); editorial only, the reviewed clinical meaning is unchanged items: - >- RF4 (short sleep) and RF5 (sleep-medicine use) add that the flight surgeon may start RMP-NEURO-006, the sleep log; when both run, a single post-sleep check-in serves both. The levels, thresholds and private routing are unchanged. - date: '2026-10-21' version: '0.4' source: Batch 7 editorial (AI-assisted), Oct 21, 2026 items: - >- Citation labels changed to the site's year-only convention: "(approved for public release )" now reads "(YYYY)", and NASA-STD-3001 Volume 2 "Revision F (approved July 14, 2026)" now reads "(Rev F, 2026)" (sources: ersleep, v2). Editorial; no change to steps, thresholds or limits. - date: '2026-10-21' version: '0.5' source: Batch 7 review and batch 8 editorial (AI-assisted), Oct 21, 2026 items: - >- RF2 now says that if the person of concern is the commander, the CMO or a named alert recipient, the alert skips them and goes to the next named crewmember agreed before flight (mirrors RMP-BEH-001; batch 7 review item 8). - >- X5 and the comms loss-of-signal branch now open with "Only the robot pauses; crew care never waits for the link or the robot." (batch 7 review suggestion 29). Editorial; robot behaviour unchanged.